The document provides information on growth and development in children from infancy through adolescence. It defines growth and development, outlines the stages and domains of development, and normal developmental milestones. Key points include defining growth versus development, identifying factors that influence development, describing normal growth parameters and developmental milestones, and signs of potential developmental delays.

1. Nahom W. Teshager, MD

2.  At the end of this lesson , students should :
 Define growth and development
 Identify principles & stages of growth and
development
 Be able to assess growth and development.

3.  The goal of pediatrics is to optimize growth and
development.
 Health professionals working in the area of
pediatrics should have basic knowledge of
normal and abnormal growth and development.

4.  Net increase in the size or mass of a tissue.
 Attributed to multiplication of cells and increase in
intracellular substance
 Measured in kg ,lb , meter etc.
 Quantitative change.

5.  Acquisition of skills and maturation of already
formed organs.
 related to the maturation and myelination of the
nervous system.
 Goes simultaneously with growth.
 Qualitative change
 Measured by observation

6.  Continuous process in a predictable pattern.
 Cephalocaudal and proximodistal.
 Depends on maturation and learning.
 General to specific.
 Simple to complex
 Sequence of development is the same, while the
rate varies.

9.  Congenital factors(hereditary and non hereditary)
 Hereditary
 Non hereditary (intra uterine conditions)
 Environmental factors

10.  Genetics
 Race
 Sex
 Temperament
 Intelligence
 Hormonal factors

11.  Nutrition
 Climate
 Season
 Home ,neighborhood and school condition
 Birth order

12.  Two growth spurts:
I. In the 2nd year of life
II. Near adolescence

13. 1. Intra uterine
2. Extra uterine

14. 1. Embryonic(1st Tm)
2. Early fetal(2nd Tm)
3. Late fetal(3rd Tm)

15. 1. Neonatal : birth -28 days
2. Infancy : 1st year of life
3. Toddler : 1-2 years
4. Preschool : 2-5 years
5. School age : 6-10 years
6. Adolescence : 10-18 years

16.  What are the hazards for each stage of growth?
 Is adolescence the same with puberty?

17. 1. Physical growth
2. Physiologic growth

18. Domains of physical growth:
1. Anthropometrics
2. Dentition
3. Osseous growth
4. Fontanels
Domains of development:
1. Gross and fine motor development
2. Mental development (speech, psychosocial,
intellectual)
3. Hearing
4. vision

19.  Weight
 Height
 Head circumference
 MUAC
 BMI

20. weight :
 Average birth weight is 3.4 kg.
 A healthy term infant may lose up 10% of birth
weight in the first week of life.
 Regain birth weight by 2 weeks of age or sooner
 Grow at a rate of 30 g /day in the first
month(period of fastest post natal growth)
 Birth weight doubles at 4months and triples at 1
year of age.

21.  From 3mo -12mo:
Wt(kg) =Age(mo)+9
________
2
 from 1-6 year:
Wt(kg)=Age(yr)x2+8
 From7-12 yr
Wt(kg)=Age(yr)x7-5
_________
2

22. Height:
 Average length of a full term newborn is 50cm
 Increases by 50% by 1 year and doubles by 3 to
4 years of age(75cm)
 Length approximately increases by 5cm/year
after the 3rd year of life .
 Increases by 2.5cm/mo in the 1st 6mo and by
1.25/mo in the 2nd 6 month.
 Ht =Age(yr)x5+80 after infancy.

23. Head circumference:
 Reflects the growth of the brain
 Av HC at birth is 35cm(32-38cm) for full term
infants
 Increases by 1cm per month in the 1st 6months
 ½ cm from 6 to 12 months.
 Increases by 12 cm at the end of 1 yr.
 Increase by 10 cm from 1 yr to adulthood.
 Increases by only 2cm from 1-2yr.

24.  Important for nutritional assessment of under five
children
 Midway b/n the shoulder and elbow joint
Interpretation?

25.  Six ossific centers at birth:
 Lower femur
 Upper tibia
 Talus
 Calcaneous
 Cuboids and
 Humeral head

26.  Take the x-ray of the wrist(carpal bones) to
calculate bone age.
 Bone age =chronological age +1
 Ossification starts at carpal bone and scaphoid is
the 1st to ossify

27.  Causes of retarded bone age:
 prematurity
 PEM
 Hypothyroidism
 Hypopitutarism
 Causes of advanced bone age
 Post maturity
 Androgenital syndrome
 Hyperthyroidism
 hyperpitutarism

28.  Decideous (milk) teeth:
 central lower incisor is the first milk teeth to
appear
(at 6mo)
 Small ,White and weak
 4 teeth every 4mo until 20 in number(3yr)
 Temporary
 Permanent teeth:
 Big ,yellow , strong and permanent
 Rate of replacement is 4teeth/yr for 5 consecutive
yrs after 6yrs of age
 32 in number
 The 1st premolar appears first( at 6yr)

29.  No teeth at 1 yr of age
 Due to local or general cause:
Local causes:
 Rigid gum
 Supernumerary teeth
 Gum cyst
General causes:
 Rickets
 Achondroplasia
 Osteogenesis imperfecta

30.  Teeth at birth
 Remove only if it has no root on x-ray.

31.  Confluence point of sutures
 6 in number
 anterior and posterior fontanels are the clinically
important ones.
 Anterior fontanel:
 2x3 cm at birth
 Closes at the age of 18mo
 Flat

32.  Posterior fontanel
 Closed or <0.5 cm at birth
 Indicates some pathologies if it is not closed at
2mo
-hydrocephalus
-hypothyroidism

33.  Used to assess growth of children
 Centile curves:
 Each parameter matched with age
 Has lower and upper normal limits
W/A- for growth velocity when multiple
readings are taken
H/A-for chronic malnutrition
HC/A-for brain development
W/H- for acute malnutrition
BMI/A-for acute malnutrition

34.  Failure to meet expected standards of growth
 could be:
 Persistently under weight
 Crossing two centile lines down or
 Arrested growth
 Two types:
1. Primary FTT- Wt was low since birth
2. Secondary FTT- Wt was normal at birth

35.  Prematurity:
 All anthropometric parameters affected
 IUGR:
 Symmetric
 Asymmetric

36.  Non organic(caloric failure)-80%
 e.g. malnutrition
 Organic causes-20%
 e.g. Malabsorption syndrome,RTA, metabolic
diseases etc.

37.  History :
 Dietetic
 Chronic disease
 Family history
 Physical examination:
 Any abnormal feature
 Thorough systemic evaluation
 Basic laboratory investigations.
 OFT and others as indicated.

38.  Respiration :
 Normal RR at birth is 30-60bpm.
 Decreases with age.
 Circulation :
 Pulmonary vascular resistance falls and peripheral
vascular resistance increases
 The existing right to left shunt reverses
 Normal HR at birth is 120-160 bpm.

39.  Hematology :
 Normal Hgb level at birth is 17-19g/dl.
 Short RBC life span
 High leukocyte count.

40.  Gross motor development:
 Head support ___________3mo
 Sitting ____________6mo
 Crawling ____________9mo
 Standing _____________12mo
 Walk _______________15 mo
 Run ______________18mo
 Go upstairs _____________21 mo
 Go downstairs and jumps _____24mo

41.  Ride tricycle , stand on one foot___3yr
 Hops on one foot, climbing, throw a ball over
head__4yr
 Skips______________5yr
 Rides bicycle and sporty_________6-8yr

42.  For gross motor development to be achieved,
there should be:
 Normal CNS
 Normal MSS and
 Good systemic environment

43. Newborn Age 6 months

44. Age 2 months
Age 8 months

45. 13 month old
Nine to 12-months

46. 6-month-old
12-month-old

49.  Suspect gross developmental delay if there is no:
 Head support _____at 5 mo
 Sitting ______10 mo
 Standing _______15mo
 walking. ________18mo

50.  Causes of delayed loco-motor development:
 Abnormalities in the CNS
e.g. Cerebral palsy
 Abnormalities of the MSS
e.g. Rickets
 chronic systemic disorders
e.g. renal failure, liver failure, pulmonary
failure, cardiac failure and congenital heart
diseases.

51.  When do neonatal reflexes go?
 moro reflex ______at 3-4mo
 Palmar grasp------4mo
 Plantar grasp-------7mo
 Suckling reflex

53.  Fine motor development:
 Hand to hand transfer_____6mo
 Pincer grasp and drink with two ear cup—10-12
mo
 Scribbling, self feeding and 3box tower ____18
mo
 6 box tower ,draw two lines & turns a page of a
book -24mo
 Copies a circle___3yr
 Copies a square__4yr
 Copies a triangle___5yr
 Copies a diamond and draw a man with 12 details

54.  Draw a man with 16 details___7
 Draw a man with many details, use musical
instruments and
typing___9-10 yrs

55.  Language development:
 Cooing_______2mo
 Mamma and papa ___10-12 mo
 Two word sentence and point to body
parts__18mo
 Three word sentence and count to
hundred___24mo
 Knows his full name______3yr
 Full address _____________5yr
 Language development is rapid from 2-3 yr
they can even use complex sentences.

56.  For a normal speech development the baby
should be able to:
 Hear
 Understand
 vocalize

57.  Psychosocial development:
 Social smile_______40 days
 Laughing__________2mo
 Mother recognition___4mo
 Stranger anxiety______7mo
 Responds to own name by smiling _7mo
 Father recognition ________9mo.

58. ◦ Cognitive/Adaptive
 handedness established_____3 year
 bowel and bladder control___ 24-30mn
 Knows sex and age___ 3 yr
Gender role _____ 4 yr

59. School age:
Develop self esteem
Lymphoid tissue hypertrophy occurs
Increase in muscle strength stamina and coordination
Active but immature sexual organs

60.  Social/language
 Receptive language
 Expressive language
 Identify with same sex parents adopting them as role models
 Further separation from the family

61.  .Cognitive/adaptive
 Concrete logical operation
Long-term memory
 Selective attention
 Reads one syllable printed word__6yr
Knows morning & afternoon _____6yr

62.  10-18yrs
 Growth spurt
 Earlier in girls than boys (10-14yrs Vs 12-16yrs)
 Males gain 7-30kg while females gain 7-25kg

63.  Birth length triples at 13 yr.
 Boys gain 10-30 cm while girls gain 5-20 cm
 Vertical growth ceases at 16-17yrs in girls while at
18-20yr in boys
 Puberty
 Occurs earlier in females.

64.  Secondary sexual characteristics develop
Boys :
 penile and testicular enlargement
 Pubic ,axillary and facial hair appears
 Coarse voice
Girls
 Breast develops
 Pubic and axillary hair appears
 Onset of menarche

65.  Rated from 1-5
 Parameters :
 Boys -Testis
-Penis
-pubic hair
 Girls
-Breast
-Pubic hair

70.  Global developmental Delay:
Delay in two or more domains of development
 Isolated developmental Delay:
Delay in one field of development
e.g. Delayed speech---18 mo with out talking any
word.
 Delayed speech could be due to
-hearing defect
-mental retardation
-articulation defect

71.  What are the warning signs at each stage of
growth and development?
 What is developmental regression?