In contrast to adults, growth of all body parameters and, later, the development of puberty are key features of
 childhood and adolescence.
Growth : increase in size.
*There are four phases of normal human growth:
Development : increase in function of processes
related to body and mind

 1- Fetal: This is the fastest period of growth, accounting for about 30% of eventual height.
2- The infantile phase : Growth during infancy to around 18 months of age is dependent on adequate nutrition.
Good health and normal thyroid are also necessary. This phase is characterized by a rapid but decelerating growth
rate, and accounts for about 15% of eventual height.
3- Childhood phase : This is a slow, steady but prolonged period of growth that contributes 40% of final height.
Pituitary growth hormone (GH) is the main determinant of a child's rate of growth .
4- Pubertal growth spurt : Sex hormones, cause the back to lengthen and boost GH secretion. This adds 15% to final
height. The same sex steroids cause fusion of the epiphyseal plates cessation of growth

 Assessment of growth:


Growth must be measured accurately, with attention to correct technique and accurate plotting of the data on
chart.
I ANTHROPOMETRIC MEASURES:
Weight :
Drug Dose in children depend on the weight
 - Normal birth Weight = 2.5-3.5Kg
- During the first 7 days there is an initial loss of weight reaching up to 10% of birth weight, due to loss of
meconium, urine and less fluid intake. The birth weight is regained by the 10th day in most full term babies.
- Double birth weight: 4-5 months.
 - Triple birth weight: 1 year .
- Quadruple birth weight: 2 year .
During 1st 4 months : Weight increased by Kg/month.

For first year can be calculated by

nd

 During 2 4 months: Weight increased by Kg/month.

( Age in months + 9 ) / 2

rd

 During 3 4 months : Weight increases by Kg/month.

For Second-Sixth year can be

calculated by





The weight doubled at 4 Months

  ( Age in year x 2) + 8 Kg

The length doubled at 4 years

Form 7 -12 years old can be
calculated by
 Age in year x 7)-5 /2

 Length or Height :
 - Normal birth length = 50cm.
 - At 1 year = 75cm i.e. increase by *25cm
- At 2 years = 87.5 cm i.e. increase by *12.5cm.
- The infant doubles his birth length at 4 years.
 So at 4 years, the length is 100 cm.

The lower limbs should be fully extended




Length(<2yrs) measurement of an infant

After the 2nd year length can be

calculated by:
 (Age in years x 5) + 80 cm.

Mid-parental height :
Boys:
 (maternal height + paternal height +13)/2
Girls:
 (maternal height + paternal height - 13)/2
Height(>2yrs) measurement:

Mid arm circumference :

 - It gives an idea about the state of muscle nutrition.
 - 13.5 14.5cm in children 1-5 years old.

The heels, buttock, scapula and occiput

should touch the wall

- Decrease in 1 cm (i.e12.5 13.5 cm) have mild to

 moderate malnutrition
- less than 12.5cm have severe malnutrition.
Head circumference : Measure the widest occipito-frontal
 circumference
- Gives an idea about the integrity of brain growth.
The maximum rate of head growth occurs during the 1st year (50%).
At birth 35 cm
At 6 months 43 cm

1 cm/mo for first yr

At 1 year 45-47 cm
At 2 years 47-49 cm
At 5 years 50 cm
 At 12 years 55 c

10 cm for rest of life

 Hold the child gently
Remember to measure by cm not inch

 Proportion of upper and lower segments:

*At birth : upper seg: Lower Seg = 1.7 : 1
- The upper segment is measured from the crown symphysis pubis
 - The lower segment is measured from the symphysis pubis the heel.

 At 3 years : the ratio = 1.3 : 1

 At 7 year : the ratio = 1 : 1



The Arm Span height :
 The arm span = the distance between the tips of the middle fingers of out stretched arms.
 Span height
* - 3 cm at 1-7 yrs
  0 cm at 8-12 yrs
  + 4 cm (in male) at 14 yrs
  + 1 cm (in female) at 14 yrs


Persistence of the fetal and infantile

proportions indicates some endocrinal
disturbances e.g. *hypothyroidism.

II FONTANELLES :
 - There are 6 fontanelles : (1. Anterior & 1. Posterior & 2. Sphenoid and 2 mastoid)
 - The anterior & Posterior ones are clinically important.
 - The post. Fontanelle : closes at full term or 1-2 month later
 - The Ant. Fontenelle : is 3 fingers at birth (average 4-5cm)
 Delayed closure In:
  2 fingers at 6 months
 Hydrocephalus.
 1 finger at 1 year
 Down syndrome.
 Hypothyroidism.
 *close at 1.5 year

III TEETHING :
Causes of delayed eruption of teeth :
(A) Deciduous (Milk) Teeth :
 They are 20 in number (10 in each Jaw)
(B) Permanent teeth :
They are 32 in number (16 in each Jaw)



 Rickets
 Hypothyroidism
 Down syndrome
 Osteogenesis imperfecta
 Under & Malnutrition
Local causes e.g. cysts, retained secondary
 teeth, supernumerary teeth.
Causes of premature eruption (rare) :
Natal teeth (at birth)
 Congenital syphilis
 Ellis van Creveld syndrome

 Assessment of Development:




They are arranged in two ways:

 1- According to the Milestones.

2- According to the age .

Study it by the way you like

Gross motor development:

Prone position:

 Birth Generally flexed Posture

 2 months Rise his chin when prone
 3 months Head support
 4 months Lifts head and shoulders with weight on forearms
6 months Arms extended supporting chest

Pull to sit:
 Birth Complete head lag
 4 months No head lag




4 months old ,no head lag

2 months old , head lag

 Sitting:
 6 weeks Curved back, needs support from adult

 67 months Sits with self-propping



9 months Gets into sitting position alone

 Standing and walking:
7 months Crawling




 10 months pull to standing position

 12 months walk with one hand held

 15 months walk alone

 24 months run well

4-6 Weeks old sitting with Curved back




Early walking is not an advantage

 30 months get up stairs alternating feet

 36 months stand momentary on one foot & rides tricycle

 48 months hops on one foot

B\C it cause more load on bone

May cause bowing

 Pencil skills:


18 months Scribbles with a pencil

 3 years Draws a circle

3 years
1.5 years

 4 years Draws a cross or square

 5 years Draws a triangle


4 years

5 years



Speech and language development:
7 months polysyllabic vowel sounds

Intelligible Speaking :


Understanding the child while speaking

 9-12 months 2-3 words with meaning (mama, dada, ----)

 18 months 10 words

At 2 years 50 % understandable

 24 months 3 words together

 36 months knows age & sex

At 3 years 75% understandable

 48 months counts 4 pennies, tells story

 60 months names 4 colors

At 1 year 25% understandable

At 4 years 100% understandable



MENTAL DEVELOPMENT :

At 2nd month *Social smile
At 3 4 months Can recognize his mother&laughing.
 At 9 months Stranger anxiety& plays peek-a-boo
At 1.5 year Sphincter control (up to 4 years normally)

According to age:


Age 2 months :
 Adaptive/ Fine motor: Follow object with eyes past midline.
 Language: Vowel sounds.
 Gross motor: Lifts head in prone position to 45 degree.
 Personal/ Social: Smiles in response to others.

plays peek-a-boo

 Age 6 months:
1- Make babbling sounds (vocalize)
2- Raise his head and chest when prone
3- reach for objects
4- *Sit without support
Age 9-10 months :
 1- Pincer grasp
 2- Says mama & baba
 3- crawls

Child at 9 Months

4- Feeds self,Gets to a sitting position.

Age 12 mo:
 1- Helps turn pages of book.
 2- 2-4 words more.
 3- Stands independently, walks one hand held, Points to indicate wants.
Age 18 months (1.5 years ) :
Motor: Runs stiffly; sits on small chair; walks up stairs with one hand held; and wastebaskets
 Adaptive: Makes tower of 4 cubes, Scribbles with a pencil

Delay speaking if 1.5 year old no even single word .

 Language: 10 words (average); names pictures; identifies one or more parts of body
 Social: Feeds self, may complain when wet or soiled.
Age 24 months( 2 years ) :

Motor: Runs well, walks up and down stairs, one step at a time; opens doors; climbs on furniture; jumps
 Adaptive: Makes tower of 7 cubes (6 at 21 mo); folds paper

 Language: Puts 3 words together (subject, verb, object), use I & you

 Social: Handles spoon well; helps to undress; listens to stories when shown pictures
*Age 36 months( 3 years ) :




Motor: Rides tricycle; stands momentarily on one foot

 Adaptive: Makes tower of 10 cubes; *copies circle .

Language: *Knows age, name and sex; counts 3 objects correctly; repeats 3 numbers or a sentence of 6
 syllables

^W
shoes); washes hands

 Age 48 months( 4 years ) :




Motor: Hops on one foot; throws ball overhand; uses scissors to cut out
 pictures; climbs well

 Adaptive: Copies bridge from model; copies square; draws man with 2 to 4 parts besides head.
 Language: Counts 4 pennies accurately; *tells story and *Speech is 100% intelligible

 Social: Plays with several children, with beginning of social interaction and role-playing; goes to toilet alone.
Age 60 months( 5 years ) :
Motor: Skips

 Adaptive: Draws triangle from copy; names heavier of 2 weights

 Language: Names 4 colors; repeats sentence of 10 syllables; counts 10 pennies correctly




Social: Dresses and undresses; asks questions about meaning of words; engages in domestic role-playing.
 Developmental warning signs:
At any age Regression in previously acquired skills
 At 10 weeks: No smiling:

 At 6 months: Persistent primitive reflexes, Persistent squint

 At 1012 months: No sitting, No double syllable babble, No pincer grasp

 At 18 months: Not walking independently, Less than 6 words, Persistent mouthing and drooling
 At 2.5 years: No 23-word sentences




At 4 years: Unintelligible speech



Milestones that are essential to remember:



46 weeks Smiles responsively

 67 months Sits unsupported

 9 months Gets to a sitting position

 10 months Pincer grasp

 12 months Walks unsupported

 Two or three words

 18 months Tower of three or four cubes

24 months Two to three word sentences

 Puberty:


 The first signs of puberty are usually:

Testicular enlargement in boys,

Breast budding in girls.

 - Puberty is precocious if it starts before the age of 8.5 years in girls and 9.5 years in boys.
 - Puberty is delayed if onset is after 13 years in girls and 14 years in boys.

- A growth spurt occurs early in puberty for girls, but at the end of puberty for boys.

After 2 years the child increase in height 6 cm\year

Until puberty where the Growth spurt occur the height increase 10-15 cm\year

- Puberty is evaluated by clinical examination of the genitalia, breasts and secondary sexual characteristics.
The scale used is known as Tanner staging.

Commonly tested milestones appear in bold :-

 Review of important Points :

- initial loss of weight reaching up to 10% of birth weight that regained within the 10th day .
- Scribbles with a pencil at 18 months .
 - Draws a circle at 3 years.

 - Draws a cross or square at 4 years.

 - Draws a triangle at 5 years .

- The maximum rate of head growth occurs during the 1st year.
- The length doubled at 4 years.
- The weight doubled at 4 Months
- ant. Fontenelle close at 1.5 year.
- Social smile at 2nd month .
- Sit without support at 6 months .
 - Speech is 100% intelligible at 4 years .