Growth and development continues after birth through distinct stages. Assessment of growth includes prenatal exams of the mother and fetus, as well as postnatal exams of physical, dental, and skeletal development. Key milestones are also used to assess development. Growth charts graphically track weight and compare it to normal growth curves to monitor nutritional status and development. Multiple nutrients are necessary for proper growth, and deficiencies can cause growth curves to flatten or decline.

4. Introduction
It would seem obvious to say that development does not stop at
birth. In fact many systems (cardiovascular, respiratory,
gastrointestinal, homeostasis) undergo significant changes at
birth, and many others (neural) have not yet completed their
development.
Postnatal development can be broadly divided into the age
categories of: Neonatal (birth to 1 month), Infancy (1 month to 2
years), Childhood (2 years to puberty), Puberty (12 years to mid-
teens) and Young Adult a new category (late teens to early
twenties).

5. ASSESMENT OF GROWTH AND
DEVELOPMENT
 1 .ANTENATAL ASSESMENT:
 A. Clinical Examination of mother;
To correlate gestational age of uterus, abdominal
girth, and weight.
 B.Ultrasonography
Measurement of foetus.
 C.Amniocentesis
Examination of amniotic fluid will help in assesing
maturity of foetus and diagnosis of neural tube
defects and chromosomal anomalies.

7. Pediatric Fundamentals - Growth and Development
Neuro notes
Nervous system anatomically complete at birth
except:
Myelination
rapid for 2 years
complete by 7 years
Posterior fontanelle closed by 6 weeks.
Anterior fontanelle closed by 18 months.
Primitive reflexes disappear in few months.

8.  POSTNATAL ASSESMENT:
 1.Physical Examination
 2.Maturity:
A.Dental- Primary decidous
B.Skeletal by radiological method.
C.Sex maturity rating
 3.Mile Stones.

9.  DENTAL:
 EVALUTION OF DENTAL MATURATION:
 Deciduous or temporary teeth -20 in no.
2 lower central incisors-6-8 months.
4 upper incisors-8-12 months.
2 lower lateral incisors-12-15 months.
4 anterior molars-12-16 months.
4 canines-16-20 months.
4 posterior molars-20-30 months.

10.  ERUPTION OF PERMANENT TEETH
 The first permanent teeth to erupt are the first
molars usually by 6 years.
They are the focal points in the dental arch and form
basis for the ultimate shape of the jaw and hence
should not be extracted.
Approximately 4 teeth are replaced per year.
 4 first molars-6 years.
 8 incisors-7-9 years.
 8 bicuspid(premolar)-10-12 years.
 4 canines-11-12 years.
 4 second molars-13-14 years.
 4 third molars-17-22 years.

11.  EVALUATION OF SKELETOL MATURITY BASED
ON RADIOLOGICAL METHOD:
 1.The number and size of certain epiphyseal
centres.
 2.Size, shape ,density and sharpness of the outlines
of the ends of bones.
 3.The distance of separation between the
epiphyseal centre and zone of provisional
calcification.

12.  ADOLESCENT GROWTH SPURTS;
It is the time interval between childhood and
adulthood usually beginning at about 10 years
in girls and 2 years later in boys, and ends with
complete physical, sexual, mental,
social,psychological and behavioral
maturation.

13. It is the period of maturation related to anatomical and
physiological changes with appearance of secondary sex
charecters, maturation of reproductive system under the
influence of hormones.
During adolescent growth spurts, there is increase in body
fat, body mass, change in voice, specially in boys due to
increase length of vocal cords.

14.  MILESTONES:
 A.Physical parameters:
Weight,height, head,chest, and midarm circumference
Weight-20gm/day---5 month.
15gm/day----6month
doubles------5to6months
triples-------1 year
four times----2years.
five times----3 years.
six times-----5years

15.  C.Height
At birth-----50cms
At one year----75cms
 D.Head circumference:
At birth--------33to35cms
I year --------+12cms
2year --------+2cms
3to 5years------+1.25cms
5to15 years------1.5cm/years
by 12 to 15 years it reaches adult size.

16.  E.Chest measurement:
birth-3cms more than head circumference.
one year-both equal
after one year-it is more than head
circumference.
 F. Mid arm circumference:
birth--------11.5cms to 12cms.
I year------14 to 16 cms
I to 5 year—0.25cm.
hence it is an age independent criteria for
assessing malnutrition.

17. Sitting height/sub ischial height;
70% of body length---in neonates
57% of body length---3years
52% 0f body length---puberty.
 Span:
The span is equal to the length of the child.

18. ROAD TO HEALTH CHART
(GROWTH CHART)

19. ROAD TO HEALTH CHART

20.  GROWTH CHART:(road-to-health)
Growth chart helps in monitoring the
growth and development of child.
It gives complete information about childs
immunization and nutritional grade.
It also gives complete information about
family size, health of siblings and parents.
Child weight is also recorded.

21.  WHY DO DOCTORS AND NURSES NEED THE
CARD?
Doctors and nurses will check the card to see:
 if your child received the necessary immunisations
 if your child received the necessary vitamin
supplementations
 the growth of the child
 the child's development according to the milestones for a
growing child.
The card - a record of immunisations and growth rate - is given
to mothers when their infant is born and is used to monitor
the development of the child until it is five years old.

22. Upward growth curve shows child is
growing normally,during illness and
malnutrition growth charts shows
downwards or flattens curve.
Feeding advise to the mother is also printed
on chart.
Childs minor ailments and the treatment
advised is printed and recorded.
 Hence growth chart offers a simple way
of monitoring weight gain.

23.  The space between the two growth curves
has been called the road-to-health.
 If the child is growing normally, the growth
line will run parallel to the road-to-health
curves.
 Flattening or falling of the childs weight
curve, signals growth failure,which is the
earliest sighn of protein-energy
malnutrition.

26. Nutritional factors affecting
Growth
 The body needs different kinds of nutrients for growth, energy and
repair.
 Nutrients:
1.Carbohydrates,Fats, Proteins , Vitamins ,Minerals and Water.
Carbohydrates and Fats provide the materials for growth and
development.
Proteins for growth and repair.
Vitamins keep the body in good conditions.
Water is essential for Metabolism and Bowel movements.

27.  Water determines the amount of blood in
circulation.
 Minarals-builds strong bones and Teeth, for helping
the nerves work for regular growths and for
clotting blood.
 Metabolism refers to all the activities going on in
the cells so that they can absorb food and energy.

28. CURVATURES OF VERTEBRAL COLUMN
 Primary curvatures:
 1.During intrauterine life the whole vertebral
column is CONCAVE ventrally and CONVEX
dorsally.
 In Adult Primary curvatures are retained only in
thoracic and sacral regions.
 They are mainly due to the shape of the
vertebrae.

29. SECONDARY CURVATURES
 Secondary curvatures are CONVEX forwards.
 They develop after Birth.
 They develop due to posture.
 They are mainly due to the shape of intervertebral
discs.

30.  Secondary curvatures are observd in cervical
and lumbar regions.
 Cervical curvature appear around 6 to 9
months when the child starts holding his
head by himself.
 Lumbar curvature appears at about 12 to 18
months when the child starts walking.