Growth and development In pediatrics medical lecture

1. Growth and Development
Dr. Raid M R Umran
Assisst. Prof. of Pediatrics
College of Medicine – University of Kufa
‫العضو‬ ‫حجم‬ ‫في‬ ‫زيادة‬ ‫العضو‬ ‫وظيفة‬ ‫ر‬ّ‫و‬‫تط‬ ‫في‬ ‫زيادة‬

2. Introduction
 Developmental pediatrics is concerned with the processes of children’s
learning and competent adaptation to the environment from birth to
adulthood.
 The goal of pediatrics care is to optimize the growth and development
of each child.
 Objectives:
 Understand normal growth, development, and behavior
 Normal physical and mental growth and development
 Normal motor cognitive and emotional development
 Observe the interrelationships between physical growth and
cognitive, motor, and emotional development
 How to assess growth and development
 Know abnormal growth and development in children

3. Pediatricians need to understand normal growth, development, and
behavior in order to monitor
• children's progress,
• identify delays or abnormalities in development,
• obtain needed services, and
• counsel parents.
By monitoring children and families over time, pediatricians can
observe the interrelationships between physical growth and cognitive,
motor, and emotional development.
The context for observing a child’s development is the family, school
and community. Family, educational, social, cultural, spiritual,
economic, environmental and political forces act favorably or
unfavorably, but always significantly, on the health and functioning of
children.
‫اﻟﺸﺮط‬

4. Childhood marks the change from the entirely dependent baby into the mature
independent adult. During this period the child:
•Builds up a store of knowledge about the environment;
•Learns motor skills to survive;
•Learns a language with which to communicate and think;
•Develops a sense of self, self-regulation of emotions and behavior and
successful interpersonal relationships.

5. Definitions:
• Growth: increase in the size or dimensions; as
weight, height, skull circumference.
is the increase in size and number of cells in certain
tissues.
• Development: Functional maturation of organs i.e.
to acquire skill, learn and to adapt to stress.
the normal process of maturation of functions.

6. Stages Growth and Development
Intrauterine:
 Embryonic period
• !st trimester (organogenesis)
– Fetal period:
– 2nd trimester (more in length)
– 3rd trimester (more in weight)
Extratrauterine:
• Infancy:
– Early Neonate: Birth to 1 week
– Neonate: Birth to 1 month
– Infancy : Birth to 1 year
• Early Childhood
– Toddler : 1-3 years
– Preschool: 4-5 years
• Middle Childhood
– School age
– 6 to 12 years
• Late Childhood
– Adolescent
– 13 -18 years approximately
Embryo
Fetus
Neonate
Infant

7. Factors affecting Stages of Growth and Development
• Genetic factors: racial & genetic.
• Nutritional factors: adequate nutrition:
• Socio-economic factors: poverty &
ignorance.
• Environmental factors: general hygiene.
• Endocrinal factors.
• Sex differences.
• Chronic diseases.
• Emotional factors.
‫ﺻﺤﯿﺤﺔ‬ ‫ﺑﺼﻮرة‬ ‫ﻣﺘﺸﻜﻼت‬ ‫ﺟﺎﻧﻦ‬ ‫اﻟﻌﻮاﻣﻞ‬ ‫ذﻧﻲ‬ ‫اذا‬ ‫ﯾﻌﻨﻲ‬
‫واﺿﺢ‬ ‫اﺧﺘﻼل‬ ‫اﻛﺜﺮ‬ ‫او‬ ‫ﺑﻮﺣﺪة‬ ‫ﺻﺎر‬ ‫واذا‬ ، ‫ﺻﺤﯿﺢ‬ ‫واﻟﺘﻄﻮر‬ ‫اﻟﻨﻤﻮ‬ ‫ﯾﻜﻮن‬ ‫رح‬
‫واﻟﺘﻄﻮر‬ ‫ﺑﺎﻟﻨﻤﻮ‬ ‫ﻣﻌﯿﻦ‬ ‫ﺧﻠﻞ‬ ‫ﻓﺪ‬ ‫اﻛﻮ‬ ‫ﯾﻜﻮن‬ ‫رح‬

8. Growth Patterns:
4 8 12 16 years

9. Growth Patterns
• The child’s pattern of growth is
in a head-to-toe direction, or
cephalocaudal, and
• In an inward to outward
pattern called proximodistal.

10. Characteristics of Growth and Development
 Growth is an orderly process, occurring in systematic fashion.
 Rates and patterns of growth are specific to certain parts of the body.
 Wide individual differences exist in growth rates.
 Growth and development are influences by a multiple factors.
 Development proceeds from the simple to the complex and from the
general to the specific.
 There are critical periods for growth and development.
 Rates in development vary.
 Development continues throughout the individual's life span.

11. Method of studying growth
1- Cross - sectional: -
2- Longitudinal: -

12. Measurements used in normal growth :
1- Linear ;
a-height
b-length
c-sitting height
d-span
2-Weight
3-Circumference
a-head circumference
b-chest circumference
c-lower limbs
4-Skin & subcutaneous fat

13. Growth Curves

15. Purposes of growth and developmental assessment
• Early detection of deviation in child’s pattern of development
• To promote optimal physical and mental health and
development for all children.
• applying principles of prevention of impairment, wherever
possible, and to reduce disability and handicap.
• to discover the means of preventing such impairments.
• to ensure early diagnosis and effective treatment of
impairments of body, mind and personality;

16. It is useful to subdivide growth and
development in to four functional Skill
areas:
• Gross motor
• Fine motor and vision
• Speech, language and hearing
• Social, emotional and behavioral
Second part.
#domains #milestones

17. FETAL GROWTH AND DEVELOPMENT
• The most dramatic events in growth And
development occur before birth. The transformation
of a single cell into an infant.
• The uterus is permeable to social, psychological, and
environmental influences such as maternal drug use .

18. MILESTONES OF PRENATAL DEVELOPMENT

20. The Newborn
• The newborn (neonatal) period begins at birth (regardless of gestational age)
and includes the 1st mo of life. During this time, marked physiologic transitions
occur in all organ systems, and the infant learns to respond to many forms of
external stimuli.
• Abnormalities in maternal-fetal placental circulation and maternal glucose
metabolism or the presence of maternal infection can result in abnormal fetal
growth. Infants may be small or large for gestational age as a result.
• Examination of the newborn should include an evaluation of growth and an
observation of behavior. The average term newborn weighs approximately 3.4
kg; boys are slightly heavier than girls are. The average length was about 50 cm
and head circumference was 35 cm in term infants.
• The weight may drop 10% below birth weight in the 1st week as a result of
excretion of the excess extravascular fluid and possibly poor intake. Infant
should regain the birth weight by 2 weeks of age and should grow at average of
30 gm per day.
Neonate

21. NEONATAL PERIOD (1ST 4 WK)
Prone: Lies in flexed attitude; turns head from side to side; head sags on ventral
suspension
Supine: Generally flexed and a little stiff
Visual: May fixate face on light in line of vision; “doll’s-eye” movement of eyes on turning
of the body
Reflex: Moro response active; stepping and placing reflexes; grasp reflex active
Social: Visual preference for human face

22. AT 1 MONTH
Prone: Legs more extended; holds chin up; turns head; head lifted momentarily to
plane of body on ventral suspension
Supine: Tonic neck posture predominates; supple and relaxed; head lags when pulled to
sitting position
Visual: Watches person; follows moving object
Social: Body movements in cadence with voice of other in social contact; beginning to
smile Rhythm
‫ﺑﻤﺮﺣﻠﺔ‬ ‫ﯾﺒﺪن‬ ‫اﻟﺮﻓﻠﻜﺴﺰ‬
‫ﻟﺤﺪ‬ ‫وﯾﺠﺮن‬ ‫اﻟﻨﯿﻮﻧﯿﺖ‬
‫اﺷﮭﺮ‬٤ ‫اﻟﻰ‬ ٣‫ال‬ ‫ﻋﻤﺮ‬

23. Primitive neonatal
Reflexes are unique in the newborn period and can further elucidate or eliminate concerns over
asymmetric function. The most important reflexes to assess during the newborn period are as
follows:
The Moro reflex: is elicited by allowing the infant’s head to gently move back suddenly (from a
few inches off of the mattress onto the examiner’s hand), resulting in a startle, then abduction and
upward movement of the arms followed by adduction and flexion. The legs respond with
flexion.
The rooting reflex: is elicited by touching the corner of the infant’s mouth, resulting in lowering
of the lower lip on the same side with tongue movement toward the stimulus. The face also turns
toward the stimulus.
The sucking reflex: occurs with almost any object placed in the newborn’s mouth. The infant
responds with vigorous sucking. The sucking reflex is replaced later by voluntary sucking.
The grasp reflex: occurs when placing an object, such as a finger, onto the infant’s palm (palmar
grasp) or sole (plantar grasp). The infant responds by flexing fingers or curling the toes.
The asymmetric tonic neck reflex: is elicited by placing the infant supine and turning the head to
the side. This placement results in ipsilateral extension of the arm and the leg into a “fencing”
position. The contralateral side flexes as well.
Most of these primitive reflexes disappear by age 3 – 4 months and a delay in the expected
disappearance of the reflexes may also warrant an evaluation of the central nervous system.
🤺

24. AT 2 MONTH
Prone: Raises head slightly farther; head sustained in plane of body on ventral suspension
Supine: Tonic neck posture predominates; head lags when pulled to sitting position
Visual: Follows moving object 180 degrees
Social: Smiles on social contact; listens to voice and coos

25. Age 2-6 Months
 At about 2 mo, the emergence of voluntary (social) smiles and increasing
eye contact mark a change in the parent-child relationship,
 Between 3 and 4 mo of age, the rate of growth slows to approximately
20g/day.
 By 4 mo, birth weight is doubled.
 Early reflexes that limited voluntary movement recede.
 Disappearance of the asymmetric tonic neck reflex means that infants
can begin to examine objects in the midline and manipulate them with
both hands.
 Weaning of the early grasp reflex allows infants both to hold objects and
to let them go voluntarily.
 Total sleep requirements are approximately 14-16 hr/24 hr, with about 9-
10 hr concentrated at night and 2 naps/day. About 70% of infants sleep
for a 6-8 hr stretch by age 6 month.

26. AT 3 MONTH
Prone: Lifts head and chest with arms extended; head above plane of body on
ventral suspension
Supine: Tonic neck posture predominates; reaches toward and misses objects;
waves at toy
Sitting: Head lag partially compensated when pulled to sitting position; early
head control with bobbing motion; back rounded
Reflex: Typical Moro response has not persisted; makes defensive movements or
selective withdrawal reactions
Social: Sustained social contact; listens to music; says “aah, ngah”
AT 4 MONTH
Prone: Lifts head and chest, with head in approximately vertical axis; legs
extended
Supine: Symmetric posture predominates, hands in midline; reaches and grasps
objects and brings them to mouth
Sitting: No head lag when pulled to sitting position; head steady, tipped forward;
enjoys sitting with full truncal support
Standing: When held erect, pushes with feet
Adaptive: Sees pellet, but makes no move to reach for it
Social: Laughs out loud; may show displeasure if social contact is broken;
excited at sight of food

28. AT 7 MONTH
Prone: Rolls over
Supine: Lifts head; rolls over;
Sitting: Sits briefly, without support; leans forward on hands; back rounded
Standing: May support most of weight; bounces actively
Adaptive: Reaches out and grasps large object; transfers objects from hand to hand;
Language: Forms vowel sounds
Social: Prefers mother; babbles; enjoys mirror; responds to changes in emotional
content of social contact
AT 10 MONTH
Sitting: Sits up alone with back straight
Standing: Pulls to standing position; “cruises” or walks holding on to furniture
Motor: Creeps or crawls
Adaptive: Grasps objects with thumb and forefinger (pincer grasp); picks up pellet
with assisted pincer movement; uncovers hidden toy; releases object grasped by
other person
Language: Repetitive consonant sounds (“mama,” “dada”)
Social: Responds to sound of name; waves bye-bye
Sit unsupported

30. AT 1 Year
Motor: Walks with one hand held (48 wk); rises independently, takes several
steps
Adaptive: Picks up pellet with unassisted pincer movement of forefinger and
thumb; releases object to other person on request or gesture
Language: Says a few words besides “mama,” “dada”
Social: Plays simple ball game; makes postural adjustment to dressing
Like: No no no

31. 15 MONTH
Motor: Walks alone; crawls up stairs
Adaptive: Makes tower of 3 cubes; makes a line with crayon; inserts raisin in bottle
Language: follows simple commands; may name a familiar object (e.g., ball);
responds to his/her name
Social: Indicates some desires or needs by pointing; hugs parents
18 MONTH
Motor: Runs stiffly; sits on small chair; walks up stairs with one hand held.
Adaptive: Makes tower of 4 cubes; imitates scribbling; imitates vertical stroke;
Language: 10 words (average); names pictures; identifies one or more parts of body
Social: Feeds self; may complain when wet or soiled.
24 MONTH
Motor: Runs well, walks up and down stairs, one step at a time; opens doors; climbs
on furniture; jumps
Adaptive: Makes tower of 7 cubes (6 at 21 mo); scribbles in circular pattern;
Language: Puts 3 words together (subject, verb, object)
Social: Handles spoon well; often tells about immediate experiences; helps
to undress; listens to stories when shown pictures

34. 30 months
Motor: Goes up stairs alternating feet
Adaptive:
Makes tower of 9 cubes; makes vertical and
horizontal strokes, but generally will not join them
to make cross; imitates circular stroke
Language: Refers to self by pronoun “I”; knows full name
Social: Helps put things away

35. Preschool age (2 – 5) years
The critical milestones for children ages 2 to 5 yr are the
emergence of language and exposure of children to an
expanding social sphere. As toddlers, children learn to walk
away and come back to the secure adult or parent.
As preschoolers, they explore emotional separation,
Somatic and brain growth slows by the end of the 2nd yr of
life, with corresponding decreases in nutritional requirements
and appetite, and the emergence of “picky” eating habits.
Increases of ~2 kg in weight and 7-8 cm in height per yr are
expected.
Birth weight quadruples by 2.5 yr of age. The head will grow
only an additional 5 cm between ages 3 and 18 yr.
Handedness is usually established by the 3rd yr.

36. 36 Months ( 3years)
Motor: Rides tricycle; stands momentarily on one foot
Adaptive: Makes tower of 10 cubes; imitates construction of
“bridge” of 3 cubes; copies circle
Language: Knows age and sex; counts 3 objects correctly; repeats
3 numbers
Social: Plays simple games (in “parallel” with other children);
helps in dressing (unbuttons clothing); washes hands
Rule of three

38. 48 Months ( 4 years)
Motor: Hops on one foot; throws ball overhand; uses
scissors to cut out pictures; climbs well
Adaptive: copies cross and square
Language: Counts 4 accurately; tells story
Social: Plays with several children, goes to toilet
alone

39. 60 months( 5 years)
Motor: Skips
Adaptive: Draws triangle
Language: Names 4 colors; counts 10 correctly
Social: Dresses and undresses; asks questions about
meaning of words

48. Dental eruption:
‫ظﮭﻮر‬ ، ‫ﺑﺮوز‬

59. WITNESS