growth is size and development is complexity of function

1. GROWTH AND DEVELOPMENT
Dr. Birhanu A (Paediatrician)1

2. CONTENTS
 Objectives
 Introduction
 Patterns of developments
 Principles of growth and development
 Factors influencing growth and development and its models
 Developmental and behavioural theories
 Developmental domains
 Periods of Growth and development
 Growth and development of infants and later ages
 Growth monitoring and assessments
2

3. OBJECTIVES
 At end of this session everyone should understand
 growth and development principles and patterns
 factors influencing G $ D
 Developmental domains
 G $ D of infants to adolescents
 Assess and monitor growth and development
3

4. INTRODUCTION
 DEVELOPMENT: indicates acquisition of function by the
tissues or the organism as a whole.
 The individual level of functioning that a child is capable
of as a result of maturation of the nervous system and
psychologic reactions.
 An increase in skill and complexity of functions.
Change in QUALITY
 It can be measured through observation.
4

5.  GROWTH: increase in the size of the organism due to increase in the
number of cells of tissues or increase in the size of each individual
cell.
Change in QUANTITY
 It can be measured in Kg, pounds, meters, inches.
5

6. PATTERN OF DEVELOPMENT
 There are definite and predictable patterns in the growth
and development that are continuous, orderly, and
progressive.
 These patterns are universal and basic to all human
beings.
 G & D follow predetermined trends in direction,
sequence, and pace.
 Each human being accomplishes in a manner and time
unique to that individual.
6

7. CONTI….
Directional trends
1.Cephalocaudal (head-to-tail) direction,
 the head end develops first and is very large and complex,
where as the lower end is small and simple and takes shapes at
a later period.
 Infants achieve structural control of the head before the trunk
and extremities.
2. Proximodistal (near-to-far)
 Shoulder control precedes mastery of the hands,
 The whole hand is used as a unit before the fingers can be
manipulated.
7

8. CONTI….
3. Mass to specific (differentiation)
 Development from simple operations to more complex
activities and functions.
 All areas of development (physical, mental, social, and
emotional) proceed in this direction.
 Physically there are gross, random muscle movements
before fine muscle control takes place.
 Infants will respond to people in general before they
recognize and prefer their mothers.
8

9. CONTI…..
Sequential trends
 In all dimensions of growth and development there is a
definite, predictable sequence.
 It is orderly and continuous, with each child normally
passing through every stage.
 E. g. children crawl before they stand, stand before they
walk.
9

10. CONTI….
Developmental pace
 Although there is a fixed, precise order to development,
it does not progress at the same rate or pace.
 There are periods of accelerated and decelerated growth
for the total body and the subsystems.
 Marked individual differences are observed between
children
 Each child grows at his/her own pace.
10

11. CONT…
11

12. PRINCIPLES OF DEVELOPMENT
 It is a continuous process
 Development proceeds cephalo-caudal fashion
 Depends on maturation and learning
 Proceeds from general to specific
 Proceeds from simple to more complex
 Unique individual rates of growth and development but
the sequence is same
 Rate of growth is more important than actual number 12

13. DETERMINANTS OF GROWTH AND
DEVELOPMENT
1. Biologic influences
 Genetic
 teratogen exposure
 low birth weight
 postnatal illness
 Exposure to hazardous substances
 Sex
 Hormonal influences
 Temperament
13

14. CONTI……….
2. psychological factors
 Attachment and
 Contingency
3.Social Factors:
 Family Systems
14

15. MODELS OF DEVELOPMENT
1. Medical model:
 Pt present with signs and symptoms
 physician focuses on diagnosis and treatment
 neglects the psychologic aspect of a person
15

16. 2. Biopsychosocial model
 societal and community systems are simultaneously
considered along with more proximal systems that make
up the person and the person's environment
 A patient's symptoms are examined and explained in the
context of the patient's existence.
16

17. 3. Ecobiodevelopmental framework model
 Social and physical environments interacts with biologic
processes to determine outcomes and life trajectories.
 Epigenetics changes are due early influences ( toxic levels
of stress ).
 E.g. DNA methylation and histone acetylation
17

18. 4. The Transactional Model (Unifying Concepts)
 child's status at any point in time is a function of the
interaction between biologic and social influences.
 The influences are bidirectional.
 Biologic factors (temperament and health status) both
affect the child-rearing environment and are affected by
it.
18

19. THEORIES OF DEVELOPMENT, EMOTION AND COGNITION
 Psychosexual theory
 Psychosocial theory
 Piaget cognitive theory
 Kohlberg moral theory
 Behavioural theory
19

20. Psychosexual theory :
 Developed by Sigmund Freud
 Idea of body-centred (or, broadly, “sexual”) drives or
pleasure areas of the body
 Freud believed that childhood experiences and
unconscious desires influence behaviour
 The emotional health of both the child and the adult
depends on adequate resolution of these conflicts.
 Fixation- If no resolution of conflict occur at specific stage
20

21. Psychosexual stages
1.oral(0-1yr)
 erogenous zone- mouth
2. anal(2-3yr)
 Erogenous zone-bowel movement and bladder control
3. phallic/oedipal(3-6yr)
 Erogenous area- genitals
4.latency(6-12yr)
 Erogenous area –sexual feelings are inactive
5. genital (12-20yr)
 Maturing sexual interests 21

22. Psychosocial theory
 Developed by Erik Erikson
 Described the impact of social experience across the
whole lifespan
 How social interaction and relationship played a role in
the dev’t and growth of human beings
 Sense of mastery and inadequacy
22

23.  Trust vs mistrust
 Birth to 1year age
 Infant is totally
dependent
 trust is based on
dependability and quality
of the child’s caregiver
 Autonomy vs shame and
doubt
 2-3 years of age
 Focus on greater sense of
personal control
 Starting to perform basic
actions on their own and
make simple decision
Stage 1 Stage 2
23

24.  Initiative vs guilt
 Age 3-6 years
 Children begin to assert
their power and control
the word through direct
play and other social
interaction
 Industry vs inferiority
 Age 6-12 year
 Develop a sense of pride
in their accomplishment
and abilities
 Encouraged and
commended develop
feeling of competence
and belief in their skill
Stage 3 Stage 4
24

25.  Identity vs role diffusion
 Age 12-20 years
 Essential for developing a
sense of personal identity
 Encouragement and
reinforcement lead to
strong sense of self and
feeling of independence
and control
 Intimacy vs isolation
 Early adult hood ( 20 -
40yr)
 People are exploring
personal relationship
 Successful resolution
results in love
Stage 5 stage6
25

26.  Generativity vs stagnation
 Age 40-65 years
 Work and parenthood are
important events
 Integrity vs despair
 Occur at old age( 65yr-
death)
 Focus of reflect back on
life
Stage 7 Stage 8
26

27. PIAGET’S COGNITIVE THEORY
 Cognition is changes in quality, not just quantity.
 Processes for children construct knowledge:
 Assimilation-taking in new experiences according to existing
schemata
 Accommodation-creating new patterns of understanding to
adapt to new information.
27

28.  Birth to 2years
 Infant know the word
through their movement
and sensation
 Learn by sucking,
grasping, looking and
listening
 2-7 years of age
 Begin to think
symbolically and learn to
uses words and pictures
to represent objects
 Tend to be egocentric
 Learn through pretend
play
Sensorimotor stage Preoperational stage
28

29.  7-11 years
 Begin to think logically
about concrete events
 Become more logical and
organized
 Begin to use inductive
logic
 Less egocentric
 12 years and above
 Begins to think abstractly
and reason about
hypothetical problems
 Begin to use deductive
logic
Concrete operational stage Formal operational stage
29

30. BEHAVIOURAL THEORIES
 focus on observable behaviours and measurable factors
that either increase or decrease the frequency
 Lack of concern with a child's inner experience
 behaviours reinforced occur more frequently; behaviours
punished or ignored occur less frequently
30

31. STATISTICS……
Statistics Used in Describing Growth and Development
 Normal means that a set of values generates a normal
(bell-shaped or Gaussian) distribution
 X-axis- quantity and y-axis frequency generates bell
shaped curve.
 The peak of curve corresponds to the arithmetic mean of
the sample, as well as to the median and the mode.
 Mean-average of sample
 Median- value above and below which 50% of the
observations lie.
 Mode- highest number of observations. 31

32. Standard deviation (SD):
 Observed values cluster near the mean
 Determines the width of the bell
32

33. observations included in
the normal range
probability of a “normal”
measurement deviating
from the mean by this amount
SD % SD %
±1 68.3 ≥1 16
±2 95.4 ≥2 2.3
±3 99.7 ≥3 0.13
33

34.  The percentile is the percentage of individuals in the
group who have achieved a certain measured quantity.
 For anthropometric data, the percentile cut offs can be
calculated from the mean and SD.
 The 5th, 10th, and 25th percentiles correspond to −1.65
SD, −1.3 SD, and −0.7 SD, respectively.
34

35. PERIODS OF GROWTH AND DEVELOPMENT
 Embryo- 0-8weaks
 Foetus- 9weak-birth
 Neonate- birth- 28weaks
 Infant- birth-12months
 Toddler- 1-2years
 Preschool- 2-5years
 School age( middle childhood)- 6-10 years
 Adolescence- 10-18years
35

36. TYPES OF GROWTH AND DEVELOPMENT
 Types of growth
 Physical growth (wt, ht, HC)
 Physiological growth ( vital sign…
 Types of development
 Motor development
 Cognitive development
 Emotional development
 Social development
36

37. DEVELOPMENTAL DOMAINS
 Domains of development:
 Gross motor
 Fine motor
 Social and motion
 Language and cognition.
37

38. 0-2MOTH
1. physical growth
 Average birth wt= 3.4kg
 Average length= 50cm
 Average head circumference= 35cm
 Weight may initially decrease 10% below with birth
weight in 1st week then regain or exceed birth weight by
2week of age
 Daily weight gain neonates after 2 weeks on should be
approximately 30g/day
 period of fastest postnatal growth.
38

39. 2. Physiological growth
 Respiration – The prime need of the new born
 Circulation - Pulmonary vascular resistance falls &
peripheral vascular resistance increases
- The existing right to left should be
reversed
- Transition from fetal to adult type of
circulation
- Normally new born hearts beats 120-
160 min.
 Hematology - High hemoglobin level 17 -19 gm/dl
- Life span of RBCS is short
- High leukocyte count
39

40. 3. Neurodevelopment
 Gross motor
-sitting position- Back bends
-Ventral suspension- momentary tensing of neck
muscles.
-Prone - momentarily holds chin off couch
- Pull to sit- almost complete head lag
-Movements are largely uncontrolled except in eye
gaze, head turning & sucking
 Fine motor - Not yet developed
40

41. 3. Language & social
- Protrudes tongue
- Hearing is well developed & prefers high pitched sound
- Near sighted with focal length of 20 - 30cm
- Spontaneous smile
-Visual preference for human face
-Body movements in cadence with voice
4. cognitive development
-Habituation
41

42. 2-6 Months
1. Physical Development
 age 4 month, birthweight is doubled and triples by 11-
12months
-Weight 3-12mn= age in mn + 9
2
 Length increase by 25 = 75 cm at 12mn
 Head circumference = increase by 12cm in 1st year
- increase by 2cm/mn in 1st 3mn
- increase by 1cm/mn 3-6mn
- increase by o.5cm/mn 6-12mn
42

43. 2. GROSS MOTOR
2month- Holds head steady while sitting
3month- Pulls to sit, with no head lag
- Brings hands together in midline
4month- Asymmetric tonic neck reflex gone
-reaches and grasps objects and brings them to mouth
-Sit with adequate support
-Roll over from front to back
43

44.  5 months
• Balance head well when sitting
• Site with slight support
• Pull feet up to mouth when supine
• Grasp objects with whole hand (Rt. or Lt.)
• Hold one object while looking at another
 6month-
• Sit alone briefly
• Turn completely over(abdomen to abdomen)
• Lift chest and upper abdomen when prone
• Hold own bottle
44

45. Fine motor
 3.5 month- Grasps rattle
 4month- Reaches for objects
 4month- Palmar grasp gone
 5.5month- Transfers object hand to hand
3.Cognitive and language
 2month- Stares momentarily at spot where object
disappeared
 3month- listens to voice and coos
 4month- Stares at own hand
 2-6 months- laughs and squeals
45

46. 4.social and emotional
3month- Sustained social contact
4month-
 Laughs out loud;
 show displeasure if social contact is broken
 excited at sight of food
AGE 6–12 MONTH
Gross motor
 6.5month- Rolls back to stomach
 7month- Rolls over, pivots, crawls or creep-crawls
46

47. 7 months
• Sit alone
• Hold cup
• Imitate simple acts of others
• leans forward on hands
8 months
• Site alone steadily
• Drink from cup with assistance
• Eat finger food that can be held in one hand
• 6-7 month- Transfers object from one hand
to the other
 9-10 month- pincer grasp 47

48. 9 months
• Rise to sitting position alone
• Crawl (i.e., pull body while in prone position)
• Hold one bottle with good hand-mouth coordination
10 months
• Creep well (use hands and legs)
• Walk but with help
• Bring the hands together
• Sits up alone and indefinitely without support, with back straight
48

49. 11 months
• Walk holding on furniture
• Stand erect with minimal support
12months
• Stand-alone for variable length of time
• Site down from standing position alone
• Walk in few steps with help or alone (hands held at shoulder
height for balance)
• Pick up small bits of food and transfers them to his mouth
49

50. 4. Language
-7month: babbles; enjoys mirror; responds to changes in emotional
content of social contact
-8-9 months: mama/dada as sounds
-10-12 months: “mama/dada specific, Responds to sound of name,
waves bye-bye
5. Social development
• He learns that crying brings attention
• The infant smiles in response to smile of others
• 7mn shows fear of stranger (stranger anxiety).
• He responds socially to his name
50

51. HEAD CONTROL
Newborn Age 6 months 51

52. SITTING UP
Age 2 months
Age 8 months 52

53. AMBULATION
13 month old
Nine to 12-months
53

54. FINE MOTOR DEVELOPMENT
IN INFANCY
6-month-old
12-month-old
54

55. Toddlers
Physical Development
 Toddlers increase in head circumference of 2 cm over the year
 They have short legs and long torsos, with exaggerated lumbar
lordosis and protruding abdomens.
 Height – increases by 1cm/month
 By 24 month children are about half their ultimate adult height.
 Head growth slows slightly with 85% of adult head circumference
55

56.  Motor:
 Walks alone
 crawls up stairs
 Hold a cup with all fingers
grasped around it
 scribble
 Adaptive/cognitive:
 Makes tower of 3 cubes
 makes a line with crayon
 inserts raisin in bottle
 Language:
 Jargon
 follows simple commands
 may name a familiar
object (e.g., ball)
 responds to his/her name
 Social:
 Indicates some desires or
needs by pointing;
 hugs parents
15month
56

57. MOTOR
 Runs stiffly
 sits on small chair
 walks up stairs with 1
hand held
 explores drawers and
wastebaskets
ADAPTIVE/COGNITIVE
 Makes tower of 4 cubes
 imitates scribbling
 imitates vertical stroke
 dumps raisin from bottle
18 month
57

58. LANGUAGE
 10 words (average)
 names pictures
 identifies 1 or more parts
of body
SOCIAL
 Feeds self
 seeks help when in
trouble
 may complain when wet
or soiled
 kisses parent with pucker
58

59. Motor:
 Runs well,
 walks up and down stairs,
 1 step at a time; opens doors
 climbs on furniture; jumps
 Hold cup with both hand
 Transfer objects hand-to hand at
will
Adaptive/cognitive:
 Makes tower of 7 cubes (6 at 21
month);
 scribbles in circular pattern;
 imitates horizontal stroke;
 Folds paper once imitatively
Language:
 Puts 3 words together
(subject, verb, object)
 Uses possessive, progressive
words
Social:
 Handles spoon well;
 often tells about immediate
experiences;
 helps to undress;
 listens to stories when
shown pictures
24month
59

60. PRESCHOOL STAGE
1. Physical growth
 Weight: - 2 kg per year
 Weight quadruple by 2.5years
- 1-6 year= (age in year x 2)+ 8
 Linear growth: - height  by 7-8cm per year
 The head will grow only an additional 5-6 cm between ages 3 and
18
 Dental development: all 20 10 tooth erupted by the age
3 year
 .
60

61.  Visual acuity reaches 20/30 by age 3 yr and 20/20 by age
4 yr.
 Growth of sexual organs is commensurate with somatic
growth.
 Physical energy peaks at this age group
 Handedness is usually established by the 3rd year.
 Bowel and bladder control emerge during this period.
 Thinking over dominated by perception than abstraction
61

62. 2. Neurodevelopment
Gross motor:
30month -Goes up stairs alternating feet
3 year - Rides tricycle,
- stands momentarily on one foot
4year - Hops on one foot;
-throws ball overhand,
-uses scissors to cut out pictures,
-climbs well
5year -Skips
Fine motor: - 3rd year copies circle
- 4th year copies a square 62

63. 3. Social /language
 30month- knows full name
-speech intelligible to strangers
 3year - Knows age and sex
 4year - Counts 4 pennies accurately
- tells story, uses past tense
 5year - Names 4 colours, uses future tense
- repeats sentence of 10 syllables
- counts 10 pennies correctly
63

64. 4. Adaptive/cognitive
 30month- makes vertical and horizontal strokes
-imitates circular stroke
-forming closed figure
 3year -imitates construction of “bridge” of 3 cubes
-copies circle
- imitates cross
 4year -Copies bridge from model
- imitates construction of “gate” of 5 cubes
-copies cross and square
-Draws man with 2-4 parts besides head
-identifies longer of 2 lines
 5year - Draws triangle from copy
-names heavier of 2 weights 64

65. SCHOOL AGE
 Age between 6-12 years referred as middle child hood or
latency
 Self esteem becomes a central issue
- Able to evaluate themselves
- perceive others’ evaluation of them
• judged according to their ability to produce socially
valued output
• Muscular strength, coordination & stamina increases
progressively
• Sexual organs remain physically immature but sexual
behavior become active & increase progressively until
puberty 65

66. 1. Physical growth
 Weight gain is 3-3.5Kg/ year
 Weight for age 7-12yr = (age (yr)x7)-5
2
 Height: -increase by 6-7cm per year
 Brain growth:- HC ↑ by 2cm throughout this period
Dental development
 Loss of deciduous teeth starts by 6 year
 First molar (6year molar) erupts (The 1st permanent
teeth)
 Replacement with & adult teeth occurs at a rate 4 per
year for the next 5 years.
66

67. 2. Neurodevelopment
Gross motor
-6-8year- ride bicycle, sporty
Fine motor
-6th year copies a diamond & draws a man with12
details
-At 7th year draw a man with 16 detail
-9-10yr draw man with many details, Typing skill,
Musical instrument
67

68. 3. Social/language
 Receptive language
 Expressive language
 Identify with same sex parents adopting them as
role models
 Further separation from the family
68

69. 4. Cognitive/adaptive
- Change from preoperational to
concrete logical operations
- Apply rules based observable phenomena
- Long-term memory
- Selective attention
- At 6 year reads one – syllable printed words
- At 6 year differentiates (knows) morning
& afternoon
- at 8 year defines words better 69

70. ADOLESCENCE
 Adolescence age is divided into 3 phases early, middle,
and late adolescence
 Each marked by a characteristic set of biologic, cognitive,
and psychosocial milestones
70

71. variables early
adolescence
Middle
adolescence
Late
adolescence
Age(years) 10-13 14-17 18-21
SMR 1-2 3-5 5
Physical growth -Females:
-Secondary sex
characteristics ,
-Start of
growth spurt
-Males:
testicular
enlargement,
start of genital
Growth
-Females: PGV,
menarche
-Males: growth
spurt,
secondary sex
characteristics,
nocturnal
emissions, facial
and body hair,
voice changes
-Change in body
composition
-Acne
-Physical
maturation
slows
-Increased lean
muscle mass in
males
71

72. Cogniti
ve and
moral
-Concrete operations
-Egocentricity
-Unable to perceive
long- term
outcome of current
decisions
-Follow rules to avoid
punishment
-formal operations
-May perceive
future implications,
but may not apply
in decision-making
-Strong emotions
may drive
decision-making
-Sense of
invulnerability
-Growing ability to
see others'
perspectives
-Future-oriented
with sense of
perspective
-Idealism
-Able to think
things through
independently
-Improved
impulse control
-Improved
assessment of
risk vs reward
-Able to
distinguish law
from morality
72

73. Self concept/
identity
formation
-Preoccupied
with changing
body
-Self-
consciousness
about
appearance
and
attractiveness
Concern with
attractiveness
Increasing
introspection
-More stable
body image
-Attractiveness
may still be of
concern
-Consolidation
of identity
Family -Increased
need for privacy
-Exploration of
boundaries
of dependence
vs
independence
-Conflicts over
control and
independence
-Struggle for
greater
autonomy
-Increased
separation from
parents
-Emotional and
physical
separation from
family
-Increased
Autonomy
Reestablishment
of “adult”
relationship
with parents
73

74. Peers Same-sex peer
affiliations
-Intense peer
group involvement
-Preoccupation
with peer culture
-Conformity
Peer group and
values recede in
importance
Sexu
al
-Increased interest in
sexual
anatomy
-Anxieties and
questions
about pubertal
changes
-Limited capacity for
intimacy
-Testing ability to
attract partner
-Initiation of
relationships and
sexual activity
-Exploration of
sexual identity
-Consolidation
of sexual
identity
-Focus on
intimacy and
formation of
stable
relationships
-Planning for
future and
commitment 74

75. 75

76. 76

77. 77

78. ASSESSMENT OF GROWTH
 Growth can be considered a vital sign in children
 Aberrant growth may be the first sign of an underlying
pathologic condition.
 The most powerful tool in growth assessment is the
growth chart
78

79. TECHNIQUES TO MEASURE GROWTH
 Head circumference measure starting at the supraorbital
ridge around to the occipital prominence.
 Length/height-
 outer canthi of the eyes are in line with the external auditory meatus
and are perpendicular to the long axis of the trunk ( supine position)
 back of the head, thoracic spine, buttocks and heels approximating
the vertical axis of one another ( standing position)
 BMI can be calculated as weight in kilograms/(height in
meters)2
79

80.  The upper-to-lower body segment ratio (U/L ratio )
provides an assessment of truncal growth relative to limb
growth.
 The lower-body segment is defined as the length from
the top of the symphysis pubis to the floor
 the upper-body segment is the total height minus the
lower-body segment.
 Arm span – proportional to height of child
 Back touch to the wall and hands outstretched perpendicular
to the trunk and measure from tip of middle finger.
80

81.  There are 5 standard gender-specific charts:
1) weight for age,
2) height (length and stature) for age,
3) head circumference for age,
4) weight for height (length and stature) for infants, and
5) body mass index for age
81

82.  REFERENCE
 NELSON 20TH AND 21ST EDITION
82

83. THANK YOU!!!!
83