Growth and development are closely related processes that are assessed simultaneously to evaluate health. Growth is a quantitative increase in size through cell growth and division, while development is qualitative maturation of organ systems and skills. Diseases have more severe impacts during periods of rapid growth and development. Growth is measured through weight, height, head circumference, and dentition, while development is assessed based on gross motor, fine motor, vision, hearing, speech, and social skills appropriate for age. Serial measurements plotted on growth charts best indicate overall health and nutrition.

2. GrowthGrowth
&&
DevelopmentDevelopment
ByBy
Dr Muhammad Saleem LaghariDr Muhammad Saleem Laghari
MBBS(KEMU), MCPS,FCPS (paeds)MBBS(KEMU), MCPS,FCPS (paeds)
Gold Medalist FCPS-IGold Medalist FCPS-I
Assistant ProfessorAssistant Professor
SZMC,RYKSZMC,RYK
22

4. GROWTHGROWTH
 Change in size resulting
from increase in number
or size of cells of the
body.
 Quantitative increase in
size of body.
 Can be measured in
terms of cm & kg etc.

5. DEVELOPMENTDEVELOPMENT
 Qualitative and
functional maturation
of organ system.
 Assessed in terms of
acquisition of skills and
ability to adopt to new
situation.

6. GROWTH & DEVELOPMENTGROWTH & DEVELOPMENT
Growth and development are assessedGrowth and development are assessed
simultaneously as they are verysimultaneously as they are very closelyclosely
relatedrelated to each otherto each other..
They provide the best and most practicalThey provide the best and most practical
means ofmeans of evaluation of healthevaluation of health of anof an
individual.individual.
Diseases tend to haveDiseases tend to have more impairmentmore impairment
when they occur during period ofwhen they occur during period of rapid
growth & development.growth & development.

8. GROWTH: WeightWeight, Length/HeightLength/Height, OFCOFC ,
MUACMUAC & DentitionDentition.
DEVELOPMENTDEVELOPMENT
1. Gross motor
2. Fine motor and vision.
3. Hearing and speech.
4. Social behavior.
ASSESMENT OF GROWTH &ASSESMENT OF GROWTH &
DEVELOPMENTDEVELOPMENT

10. GROWTHGROWTH
• Rate of growth
is more important
than actual size.
• Serial
measurements
of growth plotted
on standard
growth chart are
best indicator of
health.

11. WEIGHTWEIGHT
• The best index of nutrition & growth.
• Changes in weight occur before changes in
other aspects of growth.
• Average weight at birth is 3.2 kg. (7lb)

12. • The increase in weight is 30 gm/ day or 200
gm/week during first three months.
• Birth weight is doubled at 6-months, tripled
at 1-year and four times at 2-years age.
• Then annual increase of 5-lb/year.
• At 7-years it becomes 7-time of birth weight.
• During puberty, there is growth spurt.

13. HEIGHT (LENGTH)HEIGHT (LENGTH)
• Average length at birth is 50 cm.
• It increases by 25 cm in first year.
• It is 85 cm at 2-years, 95 cm at 3 years, 100 cm
at 4 years.
• Then it increases by 5-cm/year until puberty.
• The pubertal growth spurt leads to increase 10-
cm/year for 2 -- 3 years.
• Adult height is twice the height at 2 years age.
• Only Chronic illness affects length.

14. HEAD CIRCUMFERENCEHEAD CIRCUMFERENCE
Age
Birth
3 months
6 months
9 months
1 year
2 years
3 years
5 years
Head Circumference (cm)
35
41
44
46
47
49
50
51

15. DENTITIONDENTITION
• First MILK tooth erupts at 6-months
age
• Eruption of milk teeth completes by 2.5
years (20-teeth)
• Shedding of milk teeth at 6-years and
is complete by 12-years of age.
• PERMANENT Teething is complete by
12-years of age except wisdom teeth
which appear at 22-years (32 - teeth).

16. DEVELOPMENTDEVELOPMENT
• It takes place in cephalocaudal
direction.
• It is influenced by,
 child’s maturity,
 illness,
 hunger or thirst and
 alertness or drowsiness.

18. Development is assessed under
four headings:
1. Gross motor
2. Fine motor and vision.
3. Hearing and speech.
4. Social behavior.

19. NEONATENEONATE
Gross Motor
• In prone position turns head
to one side, limbs flexed
under the body.
• In supine position tonic neck
reflex is present.
• Pulled to sit Marked head lag
• Ventral suspension Head &
limbs are flexed, limbs hang
downward

20. NEONATENEONATE
• Fine motor and vision
• Pupils react to light.
• Optical closure from sudden bright light.
• Doll’s eye reflex present.
Hearing & Speech
• Startle response to sudden loud noise.
• Cries vigorously.
Social Behaviour
• Sleeps most of the time.
• Moro, rooting & sucking reflexes
present.
• Social smile comes at 4-6 weeks.

21. 3 MONTHS AGE3 MONTHS AGE
Gross Motor
• Pulled to sit Neck holding present.
• Prone position Lifts head and
chest above couch using forearm
as support.
• Held sitting Straight back
• Held Standing Sags at knees
• Ventral suspension Head held well
above the body, Hips extended

22. 3 MONTHS AGE3 MONTHS AGE
Fine Motor & Vision
• Grasps rattle for few
moments ( Palmer Grasp ).
• Regards mother’s face.
• Follows dangling ball/ light
through an arc of 180
degree

23. 3 MONTHS AGE3 MONTHS AGE
Hearing and speech.
• Quietens to sound of rattle
and spoon in cup
• Vocalizes & Delighted when
spoken to
• Turns to nearby voice.
• Social Behaviour
• Happy response to mother’s
face.
• Laughs at pleasurable social
contact.
• Active Grasp present.

24. 6 MONTHS AGE6 MONTHS AGE
Gross Motor
• Supine Lifts head from pillow,
Lifts legs to vertical, Grasps
feet & takes to mouth.
• Prone Lifts head and chest
well up supporting weight on
extended arms while in prone
position.
• Sitting with support present
• Held standing
Bears weight on legs

25. 6 MONTHS AGE6 MONTHS AGE
Fine Motor & Vision
• Transfers objects
from one hand to
others.
• Both eyes move in
union.
• Follows dangling ball
in all directions.

26. 6 MONTHS AGE6 MONTHS AGE
• HEARING AND SPEACH
• Responds to hearing tests
at 1 foot on ear level.
• Vocalizes in single or double e.g..
Goo, ah-ah etc.
• Shouts to attract attention.
Social Behaviour
• Mouthing present
• Imitates bye-bye.
• Fear of strangers present
from 7-months age onwards

27. 12 MONTH AGE12 MONTH AGE
Gross Motor
• Crawling (10-m)
• Walks like a bear.
• Can build a tower of
three tubes

28. 12 MONTH AGE12 MONTH AGE
Fine Motor & Vision
• Pincer grasp present (10 months)
• Imitates hand clapping.
• Drinks from a cup
• Looks for hidden and fallen toys.
Hearing & Speech
• Knows and turns to own name.
• Speaks 2-3 words (papa, mama)

29. 12 MONTHS AGE12 MONTHS AGE
Social Behaviour
• Drinks from cup
• Waves bye-bye.
• Points to desired
objects.
• Gives toys on
request.

30. 2 YEARS AGE2 YEARS AGE
Gross Motor
• Runs well, stops and
starts safely.
• Climbs on furniture.
• Walks up and downstairs
one hand held, two feet
per step.

31. 2 YEARS AGE2 YEARS AGE
Fine Motor & Vision
• Picks up pins, thread.
• Turns pages singly.
• Builds tower of six cubes.
• Holds pencil and scribbles

32. 2 YEARS AGE2 YEARS AGE
HEARING & SPEACH
• Joins 2-3 words to form
sentences.
• Refers to self by name
• Constantly asking names
of objects and people.

33. 2 YEARS AGE2 YEARS AGE
Social Behavior
• Verbalizes toilet needs
• Usually dry by day.
• Enjoy picture books and
stories.
• Lifts and replaces cup
safely.
• Handle spoon well.

35. 3 YEARS AGE3 YEARS AGE
GROSS MOTOR
• Rides tricycle using
pedals.
• Can walk on tiptoe
• Walks upstairs with
alternating feet.
• Can stand momentarily
on one foot.

36. 3 YEARS AGE3 YEARS AGE
FINE MOTOR AND
VISION
• Copies a circle
• Builds tower of 9-10
cubes.

37. 3 YEARS AGE3 YEARS AGE
HEARING AND SPEECH
• Gives full name and
knows age and sex.
• Counts up to 10 or more.
• Knows several nursery
rhythms.
SOCIAL
• Dry by night (toilet
trained)
• Washes and dries hand
under supervision.
• Can pull pants down and
up but unable to button.

38. 4 YEARS AGE4 YEARS AGE
GROSS MOTOR
• Stands on one foot 3-5 seconds.
• Runs on tiptoe.
• Climbs well.
FINE MOTOR AND VISION
• Can copy a cross.
• Draws a man with head, leg, and trunk.
• Builds three steps with six cubes.

39. 4 YEARS AGE4 YEARS AGE
HEARING AND SPEECH
• Gives full name and address
• Speaks grammatically correct and
intelligible
SOCIAL
• Washes and dries hand
• Brushes the teeth.
• Can dress and undress except shoe
laces.
• Tells a story.
• Understands taking turns as well as
sharing.

41. 5 YEARS AGE5 YEARS AGE
GROSS MOTOR
• Walks on a straight line.
• Hops and skips on one foot.
• Runs up and downstairs.
• Stands on one foot with
folded arms.
FINE MOTOR & VISION
• Can catch a ball.
• Copies square and triangle
• Thread large needle and
sew stitches.

42. 5 YEARS AGE5 YEARS AGE
HEARING & SPEECH
• Gives full name, age
and birthday.
• Name four colors.
SOCIAL
• Washes and dries hands
and face.
• Dress and undress alone.
• Affectionate and helpful to
younger sibs.
• Knows right and left.
• Goes to school unattended.

44. THANKS