1. Growth and development refers to the changes that occur during an individual's lifecycle from conception to death. It encompasses physical, cognitive, emotional, and social changes. 2. Studying growth and development allows one to understand typical behaviors and abilities at different ages, assess developmental norms, identify potential problems, and provide comprehensive care for children. 3. The main stages of growth and development are prenatal, infancy, early childhood, middle childhood, and late childhood/adolescence. Rapid physical and cognitive development occurs during infancy from birth to 12 months.

1. GROWTH & DEVELOPMENT

2. Growth and Develo pment as a unit expresses th e sum of nu merou s changes that take p lace durin g the life c ycle of an indivi dual. The entire cour se is a dynamic p rocess that encom passes several int er-related d i mensions.

3. WHY STUDY GROWTH & DEVELOPMENT? Know what to expect of a child at any age Know certain behaviours that are likely to emerge in mature forms Assess the sequence and norms of G & D of a child Know how to influence G & D favourably Diagnose undernutrition, infectious and other diseases affecting G & D Recognize the potential problems and strengths of individual children & their parents Plan for comprehensive care of the child Work with children effectively in health & disease

4. STAGES OF GROWTH & DEVELOPMENT Prenatal period (Conception to Birth) Infancy ( Birth to 12 months of age ) Early Childhood ( 1 – 6 years) Middle Childhood (6 – 12 years) Late Childhood (12 – 19 years)

5. PRENATAL GROWTH Zygote – Increased cell organization and differentiation into three basic layers – Ectoderm, Mesoderm, Endoderm. Embryo – Marked organization upto 8 weeks. Fetal phase – 8 weeks to 40 weeks (birth). - Increases in length and weight - Linear growth with maximum velocity at 4 months

6. GROWTH & DEVELOPMENT IN INFANCY

7. INFANCY Neonate – Birth – 28 days ( Early and late neonatal period) Infancy - 28 days – 12 months - Rapid motor, cognitive, and social development - Trust, physical adjustment to outside - Psychological adjustment of parents

8. GROWTH & PHYSICAL MATURATION

9. WEIGHT NBB – 2.7 – 3.9 Kg ( Av 2.5 Kg ) 0 – 7 days – 10% loss of Birth weight 10 th day - Lost weight wt regained 0 – 6/12 yr - > by 30 gms / day OR 150 gms / wk 5 – 6/12 yr – Birth weight doubled 7 – 12 “ - > by 15 gms / day OR 75 gms / wk 1 year - Birth weight trebled There after - > by 2.2 Kg / year 2½ Year - Birth weight Quadrupled

10. HEIGHT (LENGTH) NBB – 50 cms (20”) + 2 cms First 6 months - > by 2.5 cms / month Later 6 months- > by 1.25 cms / month 1 – 2 year - + 12.5 cms (5”) 2 – 12 years - 6.25 – 7.5 cms / yr 4 years - Birth height doubled 13 years - Birth height trebled

11. OCCIPITO-FRONTAL CIRCUMFERENCE (OFC) NBB – 35 cms ( 1.25 – 2.5 cms > Chest Circumference) 0 – 3 months - > by 2 cms / month 3 – 12 months - > by 2 cms / 3 months 1 – 3 years - > by 1 cm / 6 month (Equals chest circumference 1 yr) 3 – 5 years - > by 1 cm / year 5 – 6 year - Adult head size Thus, OFC at - 1 year - 47 cms 2 years - 49 cms 3 years - 50 cms 4 years - 50.4 cms 5 years - 50.8 cms 10 years - 53 cms 15 years - 55 cms Fontanelle closure – Post - 6 – 8 wks Ant – 12 – 18 months Increase of brain weight – By 2½ times in the first year

12. CALCULATION OF ANTHROPOMETRICAL PARAMETERS WEIGHT – 3 – 12 MONTHS – Age ( months ) + 9 K g 2 1 – 6 YEARS - Age ( Years) x 2 + 8 Kg 7 – 12 YEARS - Age (Years) x 7 + 5 Kg 2 HEIGHT – 2 – 12 YEARS – Age (Years) x 6 + 77 (cms) Future (Adult) height – Girls – Ht at 2 yrs x 2 Boys – Ht at 2½ yrs x 2 OFC Infant - Length (cm) + 9.5 cms 2

13. Mnemonic for Growth and Development 52 50 48 45 40 35 OFC 100 90 75 50 Ht (Cm) X 10 X 6 X 5 X 4 X 3 X 2 3 Wt (Kg) 10 7 5 4 3 2 1 5/12 3/12 0 Age (yrs)

14. CHEST CIRCUMFERENCE & MUAC Chest Circumference - 33 cms at birth, barrel shaped - At 1 year Transverse diameter > AP diameter by 25 % - At 6 years transverse diameter > AP diameter by 33 % 6 months – 39 cms 1 year - 45 cms (Equals OFC) 2 years - 49 cms 5 years - 55 cms 10 years - 64 cms 15 years - 77 cms MUAC (Mid upper arm circumference) – NBB – 14.5 cms 1 year – 16 cms. Then > by 0.25 cm / yr

15. BODY PROPORTIONS Big heads, large trunk, short extremities upto 2 years Mid point of body - In infants - 1.8 cms above umbilicus - At 2 years - Just below umbilicus - In adults - At symphysis pubis Sitting Height - At Birth – 70% of total length - At 3 years – 57% - At Puberty - 53%

16. CARDIO-CASCULAR SYSTEM Heart – Transversely placed, Apex beat at IV ICS H R – NBB – 140/mt, 5 yrs – 100/mt, 10 yrs – 90/mt, 12 yrs – 85/mt, 15 yrs – 80/mt Sleeping Pulse Rate – 10 – 20 beats lower BP – 80/50 …. 90/60 mm Hg Systole rises in the 2 nd month Diastole falls in the first 3 months, then gradually rises

17. Hematological system Hb F – The primary Hb for the first 2 -3 months ( >>> Physiological Anemia ) then Hb A increases upto 6 months Respiratory System Resp rate – 50 – 35/ mt Abdominal & diaphragmatic Trachea close to bronchi, narrow lumen Short straight eustachean tube < IgA in mucosal lining

18. Lymphatic System – Hyperplastic in children. Resolves after puberty Nervous System – NBB – Brain wt – 10% of body weight Infancy – Rapid brain growth. 80% achieved by 4 yrs Myelination begins after 3 months, completed by 2 years Primitive reflexes replaced by righting reflexes & voluntary, purposeful movements

19. GASTRO-INTESTINAL SYSTEM Salivation begins at 3 months Stomach capacity – 90 ml at birth, 360 ml at 1 yr Enzyme amylase inadequate – Poor digestion of complex CHO Liver immature throughout infancy By 1 yr – 3 meals + 1 bed time feed - 1 or 2 bowel movements

20. Immunologic System - Maternal IgG upto 3 months - Synthesizes IgG (40% of adult levels) by 1 year - IgM produced at birth. Adult levels by 9 months - IgA production gradual. Adult levels by puberty Skin – Absent shivering and sweating at birth - Accumulation of adipose tissue in 6 months ( helps insulation)

21. Fluid & Electrolytes NBB – 75% of total body wt is water - ECF vol is 40% which <es to 20% in adulthood Renal System – Immature at birth Complete maturity in 18 to 24 months Urine Sp.Gr – 1000 – 1010 Dentition – Begins at 6 – 12 months By 3 yrs – all 20 teeth Rule – Age (months) -6 = No of teeth Permanent teeth by 6 – 12 years

22. SPECIAL SENSES Hearing – Acuity at adult levels at infancy 6 months – can differentiate familiar voices 7 months – vestibular function begins Short ext auditory meatus & Eustachian canal Visual – Low acuity. Hypermetropic 6 wks – 4 months – Binocularity well estd. 7 -12 months – Stereopsis ( depth perception) begins to develop

23. MOTOR DEVELOPMENT

24. GROSS MOTOR (Devt.al maturation in posture) General movements Head balance (3/12) Rolling over (5/12) Sitting with support (4/12) Crawling & Creeping (8/12) Standing (10/12) Walking (1 yr)

25. Sitting without support…

26. Standing with support Coo, that’s How it looks to Ma and Pa!

27. FINE MOTOR Use of hands and fingers in prehension Grasp reflex at 0 – 3months Palmar grasp Crude pincer grasp – 8-9 months Neat pincer grasp – 11 months Builds a tower of 2 blocks by 1 year

28. PSYCHOLOGICAL DEVELOPMENT

29. Psychosocial Development Reflex behaviour – parent, peer response 1 month – Social smile, 4 months – laughs aloud Play helps socialize Attachment- Indiscriminate response. cry, smile Vocalize more to mother, distinct preferences 6 months – ‘peekaboo’, asks to be carried - Stranger anxiety & separation anxiety Eric Erickson- Trust Vs Mistrust - 3-4 months – Oral phase (pri narcissism) - 5-12 months – Social phase

30. Language Cry – for displeasure and pleasure 2 months – ah, eh, uh…. 3 months – coos, gurg;es, laughs (n,k p, g) 8 months – Imitates sounds t,d,w 9-10 months – Understands ‘NO’, obeys simple commands 1 yr – 3-5 words with meaning Play – Sensorimotor, narcissistic, dependant, solitary - Laughs, peekaboo, pat-a-cake, repetition, imitation - Selective after 6-8 months ( No strangers!) Sleep – 0-6 months – 18-20 hrs /day - 6-12 months – 16-18 hrs/day - 2-4 yrs - 12-16 hrs/ day - 5-10 yrs - 10-12 hrs/ day IMPORTANT – Not only ‘to play’, but to be ‘played with’.

31. Psycho- sexual development Sigmund Freud – Oral phase Cognitive ( Intellectual) development Jean Piaget – Sensorimotor Phase ( 0-2 yrs) - Use of reflexes, deliberate acts, repetitive acts(4-8 months), object permanence(10 months), develops self image by 1 yr

32. SUMMARY OF MILESTONES OF DEVELOPMENT 1 Month - Social Smile 2 Months - ah, eh, uh sounds 3 months - Head holding 4 Months - Grasps objects, sits with support 5 Months - Rolls over 6 months - Sits without support 7 Months - Crawls & creeps 8 Months - Thumb- finger prehension 9 months - Pulls up to sit, stands with support 10 Months - Walks with support 11 Months - Stands with support 12 months - Takes a few steps by self

33. NEEDS & SPECIAL CONCERNS IN INFANCY Love & security ( warmth, support to head & neck) Nutritional needs – 120 Cal/Kg (0-6 month), 100 Cal/Kg (6-12 months), Protein 5-3 gm/Kg. Weaning, prevent obesity Protection from infection (skin, eye, ear, oral, GIT, Resp, umbilical). Personal hygiene Protection from accidents Promotion of growth & development Promotion of play Care in teething, thumb sucking Sleep & activity, infant shoes Dental health Regular medical check up Psychological needs - Care to prevent separation anxiety - Encourage inquisitive behaviour - Develop sensory perception - Avoid unpleasant tastes - Avoid painful experiences

34. Thank you !