PP lecture of Growth and development of a child for UG medical students

1. GROWTH AND DEVELOPMENT
Dr.P.Natarajan

2. Percentile
• Data is arranged in ascending order from 0 to 100 to show
which percentage of the distribution is above and below the
item

3. Standard deviation & Z score
• The Standard Deviation is a measure of how far away
a particular value is from the normal. It is the square
root of the Variance
• z score is a measure of standard deviation. For Eg:
Child’s score = 70
Mean = 50
SD = 10
Then Z score = +2

4. S.D
• 1 SD=About 68%
• 2 SD=About 95%
• 3 SD= bout 99.7%
Gaussian distribution

5. DEFINITION OF GROWTH
1. It is physical maturation.
2. It is the increase in size of the body – in height,
weight and other measurable areas.
3. Rate of growth vary during different stages of
growth ;
4. The growth rate is rapid during the
prenatal,neonatal, infancy and adolescent stages
and slows during childhood.

6. Changes in body proportions

7. Growth spurts

9. Development
1. Development is physiological and
psychological maturation. It is the gaining of
behaviour and skills in all aspects of the
child’s life.
2. Developmental milestones are a set of
functional skills or age-specific tasks that
most children can do at a certain age range.

10. Five Domains of development
1. Motor:
a. Gross motor: using large groups of muscles
to sit, stand, walk, run, etc., keeping
balance, and changing positions.
b. Fine motor: using hands to be able to eat,
draw, dress, play, write, and do many other
things.

11. 2. Language: It refers to speaking, using body
language and gestures, communicating, and
understanding what others say and also reading
and writing
3. Cognitive: Thinking skills: including learning,
understanding, problem-solving, reasoning, and
remembering.

12. 4 Adaptive: Adaptive skills refer to the skills used
for daily living, such as dressing, eating,
dressing, undressing and using toilet
independently. It also includes avoiding
dangers from any sources.
5. Social: Interacting with others, having
relationships with family, friends, and teachers,
cooperating, and responding to the feelings of
others.

13. LAWS / PRINCIPLES / RULES /
PATTERNS OF G&D

14. LAWS / PRINCIPLES / RULES / PATTERNS OF G&D
1. Definite and predictable pattern,
2. Continuous & orderly
3. Normal G&D is determined by physiological maturity
and functional integrity of CNS.
4. progressive through the same stages.
1. Crawl  Creep Walk
2. Speech: Babbles  Words  Sentences;
Scribble Writing
3. Social: First child plays alone, then with others.

15. 5. There is a directional Pattern in G&D:
1. Cephalocaudal Pattern ( Head to Tail)
2. Proximal to Distal (Midline to peripheral)
3. Mass to specific (Differentiation)
6. Brain takes over spine:
1. Primitive reflexes are replaced by voluntary acts.
Eg. Reflex Grasp by voluntary grasp
2. Mass activity replaced by specific activity. Eg.
Looking at a bright object infant moves all limbs
excitedly but older child is less excited and
approaches the object with one hand

16. Cephalocaudal development

17. Ulnar grasp to pincer grasp

18. 7. All areas of development are linked together:
a. Rolling over can follow only after the
disappearance of tonic neck reflex
b. A baby cannot start to finger feed until he or she
can sit up
c. The speech development of a child is affected if
the child has difficulties in hearing
d. CNS stimulation: A child who does not receive love
and attention may fail to grow and develop.

19. 8. Definite Growth rates of different organs:
a. The general body growth is rapid during the fetal
life, first one or two years of postnatal life and again
during puberty. In the intervening years, growth
velocity is relatively slowed down.
b. The brain enlarges rapidly during the latter months
of fetal life and early months of postnatal life. At
birth, the head size is about 65-70% of the expected
head size in adults. It reaches 90% of the adult head
size by the age of 2 yr.

20. Fetal Development
1. 0-8 weeks: Embryonic period: 3 layers; Paired heart tubes,
vulnerable for teratogenic and hypoxic insults
2. Fetal period: 9 weeks to birth: organogenesis
1. 10 weeks: face recognizable; rotation of gut
2. 12 weeks: gender of genitals becomes visible; budding of
bronchi and bronchioles
3. 20-24: primitive alveoli and surfactants begin to form
4. 26 weeks: eye opening
5. III trimester: respond to external stimuli by body movements
and heart rate changes; habituation with repetitive stimuli

21. MILESTONES OF DEVELOPMENT

22. Fetal
• Embryonic period: 0-8 weeks; 3 layers; Paired heart
tubes, vulnerable for teratogenic and hypoxic insults
• Fetal period: 9 weeks to birth: organogenesis
• 10 weeks: face recognizable; rotation of gut
• 12 weeks: gender of genitals becomes visible; budding of
bronchi and bronchioles
• 20-24: primitive alveoli and surfactants begin to form
• 26 weeks: eye opening
• 3rd trimester: respond to external stimuli by body
movements and heart rate changes; habituation with
repetitive stimuli

23. Neonate
1. Wt: 2.8 to 3.4 kg; boys heavier;
2. Length: 50 cm (20”)
3. HC: 35 cm (14 ”)
4. Eye: Focal length: 8-12”; nearsighted from breast to mother’s
face; preference for faces
5. Hearing: developed well; preferential turn toward female voice
6. Gaze back at mother
7. Autonomic instability: flushing, mottling, perioral pallor,
hiccupping, vomiting, uncontrolled limb movements and
inconsolable crying

24. BEHAVIOURAL STATES BY PRECHTL AND BEINTEMA
1. Quiet sleep: not arousable by heel stick;
2. Active sleep: arousable but gets habituated by
repeated heel stick (sampling time)
3. Drowsy: repeated heel stick pushes the infant to fussy
or crying state
4. Alert: fixate on object or face and follow horizontally
and vertically; turn toward a novel sound
5. Fussy & Crying

25. 25

26. 0-2 months: Physical
1. Weight: Wt loss by 10% of birth weight in first week; regains it in 2
week; Gains 30 gm /day in first month (fastest growth in life)
2. Eye: Focal length: 8-12”; nearsighted from breast to mother’s face;
3. Hearing: developed well; preferential turn toward female voice
4. preference for faces. Gaze back at mother
5. Uncontrolled writhing and purposeless closing and opening of
hands
6. Active Moro response; tonic neck posture
7. Involuntary smiling (Pilliar plays with him!)
8. 6 behavioural states; sleep and wakefulness evenly distributed and
later sleep period more in nights
9. Eye gaze, head turning, sucking under some control
10. Visual preference to human face

27. Neonatal reflexes

29. Cognitive:
1. Recognizes facial expression like mother’s smile
2. Habituates to repeated stimuli (rocking on shoulder)
3. Increase attention to changing stimulus
4. Discriminates rhythmic patterns in language (cho cho
cho or loloie)
Emotional:
1. Crying in response to wet diaper to express
discomfort
2. Cries while hungry and smiles after feeding

30. 2-6 months: Physical
1. Birth Weight regained after 10 days; then gains 20 gm/day
doubled at 4-5 months
2. Disappearance of asymmetric tonic neck reflex and hands are
brought to midline to examine objects
3. Grasp reflex disappear to hold and release objects voluntarily
4. Bidextrous reach – 4 mo
5. Gains control over trunk muscles & intentional rolling over
6. Holds heads with bopping 3 mo, steadily at 4-5 mo while sitting and
start taking spoon feeding
7. Can gaze across at things
8. Achieves greater degree of regular sleep-wake cycle;

31. • Cognitive:
1. Starts shifting attention from breast feeding mother
to other things around
2. Starts exploring his own body by hands
• Emotional development and communication:
1. Shows anger, fear and joy for appropriate stimuli
2. Says inga - 3 mo
3. Loughs aloud - 4 mo
4. Excited at sight of food- 4 mo
5. Shows facial imitation and hand games
6. Show sadness when parents are unavailable

32. 6-12 months
• Physical:
1. At 1 year the birth weight triples; length increase by 50%;
HC increases by 10 cm
2. Sits supported 6-7 mo (tripod); without support 10 mo;
pivots while sitting 9-10 mo; examines several objects at a
time
3. Crawl and pulling to stand 8 mo, followed by cruising
4. Unidextrous reach 6 mo
5. Thumb finger grasp 8-9 mo; pincer grasp by 12 mo;
6. Walks by 1 yr
7. Mandibular central incisors erupt

33. Ulnarradialpincer

34. Development of grasp

35. • Cognitive:
1. Objects are passed from hand to hand
2. Looks down for a ball that has been dropped
3. At 9 mo, search for objects if hidden - object
permanence
4. Plays peek-a-boo (poochi showing); pat-a-cake (kai
veesamma) and waves bye bye -10 mo
• Emotional:
1. Look anxiously at stranger, clings to mother –
stranger anxiety
2. Cry to call mother in next room
3. Tantrums appear as a drive for autonomy and
mastery

36. • Communication:
1. Understands and responds to vocal and facial
expressions-7 mo
2. Shows toy to parents to share the joy - 9 mo
3. Utter mono syllables like ma, da, pa – babbling 8-
10 mo
4. Responds to name
5. Uses a first true word for the object permanence
or a person
6. Says mama, dada-12 mo

37. The second year: 12-18 mo
• Physical:
1. Growth rate slows and appetite declines
2. Relatively short legs and long torsos with exaggerated
lumbar lordosis and protruding abdomen
3. Less appetite as speech development dominates
4. Brain growth and myelinisation increase head
circumference by 2 cm
5. Walks independently with genu varus (bow leg) and gets
corrected over few months
6. Stops, pivots and stoops without toppling over
7. Increasing dexterity ( reaching, grasping and releasing) and
mobility;
8. Casting: throwing away objects onto floor

38. • Cognitive:
1. Stacks blocks
2. Uses things for intended purposes: combs for hair, cups for drinking
3. Symbolic play: pretends to drink from an empty cup
4. Imitates parent or older children
• Emotional:
1. Orbit around parents- going away and return to parents now and then
2. Exhibit temper tantrums reflecting their inability to verbally
communicate their emotional states
• Linguistic:
1. Receptive language precedes expressive language
2. Unintelligible jargon
3. Responds appropriately by words like no, bye-bye, give-me etc -12 mo
4. Names body parts and uses 4-6 words correctly- 15 mo

39. Second year: 18-24 mo
• Physical:
1. Gains 5 ” and 5 lb
2. At 24 mo they ½ their adult height
3. 90% head circumference achieved in 2 yr
4. Casting disappears by 18 mo
• Cognitive:
1. Uses a stick to get a toy out of reach – 18 mo
2. Can wind a mechanical toy
3. Symbolic play: Feeds a toy from empty plate

40. • Emotional:
1. Shows separation anxiety when parents are missing
2. Uses a toy or blanket (transitional object) while sleeping
to represent absent parent
3. Looks at the mirror and remove an unusual thing from his
nose
4. Hand over a broken toy to parents to fix
5. Says himself “no, no” when touches a forbidden object
• Linguistic:
1. 15-20 words at 18 mo and 50-100 words at 2 years
2. Combine two words
3. Understands 2 –step commands like give the ball and take
the shoes

41. Age 3 years: (Preschool)
1. In 3-year-olds, growth is still slow compared to the first year.
2. Most children have become slimmer and lost the rounded
tummy of a toddler.
3. Weight: average gain of about 2 kg per year
4. Height: average growth of about 7 cm per year
5. All 20 primary teeth have erupted by 3 yr.
6. The preschooler has genu valgum (knock-knees)
7. Mild pes planus (flatfoot). The torso slims as the legs lengthen.
(mother’s concern for weight gain)
8. Somatic and brain growth slows
9. Decreases in nutritional requirements and appetite, and the
emergence of “picky” eating habits

42. Gross motor
1. Walk with a mature gait
2. Runs steadily and jumps easily
3. Walks up stairs unassisted
4. Rides a tricycle
5. Washes and dries hands
6. Throws and kicks a ball
7. Dances to tunes
8. Stacks 10 blocks
9. Handedness is usually established

43. Fine motor:
1. Easily draws straight lines and copies a circle
2. Can stand on tip-toes
3. Uses spoon well and feeds self
4. Dresses and undresses self except for buttons and
laces
5. Holds a pencil in writing position
6. Screws and unscrews jar lids, nuts, and bolts
7. Turns rotating handles
8. Can concentrate on tasks for 8 or 9 minutes
9. Develop handedness

44. Adaptive
1. Has all 20 primary ("baby") teeth
2. Vision is nearing 20/20
3. Bladder and bowel control are usually established; uses potty
chair or toilet
4. May sleep 11 to 13 hours total, may still take a short afternoon
nap
5. Understands size differences (i.e., big and little)
6. Understands past tense (yesterday)
7. Understands long sentences
8. Understands prepositions (on, under, behind)
9. Uses pronouns correctly (I, you, he, me, etc.)
10. Asks "why" constantly
11. Counts up to four objects by 4 years old

45. Speech
1. Should be able to say about 500 to 900 words
2. Speech can be understood by others
3. Speaks in three word sentences
4. Can remember simple rhymes or lyrics
5. Uses "please" and "thank you"
6. Uses pronouns (I, you, me, we, they) and some plurals (cars,
dogs, cats)
7. Refers to self by using own name
8. Names colors
9. Says full name and age
10. More thoughts less words leave to physiological stuttering

46. Social:
1. Understands concept of "mine" and "his/hers“
2. Begins to share and likes to play with other children (peer
play) Can take turns
3. Role-play activity, as in playing house & increasingly governed
by rules(police and thief)
4. Imitates adults and playmates Spontaneously shows affection
for familiar playmates
5. Begins to show feelings in socially acceptable ways
6. Tantrums normally appear toward the end of the 1st yr of life
and peak in prevalence between 2 and 4 yr of age.