The document discusses normal growth and development from conception through childhood. It describes the stages of growth from the ovum and embryo stages through infancy, childhood and adolescence. It outlines the factors that can affect growth and development such as genetics, hormones, nutrition, socioeconomic status and intellectual stimulation. Key growth parameters like weight, height and head circumference are provided for each stage of development. Milestones for gross motor, fine motor, social and language development are also outlined. Abnormal growth such as low birth weight, microcephaly and macrocephaly are defined and their potential causes discussed.

1. NORMAL
GROWTH AND
DEVELOPMENT
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2. INTRODUCTION
It is a process by which the fertilized ovum attains
adult size.
Growth implies changes in the size or in the values
given for certain measurements of maturity.
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3. FACTORS AFFECTING G & D
1. Genetic – A legacy of biologic potential influenced by environment.
2. Hormonal – Growth hormone and its peripheral action compounds
(somatomedins), thyroxine, insulin, sex steroids.
3. Growth factors – Nerve growth factor, cartilage factor, fibroblast
growth factor and others with undifferentiated action.
4. Trauma – Prenatal or postnatal including infection, chemical or
physical trauma or immunologic.
5. Nutritional failure – Antenatal malnutrition leads to IUGR and low
birth weight which influences growth potential throughout life.
Postnatal PEM (protein energy malnutrition), iron deficiency, trace
element deficiency, vitamin deficiency.
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4. 6. Socio-economic factors – Closely influence nutrition, infection,
developmental stimulation.
7. Emotional factors – modify growth potential. Deprivation leads to
“emotional deprivation syndrome” which can stunt physical and
psychological development. Position of child in family, interaction of
parents and child, child-rearing patterns influence growth.
8. Culturopolitical factors – may limit development potential by
establishing conventional behaviour patterns and expectations and alter
schedule for acquisitions of motor and intellectual skills.
9. Intellectual stimulation and learning.
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5. GROWTH
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6. “GROWTH IS INCREASE IN SIZE OF
THE BODY OR QUANTITATIVE
GROWTH LEADING TO PHYSICAL
MATURATION”
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7. STAGES OF GROWTH
1. Ovum (0-14 days)
2. Embryo (2-9wks)
3. Fetus (9 wks to birth)
4. Newborn (first 28 days)
5. Infants ( first year of life)
6. Toddler (1-3 yrs)
7. Preschool child (3-5 yrs)
8. School child (5-9 yrs)
9. Adolescence is devided into prepubertal, pubertal & post pubertal
stages (10-19 yrs)
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8. GROWTH OF DIFFERENT
TISSUES
1. Heart beat – 4 weeks
2. Circulation- 8 weeks
3. External genitalia- 10-12 weeks
4. Bile secretion – 12 weeks
5. Fetal movement – 14 weeks
6. Early swallowing – 14 weeks
7. Meconium – 16 weeks
8. Respiration – 18 weeks
9. Phonation – 22 weeks
10. Coordinated sucking & swallowing- 34 weeks
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9. NEWBORN
1. Normal weight – 3 kgs (2.5 – 4 kgs)
2. Length – 50 cm (44-55cm)
3. Head circumference is 35 cm (33-37 cm)
4. Respiratory rate – 40 / min
5. Heart rate – 140 / minute
6. Most new borns lose up to 10% weigth initially & regain birth weight
by next 10 days
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10. GROWTH PARAMETERS-
PHYSICAL GROWTH
1. Weight: Sensitive growth parameter, first to decrease in acute
malnutrition.
◦ Foetus 8 weeks : 1 gm
◦ 12 weeks : 14 gm
◦ 28 weeks : 1000 gm
Birth: 2.5–3.7 kg. Less than 2.5 kg considered low birth weight.
Weight loss in first 10 days up to 10% body weight.
Thereafter, increase of 20 gm per day for first 5 months and about 15 gm
per day up to 12 months.
◦ Baby doubles birth weight at 5 months, triples at 1 year.
◦ 2nd year: gains 2.5 kg
◦ 3–5 years: gains 2 kg per year
◦ 6–12 years: gains 2–2.5 kg per year.
◦ Approximately 15 kg at 5 years, 25 kg at 10 years, 40 at 15 years.
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12. 2. Height or length:
◦ Foetus 8 weeks : 2.5 cm
◦ 12 weeks : 7.5 cm
◦ 28 weeks : 35 cm
◦ Birth : 50 cm
1 year: adds on 1/2 of birth length 75 cm
2 years: adds on 1/2 of 1st year’s growth 87–88 cm
Thereafter till adolescence growth spurt about 6–8 cm per year.
Weech’s formula that can be used from 2–12 years.
◦ Age (yr) × 6 + 77 cm.
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14. 3. Skull circumference: A good measure of brain growth.
oMaximal in first year, reaches 90–95% adult size by 4 years. Birth: 32–
35 cm (less than 30 cm microcephaly)
◦ First 3 months: 2 cm per month (avg. 39 cm)
◦ 4–6 months: 1 cm per month (avg. 42 cm)
◦ 6–12 months: 1/2 cm per month (avg. 46–47 cm)
◦ 2nd year: 2 cm (48–49 cm)
◦ 3rd year: 2 cm (50–51 cm)
◦ 4th year: 2 cm (52–53 cm)
◦ Adult: 53–56 cm
oUp to 13 months use formula 1/2 × length (cm) + 10 cm ± 2.5 cm.
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15. 4. Surface area: It bears constant relation to nutritional factors affecting
growth. Best calculated from normograms involving average weight and
height.
Crude methods are: (m2) = wt2 (kg) × 0.1
5. Chest circumference: Smaller than head circumference by 2–3 cm.
Cross-over of head and chest circumferences takes place in Indian
children at about 2 years of age (about 1 year in white races).
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16. SOMATIC GROWTH
6. Ossification centre appearances in infancy and childhood:
◦ Birth: Distal femoral, proximal tibial, cuboid.
◦ 3 wks: Head of humerus
◦ 2–4 mths: Hamate, capitate
◦ 4–6 months: Head of femur
◦ 1 year: Distal radial
◦ 2 years: Distal tibia and fibula, capitulum of humerus.
◦ 3 years: Triquetral bone, heads of metacarpals and phalanges of hand.
◦ 4 years: Lunate, navicular of foot, greater trochanter of femur.
◦ 5–6 years: Scaphoid, trapezoid, trapezium, lower ulnar epiphysis, upper epiphysis
of radius, medial epicondyle of humerus.
◦ 7–8 years: Lower epiphysis of ulna.
◦ 9–10 years: Olecranon, trochlea of humerus, pisiform.
◦ 11–12 years: Lateral epicondyle of humerus.
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17. 7. Teeth
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18. BOY GIRL
1. Adolescent growth spurt 13–15.5 years 11.5–14 years
2. Average increase in height 20 cm After 18 years 2.5
cms remain
8 cm After 18 years
1–2 cm remain
3. First sign of puberty Increase in length and
colour of pubic hair
Breast bud visible
or palpable
4. Age at start of puberty 12–13 years 11–12 years
8. Puberty (sexual maturity)
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19. 9. Milestones of development: Importance:
(a) Assessment of step by step age-wise physicomotor and mental
development.
(b) Early detection of motor disorders, cerebral palsy, mental retardation,
speech, auditory and visual defects.
(c) Assessment of aetiology of developmental delay – congenital if poor
milestones development from beginning, acquired or hereditary/acquired
degenerative neuromuscular or CNS disease if arrest occurs after certain
stage is reached.
(d) Assessment of approximate point in time when pathology began, e.g.
age at which malnutrition set in to cause development retardation.
Classification:
–– Motor.
–– Adaptive – (a) Fine motor. (b) Visual. (c) Auditory.
–– Social.
–– Language – (a) Perceptive. (b) Expressive.
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20. DEVELOPMENT
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21. “DEVELOPMENT IS MATURITY OF
FUNCTION OR QUALITATIVE GROWTH
LEADING TO MENTAL MATURATION”
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22. GROSS MOTOR
DEVELOPMENT
AGE MILESTONE
3 months
5 months
6 months
8 months
9 months
12 months
15 months
18 months
2 years
3 years
4 years
Neck holding
Rolls over
Sits in tripod fashion (sitting with ownsupport)
Sitting without support
Stands holding on (with support)
Creeps well; walks but falls; stands without support
Walks alone; creeps upstairs
Runs; explores drawers
Walks up and downstairs (2 feet/step); jumps
Rides tricycle; alternate feet going upstairs
Hops on one foot; alternate feet going downstairs
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24. FINE MOTOR DEVELOPMENT
Age Milestone
4 Months
6 Months
9 Months
12 Months
15 Months
18 Months
2 years
3 years
4 years
5 years
Bidextrous reach (reaching out for objects with both hands)
Unidextrous reach (reaching out for objects with one hand);
transfers objects
Immature pincer grasp; probes with forefinger
Pincer grasp mature
Imitates scribbling; tower of 2 blocks
Scribbles; tower of 3 blocks
Tower of 6 blocks; vertical and circular stroke
Tower of 9 blocks; copies circle
Copies cross; bridge with blocks
Copies triangle; gate with blocks
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26. SOCIAL & ADAPTIVE
DEVELOPMENT
AGE MILESTONE
2 months
3 months
6 months
9 months
12 months
15 months
18 months
2 years
3 years
4 years
5 years
Social smile (smile after being talked to)
Recognizes mother; anticipates feeds
Recognizes strangers, stranger anxiety
Waves "bye bye"
Comes when called; plays simple ball game
Jargon
Copies parents in task (e.g. sweeping)
Asks for food, drink, toilet; pulls people to show toys
Shares toys; knows full name and gender
Plays cooperatively in a group; goes to toilet alone
Helps in household tasks, dresses and undresses
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27. LANGUAGE DEVELOPMENT
AGE MILESTONE
1 months
3 months
4 months
6 months
9 months
12 months
18 months
2 years
3 years
4 years
5 years
Alerts to sound
Coos (musical vowel sounds)
Laugh loud
Monosyllables (ba, da, pa), ah-goo sounds
Bisyllables (mama, baba, dada)
1-2 words with meaning
8-10 word vocabulary
2-3 word sentences, uses pronouns" I", "me","you"
Asks questions; knows full name and gender
Says song or poem; tells stories
Asks meaning of words
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28. LOW BIRTH WEIGHT
Depending on the weight, the neonates are termed as low birth weight
◦ Low birth weight (LBW, less than 2500 g),
◦ Very low birth weight (VLBW, less than 1500 g)
◦ Extremely low birth weight (ELBW, less than 1000 g).
CLASSIFICATION OF SMALL FOR GESTATION AGE (SGA)
1. HYPOPLASTIC SGA BABIES – Babies with reduced growth potential
due to abnormalities or insults during early part of gestation leading to
internal or external congenital anomalies and reduction of weight,
height & head circumference (down syndrome)  these baby called
symmetrical IUGR With ponderal index OF 2-2.5.
•PONDERAL INDEX = WEIGHT (g) / LENGTH (cm) × 100
•NORMAL VALUE <2
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29. 2. MALNOURISHED SGA BABIES – Babies with reduced weight due to
placental dysfunction or maternal malnutrition during later months of
gestation  Length & head circumference are normal
These baby called  asymmetric IUGR with ponderal index <2.
3. MIXED SGA – Babies with adverse influences on growth and nutrition
from the early part going on to later parts of gestation.
They have features of both hypoplastic + malnourished babies
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31. MICROCEPHALY
Microcephaly is defined as an occipitofrontal circumference below 3cm
the mean circumference for given age, sex and gestation.
Primary microcephaly is used to describe conditions associated with
reduced generation of neurons during neural development and
migration.
Secondary microcephaly follows injury or insult to a previously normal
brain causing reduction in the number of dendritic processes and
synaptic connections
Microencephaly is the term used for an abnormally small brain, based
on findings on neuroimaging or neuropathology.
Since head growth is driven by brain growth, microcephaly usually
implies microencephaly
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32. CAUSES OF MICROCEPHALY
o Isolated microcephaly – autosomal disorders
o Neural tube defects
o Maternal diabetes mellitus
o Infections – TORCH
o Hypothyroidism
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33. MACROCEPHALY
Macrocephaly is defined as an occipitofrontal circumference greater
than 3 cm of mean ages
Megalencephaly or enlargement of the brain parenchyma may be
familial or associated with inherited syndromes or neurometabolic
disease
Infants with benign familial megalencephaly have increased head size at
birth
Hydrocephalus, characterized by an excessive amount of CSF, may be
caused by increased production, decreased absorption or obstruction to
CSF flow
Most patients show postnatal rapid increase in head size and are
symptomatic due to underlying disease or raised intracranial pressure
(nausea, vomiting and irritability).
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34. CAUSES OF MACROCEPHALY
◦ Hydrocephalus
◦ Choroid plexus papilloma
◦ AV Malformation
◦ Brain Cyst
◦ Brain Tumor
◦ Brain Abscess
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35. THANK
YOU
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