Notes on unit 02 - growth & development introduction

Mrs. Babitha K Devu
Assistant Professor
SMVD College of Nursing

Learning Objectives
• The learner will be able:
– Define Growth & Development
– State the importance of learning
Growth & Development
– Enlist the principles of Growth &
Development
– Describe the stages of Growth &
Development
2

Learning Objectives
• The learner will be able:
– Enumerate the factors influencing
– Aspects of Growth & development
– Assess Growth & Development
3

Introduction
• All children pass through predictable
stages of growth and development as
they mature.
• The process of growth and
development starts before the baby is
born i.e. from conception in the
mother’s womb. The period extends
throughout the lifecycle.
4

Introduction
• Each child’s progress is unique. A child
cannot be forced to achieve a milestone
faster than that child’s own timetable
will allow.
• The terms ‘growth’ and ‘development’ are
often used together, but are not
interchangeable because they represent
two different facets of the dynamics of
change, i.e. those of quantity & quality.
5

Definitions
Growth :
It is the process of physical
maturation resulting an increase in
size of the body and various organs.
It is quantitative changes of the
body which can be measured in
inches/cm and pounds/kg.
6

Definitions
Development:
It is the process of functional and
physiological maturation of the
individuals. It is qualitative aspect of
maturation and difficult to measure.
7

Importance of Learning
• The main need of learning growth and
development is to:
– Learn what to expect from a particular
child at a particular age.
– Assess the normal growth and
development of children.
– Detect deviations from normal growth
and development & to understand the
reasons.
8

Importance of Learning
– Ascertain the needs of the child
according to the level of growth and
development.
– Plan & provide holistic nursing
management.
– Teach & guide the parents and
caregivers.
– Develop a rapport with the child.
9

Principles/Laws of
It is an orderly process – The
development of the child takes place in
an orderly sequence. A child learns to
stand before he walks, he babbles
before he speaks clearly and he learns
to sit before he stands.
10

Principles/Laws of
Growth & Development is a continuous
process – One stage of development lays
the foundation for the next stage of
development. Infants can move their limbs
(arms and legs) before grasping an object.
Mastery of climbing stairs involves
increasing skills from holding on to walking
alone.
11

Principles/Laws of
The rate of growth & Development
occurs in sigma fashion – Though
development is a continuous process, yet the
rate of growth is not uniform. Thus, there
are periods of accelerated growth and
periods of decelerated growth. During the
first three years of infancy, the rates of
growth is rapid, then, the rate growth slows
down, which is again accelerated at the
adolescent stage. Similarly, neither all parts
of the body same rates.
12

Principles/Laws of
The pattern of growth & development
is unique for every individual – each
child will have different rate and pattern of
growth though it is orderly process.
13

Principles/Laws of
The pattern of growth & development is
predictable i.e. Either cephalocaudal
or proximodistal
– Cephalocaudal pattern: Growth
proceeds from head to foot (cephalo=head,
caudal=tail)--lift head, pickup objects, walk to
objects.
- Proximodistal pattern: Growth proceeds
from near to far. First the child moves whole
body to grab an object.
14

Principles/Laws of
Growth & development is influenced
by environmental & genetic factors:
Neither heredity alone, nor mere
environment is responsible for the
development of individual. Both are
responsible for human growth and
development though, it is not possible to
indicate exactly in what proportion heredity
and environment contributes to
development of an individual.
16

Principles/Laws of
Growth & development proceed from
simple to complex: Initial mass activities
and movements are replaced by specific
responses or actions by the complex
process of individualized changes. In motor
development, the infant will be able to
grasp an object with the whole hand before
using only the thumb and forefinger.
18

Principles/Laws of
Certain stages of growth &
development are more critical than
others: It is known for example, the 1st
10 to 12 weeks after conception are
critical. The incidence of congenital
anomalies can increase in this stage than
others.
19

Principles/Laws of
Coordination exist between
increase in size and maturation:
Maturation refers to the sequential
characteristic of biological growth and
development. The biological changes occur
in sequential order and give children new
abilities. The children must mature to
certain level before progress to a new
skill.
20

Principles/Laws of
Individual difference: The tempo of
development is not even. Individuals
differ in growth and development.
Boys and girls have different rate of
development.
21

Principles/Laws of
Growth & development proceeds by
stages & it’s sequence is
predictable & same in all children
but there may be difference in the
time of achievement:
22

Principles/Laws of
There is a positive correlation
between physical, mental, emotional
development and they are
interrelated:
23

Stages of
The prenatal period
comprises, on the average, about 10 lunar
months (there are 28 days in a lunar
month), 9 calendar months, or 40 weeks.
• Prenatal growth has three distinct stages:
the fertilized ovum (egg), or zygote (first
2 weeks); the embryo (from 2 to 8 weeks)
and the foetus (from 2 to 10 lunar
months).
24

Stages of
25

Stages of
The postnatal period
comprises of period after birth. This
comprise of the following stages:
– Neonatal period
– Infancy
– Toddler
– Childhood
– Adolescent
26

Stages of
Stages Time Period
•Ovum 0 – 14 days after conception
•Embryo 2 weeks to 8 weeks
•Foetus 9 weeks till birth
•Neonate Birth to 28 days
oEarly neonate Birth to 7 days
oLate neonate 07 days to 28 days
27

Stages of
Stages Time Period
•Infancy First year of life
•Toddler 1 – 3 years
•Preschooler/
Early childhood
3 – 6 years
•Schooler/
Middle Childhood
For Girls: 7 – 10 years
For Boys: 7 – 12 years
28

Stages of
Stages Time Period
•Adolescent From puberty to
adulthood
oPrepubescent/ Early
Adolescent/Late
Childhood
oPubescent/Middle
Adolescent
oPost pubescent/Late
Adolescent
For Boys: 16 – 20 years 29

Factors Influencing
• Growth & Development depends upon
multiple factors or determinants. The
factors can be divided as hereditary and
environment.
• Hereditary determines the extent of
growth & development that is possible, but
environment determines the degree to which
the potential is achieved. Environment
includes both prenatal and postnatal factors.
30

Factors
Hereditary/
Genetics
Sex Race &
Nationality
Environmental
Prenatal Postnatal
31

Factors
Environmental
Prenatal
Maternal
malnutrition,
infection,
substance abuse,
illness, hormones,
miscellaneous
Postnatal
Growth pattern, nutrition,
childhood illness, physical
& physiological
environment, cultural
influence, socioeconomic
status, climate, play &
exercise, birth order,
intelligence, hormone
32

Factors Influencing
33
• Genetic Factor: Different
attributes such as height, colour
etc depend upon inherited gene
from parents. Abnormal genes
from ancestors may produce
different familial disease which
usually hinders the growth &
development. Eg:- Thalassemia,
chromosomal abnormalities etc.

Factors Influencing
34
• Genetic Factor:
– Sex: It is influenced by various physical
attributes & pattern of growth. At birth
male babies are heavier and longer than
female babies. Girls mature earlier than
boys.
– Race & Nationality: Growth potential of
different racial groups is different in
varying extent. Physical characteristics of
different national groups also vary.

Factors Influencing
35
• Environmental Factor
(Prenatal): Intrauterine
environment is an important
predominant factor of growth &
development. The following are
the various factors influencing
the fetal growth in utero.
– Maternal malnutrition: Dietary
insufficiency & anemia lead to
IUGR, LBW and preterm babies
having poor growth potentials.

Factors Influencing
36
(Prenatal):
– Maternal Infection: Different
intrauterine infections like HIV,
STORCH etc. May transmit to the
foetus via placenta and affect the
fetal growth. It can also result in
complications like congenital
anomalies, congenital infections etc.
Which affect the growth &
development in extra uterine life.

Factors Influencing
37
(Prenatal):
– Maternal Substance Abuse:
Intake of teratogenic drugs like
ACE Inhibitors, phenytoin by
pregnant women in the 1st
trimester affects the
organogenesis and lead to
congenital malformation. Intake
of tobacco & alcohol also can
restrict fetal growth.

Factors Influencing
38
(Prenatal):
– Maternal Illness: Pre
existing chronic systemic
diseases like PIH, anaemia,
heart disease, DM and
obstetric complications can
restrict the fetal growth.

Factors Influencing
39
• Environmental Factor (Prenatal):
– Hormones: Hormones like thyroxin and insulin
influence the fetal growth. Thyroxin deficiency
retards the skeletal maturation of the foetus.
Excess insulin lead to macrosomnia in newborn.
– Miscellaneous: Various prenatal conditions
may influence fetal growth include uterine
malformations, malpositions, amniotic &
placental abnormalities

Factors Influencing
40
• Environmental Factor (Postnatal):
– Growth Potential: It is indicated by the child's
size at birth.
– Nutrition: Balanced amounts of essential nutrients
have significant role in growth & development of
children. Both quantitative and qualitative supply of
nutrition in the daily diet are necessary for
promotion of growth and development. The
requirement depends on age, sex, growth rate, level
of activity and health status.

Factors Influencing
41
– Childhood Illness: Chronic childhood
diseases of heart (CHD, RHD), chest (TB,
asthma), kidneys (Nephrotic syndrome),
liver (Cirrhosis), malignancy, GI disorders
etc. Lead to growth impairment.
• Acute illnesses like ARI, diarrhoea etc
result in malnutrition and growth
retardation.

Factors Influencing
42
– Physical Environment: Housing, living
conditions, safety measures, environmental
sanitations, safe water supply are having direct
influence on child's growth & development.
– Psychological Environment: Healthy family,
good parent child relationship & healthy
interaction with other family members are
important factors for promoting emotional,
social & intellectual development.

Factors Influencing
43
– Cultural Influences: The child rearing
practices food habit, traditional beliefs,
social taboos, standard of living etc
influences the growth & development. The
child learns the standard of traits like
honesty, discipline, manners etc from
culture of the family & society.

Factors Influencing
44
– Socio-economic status: Poor socioeconomic
groups may have less favourable environment for
growth & development than the middle & upper
groups. Parents of unfortunate financial
conditions are less likely to understand and adopt
modern scientific child care.
– Climate: The velocity of growth may alter in
different seasons and is usually higher in spring
and low in summer months. Infections and
infections are common in hot and humid climate.

Factors Influencing
45
– Play & Exercise: It promote physiological
activity & stimulate muscular development.
– Birth Order: It has a significant influence
on intelligence, personality traits or method
of coping.
– Hormone: Normal development cannot
proceed without the right milieu of hormones
in the body throughout childhood and
adolescence.

Assessment of Growth
46
Assessment of physical growth can be done
by
Anthropometric measurements
The study of velocity of physical growth

47
The criteria for assessment of physical growth are:-
Weight
Height
Head circumference
Chest circumference
MUAC (Mid Upper Arm Circumference)
And various growth parameters like BMI, body
proportion, skin fold thickness, dentition and
bone age

48
Weight: A normal neonate weighs 2.5 to 3.8 kg.
There is about 10% loss of weight during 1st week
of life, which can be regained by 10 days of age.
Then weight gain is about 25 – 30 gm/day for 1st
3 months and 400gm/month till 1 year of age.
Infant double birth weight – 05 months
Tripled – 01 year
Four times – 02 year
Five times – 03 year
Six times – 05 year
Seven times – 07 years
Ten times – 10 years

49
Weight: Weight can be measured by using
beam balance, electronic weighting machine
and adult weighing machine according to
availability and child's age. This has to be
always plot on Growth Chart.

50
Height: Increase in height indicates skeletal
growth.
At birth – 47 – 50 cm
At 3 months – 60 cm
9 months – 70 cm
1 year – 75 cm
2 year – 12 cm increase
3 year – 9 cm increases
Afterward 5 cm increase every year till
onset of puberty.

51
Height: child doubles height at 4 – 5 years
Recumbent height is measured up to 2 years of
age. For this infantometer/inch tape can be used
to measure crown to heel length.
In older standing height is measured by using
vertical height scale or tape.

52
Head circumference: It is related to brain
growth & development or intracranial volume.
At birth – 33 – 35 cm
At 3 months – 40 cm
6 month – 43 cm
1 year – 45 cm
2 year – 48 cm
7 year – 50 cm
12 year – 52 cm

53
Chest circumference: Or thoracic diameter is an
important parameter of assessment of growth
and nutritional status.
At birth – 30 – 33 cm (2-3 cm less than HC)
6 – 12 months – HC = CC
1 year – CC > HC by 2.5 cm
5 year – 5cm > HC

54
MUAC (Mid Upper Arm Circumference): This
measurement helps to assess the nutritional
status of younger children. It is measured while
the hand is left hang freely. The measurement is
taken at the midpoint of the upper arm between
the tip of acromium process of scapula &
olecranon process of ulna.

55
MUAC (Mid Upper Arm Circumference):
At birth – 11 to 12 cm
At 1 year – 12 to 16 cm
At 5 years – 16 to 17 cm

56
MUAC (Mid Upper Arm Circumference):
• The mid arm muscle circumference (MAMC) is
a measure of somatic protein or muscle mass.
It is calculated by taking a measurement of
the total mid arm circumference (MAC) and
deducting an amount for the layer of adipose
tissue based on the triceps skin-fold (TSF).
The calculation uses the formula:
• MAMC = MAC (cm) - 3.14 x TSF (cm)

57
Body Mass Index(BMI):
What’s your
BMI

58
Body proportion: It is the upper & lower segment
ratio of the body.
At birth – 1.7:1.0
At 3 years – 1.3:1.0
At 10 to 12 years – 1:1

59
Skin fold thickness: A skinfold caliper
(Herpenden’s caliper) is used to assess
the skinfold thickness, so that a prediction of
the total amount of body fat can be made.
Normal is >10mm in children age 1-6yrs.
7 Site Skin fold Measurements
– Triceps.
– Chest/Pectoral.
– Midaxillary.
– Subscapular.
– Suprailiac.
– Abdominal.
– Thigh.

60
Dentition:

61
Dentition:

62
Bone age/Osseous Growth: Bony growth follows a
definite pattern & time schedule from birth to
maturation. It is calculated by the appearance of
ossification center by X-ray study. skeletal
maturation starts from intrauterine life and
continue up to 25 years of age.
Fontanels closure: At birth, anterior and
posterior fontanel's are usually present. Posterior
fontanels closes within (6-8 weeks) and anterior
fontanels takes 11/2 years.

63
Arm Span: Arm span is measured
from finger tips on one side to
finger tips of the other side with
both hands horizontally extended
perpendicular to the body.
In <10years – 1-2 cm < height
Adolescent - = height
Adult - >2 cm of height

Aspects of Development
• In humans, development has different
aspects which include main five separate
areas like gross motor, fine motor, speech &
language and social & emotional, cognitive
development.
• Child development is a process every child
goes through which involves learning and
mastering skills like sitting, walking, talking,
skipping, and tying shoes. Children learn
these skills, called developmental
milestones, during predictable time periods.
65

1. Motor Development: Motor
development refers to
the development of a child's bones,
muscles and ability to move around and
manipulate his or her environment.
Motor development can be divided into two
sections:
Gross motor development
Fine motor development.
66

1. Motor Development:
Gross Motor Development - This is the child's
ability to use large muscles which increase
his/her mobility. For example, a six-month-old
baby learns how to sit up with some support, a 12-
month-old baby learns to pull up to a stand holding
onto furniture, and a five-year-old learns to skip.
Fine Motor Development - This is the child's
ability to use small muscles, specifically their
hands and fingers, to pick up small objects, hold a
spoon. It depends up on neural tract maturation.
67

2. Speech & Language development: This is the
child's ability to both understand and use
language. Examples includes a 12-month-old
baby saying his first words, a two-year-old
naming parts of her body.
3. Social and Emotional Development: This is
the child's ability to interact with others,
including helping themselves and self-control.
Examples would include: a six-week-old baby
smiling, a ten-month-old baby waving bye-bye
68

4. Cognitive Development: This is the child's
ability to learn and solve problems. For
example, this includes a two-month-old
baby learning to explore the environment
with hands or eyes or a five-year-old
learning how to do simple math problems.
5. Sensory Development: It depends up on
myelinization of nervous system and
responds to specific stimuli. All senses are
present in newborn expect visual system
which take 6-7 years to mature.
69

Assessment of Development
It is essential to detect abnormal
developmental delays. When assessing the
developmental stages of children, the nurse
looks for strengths as well as weakness. Both
father and mother can assist the nurse in
making developmental assessment. Accurate
determinations of behaviour are made during
each assessment. Developmental assessment
of children are done on a serial basis
because progression/regression can be
determined only over a period of time.
70

Assessment tool: The nurse must follow
the standardized procedure given for
using each tool for the result to be valid.
The mostly used assessment tools are –
Denver Developmental Screening Test
(DDST)
The Brazelton Neonatal Behavioural
Assessment Scale (NBAS)
The Denver Articulation Screening
Examination (DASE)
71

Assessment tool:
Bayley Developmental Screening Test
Woodside Developmental Screening
Test
Other Developmental Screening Test
used in India are:-
– Developmental Assessment Scale of Indian
Infant (DASII)
– Baroda Developmental Screening Test
– Trivandrum Developmental Screening Test
72

(DDST)
It was first published in 1967 (Frankenburg &
Dodds, 1967), was one of the first screening tools
developed to identify young children at risk for
developmental delay and disability.
It’s format was similar to the construction of
pediatric growth charts, with 105 developmental
items for children from birth to 6 years of age
aligned chronologically along horizontal age lines,
divided into four discrete developmental domains:
personal-social, fine motor-adaptive, language, and
gross motor.
73

(DDST)
There were concerns raised from that time about
specific items in the test and, coupled with changing
normal values, it was decided that a major revision
of the test was necessary in 1992. It was originally
designed at the University of Colorado Medical
Center, Denver, USA.
Hence DDST – II was designed. The test consists
of up to 125 items, divided into four parts:
• Social/personal: aspects of socialisation inside and
outside the home, eg smiling
74

(DDST)
• Fine motor function: eye/hand co-ordination, and
manipulation of small objects, eg grasping and
drawing
• Language: production of sounds, ability to recognise,
understand, and use of language, eg ability to
combine words
• Gross motor functions: motor control, sitting,
walking, jumping, and other movements.
denver-ii-developmental-form-ii.pdf
75

Assessment tool:
– Baroda Developmental Screening Test
Baroda Developmental Screening Test is a
screening test for motor-mental assessment
of infants, developed from Bayley Scales of
Infant Development. It is 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.
76

Assessment tool:
– Trivandrum Developmental Screening Test
It is a developmental screening test for
children. It was developed by selecting 17
test items from BSID (Baroda Norms).
– TDST - 1.png
– TDST - 2.gif
77

Notes on unit 02 - growth & development introduction

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Notes on unit 02 - growth & development introduction