Growth and development

1. Growth and Development
By: Wubet Tazeb
(BSc, MSc in PCHN)
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2. Outline
After the end of this session the students will
able to:
Define growth and development
Identify principles of G &D
Identify the pattern and trend of G&D
Describe factors affecting G&D
Describe physical growth
Identify assessment of development
Describe G & D at specific age period
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4. DEFINITIONS
• Growth -increase in size of the body and various
organs as a whole or any of its parts.
• Changes in size are outcomes of three underlying
cellular processes:
Increase in cell number
Increase in cell size
 An increase in intercellular substances or
accretion.
• Growth is a quantitative change.
• It can be measured in Kg,, meters,, ….. etc.
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5. Con’t ...
Development- is functional or physiological maturation and
myelination of the nervous system.
is the sequential process by which infants and children gain
various skills and capability to functions.
 It signifies accomplishment of mental, emotional and social
abilities.
It is a qualitative change in the child’s functioning.
• It can be measured through observation
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6. Growth and Development
GROWTH: Change in QUANTITY
It is increase in size
DEVELOPMENT:  Change in QUALITY
Increase in skill and capacity to function.
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7. Principles of Growth & Development
• Continuous process
• Predictable Sequence
• Don’t progress at the same rate
• Not all body parts grow in the same rate at the
same time
• Each child grows in his/her own unique way
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8. Changes in bodily proportions with age
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9. Patterns of Growth & Development
• There are definite and predictable patterns in the
growth and development that are:
Continuous,
Orderly, and
progressive
• These patterns are universal and basic to all human
beings
• Growth & Development follow predetermined
trends in direction, sequence, and pace, but each
human being accomplishes these in a manner and
time unique to that individual.
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10. 1. Directional trends
Cephalo-caudal progression: - head to tail
• Starts at the head & moves downward. e.g. the child
control over the head, & neck before it can control its
arms & legs.
Proximal to Distal or near to far :- midline to
peripheral
• Starts in the center & processes to the periphery
• E.g. mov’t & control of the trunk section of the body
occurs before the mov’t & control of arms
Differentiation: simple to complex progression of
achievement of developmental milestones
• E.g. Progressing from crawling to walking to skipping
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12. 2. Sequential trends
• In all dimensions of growth and development
there is a definite, predictable sequence
• The process of growth moves from the simple to
complex
• It is orderly and continuous, with each child
normally passing through every stage
• E. g. children crawl before they stand, stand
before they walk
• The child babbles, then forms words, and finally
sentences; writing emerges from scribbling
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13. 3. Developmental pace
 Occurs at a variable rate among children of the same age
and in the individual child
 Each child grows at his or her own pace
o Distinct differences are observed among children as they
reach developmental milestones
 Not all areas of development occur at the same pace
o When a spurt occurs in one area such as gross motor,
minimal advances may take place in language, fine
motor, or social skills
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14. Factors influencing growth and development
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15. Genetic Factors
• Heredity:-Parental traits are transmitted to the offspring.
Tall parents are likely to have tall off springs.
• Level of intelligence of parents influences the intelligent
quotient (IQ) of their children.
• Genetic disorders/abnormal genes:- Transmission of some
abnormal genes may result in a familial illness which
affects the physical and/or functional maturation, e.g,
hemophilia, etc.
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16. Nutritional Factors
• Malnourished mothers are known to produce LBW
babies, especially with intrauterine growth
retardation (IUGR).
• Nutritional deficiency of considerably retards
physical growth and development.
• Overnutrition, beyond a limit, may cause obesity.
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17. Socioeconomic Factors
• Poverty is associated with diminished and
affluence with good growth.
• Children from well-to-do families usually are
better nourished.
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18. Environmental and Seasonal
Factors
• Physical surroundings (sunshine, hygiene, living
standard) and psychological and social factors/
relationship affect growth and development.
• It has also been observed that maximum weight gain
occurs during fall season.
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19. Chronic Diseases
• Chronic diseases of the heart (congenital heart,
chronic rheumatic heart), chest (tuberculosis,
asthma, cystic fibrosis), kidneys (nephrotic
syndrome, nephritis, bladder neck obstruction),
liver (cirrhosis, hydatid cyst), neoplasms, digestive
or absorptive disorders, hypothyroidism,
hypopituitarism, etc. impair’s growth.
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20. Growth Potentials
• The smaller the child at birth (especially in
context of gestation) the smaller he is likely to
be in subsequent years.
• The larger the child at birth, the larger he is
likely to be in later years.
• Thus, the growth potential is somewhat
indicated by child’s size at birth.
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21. Prenatal and Intrauterine
Factors
• Intrauterine growth retardation (IUGR), maternal
infections like rubella, cytomegalic inclusion body
disease and toxoplasmosis, and maternal diabetes
mellitus, hypothyroidism
• Medication taken during pregnancy etc. adversely
affect the fetus and thereby the newborn.
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22. Emotional Factors
• Emotional trauma from unstable family, insecurity,
sibling jealousy and rivalry, loss of parent(s),
inadequate schooling, etc.
• All have negative effect on growth and development.
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23. Hormonal Factors
• Growth hormone:- Whereas growth hormone is not needed
for fetal growth, its role in postnatal growth is significant.
• Thyroxine deficiency :- May cause fetal goiter and
hypothyroidism with retardation of the skeletal growth of
the fetus.
• Insulin:- Diabetic mothers cause increase in fetal blood
sugar that leads to elevation of insulin production.
• This results in stimulation of fetal growth. That is why fetus
is large with high birth weight in diabetic mothers.
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27. Types of growth:
– Physical growth (Ht, Wt, head & chest
circumferance)
– Physiological growth (vital signs …….)
Types of development:
• Large/Gross motor skills.
• Small/Fine motor skills.
• Language skills.
• Cognitive skills.
• Social/Emotional skills.
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28. Assessment of Growth
• Assessment of physical growth can be done by
anthropometric measurement
• Weight
• Height
• Head circumference
• Mid upper arm circumference
• Body mass index
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29. Physical Growth
 Weight: Birth weight = 3.25kg (2.5- 4kg)
– lose 10% of Birth weight in the 1st week
– regain birth weight:
term by 7-10 days &
preterm by 10-14 days
– Doubles birth weight by 4 - 6 months
– Triples birth weight by end of first year
– Quadruples birth weight by age 2 years
• Average weight: 10 kg at 1 yr. , 20 kg at 5 yr. ,
30 kg at 10 yr.
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31. Question 1. What is the approximate weight of a
9month and 4 year-old children respectively?
– Answer
• 9kg
• 16kg
Question 2. A 10 year-old child was 3kg weight at
birth. What is the approximate current weight of
this child ?
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32. Height:
• Boys average Ht = 50 cm , girls Ht = 49 cm
• Normal range for both (47.5- 53.75 cm)
• Doubles by 4 years of age
• Average length at one year of life: 75 cm
• Predicted adult height= ( age at 2yrs) * 2
• Increase by 6cm/year up to 12 years of age
• Triples by about 13 years of age
 Exponential increment in height at puberty
 Expected height between 2-12 years in cm (weech
formula) = ( age in years *6) + 77
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33. Question :- What is the approximate height of
a 4 year-old child?
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34. • Mid – parental target height, a good predictor of adult height is
calculated by the following formula:
• Boys
 Target height =(Mothers height in cm + Fathers height in cm ) +13
2
• Girls
 Target height = (Mothers height in cm + Fathers height in cm )-13
2
• Expected adult height in cm = mid-parental target height +8
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Measurement of Height or length for age
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36. Head circumference
• HC: 33-35 cm
• Head is ¼ total body length
• 3mo - 41 cms
• 12 mo - 45 cms
• 2yrs - 48 cms
• 12 years - 52 cms
• Grows 2cm per month during the first 3 month
• HC reaches adult size at about 12 years of age
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37. • HC is measured by taking the greatest distance
around the mid forehead-above the ears to the
most prominent-occiput (maximal-fronto-
occipital circumference)
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38. Growth of Head Circumference
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39. • Mid-upper arm circumference (MUAC)
MUAC is measured on the upper left arm
To locate the correct point for measurement, the child's
elbow is flexed to 90°, with the palm facing upwards
A measuring tape is used to find the midpoint between
the end of the shoulder (acromion) and the tip of the
elbow (olecranon); this point should be marked
The arm is then allowed to hang freely, palm towards
the thigh, and the measuring tape is placed snugly
around the arm at the midpoint mark
The tape should not be pulled too tight or too loose
Read the measurement to the nearest 0.1 cm
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40.  MUAC works for 1 –5 years child
 Used for screening purpose
 The normal value at birth > 12.5 cm (Green color)
 11.5 – 12.5cm is moderate malnutrition( yellow color)
 < 11.5cm is severe malnutrition (Red color)
Normal Value
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44. Average age for teeth eruption
• Lower central incisors
• Upper central incisors
• Upper lateral incisors
• Lower lateral incisors
• Lower first molars
• Upper first molars
• Lower cuspids
• Upper cuspids
• Lower 2nd molars
• Upper 2nd molars
• Erupt at 6 months
• Erupt at 7.5 months
• Erupt at 9 months
• Erupt at 11 months
• Erupt at 12 months
• Erupt at 14 months
• Erupt at 16 months
• Erupt at 18 months
• Erupt at 20months
• Erupt at 24 months
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45. Developmental Assessment
• Domain of development
– Motor development
– Cognitive development
– Social /Emotional development
– Language development
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46. Developmental mile stones
• Milestones – limit ages for a skill (i.e age at which most
children acquire the skill) in each dev’tal domains
• Milestones provide a framework for observing and
monitoring a child over time
• A thorough understanding of the normal or typical
sequence of development in all domains allows you to
formulate a correct overall impression of a child’s true
developmental status
• The milestones cited are, on average, those at the 50th
percentile for age
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47. DEVELOPMENTAL
MILESTONES
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51. • 12-20 weeks – child observes his own hands
(hand regard)
• 4 months – hand of the children come together
at midline as he plays
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52. • 1-2 months: social smile
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53. • 3 months : enjoys looking around and recognizes
the mother
• 6 months : vocalizes and smiles at his mirror
image and imitates acts such as cough or tongue
protrusion
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54. • 6-7 months :
- stranger anxiety
• 9 months :
‘bye- bye’, baba mama
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55. • 6 months – sitting with support
• 9 months - _ begins to stand holding on the
furniture , crawling
• 10 – 11 months – start cruising around the
furniture
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56. 12- 13 months
• Stands independently
13- 15 months
Start walking independently
• 18 months _ runs
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58. What is the age of this infant?
• Infants starts to say baba mama , crawling,
hold bottle , throw object
• stands independently
• Walks alone
• Run
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59. Red Flags in development
• Poor head control by 5 months
• Unable to sit alone by age 9 months
• Unable to transfer objects from hand to hand by age 1
year
• Abnormal pincer grip or grasp by age 15 months
• Unable to walk alone by 18 months
• Failure to speak recognizable words by 2 years
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60. Red flags: preschool
• Inability to perform self-care tasks, hand
washing, simple dressing, daytime toileting
• Lack of socialization.
• Unable to play with other children.
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61. Red flags: school age
• Lack of friends
• Social isolation
• Aggressive behavior: fights, fire setting, animal
abuse
• Unable to follow directions during exam
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62. Growth Monitoring
• It is the regular measurement of a child’s size
• Is the process of following the growth rate of a
child
• Growth monitoring and promotion is provided for
all children below five years of age (under-5
children)
• The most powerful tool in growth monitoring is
the growth chart used in combination with
accurate measurements of growth parameters
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63. • Growth chart- is defined as a visible display of
child’s growth.
• Goal:-
Early detection of abnormal growth and
development
Early treatment or correction of any conditions
that may be causing abnormal growth and
development
To provide an opportunity for giving health
education and advice for the prevention of
malnutrition.
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64. • Growth Chart parameters/Measure:
• Length/height for age: - stunting
• Weight for length/height :-Wasting
• Head circumference for age: -information about
brain development
• MUAC:- growth of muscle & subcutaneous fat
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65. Weighing scale for infants/
young children
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66. Measuring Wt by Salter scale
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67. Weighing scale
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68. Standing weighing scale
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69. Weighing
accuracy
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70. Measuring accuracy
Measurement of length using infantometer
for those < 2 yrs
Stadiometere to measure standing
height
Height or length for age
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71. Accurate Measurement of height
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72. Accurate Measurement of height
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73. Head circumference
• Head circumference is determined using a flexible tape
measure run from the supraorbital ridge to the occiput
in the path that leads to the largest possible
measurement.
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74. Mid-upper arm circumference (MUAC)
• Let the left arm to hang by
side of body
• Find out the mid point b/n the
olecranon and the acromion
• The circumference at this
level is MUAC
• MUAC of less than 12.5cm
indicates malnutrition and
when less than 11.5 cm,
severe malnutrition.
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75. BMI can be calculated as
• BMI= weight (kg)
height (m2)
• BMI > 85th percentile is overweight
• BMI > 95th percentile is obese.
• BMI < 5th percentile is underweight
• Plot measurements on the BMI chart.
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77. Types of growth Curves/Charts
 WHO growth charts: is age and gender specific, and
extend from birth to 5 years
Wt. for age → boys and girls
Ht/length for age → boys and girls
Wt for Ht/length → boys and girls
• The normal range is generally defined as between -
2SD and +2SD, which corresponds to approximately
the 2nd and 98th percentiles
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78. CDC growth curves: is age and gender
specific, & extend from birth to 18 years
Wt for age → boys and girls
Ht/length for age → boys and girls
Wt for Ht/length → boys and girls
Head circumference → boys and girls
• The normal range is generally defined as
between the 5th and 95th percentiles
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83. THANK YOU!!!
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