This document discusses child growth and development from infancy through adolescence. It covers developmental milestones, factors influencing growth such as genetics and nutrition, assessing growth using measures like weight and height, and recommendations around breastfeeding and complementary feeding for infants. The key topics covered are growth and developmental principles, milestones by age, influences on development, assessing growth, and infant and young child feeding recommendations including exclusive breastfeeding for six months and introducing complementary foods thereafter.

2. Unit Two
Child Growth and Development

3. Objectives
At the end of this lesson you will be able to :
• Define growth & development
• List the principles of growth & development
• Discuss the common developmental milestones of a child
• Mention factors affecting growth & development
• Demonstrate how to assess growth using several measures
• List the advantages of breast feeding for the child & mother
• Discuss the recommended breast feeding practice
• Describe the recommended complementary feeding practice
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4. Introduction
• The process of growth and development continues from
conception all the way to death.
Growth
• is the physical increase in the body’s size and
appearance caused by increasing numbers of new
cells.
Development
• It’s the progressive change in the child maturation.
• It is an increase in skill and complexity of function.
• As children develop, their capacity to learn and think
increases.
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5. General Principles of G&D
• Follows an orderly pattern starting with the head and
moving downward referred as cephalocaudal.
o The child is able to control the head and neck before being able
to control the arms and legs.
• Proceeds in a pattern referred to as proximodistal, in
which growth starts in the center and progresses toward
the periphery or outside.
o The child can control movement of the arms before being able to
control movement of the hands.
• The process moves from the simple to complex.
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6. 6

7. Fields of developmental skills
• There are four fields of developmental skills to consider
whenever a young child is seen:
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Gross
motor
Vision &
fine
motor
Social,
emotional
&
behavioral
Hearing,
speech &
language

8. Fields of developmental skills
• The acquisition of developmental abilities for each
skill field follows a remarkably constant pattern
between children, but may vary in rate. It is like a
sequential story.
• Thus, the normal pattern for acquisition is
o Sequentially constant
o Should always be considered longitudinally, relating
each stage to what has gone before and what lies
ahead
o Varies in rate between children.
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9. Developmental milestones
• Developmental milestones are basic achievements
associated with each stage of development.
• These tasks must be mastered to move successfully to
the next developmental stage.
• Developmental tasks must be completed successfully at
each stage for a person to achieve maturity.
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10. Developmental …
When considering developmental milestones:
• The median age is the age when half of a standard
population of children achieve that level;
• It serves as a guide to when stages of development are
likely to be reached but does not tell us if the child’s skills
are outside the normal range.
• Limit ages are the age by which they should have been
achieved.
• Limit ages are usually 2 standard deviations (SD) from
the mean. They are more useful as a guide to whether a
child’s development is normal.
• Failure to meet them gives guidance for action
regarding more detailed assessment, investigation or
intervention.
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11. Developmental milestones by median age
From birth to 2 years
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12. Gross motor Limit Age
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13. Vision and Fine motor Limit Age
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14. Hearing, speech & language Limit Age
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15. Social, emotional & behavioral Limit Age
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16. Physical Development of the Child
• Weight: Birth weight = 3.25kg
o Doubles by end of first 6 months
o Triples by end of first year
o Quadruples by age 2 years
• Height: Birth length = 50cm
• Doubles by 4 years of age
• Triples by about 13 years of age
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17. Head Circumference
• Birth 35 cms
• 3mo 41 cms
• 12 months 45 cms
• 2yrs 48 cms
• 12 yr 52 cms
• Grows 1cm per 2 weeks during the first 3 months
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18. Preschool (2-5 years)
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Gross motor & fine motor
At 2 & half yr walk upstairs alternating feet,
at 3 yr ride tricycles & copy circle, throw ball over head &
copy cross;
at 4 & half yr copy square;
at 5 yr skip & copy triangle

19. Preschool (2-5 years)
• Psychosocial growth is substantial but physical growth
slows.
• By the age of 6, children usually have achieved 20/20
vision.
• Language develops rapidly during the preschool period,
progressing from the ability to use simple sentences at
age 3 to telling sometimes long and involved stories by
age 5.
• Language development may be delayed because of
hearing impairment , lack of stimulation, overprotection, or
lack of parental support.
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20. Pre school …
• Magical thinking and imagination contribute to fears
and anxieties of the preschooler because these make it
difficult for the child to separate fantasy from reality.
• Caregivers must acknowledge these concerns, be
patient with explanations, and offer reassurance to the
child.
• Dramatic play allows for acting out troubling situations
• Cooperative play is seen when children play in
organized groups, and associative play occurs when
there is no organization or rules, but children are
engaged in a similar activity
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21. Pre school …
• May show verbal aggression by name calling and
physical aggression by pushing, hitting, or kicking.
• The caregiver serves as a role model and disciplines by
setting limits and helping the child to develop inner
control and take responsibility for his/her actions.
• The preschooler learns to share with family and
playmates and in the process often shares infections.
• To prevent infection, the child is taught
o To cover his or her mouth when coughing or sneezing,
o Proper disposal of tissues, correct wiping after bowel
movements,
o Good hand washing, and not to share cups, utensils,
food, or toothbrushes.
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22. School Age Child ( 6-10)
• The child engages in many activities using motor,
cognitive, and social skills.
• Success in these activities is necessary for the child to
develop a sense of competency.
• Physical growth is slow and steady during the school-
age years.
• The child begins to lose deciduous teeth and the first
permanent teeth appear at about 6 years of age.
• Even though family is still a major influence, the school-
age child has a need to be accepted by groups of peers,
often spends time in activities with children of the
same sex, and enjoys team sports and completing
projects.
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23. Adolescent ( 10-18)
• The preadolescent period is between ages 10 and 12
years, and the ages from 13 to 18 years are known as
adolescence.
• Offering preadolescents information about their
changing bodies and feelings is important.
• The rapid growth of the skeletal system outpaces the
growth of the muscular system, contributing to the
clumsiness sometimes noted in the adolescent.
• Secondary sexual characteristics seen in the
adolescent boy include penis, testes, and scrotum
reaching adult size and shape, as well as pubic hair,
increased strength, and a deepening of the voice.
• Adolescent girls develop breasts and pubic hair and
begin ovulation and menstruation.
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24. Adolescent …
• The adolescent’s task is to establish his or her own
identity and to find a place in society.
• Intimate relationships in adolescents help in
preparation for long-term relationships.
• The peers exert influence, and the adolescent feels a
need to conform and to “fit” with peers.
• Body image and self-esteem are closely related, and
the adolescent struggles with wanting to be attractive
and accepted.
• This drive can create anxiety in the adolescent, which
can lead to unhealthy behavior, practices, and
conditions.
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25. Adolescent …
• Health problems that threaten the adolescent’s body
image may threaten the satisfactory completion of
developmental tasks.
• Health education in the adolescent needs to include
information regarding
o Sexuality, sexual responsibility, STIs,
o Contraception, as well as
o About substance abuse and mental health issues and
concerns.
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26. Factors Affecting G & D
There are many influences
• Prenatal factors
• The mother’s general health and nutrition,
• Her behaviors during pregnancy
• Genetic factors
• Nutritional factors, and
• Environmental factors
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27. Genetics
• Human cells contain 46 chromosomes, consisting of 23
essentially identical pairs.
• At conception, the union of the sperm and egg forms a
single cell.
• This cell is made up of one member of each pair
contributed by the father and one member of each pair
contributed by the mother.
• This combination determines the sex and inherited
traits of the new organism.
• The genetic makeup of each child helps determine
characteristics such as the child’s gender, race, eye
color, height, and weight.
• Growth and development of the child is influenced by
these factors.
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28. Nutrition
• The quality of a child’s nutrition during the growing years has a
major effect on the overall health and development of the child.
• It is important that the child have adequate amounts of food and
nutrients for the body to grow.
• Nutrition is also a factor in the child’s ability to resist infection
and diseases.
• Motor skill development is influenced by inadequate, as well as
excessive, food intake.
• Nutritional habits and patterns are established early in life, and
these patterns are carried into adulthood, thus influencing the
individual’s growth, development, and health throughout life.
• Normal nutritional needs vary at each stage of development.
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29. Environment
• The family structures, including family size, sibling order,
parent–child relationships, and cultural background, affect
G &D of the child.
• The socioeconomic level of the family can affect the child,
especially if there are not sufficient funds to provide
adequate nutrition, childcare, and health care for the
growing child.
• Play and entertainment are important environmental aspects
in the development of a child.
• Other factors include family homelessness and divorce; a
latchkey situation, in which children come home from school
to an empty house each day; and running away from home.
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30. Assessment of Growth
• Growth assessment is an essential component of pediatric
health surveillance Why ?
• Because almost any problem with in the physiologic, inter-
personal and social domain can adversely affect growth.
• And it can be used to
o Screening of malnutrition,
o Parental education
o Evaluation of nutrition programs
• In practice, several measures such as body weight, height or
length, head circumference, skin fold thickness and mid-
upper arm circumference (MUAC) may be used.
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31. Assessment of Growth …
• The most powerful tool in growth assessment is the
growth chart.
• The growth chart provides most of the information
needed to assess growth.
• The standard charts are based on data collected on
weight for age, height for age, head circumference for
age, and weight for height.
• Separate charts are provided for boys and girls.
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32. Assessment of Growth …
• Each chart is composed percentile curves, which
indicate
o The percentages of children at a given age on the X-axis whose
measured values fall below the corresponding value on the Y-
axis.
• The normal values for age are represented between the
5th and 95th percentiles, and the 50th percentile
represents the median (standard) value.
• In children under 5 years old an additional chart (Harvard
standard) is used to measure weight for age as
percentages of the median or standard value in the
NCHS curve.
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33. Assessment of Growth …
Weight for age
• Weight is usually measured using beam balance or
spring balance for small children and a standing scale for
older children.
• When weighing, children should be undressed or wear
light clothing.
• Children falling below the 5th percentile of NCHS or
below the 80% of Harvard Standard are labeled as
underweight.
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34. 34

35. 35

36. Assessment of Growth …
Height or length for age
• Height is measured for children more than 2 years of
age, and those younger than 2 yrs, length should be
taken.
• Length is taken by two examiners.
• One should position the child (with the child supine on a
measuring board).
• Then the child’s head should be held with the ear/eye
plane vertical, the ankles gently pulled to stretch the
child, and the feet turned up vertically.
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37. Assessment of Growth …
• Height is measured in the upright position
• The child should stand straight against a wall or the erect
measuring scale; and his head, shoulder, buttocks and
heels should touch the wall or scale.
• Then, he should take a deep breath to relax the
shoulders and with a flat object such as a book, the
upper level of his head should be marked against the
scale.
• A height for age measure shows linear skeletal growth.
• A height for age that is below normal shows stunting
and indicates chronic states of malnutrition.
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38. 38

39. Assessment of Growth …
Weight for height
• Getting an accurate age may be a problem in countries
like Ethiopia, where the majority of people are from rural
areas and illiterate.
• Weight for height measurements can overcome this
problem.
• However, it only identifies children with acute
malnutrition (wasting ), whose height has not been as
affected as their weight.
• Those with weight for height falling below the 5th
percentile of NCHS are labeled as malnourished.
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40. 40

41. 41

42. Assessment of Growth …
Head circumference for age
• Head circumference is measured by crossed tape
technique.
• Placing a measuring tape just above the brow anteriorly
and the occiput, measure the occipito-frontal
circumference.
• Values below the -3 standard deviation (SD) are labeled
as microcephaly and above +3 SD a macrocephaly.
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43. 43

44. 44

45. Assessment of Growth …
Mid-upper arm circumference
• The circumference of left upper arm is taken at mid point
while the arm is hanging by the side.
• This is used as an age independent criterion for
detecting malnutrition in children of age one to five
years.
• A mid upper arm circumference of less than 12.5cm
indicates malnutrition and when less than 11cm, severe
malnutrition.
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46. Assessment of Growth …
Taking the MUAC
• children from one to five years: however, its use has been
extended to include children of over
• 65cm in height – or children of walking age.
• Ask the mother to remove clothing that may cover the
child’s left arm.
• Calculate the midpoint of the child’s left upper arm by first
locating the tip of the child’s shoulder (arrows 1 and 2)
with your finger tips.
• Bend the child’s elbow to make the right angle (arrow 3).
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47. Assessment of Growth …
• Place the tape at zero, which is indicated by two arrows,
on the tip of the shoulder (arrow 4) and pull the tape
straight down past the tip of the elbow (arrow 5).
• Read the number at the tip of the elbow to the nearest
centimeter.
• Divide this number by two to estimate the midpoint.
• As an alternative, bend the tape up to the middle length
to estimate the midpoint.
• A piece of string can also be used for this purpose; it is
more convenient and avoids damage to the tape.
• Mark the midpoint with a pen on the arm (arrow 6).
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48. Assessment of Growth …
• Straighten the child’s arm and wrap the tape around the
arm at the midpoint.
• Make sure the numbers are right side up. Make sure the
tape is flat around the skin (arrow 7).
• Inspect the tension of the tape on the child’s arm.
• Make sure the tape has the proper tension (arrow 7) and
is not too tight or too loose (arrows 8 and 9).
• When the tape is in the correct position on the arm with
correct tension, read and call out the measurement to
the nearest 0.1cm (arrow 10).
• Record the measurement.
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49. 49

50. Infant and Young Child
Feeding
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51. Introduction
• Optimal feeding of infants and young children means
exclusive breastfeeding from birth to about six
months, followed by introduction of complementary
foods drawn from the local diet at about six months
• Breast-feeding is an unequalled way of providing ideal
food for the healthy growth and development of all
infants.
• Breastfeeding should be sustained well into or beyond
the second year of life, with increasing amounts of
complementary foods.
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52. Introduction …
• Complementary feeding means the provision of other
foods or liquids along with breast milk.
• At six months of age, breast milk alone does not provide
sufficient calories and nutrients to sustain optimal growth
• At this age infants are developmentally ready to take soft
and semi-solid foods in addition to breast milk.
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53. Introduction …
Appropriate complementary feeding involves
• Continuing on demand breastfeeding
• Improvements in the quantity and quality of foods,
• Hygienic food preparation and
• Active feeding of the child.
The best complementary foods for children are foods that are:
• High in energy (calories) and protein
• Good in variety
• Easy to digest
• Pure and clean
• Easy and inexpensive to prepare
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54. The advantages of breast-feeding
• Breast milk is the best nutrition for infants and also
young children.
The benefits of breastfeeding for the child include:
• It is the best natural food for babies.
• It contains sufficient amount and the right mixture of
fats, sugars, proteins, minerals, and most vitamins for a
growing baby.
• It changes in composition to meet baby’s changing
needs.
• It is easy to digest and nutrients are well absorbed.
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55. The advantages of breast-feeding ..
• It contains enough fluids for the first 6 months of life
(breast milk is 90 % water)
• It protects the baby from disease, especially colostrum,
contains protective substances against the germs that
cause diarrhea, respiratory and other infections.
• Breast-fed children have fewer diarrheal, respiratory, and
ear infections.
• It is always clean and available 24 hours a day and
requires no special preparation.
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56. The advantages of breast-feeding ..
• It does not cost anything.
• It creates bonding between the mother and baby that
leads to better psychomotor and social development.
• It protects against allergies because it contains no
substance that could provoke allergic reactions.
Because of its above benefits, breast milk promotes normal
growth and development and saves lives of children.
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57. The advantages of breast-feeding ..
The benefits of breast-feeding for the mother include:
• Breast-feeding provides an efficient contraceptive
method during the first 6 months if breast-feeding is
exclusive and frequent.
o This has health benefits for the mother and child.
• It reduces the risk of post-partum hemorrhage.
• It prevents breast engorgement and its consequences.
• It reduces the mother’s workload since breast milk is
available at any time and anywhere and it does not need
any processing.
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58. Recommended Breastfeeding Practices for
Infants and Young Children:
• Optimal breastfeeding practices from 0 to 6 months
include:
1. Initiating breastfeeding within one hour of birth.
The first milk (colostrum) is of particular nutritional
and health value to the infant because of its high
content of proteins and fat-soluble vitamins and its anti-
infective properties.
2. Do not give any prelacteal feeds such as water, other
liquids, or ritual foods.
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59. Recommended Breastfeeding Practices ..
3. Establish good breastfeeding skills,
i.e. proper positioning, attachment and effective
feeding.
Correct positioning means
• Mother’s back is supported whether sitting or lying down
and
• The baby is held close to the mother,
• The baby facing the breast with
• The baby’s ear, shoulder, and hip in a straight line.
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60. Recommended Breastfeeding Practices ..
Proper attachment signs are:
• Infant’s mouth is open wide
• The lower lip is turned outwards
• The chin touches mother’s breast
• The entire nipple and a good portion of the areola (dark
skin around the nipple) are in infant’s mouth.
• More areola shows above than below.
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61. Recommended Breastfeeding Practices ..
4. Exclusive breast feeding for the first 6 months.
• Do not give any fluids such as water, other liquids and
foods other than breast milk before 6 months of age.
5. Frequent and on-demand breastfeeding, including
night feeds (as often as infant wants).
• Feeding every 2 to 3 hours (8 to12 times per 24 hr) or
more frequent suckling is important for milk production
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62. Recommended Breastfeeding Practices ..
6. Offer second breast after infant empties the first.
The infant receives both ’fore‘ milk (which has a
high water content to quench the thirst) and
hind‘ milk (which is rich in fat and nutrients).
7. Mother continues breast feeding more often when the
infant is ill.
8. A mother who will be away from her infant for an
extended period expresses her breast milk and the
caregiver feeds the milk from a cup.
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63. Recommended complementary
feeding practices
Include:
1. Introducing complementary feeding at six months of
age.
2. Continuing frequent and on-demand breastfeeding until
24 months.
• Breast milk is still major source of energy and key source of
fat, vitamin A, calcium, riboflavin.
3. Increasing food quantity and frequency as the child
grows.
• A healthy breastfed child needs:
o 2-3 meals per day at 6-8 months
o 3-4 meals per day at 9-12 months and 1-2 snacks
o 3-4 meals per day at 12-24 months and 2 snacks
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64. Recommended complementary ..
4. Gradually increasing food consistency and variety
as the child gets older:
• Feed mashed and semi-solid (thick gruel) foods by 6
months of age.
• Feed energy-dense soft foods to 6-11 months.
• Introduce snacks that can be eaten by children alone by
8 months and family foods by 12 months
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65. Recommended complementary ..
5. Diversifying the diet to improve quality and
micronutrient intake:
• Feed vitamin A rich fruits and vegetables daily.
• Feed meat, poultry, or fish daily or as often as possible
• Use fortified foods or other staples, when available
• Give vitamin-mineral supplements when animal products
and/or fortified foods are not available .
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66. Recommended complementary ..
6. Practicing active feeding:
• Feed infants directly and assist older children when they feed
themselves
• If they refuse, experiment with different food combinations,
tastes, textures and methods.
• Feed slowly and patiently. Do not force.
7. Frequent and active feeding during and after illness:
• During illness, increase fluid intake by more frequent
breastfeeding and patiently encourage children to eat favorite
foods.
• After illness, breastfeed and give foods more often than usual,
and encourage the child to eat more food
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67. Recommended complementary ..
8. Practicing good hygiene and proper handling of
foods:
• Wash caregivers and children’s hands before and after
food preparation and feeding.
• Serve food immediately after preparation.
• Use clean utensils to prepare and serve food.
• Serve using clean cups and bowls, and never use
feeding bottles
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