2. Definitions
1. Growth: It is physical maturation. It is the increase in size of the body – in height,
weight and other measurable areas. Rate of growth vary during different stages of
growth; The growth rate is rapid during the prenatal, neonatal, infancy and
adolescent stages and slows during childhood.
2. Development: Development is physiological and psychological maturation. It is the
gaining of behaviour and skills in all aspects of the child’s life.
3. Developmental milestones: Developmental milestones are a set of functional skills
or age-specific tasks that mo.t children can do at a certain age range.
3. Five Domains of development:
1. Motor:
Gross motor: using large groups of muscles to sit, stand, walk, run, etc., Keeping balance, and
changing positions.
Fine motor: using hands to be able to eat, draw, dress, play, write, and do many other things.
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.
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.
4. FACTORS AFFECTING GROWTH AND DEVELOPMENT
1. Major factors are classified as:
a. Nature (intrinsic forces) Eg. genetic makeup; sex etc.
b. Nurture (extrinsic forces) Eg. Nutrition, loving care etc.
2. Pre-natal environment
a. Maternal Nutritional deficiencies: IUGR; Preterm
b. Diabetic mother: macrosomia
c. Exposure to radiation: growth retardation, malformations, impaired brain function
d. Infection with German measles: Rubella syndrome with LBW
e. Smoking carbon monoxide and nicotine; low birth weight; intellectual impairment
f. Use of drugs: Hydantoin syndrome: developmental delays; microcephaly; Foetal alcohol syndrome.
3. Genetic control
a. The stunted growth in achondroplasia is inherited as a simple dominant gene.
b. Chromosomal abnormalities like trisomy 18 and 21 are associated with growth retardation.
c. Genetic short stature: Rubinstein Taybe
d. Genetic origin of mental retardation: Rett syndrome
5. 4. Endocrine:
a. Growth hormone controls the rate of growth up to the time of adolescent spurt.
b. Thyroid hormone plays a vital role throughout the whole of growth; short stature and mental deficiency are
features of hypothyroidism.
5. Nutritional:
a. Essential amino acids: for growth
b. Deficiency of zinc: stunting, interference with sexual development
c. Iodine deficiency: hypothyroidism
6. Postnatal:
a. Meningitis: can affect pituitary gland
b. Brain injury: CP with malnutrition and mental and motor retardation
c. Chronic illness:
d. CHD: hypoxia and poor feeding affects growth
7. Secular trend:
a. Overall economic conditions of world have improved in last 100 years and there is found tendency for children to
become progressively larger ay all ages.
b. There has been rather a fast reduction in the age of menarche
6. LAWS / PRINCIPLES / RULES / PATTERNS OF GROWTH & DEVELOPMENT
1. Development is continuous from conception to maturity and its sequence is the same in all children.
2. The sequence of development is identical in children
a. Child starts crawling before walking- Crawl à Creep à Walk
b. Speech: Babbles à Words à Sentences; Scribble à Writing
c. Social: First child plays alone, then with others.
3. There is a directional Pattern in G&D:
a. Cephalocaudal Pattern: Child gets head control first, crawls and then walks
b. Proximal to Distal: Shoulder first, elbow second and wrist and finger control last
4. Brain takes over spine:
a. Primitive reflexes are replaced by voluntary acts. Grasp reflex is replaced by voluntary grasp
b. Mass activity replaced by specific activity. Excited infant kicks all limbs while approaching mother but older child extends only upper
limb to reach her.
5. 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.
7. 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 also during puberty. In the intervening years of mid childhood, the somatic growth
velocity is relatively slowed down.
b. The brain enlarges rapidly during the latter months of fetal life and early months of postnatal
life.
c. Growth of gonads. Gonadal growth is dormant during childhood and becomes conspicuous
during pubescence.
d. Lymphoid growth. The growth of lymphoid tissue is most notable during mid-childhood.
e. Growth of body fat and muscle mass: After the pubertal growth spurt, boys have greater lean
body mass compared to girls. Girls have more subcutaneous adipose tissue than boys.
Moreover, the sites and quantity of adipose tissue differs in girls and boys. Girls tend to add
adipose tissue to breasts, buttocks, thighs and back of arms during adolescence.
8. Growth chart & Growth Monitoring
1. Basic growth assessment involves measuring a child’s weight and length or height
and comparing these measurements to growth standards. The purpose is to
determine whether a child is growing “normally” or has a growth problem that
should be addressed.
2. It is otherwise called road to health chart and was original popularized by David
Morley.
3. Definition: Regular monthly recording weight of the children and plotting it on the
growth chart which enables us to see the changes in the weight and giving advice
to mother about the growth of child is called GROWTH MONITORING.
9. Types of Growth charts:
1. WHO growth chart: WHO Pediatric growth chart has two reference weight curves, depicting 50th percentile (upper curve) and
3rd percentile (lower curve). The graph area between these curves is shaded to represent the range of permissible variations in
Weight and hence also termed as “Road to-health”. Any child, whose Weight falls on this road, may be considered as apparently
normal in terms of growth.
2. Government of India Pediatric growth chart has four reference curves, depicting 50th percentile of weight values as top most
curve, followed downward by curves showing 80%, 70% and 60% of these values in that order. These Pediatric growth charts are
more useful for nutritional assessment and grading of malnutrition. Any child with his weight falling below the 80% curve is taken
as malnourished, while weight below the 60% curves indicates severe malnutrition.
3. ICDS Charts:
a. The standard used is 50th percentile of WHO growth standard as normal. The new chart has three coloured tracks viz:
Green, Yellow and Orange instead of the earlier classification lines of Normal, Grade I, Grade II, Grade III and grade IV .
Children plotted in the green track are termed Normal; children plotted in the yellow track as moderately underweight and
children plotted in the orange track termed as severely underweight.
b. This helps to detect growth faltering and helps in assessing nutritional status. Besides, severely malnourished children are
given special supplementary feeding and referred to medical services.
c. Two charts for boys and girls
10. Growth chart
Growth chart has two axes:
1. The horizontal axis is for recording the age of the child and is being referred
as ‘month axis’.
2. The vertical axis is for recording the weight of the child and is being referred
as ‘weight axis’.
3. Four growth curves on the growth Chart depict the growth of the child and
help in assessing his/her nutritional status.
4. Weight of the child as per the age is plotted on the Growth Chart.
11. Recording
1. Obtain accurate measurements
2. Select the appropriate growth chart for age and sex.
3. Find the child’s age on the horizontal axis. Find the appropriate weight on the
vertical axis.
4. Use a straight edge or right-angle ruler to draw a horizontal line across from that
point until it intersects the vertical line. Make a small dot where the two lines
intersect.
5. Interpret the plotted measurements: Eg. when the dot is plotted on the 95th
percentile line on the growth chart, it means that 5 of 100 children (5%) of the
same age and sex in the reference population have a higher weight-for-age.
