Growth and development monitoring Child Health Nursing Pediatric Nursing Melba Sahaya Sweety Chinna Chadayan

1. Mrs.D. Melba Sahaya Sweety
M.Sc Nursing
Pediatric Speciality
GIMSAR

2. INTRODUCTION
Growth monitoring consists of routine
measurements to detect abnormal growth,
combined with some action when this is
detected. It is widely accepted and strongly
supported by health professionals, and is a
standard component of community paediatric
services throughout the world. Growth of a
baby is seen in many ways: increase in size,
height and weight, clothes becoming smaller
than they used to be, a string on the waist
becoming tighter etc. These are all signs of
growth but they cannot tell us if the child is
growing well enough for its age.

3. BENEFITS OF MONITORING THE
GROWTH AND DEVELOPMENT OF THE
CHILD
• Weightgainis themostimportantsignthata childis
healthyandis growinganddevelopingwell.
• A healthcheck-upcanalsodetectif a childis gaining
weighttoofastforhisorherage.Thisrequires
examininga child’sweightinrelationtohisorher
height,whichcandetermineif thechildis overweight.
• If thechildisunderweightoroverweight,it is
importanttoexaminethechild’sdietandprovidethe
parentsorothercaregiverwithadviceongood
nutrition.

4. BENEFITS OF MONITORING THE
GROWTH AND DEVELOPMENT OF THE
CHILD
• Everychildshouldhavea growthchart that tracks his or
her growth. It showswhetherthe childis growing
appropriatelyfor his or her age. At eachweighingthe
child’sweightshouldbe markedwitha dot on the growth
chartandthe dotsshouldbe connected.
• A childwho is not gainingenoughweight overone or two
months may needlargerservings, more nutritiousfoodor
morefrequent meals. The childmaybe sickor may need
moreattentionandcareor assistance witheating. Parents
andtrainedhealthworkers needto act quicklyto discover
the causeof the problemand takestepsto correct it.

5. IMPORTANCE OF GROWTH
AND DEVELOPMENT FOR
NURSES
▶ To Learn What To Expect From
A Particular Child At Particular
Age.
▶ To Assess The Normal Growth
And Development Of Children.
▶ Gaining Better Understanding
Of The Reasons Behind
Illnesses.
▶ Helping In Formulating The
Plan Of Care.

6. STAGES OF
GROWTH AND
DEVELOPMEN
T
Prenatal
Period
Ovum (0 to 14 days after
conception
Embryo ( 14 days to 8 weeks
Fetus ( 8 weeks to Birth)
Postnatal
Period
Neonate ( Birth to 4 weeks of life)
Infancy (1 Month to 1 Year)
Toddler (1 to 3 Years)
Preschooler (Early childhood:
3 to 6 years)
School going (Middle Childhood :
6- 10 Years [girls] , 6-12 years [boys] )
Adolescent :(Late Childhood) From
Puberty to Adulthood (12 – 20 years
for Boys, 10-18 Years for Girls)

7. ASSESSMENT OF GROWTH
• Assessment of physical growthcan be done by anthropometric
measurement and the study of velocity of physical growth.
ASSESSMENT
OF GROWTH
Weight
Length/
Height
Head
Circumference
Chest
Circumference
Mid-upper arm
circumference Eruption of
Teeth
Osseous
Growth
Fontanel's
Closure
Body
Mass
Index

8. Weight of full term infant: 2.5-3.8 kg
10% loss of weight in first week of life
which regain by tenth day of age
25-30gm/day increases till 3 months.
400gm/month increases till 1 yr
Doubled their birth weight in 5 months
old.
Tripled by one year of age.
Four times in 2 yrs
Five times in 3 yrs,
Six times in 5 yrs
7 times in 7 yrs,
10 times in 10 yrs

9.  Height improvement
indicates skeletal growth.
 At birth average length is
about 50cm.
 Increases to 60cm at 3
months, 70cm at 9 months.
 75cm-1 yr
 12cm increases in 2nd yr
9cm increases in 3rd yr
7cm increases in 4th Yr
 6cm increases in 5th yr
Doubles in height 4-5yrs
 After5yrs there is about 5 cm
increase in every year till onset of
puberty.

10. Body mass index (BMI) is one way to estimate a
person's body fat that takes into consideration
the person's height. BMI is calculated using a
person's weight and height. In children and
teens, BMI is used to find out if a child or teen
is underweight, of a healthy weight, overweight,
or obese. A child's body fat changes with age.
Also, girls and boys differ in their amount of
body fat as they mature. This is why BMI for
children, also known as BMI-for-age, includes
gender and age
BMI = Weight in Kg
Height in M2
• BMI remains constant up to
5 yrs of age.
• BMI >30kg/ M2 indicates

11. • It is related to brain growth and
development of intracranial volume. Average
head circumference measured about 35 cm at
birth.
• • At 3 months it is about 40 cm, at 6 month
43 cm, at one year 45cm, at 2 years 48 cm, at
7 year 50 cm and at 12 years of age it is about
52 cm, almost same a adult.
• If head circumference increase more than 1
cm in two weeks during the first 3 month of
age then hydrocephalus should be suspected.

12.  At birth, anterior and posterior fontanels are usually
present.
 Posterior fontanels closes early few weeks(6-8week) of age.
 The anterior fontanel normally closes by 12- 18 months of age.
 Early closure of fontanel indicates craniostenosis due to
premature closure of skull sutures.

13.  Chest circumference or thoracic diameters
is an importance parameter of assessment
of growthand nutrition status.
 At birthit is 2-3cmless than head
circumference.
 At 6 to 12 months of age bothbecome
equal.
 After first year of age, chest circumference
is greaterthan head circumference by 2.5
cm and by the age of 5 year, it is about 5
cmlarger than headcircumference.

14. • This measurement helps to asses the nutritional
status of younger children.
• There is growth due to inadequate nutritional,
which can be this simple particle and useful
measurement.
• The average MUAC at birth is
11 to 12 cm,
• At one year of age it is 12 to 16
cm,
• At 1 to 5 years it is 16 to 17 cm,
• At 12 years it is 17 to 18 cm and
• At 15 years it is 20 to 21cm.

15. • There is a variation for the time of eruption of teeth. First
teeth commonly the lower central incision may appear in 6
to 7 months of age. It can be delayedeven up to 15 months,
which also can be consideredwithin the normal range of
time for teething. So dentition is not dependable
parameters for assessment of growth. •

16. Permanent teeth
 All temporary teethreplaced by permanent teeth.
 It starts from6yrs and 12yrs.
 Third molar appears at 18 yrs or later in some children.
 Some babies born with teeth, it is calledas natal teeth.
 Malocclusion of teeth due to thumb sucking
Types of Teeth:
•Temporary for small face in small size
•Permanent teeth Bigger in size for growingface.
Temporary teeth
Alsocalled as Milk teeth/Deciduous teeth, which erupt at the rateof one
toothevery month. By the age of 2.5-3yrs all (20)temporary teeth erupts.

17. • Total number of teethTemporary teething
• 6 - 12 months Incisors (central and lateral)
[2- 8 ]
•12 - 15 months First moral [8- 12]
• 15 - 24 months Canines( cuspids) [12 - 16 ]
•24 – 30 months Secondary moral [16 – 20]
•Permanent teething 6 -7 years
•First permanent molars (24 ) at 7- 10 years
•Replacement of temporary 10 -12 years
• Replacement of temporary molar by premolars
• 12 – 15 years Secondary permanent molars (28 )
•At 16 years Third permanent molars (32)

18. Osseous growth Bony growth
is essential for the proper
height of the child.
 Bony growth follows a definite
pattern and time schedule from
birth to maturation.
 It is calculated by the
appearance of ossification
centre by X – ray study.
Skeletal maturation or bone growth is
an indicator of physiological
development and continue up to 25
years of age.
Full term neonate have five ossification
center.

19. GROWTH MONITORING
• Assessment of growth may be done by longitudinal &
cross sectional studies. The common parameters used for
growth monitoring include, head circumference, chest
circumference, UL/LS ratio (The upper-to-
lower body segment ratio can be determined by measuring
the distance from the symphysis pubis to the floor
(i.e., lower body segment) in a patient standing erect
against a wall. The lower body segment is subtracted from
the child's height to obtain the upper body segment value).
The following are the 3 members used for comparisons:-
• Use of mean/median values.
• Use of percentile
•Use of indices as weight for height & weight for age.
Common reference values
•WHO reference value
•Indian standards

20. TECHNIQUES
OF
ASSESSMENT
OF GROWTH
Weight
Height
Head
Circumference
Chest
Circumference
Abdominal
Circumference
Skin fold
Thickness
TECHNIQUES OF ASSESSMENT OF
GROWTH

21. • Weech’s Formula For Estimating
• Weight In Children (Kg) At birth : 2.5 - 3.5 Kg
• 3 to 12 months: Age in months + 9
2
• 1 to 6 Years: (Age in years X 2 ) + 8
• 7 to 12 Years: (Age in years X 7) - 5
2
Weight Height Calculation
3 15 (5x3)
5 18 (6x3)
7 21 (7x3)
10 30 (10x3)
•Routine Estimate Of Weight Of A
Baby Having Birth Weight 3 Kg • Weight For Height is
calculated by:

22. • Body Mass Index (BMR Index)
• It is used to determine if children are
overweight, obese or underweight.
BMI = (weight in Kg/height in m²)
• If the value is less than 0.15, it
indicates malnutrition. This remains
constant upto 5 years of age.
BMI Categories:-
Underweight = <18.5
• Normal weight = 18.5–24.9
• Overweight = 25–29.9

23. • Height Or Linear Growth Or Length
• Height refers to the measurement taken
when the child stands upright. It occurs
as a result of skeletal growth and it is a
stable measurement of general growth.
Maximum rate of growth in length
occurs before birth.
• Maximum rate of growth in length
occurs before birth.
• When height is measured in
supine(lying) position, it is called length.
• Special length can be measured such as
sitting height

24. • DIGITAL SCALE FOR CHECKING
WEIGHT AND LENGTH
Till the child is 24 to 36 months of age,
measure recumbent length. Keep the child in
fully extended position by holding the head in
midline, grasping the knees together gently,
and extending the knees by gently pushing
down on the knees on a bed or a measuring
board. Measure the length by placing the
child on a paper or colorless cloth – covered
surface. Mark the end points of the top of the
head and heels of the feet and measure
between these points. Keep the head in
midline. Position the feet with the toes
pointing upwards.

25. • It refers to the measurement taken when
the child stands upright, Remove the
shoes, make the child stand as straight as
possible, head in midline looking straight.
Child stands with the back to the wall
with shoulders, buttocks and heel
touching the wall.
• Weech’s formula for the estimation of
height in children.
• At birth: 50 cm
• 1 year: 75 cm
• 2 to 12 years: (age in years X 6)+77cm
OR (age in years X 2) + 30 inches

26. • It is measured by using a tape that
does not stretch. Measure the head
circumference until the child is 3 years
of age and in any age when the head
size is questionable.
• The maximal circumference of the
head is measured by placing the tape
measure over the eyebrows or
supraorbital ridges and pinna of the
ear anteriorly and over the occipital
prominence posteriorly.
• Newborn’s head circumference (33-35
cm) is larger than the chest
circumfernec by 2-3cm.

27. • It is measured at the
level of nipple line at
mid respiration.
Place the tape
measure at right
angles to the
vertebral column.
Newborn’s chest
circumference is 31-
33cm.

28. • Keep the child in
recumbent position.
Place the tape measure at
the level of umbilicus at
right angles to the
vertebral column. Check
the measurements as
indicated. Abdomen of
children upto 3 years of
age who have chronic
intestinal problems are
measured.

29. Tissue growth assessment
• Arm circumference is an
indirect measure of muscle
mass. Measure the midpoint
of the arm with a tape or
paper. Place the tape
vertically from acromion
process of scapula along the
posterior aspect of upper arm
to the olecranon process.
Half of the measured length
is the midpoint.

30. • Shakir Tape is used to
measure the MUAC
• Interpretation of
MUCA
• Normal: Above 13.5 cm
• Moderate PEM: 12.5-
13.5 cm
• Severe PEM: below 12.5
cm
Tissue growth assessment

31. • It is the measure of
the body fat.
• It is measured with
special calipers such
as lauge calipers.
• Common sites are
triceps, sub scapula,
abdomen, upper
thigh and supra
iliac.
Tissue growth assessment

32. •Useful for detecting protein energy
malnutrition in children between 4
months and 4 years.
KI = Mid arm circumference
Head circumference
Normal : > 0.32
Mid under nutrition: > 0.28 - 0.32
Moderate under nutrition: 0.25 – 0.28
Severe undernutrition: > 0.25
Tissue growth assessment

33. When both arms are spread apart, the distance
between the tips of the middle fingers is
measured as arm span. In young children, it is
1-2 cm less than the height. It equals the
height at 10 years and afterwards it is about 1-
2 cm more than the height.
Tissue growth assessment

34. ASSESSMENT OF DEVELOPMENT
 Development is a process of acquiring variety of
competencies for the optimal functioning in the society.
 Development is a qualitative as well a quantitative
change.
 If developmental delay is recognizedearly, intervention
to reduce long termsequel can be started.
 It is important to monitor growth and development at
every stage.
 A child is said to have developmental delay if the child
does not reach the expected developmental milestones for
the age.

35.  To determine if any
developmental delay exists.
 To identify strengths and
needs.
 To develop strategies foe
intervention.
 To serve as a basis for
reporting to parents.
ASSESSMENT OF DEVELOPMENT

36. Domains of Assessment of
Development
Physical or Biological Development
Gross Motor Development
Fine Motor Development
Sensory Development
Psychosocial Development
Psychosexual Development
Intellectual development
Moral Development
Spiritual Development
Language Development
ASSESSMENT OF DEVELOPMENT

37. • Physical Development means physical
changes of, the increase in size, height and
weight Physical development will usually
follow a sequence even though the age may
vary.
• Biological development, the progressive
changes in size, shape, and function during
the life of an organism by which its genetic
potentials (genotype) are translated into
functioning mature systems (phenotype).
• Physical development is divided into fine
motor skills and gross motor skills.

38. • Gross motor skills involve movements of
the large muscles of the arms, legs, and
torso. Examples of gross motor
skills include sitting, crawling, running,
jumping, throwing a ball, and climbing
stairs.

39. Mile stone
Age
Mile
Stone
Image
3 Month Neck
Holding
5 Month Roll Over

40. Mile stone
Age
Mile
Stone
Image
6 Month Sit with
own
support
8 Month
Sit
without
Support

41. Mile stone
Age
Mile
Stone
Image
9 Month Standing
with
support or
Holding
on
12
Month
Creep well
and Stand
without
support,
Walks but
fall

42. Mile stone
Age
Mile
Stone
Image
15
Month
Walk
alone and
Creep
upstairs
18
Month Runs

43. Mile stone
Age
Mile
Stone
Image
2 Years
Walk Up
and
Down
3 Years
Rides
Tricycle

44. Mile stone
Age
Mile
Stone
Image
4 Years
Hops on
one feet
Alternating
feet going
downwards

45. • Fine motor skills are the ability to make
movements using the small muscles in our
hands and wrists. People use fine motor
skills to do many school- and work-related
tasks. Fine motor development upon neural
tract maturation. Example for fine motor skill are
• Academics skills including
– Pencil skills (scribbling, colouring, drawing,
writing)
– Scissors skills (cutting)
• Play Skills
– Construction skills using lego, duplo,
puzzles, train tracks
– Doll dressing and manipulation
– IT use (e.g. mouse and stylus manipulation)

46. Mile stone
Age
Mile
Stone
Image
4 Month
Reaching
out for the
objects
with both
hands
Reaching
out for the
objects
with one
hand
6 Month

47. Mile stone
Age
Mile
Stone
Image
9 Month
Immature
pincer
grasp
Mature
pincer
grasp
12
Month

48. Mile stone
Age
Mile
Stone
Image
15
Month
Imitates
Scribbling
Build
Tower of
2 Blocks

49. Mile stone
Age
Mile
Stone
Image
18
Month
Scribbles
Build
Tower of
3 Blocks

50. Mile stone
Age
Mile
Stone
Image
2
Years
Build
Tower of
6 Blocks
Draw
Vertical or
Circular
Stroke

51. Mile stone
Age
Mile
Stone
Image
3
Years
Build
Tower of
9 Blocks
Draw
Circular
Stroke

52. Mile stone
Age
Mile
Stone
Image
4
Years
Bridge
with
Blocks
Copy
Cross

53. Mile stone
Age
Mile
Stone
Image
5
Years
Gate with
Blocks
Copy
Triangle

54. • Personal and social development
includes personal reactions to his
own social and cultural situations
with neuromotor maturity and
environment stimulation. It is
related to interpersonal and social
skill as social smile, recognition of
mother, use of toys.
•

55. Mile stone
Age
Mile Stone Image
2 Month
Social
Smile
3
Month
Recognizes
Mother

56. Mile stone
Age
Mile Stone Image
6 Month
Recognizes
Stranger,
Stranger
Anxiety
9
Month
Waves
Bye-Bye

57. Mile stone
Age
Mile Stone Image
12
Month
Comes
when called
Play simple
ball games

58. Mile stone
Age
Mile Stone Image
15
Month
Use
Jargons
18
Month
Copies
Parents in
task

59. Mile stone
Age
Mile Stone Image
2 years
Ask for
food
,drinks and
toilet
3 Years
Share toys
and Knows
full name
and gender

60. Mile
stone
Age
Mile Stone Image
4years
Plays
cooperatively
in a group
Goes to toilet
alone

61. Mile
stone
Age
Mile Stone Image
5 years
Helps in
house hold
task
Dressing and
undressing

62. Language
development Age
Milestone
1month Alerts to sound
3 month Coos ( musical vowel sounds)
4 month Laugh loud
6 month Monosyllables (ba, da, pa) sound
9 month Bisyllables ( mama, baba, dada)
sound
12 month 1-2 words with meaning
18 month 8 -10 words vocabulary
2 years 2-3 word sentences, uses pronouns
“I”, “Me”, “you”
3 Years Ask question
4 Years Says songs or poem, tell stories
5 Years Asks meaning of words

63. TECHNIQUES OF ASSESSMENT
OF DEVELOPMENT
• Standardized tools are used for screening developmental changes
in a systematic way. Several assessment tools are used.
Gesell development schedule
The Denver developmental screening test (DDST)
The Brazelton neonatal behavioral assessment scale
The Bayley scale of infant development
Trivandrum development screening chart (TDSC)
The Denver articulation screening examination (DASE)
Baroda Developmental Screening Test
Developmental assessment scale for Indian infant(DASII)

64. • This scale by Gesell provides an estimate in
four major areas of development, such as
motor, adaptive, language and personal social.
During the first year, development is assessed
every week, then every two weeks till two years
and every six months till five years of age.
• Scale gives development quotient (DQ) for
each area separately and it also gives overall
DQ.
DQ =
• Child with DQ between 65 and 75 is at risk for
development delay. It can be applied for
handicapped children satisfactorily

65. • The Denver Developmental Screening Test (DDST) (Age
Range 2 Weeks To 6 Years) It was originally developed by
Frankenburg and Dodds, which is revised recently. It is
simple, economic and useful test for screening
developmental delaym during infancy and preschool
period.
• It is a screening tool. It is not an intelligence test.
Assessment is done in four areas. Social, fine motor,
language and gross motor skills. While using the test,
make each child comfortable. Explain the tasks at the
child’s level of understanding. Make sure the child
listens and pays attention to each task. After scoring the
test, interpret the results and inform the parents

67. • The Brazelton Neonatal
Behavioral Assessment Scale It
was developed by T Berry
Brazelton for assessing newborn
behavior during the first month
of age. It records individual
differences in the baby. This tool
can be used for normal as well as
high – risk neonates such as
premature babies.

69. • The Bayley scale of infant
development It is used to evaluate
children between 6 and 30 months
of age. Three general areas such
as mental, psychomotor and
behavioural development are
evaluated.

71. • Trivandrum development screening
chart (TDSC) This test is developed at
Trivandrum (Child Development
Centre, Medical College Hospital). It is
a simplified version of Bayley scale of
infant development. Since the norms
for TDSC are taken from Bayley scale,
which is a universally accepted
developmental scale for children up to
30 months of age, it can be used in
other states also.

73. • The Denver Articulation Screening
Examination (DASE) Language and
speech development can be assessed by
evaluating child’s verbal ability by direct
observation and by testing. DASE is a
tool to test the child’s ability to imitate
vocal sounds. This test is easy to
administer as the child is only asked to
repeat 30 sound elements.

74. • Baroda Developmental Screening Test is
a screening test for motor-mental
assessment of infants, developed
from Bayley Scales of Infant
Development It s meant to be used by
child psychologists rather than
physicians. It can be applied up to 30
month of age.
The test was developed by Promila
Phatak in 1991 at Department of Child
Development, University of Baroda.

75. • Developmental Assessment Scale
for Indian Infants(DASII) This
tool is also based on Bayley scale
of infant development. This scale
was developed by Ms. Pramila
Phatak of Baroda University. Age
range is till 2.5 years. DASII
consists of two scales – mental
scale and motor scale