Growth and Development

Growth - refers to an increase in physical size of the whole body or any of its parts.
It is simply a quantitative change in the child’s body.
It can be measured in Kg, pounds, meters, inches, ….. etc

Development refers to a progressive increase in skill and capacity of function. It is a qualitative change in the child’s
functioning. It can be measured through observation.

2 Parameters of Growth and Development

Weight - Most sensitive measurement for growth

Weight Gain:
5-6 months = 2x
1 year = 3x
2 – 2 1/2 = 4x

Height
-Estrogen responsible for increase in height in female
-Testosterone responsible for the increase in height in male
-Stoppage of height coincide with the eruption of the wisdom teeth

1-6 months = increase in 1 inch / month

7-12 months = increase 1.5 / month
1 year = increase 50% / month

Height comparison
• 9 y/o = Male = Female
• 12 y/o = Male < Female
• 13 y/o = Male > Female

Development
• Increase in the skills or capacity to function
• Qualitatively
• How to measure development
– By simply observing the child doing simple task
– By noting parent’s description of the child’s progress
– Measure by Denver Developmental Screening Test (DDST)
• MMDST
• Metro Manila Developmental screening Test
• Philippine based exam
Main Rated Categories
• Language = ability to communicate
• Personal/Social = ability to interact
• Fine motor adaptive = ability to use hand movements
• Gross motor skills = ability to use large body movements
Cognitive Development
• Ability to learn and understand from experiences.
• To acquire and retain knowledge
• To respond to a new situation and to solve problems
• Learning = change of behavior
• IQ = [Mental Age/ Chronological Age] x 100
• Normal IQ = 90 – 110
• Gifted Child = >130 IQ level
Stages of Growth and Development
• Prenatal
– Conception to birth
• Infancy
– Neonatal = first 28 days
– Formal Infancy = 29th -1 year
• Early Childhood
– Toddler = 1-3 y/o
– Preschool = 4-6 y/o
 • Middle Childhood
– School Age = 7 to 12 y/o
• Late Childhood
– Pre-adolescent = 11-13 y/o
– Adolescent = 12 – 13 y/o up to 21
Principles of Growth and Development
1. Each child is unique.
2. Growth and Development is a continous process
– From womb to tomb principle
– Begins from conception and ends with death
• Human Growth & Development
“from womb to tomb”
• Human Growth & Development
“from womb to tomb”
3. Not all parts of the body grows at the same time or at the same rate
– ASSYNCHRONOUS GROWTH
4. Growth and development occurs in a regular direction reflecting definite and predictable patterns or trends
Locomotion
Behavior = most comprehensive indicator of developmental stages
Play = universal language

GENERAL PRINCIPLES
Definition of Terms
A. Growth: increase in size of a structure. Human is orderly and predictable, but not even; it fc cyclical pattern.
B. Development: maturation of physiologic & psychosocial systems to more complex state.
C. Cephalocaudal: head-to-toe progression of growth & development
D. Proximodistal: trunk-to-periphery (fingers & toes) progression of growth and development
E. Phylogeny: development or evolution of a sp group; a pattern of development for a species
F. Ontogeny: development of an individual species
• Rates of Growth and Development
• Rates of Development
A. Fetal period and infancy: the head and neurologic tissue grow faster than other tissues.
B. Infancy and adolescence: fast growth periods
C. Toddler through school-age: slow growth periods
D. Toddler and preschool periods: the trunk grows more rapidly than other tissue.
E. The limbs grow most during school-age period.
F. The trunk grows faster than other tissue during adolescence.

Factors Influencing Growth Development

• Race
• Sex
• Intelligence
• Nationality
• Nutrition
• Socio-economic Status
• Health
• Ordinal Position in the family
• Parent – child Relationship
• Theories of Growth and Development
• Sigmund Freud’s
Psychosexual Theory
• 1856 – 1939
• Australian Neurologist
• Founder of Psychoanalysis
• 1st to introduce Personality Development

Time of “Family Romance”

A. Oedipal Complex
- This is marked by jealousy and rivalry toward the same sex parent and love of the opposite sex.
- Seen in boys.
B. Electra Complex
- Seen in girls.
CASTRATION ANXIETY
Values and rules learned from parents.
Guilt and self-esteem develop.
Desires are repressed and introjection and role identification with parent of the same sex.
Psychosexual model
1. Oral: 0-18 months
a. Pleasure & gratification through mouth
b. Behaviors: dependency, eating crying, biting
c. Distinguishes -between self and mother.
d. Develops body image, aggressive drives
2. Anal: 18 months - 3 years
a. Pleasure through elimination or retention of feces
b. Behaviors: control of holding on or letting go
c. Develops concept of power, punishment, ambivalence, concern with cleanliness or being dirty
3. Phallic/Oedipal: 3 - 6 year
a: Pleasure through genitals
b. Behaviors: touching of genitals, erotic attachment to parent of opposite sex
c. Develops fear of punishment by parent of same sex, guilt, sexual identity
4. Latency: 6 - 12 years
a. Gain new skills in social relationships
b. Behaviors: sense of industry and mastery
c. Learns control, over aggressive, destructive impulses
5. Genital: 12 - 20 years
a. Sexual pleasure through genitals -
b. Behaviors: becomes independent of parents, responsible for self
c. Develops sexual identity, ability to love and work

Erick Erickson’s Stages of Psychosocial theory

Former student of Freud
• Stresses the importance of culture and society to the development of one’s personality
1. Trust vs. Mistrust
• Trust is developed via
– Satisfying needs of infants on time
– Care must be consistent and adequate
– Give experiences that will add security
2. Autonomy vs. Shame & Doubt
• Independence and self-government
3. Initiative vs. Guilt
• Learns how to do BASIC things
4. Industry vs. Inferiority
• Learns how to do things well
5. Identity vs. Role Confusion
• Learns who he is or what kind of person he will
• Adjusting to new body image and seeking freedom from parents
6. Intimacy vs. Isolation
• Career focus
• Looking for a lifetime partner
7. Generativity vs. Stagnation
8. Integrity vs. Despair
Summary of Psychosocial Model
• Erik Erikson
Jean Piaget’s Stages of Cognitive Development
• Jean Piaget
• Swiss Psychologist
• Genetic Epistemologist
• Reasoning Powers
COGNITIVE DEVELOPMENT
Cognitive Theory
1. Sensorimotor
• 0-2 years old
• Also called “Practical Intelligence”
– Words and symbols are not yet available
– Communication through senses
Schema 1: Neonatal reflexes
• 1 month
• Early reflexes
Schema 2: Primary Circular Reaction
• 1-4 months
• Activities related to body
• Repetition of behaviour
– example: thumbsucking
Schema 3: Secondary Circular Behaviour
• 4-8 months
• Activities not related to the body
• Discover person
• Object permanence
• Memory traces
• Anticipates familiar events
Schema 4: Coordination of Secondary Reaction
• 8-12 months
• Exhibit goal directed behavior
• Increase sense of permanence and separateness
• Play activities: Throw and retrieve
Schema 5: Tertiary Circular Reaction
• 12-18 months
• Use trial and error to discover characteristic of places and events
• “Invention” of new means
• Capable of space and time perception
Schema 6: Invention of New means thru Mental Coordination
• 18-24 months
• Symbolic representation
• Transitional phase to the pre-operational thought period
2. Pre-operational Thought
1. Pre-conceptual thought
- 2-4 yrs old
- Concrete
- Literal
- Static thinking
- EGOCENTRIC
- Reversibility
- Animism
2. Intuitive thought
beginning of causation
• Concrete Operational
• 7-12 yrs old
• Systematic reasoning as solution to the problems
• Concept of reversibility
• Concept of Conservation
• Activity Recommended: Collecting and Classifying
4. Formal Operational
• 12 years old and above
• Period when recognition achieve its final form
• Can solve hypothetical problem with SCIENTIFIC REASONING
can deal with the past, present and future
• Capable of abstract, mature thought and formal reasoning
• Activity recommended: talk time; focus on opinions and current events

Summary of Growth and Development

Age Stages Freud’s Psycho- Erickson ‘s Psycho-social Piaget’s

sexual Theory Theory CognitiveTheory
0-1 yrs Infant Oral Trust vs. Mistrust Sensory Motor
1-3 yrs Toddler Anal Autonomy vs. Shame & Doubt Sensory Motor
3-6 yrs Preschool Phallic Initiative vs. Guilt Pre-conceptual or
Pre-operational
6-12 yrs School Age Latency Industry vs. Inferiority Concrete Operational
12-20 yrs Adolescent Genital Identity vs. Role Confusion Formal Operational
20-25 yrs Young Intimacy vs. Isolation
Adult
25-60 yrs Old Adult Generativity vs. Stagnation
60 and above Senescence Integrity vs. Despair

Stages Significant Person/s Virtues

Infant Primary Caregiver Hope, Faith
Toddler Paternal Will, Determination
Preschool Family Purpose, Courage
School Age Teacher Competence
Adolescent Peer group Fidelity, Loyalty
Role models
Young Adult Partners/ Friends Love
Old Adult Household, workmates Care
Senescence Mankind or My kind Wisdom

Stages Type of Play Fears

Infant Solitary Stranger Anxiety by 6 & 9 months
Toddler Parallel Separation anxiety,
Big Animals
Preschool Associative or cooperative Dark, Ghost, Witches, Castration, or Body Mutilation
School Age Complex Failure at School, Bullies, Intimidating Teachers,
Replacement, Displacement in school, Loss of Privacy,
Death
Adolescent Competitive Relationship with Opposite sex, Adult Roles
 Stages Common Problem Age Appropriate Toys
Infant -Aspiration of foreign bodies Mobiles
-Suffocation Rattles
-Fall Musical Box
-Burn Squeeze toys
-Baby Bottle Syndrome Teething Rings
-Diaper Rash Textured Balls
Colic Large Soft Cuddly Toys
Toddler -Aspiration Push and Pull Toys
-Fall Building blocks
-Motor Vehicle Toys to ride on
Stuffed Toys
Preschool -Poisoning House Keeping toys
-Motor Vehicle Play Ground Equipments
-Drowning Tricycles
-Fall Watercolors
Coloring Books
Puzzles
School Age -School Phobia Dolls
-Enuresis Trains and Model kits
Games
Jigsaw puzzles
Collecting Objects
Adolescent -Motor Vehicular
-Accidents
-Suicidal tendencies
-Acne Vulgaris
-Obesity

Phase Age Group Significant Person Virtues Maladaptation &

Malignancies
1. Trust vs. Mistrust 0-1 years Mother/ Caregiver Hope, Faith Sensory distortion/
Withdrawal
2. Autonomy vs. 1-3 years Parents will Impulsivity/
Shame and Doubt Determination
compulsion
3. Initiative vs. guilt 3-5 years Family Purpose Ruthlessness/
Courage inhibition
4. Industry vs 6-12 Teacher Competence/ Skill Narrow Virtuosity/
Inferiority Inertia
5. Identity vs. Role 12-20 years Peers, groups, Role Fidelity, Loyalty Fanaticism/
confusion models Repudiation
6. Intimacy vs. 20-25 years Partner Love Promiscuity/
Isolation exclusivity
7. Generativity vs. 25-45 years Household, Care Overextension/
stagnation workmates Rejectivity
8. Integrity vs. 45 years to end of Mankind or “my Wisdom Presumption/
Despair life kind” despair

DEVELOPMENTAL MILESTONES

Infancy Diminishes: 9 months

Solitary play
Consider when choosing a play Neonate
Safety Complete head lag
Age appropriateness Largely reflex visual fixation for human face
Hygiene Hands fisted with thumbs in
Fear: Stranger Anxiety Cries without tears because lacrimal glands are not fully
Begins: 6 – 7 months developed
Peaks: 8 months
1 month 12 months
Dance reflex disappears Stands alone
Looks at mobile; follows midline Walk with assistance
Alert to sound, regards face Drink from cup, cooperates in dressing
Says two words other than mama and dada
2 months Pots & pans, pull toys and nursery rhymes
Holds head up when in prone Imitates actions, comes when called
Social smile, cries with tears, cooing sound Follows one – step command and gesture
Closure of posterior fontanel (2-3 months) Uses mature pincer graps, throws objects
Head lag when pulled to sitting position
No longer clinches fist tightly Toddlerhood
Follows object past midline Parallel Play – 2 toddlers playing separately
Recognizes parents  Provide 2 similar toys for 2 toddlers
Toys
3 months Squeaky frogs to squeeze
Holds head and chest up when in prone Waddling ducks to pull
Holds hands open at rest Trucks to push
Hand regard, follows object past midline Building blocks
Grasp and tonic neck reflexes are fading Pounding peg
Reaches for familiar people or object Fear: Separation Anxiety
Anticipates feeding Begins: 9 months
Peaks: 18 months
4 months 3 stages
Head control complete Protest
Turns front to back; needs space to turn Despair 
Laughs aloud; Babbling sound Denial
Babinski Reflex disappears Prevent:
Do not prolong goodbye
5 months Say goodbye firmly
Turn both ways (roll over) Say when you’re back
Teething rings, handles rattle well
Moro reflex disappears (5 – 6 months) Toddler Characteristic Traits
Enjoys looking around environment Negativistic: says no most of the time
Saying no – way of developing independence
6 months Limit questions, offer choices
Reaches out in the anticipation of being picked- up Rigid, ritualistic and stereotyped
Sits with support Ritualistic – way to gain mastery
Puts feet in mouth in supine position Temper Tantrums
Eruption of first temporary teeth ( Lower 2 central incisors) Stomping of feet
Vowel sounds “ah, eh” Holding breath
Uses palmar grasp; handless bottle well Screaming
Recognizes strangers Head banging
NC: Ignore the behavior 
7 months Scaphoid abdomen – underveloped abdominal muscle
Transfer objects from hand to hand (6 – 7 months) Physiologic Anorexia
Likes objects that are good sized for transferring food fad, food jag that last for a short period of time due tothe
preoccupation to environment
8 months
Sits without support 15 Months
Peak of stranger anxiety Plateau stage
Plantar reflex disappear (6-8 months) WALKS ALONE
 – lateness in walking is a sign of mild mental retardation
9 months Puts small pellets into small bottle
Creeps or crawls; need space for creeping Creep upstairs
Neat pincer grasp reflex, probes with forefinger  4 – 6 words
Finger feeds, combine 2 syllables “mama & dada” Scribbles voluntarily with pencil, holds spoon
well, seat self in a chair 
10 months
Pulls self to stand 18 Months
Understand the word no Height of POSSESIVENESS – favorite word MINE
Respond to name Bowel control achieved
Peek – a – boo, pat a cake, since they can clap No longer rotates a spoon
Can run and jump in place
11 months Walks up and downstairs holding on to a person’s hand or
Cruising, stand with assistance railing, typically placesboth feet on one step before
Walking while holding to his crib’s handle advancing
One word other than mama and dada Names one body part
24 months  Protects the eyes from any object
TERRIBLE TWOS coming near it
Turns pages one at a time, removes shoes, pants, etc  Seen as rapid eyelid closure
Can open doors by turning door knobs, unscrew lids  Elicited when the eye recieves
50 – 200 words (2 word sentences), knows 5 body parts strong light by shining a strong light
Walk upstairs alone, still using feet on the same step at on the eye
same time 6. sneezing, coughing Reflex
Daytime Bladder Control  protects and clears the airway
best time to bring the child to dentist: 2 – 3 years or when 7. Yawning Reflex
temporary teeth iscomplete protects cells from depleted oxygen
8. Gag Reflex
30 months lifelong reflex to protect the airway
Makes simple lines or stroke or crosses with pencil 9. Moro Reflex
Can jump down from chair  seen as embracing motion of the arms
Knows full name, holds up finger to show age abduction followed by adduction of the arms
Copy a circle and legs in response to:
Temporary teeth complete (posterior molar: last to erupt) – A sudden jarring of the crib
20 deciduous teeth – Falling sensation
tooth brushing: 2 – 3 years – Loud noise
9. Moro Reflex
36 months  disappears by the end of the 4th and
TRUSTING THREES fifth month when an infant can
Tooth brushing with little supervision already roll away from the attacker.
Unbutton buttons  the reflex stimulates the action of
Draws a cross, learns how to share someone trying to ward off an
Knows full name and sex atacker, then covering up to protect
Speaks fluently, 200 – 900 words self
NIGHTIME BLADDER CONTROL achieved 10. Babinski Reflex
Rides tricycle  Fanning or hyperextension of the
toes when the sole is stoked from
Preschoolers the heel upwards
Cooperative play – playhouse  Due to immaturity of the nervous
Role playing is usual system
 Most acute in the first month and
Reflexes in the Newborn gradually disappears until the 12th
Neuromuscular System month
Feeding Reflexes 11. Tonic Reflex
1. Rooting Reflex  When on supine, infant turns his
– Turns head to the direction of the head to one side, and the arm and
stimulus. leg on the side to which the head
– Opens lips to suck when the object turns extend, and the opposite arm
touches his cheeks or mouth and the leg flex
– Reflex needed for locating food  boxer or fencing reflex
• Variable time for disappearance of  Disappears at 4 weeks
Rooting Reflex 12. Darwinian/ Step in place/ dancing/ walk
 Acceptable time for disappearance: 3-4 reflex
months  demonstration of a few quick
 7 months: last period of disappearance alternating step when the newborn is
• Feeding Reflexes held in a vertical position and the
2. Sucking Reflex feet touch a hard surface
 anything that touches his lips is sucked  disappears after 4 weeks
 Needed for physiologic and psychologic 13. Grasp Reflex
needs  Palmar: the infant grasps an
 Disappears: 6 months examiner’s finger when palm is
• Feeding Reflexes stimulated
3. Swallowing Reflex  Disappears at 4 months when the
o Swallows anything that touches the babycan already reach for objects
posterior tongue.  Plantar: Tendency to curl toes
4. Extrusion Reflex inward when the sole of the foot is
 Anything that touches the anterior stimulated
tongue is extruded  Lessens after 8 to 9 months in
 Protects infant from swallowing preparation for walking
inedible substances 14. Landau Reflex
 Disappears: 4-6 months – When held prone with one hand
 Protective Reflexes underneath him supporting his trunk,
• Protective Reflexes the baby demonstrates some muscle
5. Blinking Reflexes tone and keeps his head in line with
the trunk
– Sagging muscle tone: Hypotonia