growth, development, milestones, weaning, growth chart, anthropometry, growth monitoring

1. NORMAL GROWTH AND
DEVELOPMENT
Dr. Shafini beryl

2. Outline
• GROWTH
– Introduction
– Assesement of growth
– Growth charts
– Management
• DEVELOPMENT
– Principles of development
– Domains of development
– Early childhood development
– Milestones and red flags
– Developmental screening
– Autism

3. INTRODUCTION
• Increase in size of the body or quantitative growth
• Regular and continuous growth is the essence of health
• Optimal child growth occurs only with adequate food, a
caring, nurturing, social environment and absence of illness.

4. GROWTH
• An infant grows rapidly, doubling its birth weight by 5 months
and tripling it by 1 year of age.
• It is measured in Kg, pounds, meters, inches, Etc.

5. ASSESSMENT of growth
• Anthropometry
• Biochemical indicators
• Clinical
• Dietary
• Epidemiological

6. ANTHROPOMETRY
AGE DEPENDENT
• Weight
• Length/height
• Head circumference
• Chest circumference
• Upper segment Lower
segment
AGE INDEPENDENT
• Weight for height
• Body Mass Index
• Bangle test
• Mid arm circumference
• Kanawati index
• Duglade index
• Skin fold thickness
• Ponderal index
• Arm span

7. WEIGHT
• Spring balance- Salter type
scale
• Beam scale- gold standard
• Electronic
Accuracy to the nearest
500 gm in older children
100 gm in smaller children
20- 50 gm in newborn

9. HEIGHT

10. Infantogram

11. IAP Growth charts

12. Head circumferance
• Maximum occipitofrontal
circumferance
• Flexible non stretchable tape
• Anteriorly supra orbital region
• Posterior- maximum occipital
protuberance

13. CHEST CIRCUMFERENCE
• Measured at nipple
• HC:CC > 1 in after 9 months --> PEM
CC
AT BIRTH HC> CC
9 MON – 1 YR HC = CC
> 1 YR CC> HC

14. Measurements

15. BMI
• Body mass index (BMI) is
then calculated by dividing
weight in kilogram by height
in meter square.

16. WEIGHT FOR HEIGHT

19. GROWTH CHART
• Growth chart is a tool for assessing and monitoring the
growth of a child.
• It is used for recording the weight of children as per their age
up to 5 years.
• Based on new WHO Child Growth Standards.
• There are separate growth charts for girls and boys.

20. Plotting in appropriate charts

21. GROWTH CHART
• The 1st top curve line on the growth chart is the
median which is the average.
• Weight of all normal and healthy children fall above
2nd curve (green band)
• Weight of moderately underweight children fall in the
yellow band
• Weight of severely underweight children fall below the
3rd curve (orange band).

22. GROWTH CHART

25. Stunting and wasting

26. Growth monitoring
• Growth Monitoring is done to monitor or measure growth
regularly to see whether the childis growing properly.
• “A GROWING CHILD IS A HEALTHY CHILD”
• When growth slows or stops, we say growth “falters”. This is a
sign that something is wrong with the child and must be
discovered at the earliest and set right

27. Growth monitoring
• Weighing of the child at regular intervals, the plotting of that
weight on a graph (called a growth chart)
• This enables one to see changes in weight
• It should be done once every month, up to age of 3 years and
at least once in 3 months thereafter.

28. Growth curve
• Each time a child is weighed, the weight is recorded by
marking a point on the chart.
• These points are joined by a line. This line is called a growth
curve

29. Steps of growth monitoring
• Step 1: Determining correct age of the child
• Step 2: Accurate weighing of the child
• Step 3: Plotting the weight accurately on a growth chart of
appropriate gender
• Step 4: Interpreting the direction of the growth curve and
recognising if the child is growing properly
• Step 5: Discussing the child’s growth and follow-up action
needed, with the mother

32. SAM

33. 10 steps of SAM management

34. Why this topic?
• According to the 2022 GHI
scores 9 countries have
alarming levels of hunger
and 35 have serious levels
of hunger

35. India’s performance in Global Hunger index
2022
• India ranks 107th out of 121
countries in the GHI 2022
• India has the highest child
wasting rate of all countries
covered in the GHI.
• India is ranked behind most
of its neighbouring countries.
• Pakistan – 99
• Sri Lanka – 64
• Nepal – 81
• Bangladesh – 84

37. Its a cycle !

38. What to do if there is growth faltering?
• FIRST STEP in giving specific advice to mothers is to observe
the growth curve of the child and determine the growth
trend.
• SECOND STEP is to ask the mother what has been happening
to the child during the last month to make her child’s growth
pattern happen that way- LISTEN carefully to mother
• THIRD STEP is to discuss with the mother specific action(s)
she can take to promote her child’s growth

39. Specific actions
i) Episodes of illness, such as fever, cough, cold, measles,
malaria, diarrhoea etc;
ii) Child’s unwillingness to eat anything;
iii) Inability to introduce complementary food due to lack of
understanding of the child’s nutritional requirements, customs
and, beliefs or refusal of food by the child; and
iv) Abrupt discontinuation of breast milk without introduction
of complementary food due to second pregnancy.

40. Specific actions
• Show the child to the doctor to take care of infections and any
chronic disease which the child may have.
• AWC for supplementary feeding
• 1-2 teaspoon of extra oil/ghee, be added to the child’s food at
each meal
• Demonstrate the preparation of Micronutrient-fortified food
and/or Energy-dense food

41. Specific actions
• Advise mother to take quick action in case the child has any
illness. Give oral rehydration solution and other fluids in case
the child has diarrhoea. Mother should continue to feed the
child during illness
• Vaccination
• Food safety and hygiene

42. Feeding
• Exclusive breastfeeding for 6 months; do not give any
other food or drinks and not even water
• Continue breast feeding after 6 months till 2 years of
age

43. Dietary diversity

45. Double malnutrition

46. Double duty actions

48. Poshan-Adopt a Balanced Diet. Prevent
Malnutrition

49. Lets PAUSE!

50. DEVELOPMENT

51. DEVELOPMENT
• Development refers to a progressive increase in skill and
maturation of function.
• It is a qualitative change in the child’s functioning.
• It can be measured through observation.

52. Principles of growth and development
• It is a continuous process
• It is related to the maturation on Central nervous system
• The sequence of development is identical in ALL children but
the rate of development varies from child to child.
• It progresses in cephalocaudal direction.
• Primitive reflexes have to be lost
• Initial disorganised mass activity is replaced by specific and
useful actions

53. DOMAINS OF DEVELOPMENT
• GROSS MOTOR
• FINE MOTOR
• PERSONAL AND SOCIAL
• LANGUAGE
• VISION
• HEARING

54. Early Childhood Development
• ECD encompasses physical, linguistic, cognitive, sensorial,
social and emotional development of a girl or a boy, beginning
from birth up to eight years of age.
• Over 80% of a child’s brain is formed by the age of three years
(critical period of growth).
• Yet, too many children are still missing out on the ‘eat, play,
love’ that their brains need to develop optimally.
• Family members have the power to help their babies grow
and thrive, by feeding, playing, talking, reading, hugging and
singing with them

55. Why is early childhood important?
• Quality of child care and relationships in early years has a
direct effect on a child’s brain development which affects the
way they think and manage their lives in their adulthood.

56. What is needed to build a healthy
brain?
• Nutritious food, as more than half of what is eaten in each
meal goes to build a child’s brain.
• Play and interaction time with a lot of talking, singing, telling
stories and playing.
• Trusting relationships with caring adults who show love and
affection. Hug, kiss, smile and laugh with their child.
• Safe, secure and happy environment to live and grow
well.

57. Nutrition and feeding practices
• Birth to Six months: Early and Exclusive Breastfeeding
• Six months to two years: Complementary Feeding along with
breastfeeding
• Dietary Diversity- Four out of seven food groups:

59. Early child development
• Age appropriate milestones
• Parenting tips
• Warning signs

68. Age wise

69. 2-3 MONTHS
(The quiet observer)

70. RED FLAGS- 3 months
• Rolling prior to 3 months- Hypertonia
• Persistent fisting for 3 months - NEUROMOTOR DYSFUNCTION
• Failure to alert to environmental stimuli- Vision/ Hearing

71. 4-6 months
(The Active looker)

72. RED FLAGS- 6 months
• Poor head control-Hypotonia
• Failure to reach for objects for 5 months- MOTOR,VISUAL OR
COGNITIVE DEFECTS
• Absent smile-Vision, attachment problems

73. 7-9 months
(The Cruiser)

74. RED FLAGS- 9 months
• Absent babbling for 6 months-HEARING DEFECT
• Inability to localize sound by 10 months-
UNILATERAL HEARING LOSS

75. 10-12 months
(The explorer)

76. RED FLAGS- 12 months

77. 18 months
(The Walker)

78. RED FLAGS- 18 months

79. 24 months
(The doer)

80. RED FLAGS- 24 months

81. 3 Years
(The communicator)

82. RED FLAGS- 236 months

84. Developmental assessement
• Developmental assessment includes early identification of
problems through screening and surveillance

85. Who needs to be screened?
• Children with perinatal risk factors
– Follow up of HIGH RISK NEONATES for early detection of cerebral
palsy
– Child with developmental, chromosomal or neurological disorders
• Children with red flag signs

87. TDSC

88. Good enough draw a man test

90. Definitive test
• If screening tests or clinical assessment are abnormal
Some common scales
• Bayley scale for infant development II
• Wechsler intelligence scale for children IV
• Stanford-Binet intelligence scales , 5th editn.
• Developmental Activities Screening Inventory

91. Autism
• Autism spectrum disorder (ASD) is a developmental disability.
• Children with ASD have problems with social, communication
and interaction, and restricted or repetitive behaviors or
interests.
• Some signs:
– Delay in verbal language
– Repetitive use of language and/or motor mannerisms
– Little or no eye contact
– Lack of interest in peer relationships
– Lack of spontaneous or make-believe play
– Persistent fixation on parts of objects
• There are no medical tests for diagnosing autism

93. Why should you look for it?
• Autism can be diagnosed at the early age; early diagnosis and
early intervention can help child to progress.
• Children do not “outgrow” autism, but studies show that early
diagnosis and intervention lead to significantly improved
outcomes

95. Do you have any questions?
THANK YOU FOR YOUR ATTENTION