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1. GROWTH AND DEVELOPMENT
• OBJECTIVES:
• Define the term growth
• Define the term development
• State the uses of assessing growth and development
• State the factors which promote growth
• State the factors which impair growth
• Measure growth correctly, plot the measurements on a growth chart,
and interpret correctly the growth pattern of an individual child
• Report the measurements to the mother and inform her how her
child is growing
• Outline the patterns of weight, length or height and head
circumference and mid upper arm circumference growth.
• Outline the patterns of gross motor, fine motor, social, speech,
intellectual and emotional development. and
• Assess the development of a child

2. What is growth?
• Growth is progressive increase in size of
the child or his/her parts from fertilization
to maturity. Commonly taken parameters
of growth are weight, length or height,
occipitofrontal head circumference,and.
mid upper arm circumference.

3. Definition of development
Development is progressive acquisition of
increasingly complex skills essential for
independent living. Development results
from maturation of the nervous system
and learning reactions. Development is
tracked through gross motor, fine motor,
social, cognitive and emotional domains.
Each of the domain follows a sequence of
successive stages or developmental
milestones.

4. Principles of growth and
development
Growth and development are continuous
processes.
The stages of growth and development are
prenatal, neonatal, infancy, preschool, school
and adolescent
Each child grows and develops at his own
individual rate.
Growth and development follow a cephallocaudal
progression, (from head to toe) and
proximodistal progression (from the centre to the
extremities).

5. Uses of assessing growth
and development
• evaluating the state of health and nutrition
of a child.
• ascertaining the adequacy of breast
feeding,
• indicating a need for intervention,
• evaluating the intervention

6. Importance of assessing growth
and development contd
• Continuously normal growth and
development indicate a good state of
health and nutrition of a child. Abnormal
growth is a symptom of disease. Hence,
measurement of growth is an essential
component of the physical examination.
Without an assessment of growth and
development, no physical examination is
complete .

7. Factors determining growth
and development
Each child’s path or pattern of growth and
development is determined by genetic and
environmental factors. The genetic factors
determine the potential and limits of growth and
development. If favourable, the environmental
factors, such as adequate nutrition, hormonal
balance, and appropriate stimulation, facilitate
the achievement of the genetic potential for
growth and development. Unfavourable factors, slow
or stop growth and development.

8. Factors adversely affecting growth and
development
• malnutrition,
• infections,
• congenital malformations,
• hormonal disturbances,
• disability,
• emotional neglect,
• lack of play, and
• lack of language training.

9. Catch up growth
• This is a sudden weight growth
acceleration a rate greater than the
average for age after removal of an
unfavourable factor. As a result of the
catch up growth, the previously lost weight
is recovered. Once the lost weight is
recovered, the growth rate returns
to the individual’s normal rate which is
determined by the individual’s genetic
constitution.

10. More growth rate variation
• A child genetically determined to be tall
grows slightly more rapidly than a child
genetically determined to be short.
Similarly, a child genetically determined to
be clever develops more rapidly than a
child genetically determined to be less
intelligent.

11. The essentials in measuring
growth
One measuring growth must
• make the measurements accurately
• use reliable equipment must and
• must apply the correct measuring techniques

12. An individual child’s growth pattern
. This is the line or graph obtained when the
individual child’s successive
measurements are carefully plotted on
appropriate growth chart. The first plotting
in the growth chart should be the birth
measurement.

13. Interpreting a child’s growth pattern
The key to the interpretation of a child’s
growth pattern is observing the direction of
the child’s growth pattern.The child is
growing well if his or her pattern is parallel
to the printed reference percentile lines.
Any lateral, horizontal or downward
deviation indicates danger. After
interpreting a child’s growth pattern, you
must report the findings to the mother or
caretaker and inform her how the child is
growing

14. Measuring the head circumference
The head circumference is measured by
encircling the head with an unstretchable tape
measure, passing over the most prominent part
of the occiput posteriorly and just above the
supraorbital ridges anteriorly to obtain the
greatest distance around the head. Serving as
an estimate of the growth of the brain, head
circumference must be measured at every visit
in the first 4 or 5 years with recording in
appropriate charts..

15. Head circumference growth pattern
At birth, the head circumference of term babies
averages 35cm with a range of 33-37 cm. Monthly
increases are 2cm in the first quarter and 1 cm in the
second quarter. The head circumference increases by 9
cm in the first 6 months and by other 4 cm in the second
six months. So the average head circumference is
approximately 44cm by 6 months, and 45 to 47 cm by
one year, an increase of 10-12 cm in the first year.
Subsequent annual increases are 2 cm in the second
year, 1 cm in the third year, 0.4 in the 4th and 5th years to
reach 49.2 and, 50.5cm at age 2 and 3 respectively.

16. Measuring the mid upper arm
circumference
• The mid upper arm circumference is measured
using a tape. The midpoint is determined after
measuring the distance between the olecranon
and acromion processes. The midpoint is
marked. The tape is placed around the upper
arm at this midpoint. Care is taken not to pull the
tape too tightly. The measurement is read.

17. The mid upper arm circumference
growth pattern
• The mid-upper arm circumference
increases to about 16 cm by the end of the
first year. It then increases by about 1 cm
during the second to the fifth years. A 1-5-
year- old well nourished child may have a
mid upper arm circumference of 13.5-
17cm. Among 1- 5-year-old children, a mid
upper arm circumference less than12.5cm
indicates malnutrition, 12.5 to 13.5cm,risk
of malnutrition.

18. Measuring length or height
The length of a child is measured is the first 2 years of life
while the height is measured in children aged more than
2 years.The length is measured using a horizontal
measuring board put on the ground or on a table. The
child is laid supine with the head against the fixed head
board. A helper holds the child’s head so that the eye
angle- external ear canal line is vertical and also keeps
the body straight.
With one hand, the health worker straightens the child’s
legs fully by pressing the child’s knees down. With the
other hand, the sliding foot board is placed to touch the
child’s heels firmly. The length is then read.

19. Measurement of height
The height is measured with a rule fixed to a
vertical wall or with a stadiometer. A bare foot
child stands erect with the feet together. The
heels, the buttocks and the occiput lightly touch
the measuring device. The head is aligned so
that the external eye angle–ear canal plane is
horizontal. The child is told to stand tall and is
gently stretched upward by pressure under
mastoid processes with the shoulders relaxed
The sliding head peace is lowered to rest firmly
on the head. The height is read and recorded on
the chart.

20. Pattern of length and height growth
An average term baby is 50 cm long. The
birth length increases by 50% in the first
year and doubles by 4 years. Between 2
and 12 years of age, the average height is
(77+ 6 x age in years )cm. Height growth
stops at about 18 years in girls and 20
years in boys.

21. Measurement of weight
. The infant or child is weighed naked or with
minimum clothing. The weight is best
measured to the nearest 10 grams in
infants and 100 grams in children using a
beam balance.

22. Weight growth pattern
An ‘average’ term newborn weighs 3.5 kg
(range 2.5 kg - 4.6 kg). The birth weight
must be plotted and written in the first box
of the growth chart and recorded in the
appropriate space on the growth chart.
Within the first 3-4 days, a term newborn
loses 5-10 % of the birth weight. This
weight loss is usually regained in 2 weeks
by term babies and longer by premature
babies.

23. Weight growth pattern cont
An average term baby doubles the birth weight in 4-6 months, triples it
by one year and quadruples it by two years of age.
• Average weights in kg between 3-9months= ½(age in months
+9),
• between 1-6 years = 2 (age in years) + 8 and
• between 7-12 years it is ½(age (yr)X7 -5)
To monitor growth, you must use the growth chart maternal and child
health booklet. You need to study a blank growth chart to be
thoroughly familiar with its contents. To start with, note that the top
line represents the 2SD growth line of healthy children and the
bottom line is the -2SD, the lower limit of normal weight-for-age.

24. Gross Motor Development
At birth, the baby displays several reflexes:
•Moro’s reflex,
• rooting reflex,
•sucking reflex
•, swallowing reflex,
• tonic neck reflex,
• walking reflex and
• grasping reflex etc.
These primitive reflexes must disappear
before voluntary motor activities.

25. Gross motor development
• Head control while sitting 2 months
• Pulled to sit with no head lag 3 months
• Bringing hands together in midline 3 months
• Asymmetric tonic neck reflex gone 4
• Sitting without support 6.5 months
• Rolling back to stomach 6.5
• Standing with support 9 months
• Crawling 9 months
• Walking alone12 months
• Running 16 months

26. Gross motor development
milestones cont
• Riding tricycle 3 years
• Hopping on one foot 4 years
• Skipping 5 years

27. Fine motor development
milestones
• Grasping a rattle 3.5 months
• Reaching objects 4 months
• palmar grasp disappearance 4 months
• Transferring objects 5.5 months
• Thumb-finger grasp 8 months
• Turning pages of a book 12 months
• Scribbling 13 months
• Builds a tower of 2 cubes 15 months

28. Fine motor milestones contd
• Building a tower of 4 cubes 18 months
• Building a tower of 6 cubes 22 months
• Builds a tower of 7 cubes 24 months
• Imitating horizontal strokes 24 months
• Building a tower of 9 cubes 30 months
• Making vertical and horizontal strokes 30months
• Imitates a 3 cubes bridge 4 years
• Draws a man with 2-4 parts 48 months
• Copies a triangle 5 years

29. Communication and language
• Smiling in response to face or voice1.5 months
• Monosylabic babble 6 months
• Inhibiting to no 7 months
• Following a one step command with gesture 7 months
• Following a one step command without gesture
10months
• Saying mama or dada 10 months
• Pointing to objects 10 months
• First meaningful word 1 year
• Speaking 4-6 words 15 months
• Speaking 10-15 words 18 months
• Making a 2 word sentence 19 months

30. Social development
• Visual preference of human face at birth
• Smile to human face or voice 2 months
• Smile and vocale to strangers 6 months
• Preferring mother 6 months
• Pats own image in a mirror 6 months
• Responding to sound of name, playing peek- a boo,
waving bye-bye, displaying stranger anxiety 9 months
• Playing simple ball game 1 year
• Indicating some desires by pointing 15 months

31. Social development contd
• Hugging parents 15 months
• Uses spoon spilling most of the food 15m
• Feeding self well using spoon and cup, seeking help if in trouble,
complaining when wet or soiled 18 months
• Indicating that the nappy is wet 18 m
• Pulling up pants 18 months
• Clean and dry by day 2 years
• Handling spoon well, helping to undress 2 years
• Helping put things away 2.5 years
• Pretending in play 30 months
• Playing in parallel 36months
• Full toilet training 3 years

32. Social development cont
• Helping in dressing (unbuttoning putting
on shoes) 36 months
• Washing hands 36 months
• Playing cooperatively 48 months
• Dressing and undressing 5 years
• Asking questions on meanings 5 years
• Domestic role playing 5 years.

33. Emotional development
displaying pleasure and distress 0-1 month
displaying delight with smile to a human face 2
months
stopping to cry on noting mother’s approaching 3-4
months
displaying anger, joy, interest, fear, disgust, and
surprise by distinct facial expressions 5 months
manifesting elation and stranger anxiety 7 months
showing affection and love to primary caretaker
10-11 months
extending affection to other infants 15 months

34. Emotional development cont
displays jealousy 1.5 years
displaying humour and anxiety over
possibility of punishment or disapproval 2-
3 years
expresses love, anger, empathy, sadness,
surprise, enjoyment 3 years
manifests shame, grief, guilt and anxiety 4
years

35. Cognitive development
• Stares momentarily where the objects disappeared 2
months
• Stares at own hands 4 months
• Bangs 2 cubes 8 months
• Uncovers a toy after seeing it hidden 8mts
• Egocentric symbolic play eg pretends to drink from a cup
12 months
• Uses a stick to reach a toy 17 months
• Pretending play with a doll (eg gives a doll food 17
months
• Preoperational (prelogical) stage 2-5 years
• Concrete logical operations 6-12 years
• Concrete formal operations 13- 20 years

36. Assessment of development
• History of the milestones
• Observation of the child’s activities
• Denver prescreening developmental
questionnaire
• Screening tests such as Denver
Developmental screening test.

37. REFERENCE
• Nelson textbook of paediatrics, 18th Edition
• Current diagnosis and treatment in
paediatrics. 19th Edition
• Essential paediatrics, by David Hull,4th
Edition
• Human growth after birth by David Sinclair