This document discusses growth and development from conception through maturity. It defines growth as an increase in size due to increased cell number, cell size, and intercellular substances, which can be accurately measured. Assessment of growth includes anthropometry (measurements of weight, height, head circumference, etc.), tissue growth, radiography of bone development, and biochemical/histological examination. Anthropometry is the most commonly used assessment tool in daily practice. Growth progresses through defined phases from the neonatal period through infancy, toddlerhood, preschool, school age, and adolescence according to standard growth charts and percentiles.

1. GROWTH

2. GROWTH & DEVELOPMENT
• Privilege of pediatricians
• It’s unique for children
• Begins at conception
• Ends at maturity
• Terms ‘growth & development used together normally
• They progress together
• They can but depart under special /abnormal situation

3. GROWTH MEANS INCREASE IN SIZE
DUE TO..
• Increased number of cells
• Increase in their size
• Increase in intercellular substances
The increase can be seen and measured
accurately

4. ASSESSMENT OF GROWTH DONE BY
• Anthropometry
– Includes – weight, height, measurement of head, chest,
abdomen,pelvis etc.
• Tissue growth
– Skin fold thickness – measuring subcutaneous fat and
measuring muscle mass
• Radiography - appearance and fusion of various
epiphyseal centres
• Biochemical & histological examination
• Dental age

5. ANTHROPOMETRY
• Most commonly used in day to day practice
• Length:
– most important parameter not altered by acute eposodic illnesses e.g.
Acute diarroea
– Referred as length when measured in lying down position on
infantometer. (Till the child is able to stand)
• Height:measured in erect standing position on stadiometer
Total length: divided
• Upper segment-head to pubic symphisis
• Lower segment- pubic symphisis to toes
• U/l segment ratio = 1.7:1 at birth
1:1 at 7 years

6. ANTHROPOMETRY – Contd..
• Weight
– Commonest & important
– Accuracy is important
– Acute variation due to acute illnesses must be considered
• Head circumference: important in first 2 years of life.
• Chest circumference - important in first year of life
especially when compared to the head.
• Midarm circumference( MAC) important during field
practice when weighing scales may not be available
• Midarm is measured at about insertion deltoid. Special
tapes are available to measure midarm.

7. ANTHROPOMETRY – Contd..
Body Mass Index (BMI) = Wt. IN KG
Ht IN M2
BMI Value is useful in assessing the nutritional status
Normal Value = 0.25
This Age Independent Index To Assess Nutrition
Weight For Height
Weight Is Compared To Height On Percentile Growth
Curve. Different types of malnutrition can be assessed such
as acute vs chronic

8. ANTHROPOMETRY – Contd..
• Age independent anthropometry
• Useful when the age of the child is not known . also
useful in field practice sessions in remote areas where
all equipments are not available. Only a measuring tape
can be carried and used.
Quack stick
Useful to assess malnutrition. Height measuring stick is
calibrated for MAC . This was popular in Africa & then
adapted for field studies in other developing places

9. COMPARISON OF MAC AND HC
MAC
HC = 0.28 TO 0.3 NORMAL
Less Than 0.28 Is Malnutrition
Ponderal Index (PI)
Useful For Assessment of Intrauterine Growth
Retardation - New Born Babies

10. TISSUE GROWTH
• Not useful in routine practice.
• Needs special instrument (caliper) it
assesses skinfold thickness measured over
triceps, subscapular region, biceps region.
• Assesses amount of subcutaneous fat

11. BONE AGE AND SKELETAL MATURITY
• Epiphyseal centres appear at specific ages in Sp.
Bones. X-rays of wrist, elbow, knee, ankle and
pelvis are useful.
• X-ray of wrist commonly used upto 6-8 years of age
and at puberty
• Fusion of epiphyseal centres also occurs at specific
age in special sequence.
• Dependence upon age of the child and purpose of
assessment, various x-rays are used.

12. DENTAL DEVELOPMENT
ERUPTION OF TEETH FOLLOW DEFINITE PATTERN. USEFUL FOR ASSESSMENT OF
AGE.
• TEETH – TWO SETS
TEMPORARY PERMANENT
TEMPORARY – NO. 20 ALL REPLACED BY PERMANENT TEETH
ERUPTION BEGINS AT 6-10 MONTHS OF AGE
COMPLETED 24 – 30 MONTHS OF AGE
6 MONTHS – 1 YEAR 2 TO 8 INCISORS
1 YEAR – 2 YEAR INCISORS AND 1ST MOLARS + CANINES AT
16 MONTHS
2 YEAR 2 ½ + 4 2ND MOLAR = 20
PERMANENT
6 YEARS - 7 YEARS 20 + 4 PERMANENT 1ST MOLAR
7YEARS – 12 YEARS 20 TEMPORARY TEETH REPLACED
12 YEARS – 16 YEARS
16 YEARS ONWARDS ERUPTION OF 2ND & 3RD PERMANENT MOLARS

13. CONCEPT OF PERCENTILES
• Percentiles Are Used For All Common Parameters Of
Growth Assessment (Ht/Wt/HC)
• All Normal Children Of Same Age Always Vary In All
Proportions For Each Parameter E.G. Wt.
• 100 Normal Children Of Same Age Stand In A Line –
Smallest Or Longest - First In Line
Tallest Or Heaviest - Last In Line
All Children - 50th In Line = 50th Percentile
- 10th In Line = 10th Percentile
& So On
All Children 3rd To 97th Are Considered Normal

14. VELOCITY OF GROWTH
• Means - rate of growth
• Rates vary at different
ages
• Growth rate slows down
with age upto 10 – 15
years
• Velocity increases with
onset of adolescence

15. GROWTH CHARTS
• Standard charts contain wt/ht/HC
• For convenience they are grouped
– Birth - 3 years - separate for boys & girls
– 2 years – 20 years – separate for boys & girls
• Also described as ‘road to health’ , who has
accepted charts of national centre for health
statistics (NCHS) USA, for international use
• Velocity charts also available based on long term
longitudinal studies

16. TYPES OF GROWTH STUDIES
• Linear growth studies
– Long term - small number of children
• Cross section
– Large number studied for separate parameters

17. SURFACE AREA (SA)
MEASUREMENT OF SA ESSENTIAL
• Weight & height are
essential to calculate
SA.
• SA useful for
assessment of
growth, nutrition,
calculation of
dosages of drugs.

18. TISSUE GROWTH
• All Tissues Do Not Grow At Same Rate, At
Same Age.
Four Patterns
• General Growth Curve
• Neural Growth Curve
• Lymphoid Growth Curve
• Genital Growth Curve

19. GROWTH – BIRTH TO PUBERTY
Phases Of Growth Growth
Intrauterine Extrauterine
Ovum
Concpt To 2
Wks
Embryo
2wks To 8
Wks
Foetus
8 Wks To
40 Wks

20. Extrauterine Period
• Neonatal Period – 1st Month Of Life
• Infancy - 1st Year Of Life
• Toddler - 1-3 Years
• Preschool / School Age - 3- 10 Yrs
• Adolescent
– Girls 10 To 17 Yrs
– Boys 12 To 18 Yrs

21. NEONATAL PERIOD
• Normal Mature Newborn Wt. More Than 2.5 Kg
– Average 2.75 – 3.25kg
– Large New Born Wt. >3.25 Kg
– Low Birth Wt < 2.5kg
– Loss Of Wt During First Wk Regained By 10 Days Of Life
– WT – increase 20-30 gm / Day FROM 10 DAYS TO 90 Days of
life
– End Of First Month - Birth Wt. + 400-500gms
• Length- 50 - 52 Cm
• HEAD : 33 - 35 Cm

22. INFANCY
• Weight
– Wt. INCREASE 20-25 /cm/day UPTO 90 DAYS OR 3 MONTHS
– End of 3 months wt = birth wt. + 2 kg
– End of 6 months double the birth wt.
– End of 1 year triple the birth wt. Approx 8.5 TO 9 kg
• Height
– Ht. Increases by 2.5 cm/month UPTO 6 MONTHS
– 6 MONTHS TO 1 YEAR - 1.5 cm/month
– AT 1 YEAR HT= 72-75 cm
• Head Circumference
– 33-35 cm AT BIRTH, INCREASES BY 2.5cm/2months
– 6 months = 40-42.5 cm
– 1 YEAR= 44-46 cm
• Chest - Same as head at 1 year

23. PRESCHOOL PERIOD
• Wt.
– 3kg/ yr in second year
– 2 - 2.5kg/ yr 3 to 10 years
• Ht.
– 10cm in second year
– 6 - 7.5cm/ yr 3 to 10 years
• Head Circumference
– 3 - 4 cm in second year
– 2 - 3 cm in third year
• Chest - more than head in second year
• If less – indicates malnutrition

24. SCHOOL PERIOD
• Growth slows down after the second year
• WT. GAIN 2.5 Kg/ yr
• HT. GAIN 5 - 7cm/ yr
• Head 2-3 cm are added during the whole period
upto adolescence

25. GROWTH DURING ADOLESCENCE
PERIOD EXTENDS
• 10-16 years in girls and 12-18 years in boys
• Puberty - onset of menstruation in girls 11-14 years
• 2nd GROWTH SPURT - i..e., Acceleration of weight &
height, starts at 10 – 12 years, early in girls
• Other changes include-
– Sex maturation – measured as SMR (sex maturation rate)
– Psychological changes
– Metabolic changes
– Emotional changes

26. BONE AGE
• Useful to assess maturity of newborn especially in
some medicolegal situations
• Some endocrine disorders like hypothyroidism –
bone age delayed

27. BONE AGE – RADIOLOGY
• At birth - x -ray of knee & epiphyseal centres Present
include –
– Distal end of femur
– Proximal end of tibia
– Head of humerus
– Calcaneus, talus & cuboid
• X-ray wrist-
– Carpal centres start appearing at 2 months
– End of 1 year 2 carpal centres
– Till 6 years 1 centre is added each year
– Pisiform 8th carpal centre appears approx 1 year before puberty

28. Thank you