This document discusses growth and development from infancy through adolescence. It begins by defining growth and development and outlining objectives. Normal growth patterns are then described for weight, length/height, head circumference, and dentition at different age groups. Factors affecting growth such as genetics, nutrition, and hormones are explored. The document outlines methods for assessing growth, including growth charts, weight for age, and developmental milestones. Growth and development during infancy, toddlerhood, preschool years, school age, and adolescence is detailed.

1. AMU School Of Medicine
By: Ephrem F. (MD)
GROWTH AND DEVELOPMENT

2. OBJECTIVES
 Define growth and development
 To discuss on the normal patterns of growth and development at
different age groups
 To discuss on how to assess growth and development
 To discuss on the factors affecting growth and development
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3. DEFINITIONS
 Growth: is an increase in size of the body and its various organs
from simple to complex, from its earliest stage to maturity.
 Development: implies an increase in skill and complexity of
function.
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4. NORMAL GROWTH PATTERNS
 The rate of growth in the first year of life is the most rapid one,
tripling his birth weight and increasing his length by 50% .
 The increase in the head circumference is also one of the rapid rates
in his entire life which is 12cm
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5. WEIGHT
 Average birth wt is said to be abt 3.25 kg
 New born loses up to 10% of body wt in the first week and regains
the birth wt at the 10’th day of life.
 For the first 3 months the infant gains about 30 gm per day.
 Then gains about 40 gm per month for the rest of the first year.
 The infant doubles his birth wt. at 5 months and triples it at 1 yr.
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6. WEIGHT
 At 1yr is 3 times birth weight
 At 2yrs is 4 times Birth weight
 At 3yrs is 5 times the birth weight
 At 5yrs is 6 times the birth weight
 At 10yrs is 10 times the birth weight
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7. LENGTH / HEIGHT
 The birth length on average is about 50 cm
 75 cm at 1yr
 85 cm at 2yrs
 95 cm at 3yrs
 Then the child increases by 5 cm every year till puberty
 Approximate height for those b/n 2-12yrs is
Ht. =( age in yr. x6)+77cm
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Ht. =( age in yr. x6)+77cm

8. Formulas to approximate wt. and ht. when the age is known
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9. HEAD CIRCUMFERENCE
 Represents the growth of the brain
 Average HC
◦ 35 cm at birth
◦ 47 cm at one yr
◦ 50 cm at 7 yrs
◦ 52 cm at 12yrs
 90% of adult head circumference is achieved by age 2 yr,
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10. DENTITION
 Dental development includes mineralization, eruption, and
exfoliation
 Mineralization begins as early as the 2nd trimester and continues
through 3 yr of age for the primary (deciduous) teeth and 25 yr of
age for the permanent teeth
 Average age for the eruption of the first teeth is at 6-7 months
 Eruption begins with the central incisors and progresses laterally.
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11.  The rest of the milk teeth appear at a rate of one teeth per month
 By 2&half to 3 yrs the child has the 20 milk teeth
 At 6yrs exfoliation of milk teeth begins and continue up to 12 yrs.
 Delayed eruption of tooth as late as 13 months is normal
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12. FACTORS AFFECTING GROWTH AND
DEVELOPMENT
 Genetic/biologic factors
 Neuro hormonal factors
 Nutritional factors
 Psychological factors
 Social factors
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13. GENETIC FACTORS
 The growth of a child is a result of complex interactions of genetic
and environmental factors.
 As a result of multiple genetic differences, certain people are taller
than others.
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14. NEURO HORMONAL FACTORS
 It has been suggested that there may be a growth center in the brain
that keeps the child in his or her genetically determined growth
curve.
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15. HORMONAL INFLUENCE
 Most of the endocrine glands influence growth significantly either
by promoting protein synthesis, regulating substrate supply, or
enhancing the effect of other hormones on specific organs.
 Hormones with a great influence on growth are: growth hormone,
somatomedines, insulin, thyroid hormone, and sex hormones.
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16. NUTRITION
 Adequate food to provide substrate for energy and synthesis of
proteins is essential for normal growth.
 Illnesses which interfere with nutritional intake or compete for it
delays growth and dev’t.
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17. ASSESSMENT OF GROWTH AND
DEVELOPMENT
 Important for early detection of deviation in child’s pattern of
growth and development, and to take appropriate action.
 The most powerful tool in growth assessment is the growth chart
which provides most of the information needed to assess growth.
 The standard charts are based on the data collected from 1963
to1975 by the National Centers for Health Statistics (NCHS).
 The new standard chart prepared by CDC also provides body mass
index (BMI) curves through age 2yrs to 20yrs, facilitating
identification of obesity.
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18.  Separate charts are provided for boys and girls.
 Each chart is composed of seven percentile curves, which indicate
the percentages of children at a given age on the X-axis whose
measured values fall below the corresponding value on the Y-axis.
 The normal values for age are represented between the fifth and
ninety-fifth percentiles, and the fiftieth percentile represents the
median (standard) value.
 In children under 5 years old an additional chart (Harvard standard)
is used to measure weight for age as percentages of the median or
standard value in the NCHS curve.
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19.  The data are presented in 5 standard gender-specific charts:
(1) weight for age;
(2) height/length for age;
(3) head circumference for age;
(4) weight for height/ length; and
(5) BMI for age, for children over 2 yr of age
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20. WEIGHT FOR AGE
 Children falling below the 5th centile of NCHS or below the 80% of
Harvard Standard are labelled as malnourished.
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21. HEIGHT/ LENGTH FOR AGE
 A height for age that is below normal shows stunting and indicates
chronic states of malnutrition.
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22. WEIGHT FOR HEIGHT
 Getting an accurate age may be a problem in countries like
Ethiopia, where the majority of people are from rural areas and
illiterate.
 Weight for height measurements can overcome this problem.
 Those with weight for height falling below the normal are labeled
as wasted (acute malnutrition).
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23. HEAD CIRCUMFERENCE FOR AGE
 Values below the -3 standard deviation (SD) are labelled as
microcephaly and above +3 SD as macrocephaly.
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24. Mid-upper arm circumference (MUAC)
 This indicates acute malnutrition and values less than normal are
labeled as wasting.
 For children 6 month to 5yrs:
<11cm is severe wasting
11-12.5cm is moderate wasting
12.5- 13.5 is mild wasting
>13.5cm is normal
 Not used in children less than 6 months.
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25.  There are four components of developmental Assessment
1. Gross motor development
2. Fine motor development (manipulation)
3. Cognition and social skill development
4. Language development
 Development follows in a predictive manner i.e,central to
peripheral , proximal to distal, and cephal to caudal.
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ASSESSMENT OF DEVELOPMENT

26. Gross motor development
 Denotes a neuromuscular development including posture,
independent mobilities, progresses from head control when the
child is sitting alone to standing, walking and running.
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27. Fine motor development
 Fine motor development denotes the ability of the child to reach
for, grasp and manipulate objects.
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28. Cognition and social skill
 These include social smile, watching a mirror, waving goodbye,
general alertness, and curiosity about the surrounding.
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29. Language
 Development of speech.
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30. Infancy
 Gross motor: lift their heads with good control at 3 months, sit
independently at 6 months without support , crawl at 8 months,
stand and start to walk at 1 year.
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31.  Fine motor: at 3-4 months babies can grasp objects, at 5-6 months
they can transfer objects from hand to hand, at 9 months they can
achieve a thumb-finger grasp, and at around 12 months they start to
scribble.
 Cognition and social skills: at 6-8 weeks babies start to smile in
response to faces or voices, at 4 months they laugh, at 6-8 months
they develop stranger anxiety.
 Language: during their first 6 months babies pronounce vowels; at
7 months they start to voice consonants, at age 12 months they start
saying ‘mama’ & ‘dada .
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32. Toddlerhood
 In this period the growth rate slows down compared to infancy.
 Gross motor: toddlers start to walk independently between the age
of 12 to 15 months; at 18 months, they can run stiffly and walk
upstairs with one hand held, at 24 months they can run well.
 Fine motor: at 15 month toddlers can make a line with crayon and
insert pellet in a bottle; at 18 month they can imitate a vertical
stroke, and at 24 months they can imitate a horizontal stroke.
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33.  Cognition and social skills: at 15 month toddlers can indicate
some desires by pointing; at 18 month they can feed themself and
they may complain when wet or soiled; at 24 months they can listen
to stories with pictures.
 Language: at 15 month toddlers start to speak in jargon; at 18
months they can say 10 to 15 words; at the end of 24 months they
can say two word sentences (e.g. mama shoe)
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34. Pre school years
 Gross and fine motor: at two and half years children can go
upstairs alternating feet, at 4 years they can hop on one foot, and at
5 years they can skip.
 Handedness is usually established by the 3rd yr.
 Bowel and bladder control emerge during this period.
 Bed-wetting is normal up to age 4yrs in girls, 5yrs in boys.
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35.  Cognition and Language: language development occurs most
rapidly between the ages of 2 - 5 years.
 At two and half years most children know their full name and at 3
years they know their age and sex, count three objects correctly.
 At 4 years children can tell a story and play with several children;
at five years they can name 4 colors, count 10 objects correctly, and
dress and undress.
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36. School age
 Motor: able to perform complex movements such as dancing.
 Cognition and language: children start thinking in concrete logical
operations.
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37. Adolescence
 Children undergo rapid changes in body size, shape, physiology,
and psychology and social functioning.
 It proceeds in three phases; early, middle,& late adolescence.
 Each phase has its own characteristics
 The common changes that occur during each phase are described in
the following table.
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39. Sexual maturity rating for adolescence assessment,
males
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40. Sexual maturity rating for adolescence
assessment,females
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41. Sexual changes in boys and girls during adolescence
Fig. A – Sex maturity ratings of pubic hair changes in adolescent boys and girls
Fig. B – Sex maturity ratings of breast changes in adolescent girls
A B
2 3
4 5
2 3
4 5
1
2
3
4
5
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42.  In the girls, the first visible sign of puberty is the appearance of
breast buds, between 8 and 12 yr of age.
 Menses typically begins at median age of 12 yr; (9–16 yr.)
 In boys, the first visible sign of puberty is testicular enlargement,
beginning as early as 9½ yr. followed by penile growth.
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43. THANK YOU!
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