GROWTH AND DEVELOPMENT
Growth - is an increase in physical
size, measured as height, weight, and
other body parts. Measured in terms of
quantity.
- Size
Development - the progressive
increase in skills, maturity in mental,
physical and social markers. A.k.a.
Maturation. Measured in terms of
quality
- Skill
- These two always go together or
else the child will grow abnormally
PRINCIPLES OF GROWTH AND
DEVELOPMENT
- Principles that guide parents in their
baby care and discipline
- A golden rule in pediatrics
1. It is a lifelong process - from
conception to death
2. Directional/orderly sequence
● Cephalocaudal: head to tail
○ The baby learns to move his
head first, then his back, his
buttocks, then his legs
● Proximodistal: near to far
○ Newborn reflexes are
primitive reflexes
○ A newborn’s fists are always
fisted because it’s still a reflex
○ They first use their palms
before they could learn how
to use their fingers
○ They are able to control a
part of their body that is near
their body first, “proximal”
● General to specific
○ The way a baby reacts to
stimuli
○ The pain response is general
at first
○ As they grow, the pain
response is specific
○ This is because you can now
identify the pain stimulus
● Simple to complex
○ The way a baby
communicates is through
crying (simple)
○ As they grow, they start to
learn how to pronounce
words (complex)
3. Influenced by numerous factors
● Harmful/chemical factors - these
factors can cause numerous
defects on the baby
● Genetics
● Food you were given
● Environment
4. Individualized - unique
● Don’t compare your patients
with each other because they
are different from one another
● Even twins are uniquely different
5. Predictable stages at different
rate
● Rates of growth are different
● Rapid (growth spurts) - infancy,
adolescent
● Slow (growth gaps) - toddler,
preschool, school-age (slower
process of growth)
● Some toddlers or preschoolers
are often found as picky eaters.
This is because their body
dictates that they dont need as
much food. Because growth has
slowed down = decreased
appetite
6. Skills and behavior are learned
by practice
● For a baby to learn something,
they are encouraged to repeat
that action again and again until
they’ve mastered it (ex: teaching
a baby to close open his hands
to teach them how to control
their fingers and be able to
grasp things better)
7. Primitive reflexes must disappear
first before development begins
8. Play is central to the life of the
child
● A child learns how to socialize
through play
9. Body systems do not develop at
the same time
● Baby inside the womb can’t
breathe on their own yet
● As you get older, your systems
mature
● One system remains dormant
until you undergo puberty >
reproductive system
GAMES CHILDREN PLAYS
- Games can be used in monitoring
behavioral changes in children
Things to consider in buying toys:
1. Must be safe - no small parts,
non-toxic, not sharp
2. Must be chosen based on the child’s
stage of development or age
3. Must have a purpose
4. (if the child is sick) Must be chosen
based on the limitation of a child’s
condition
Infants
● Plays alone - SOLITARY GAMES
● Plays with their BODY AND
SENSES (a baby usually plays first
with his mouth, his hands, etc.)
● TOYS - mobiles, rattles, teething
rings, music boxes, squeeze toys
Toddler
● I, Me, Mine
● Egocentric
● Very possessive/ cannot share
● They don’t want to share but they
want company so they play beside
someone
● Loves to play BESIDE another child
but must have each a toy
PARALLEL GAMES
● TOYS - promote skills of walking -
push and pull toys, and talking - toy
telephone, coordination - blocks
Preschooler
● Children under this stage are very
imaginative
● Loves to share and imitate adults in
their play role-play -
COOPERATIVE/ASSOCIATIVE
GAMES
● TOYS - role-playing games -
playschool, playhouse, doctor-nurse
kit etc.
Schooler
● Must have a winner at the end of
the game COMPETITIVE GAMES
● TOYS - card games (flash cards,
unggoy ungguyan), scrabble,
hopscotch, skipping rope, etc
FACTORS INFLUENCING
GROWTH AND DEVELOPMENT
Genetic Factors
● Heredity - sex, genetic traits like
gender, height and weight, physical
characteristics, personality
 (temperament), medical conditions, ● Socioeconomic level - lack
race and nationality, intelligence resources to provide an
● The baby’s gender comes from the environment for optimum health
father ○ Despite economic status being a
Environmental factors factor in a child’s growth, it is
● Neuroendocrine factors - growth also important to know that it’s
hormones, also about being wise in
○ Influences the pattern of your choosing the right food and
growth right after you were born using the right resources to
○ May also be factors that ensure the child’s healthy and
influence the baby while they proper growth
are inside the womb
○ Hormonal problems that may ENVIRONMENTAL HAZARDS
affect your growth Pre-natal
● Nutrition - diet, amount, kind of ● Maternal infection (rubella),
food chemicals, radiation, water, air, and
● Interpersonal relationship - plays food contamination, smoking, drugs,
a critical role in emotional, alcohol
intellectual and personality ● Maternal infection may cause
development natural abortion
○ Cultural norms ● Chemicals may cause birth defects
○ Mothering person - single most Post-natal
influential person during early ● Environment at home, in school, the
infancy; molds the child city and the country
○ Ordinal position in the ● The home you grew up in; what you
family/family size; ex: the see in the people you are with; you
earliest child is usually the most imitate what they do
responsible, the youngest is the
spoiled, the middle child is DEVELOPMENTAL THEORIES
usually neglected (not always Freud’s PSYCHOSEXUAL THEORY
tru) ● Behavior is the result of instinctual
● Health and disease - skeletal drives of a primarily sexual nature
disorders, dwarfism, rickets, (libido)
cretinism (congenital ● Sexual gratification is focused on a
hypothyroidism) particular body part
○ Childhood is our sickly stage ○ Infancy: oral
○ Very old and very young are the ○ Toddler: anal
most vulnerable ○ Preschooler: phallic (for gender
○ You may get these identification)
diseases/disorders if you weren’t ○ School age child: latency (calm;
given enough vitamins/food still focuses on the genitals but
not the main focus)
 ○ Adolescent: Genital (puberty)
Erikson’s PSYCHOSOCIAL THEORY
● Behavior is the result the person’s
social view of self. The resolution of
a conflict in each stage leads to
accomplishment of his
developmental task
● Developmental tasks:
○ Infancy: trust vs. mistrust
○ Toddler: autonomy vs. shame
and doubt
○ Preschooler: initiative vs. guilt
○ School age child: industry vs.
inferiority
○ Adolescent: identity vs confusion
Infancy
● Freud’s oral/ erikson’s trust vs
mistrust
● The infant receives pleasure
through his mouth. Answering their
cry (needs) helps develop trust
● When a baby cries, they are asking
for physiologic needs; it’s not true
that when they are crying, they
should be ignored for a while in
order for them not to grow spoiled;
mistrust may develop
● Mistrust develops when care is
inconsistent and inadequate
Toddler
● Freud’s anal/erikson’s autonomy vs
shame and doubt
● Elimination gives the child a sense
of autonomy; they are able to
control their bowel needs already at
this stage
● Finds pleasure in controlling his
eliminatory function
● Toilet training begins
● The child is taught the right place,
right manner and right time to
eliminate bowel functions
● Feeling of independence
● Shame and doubt develop when he
learns that his assertiveness is not
acceptable
● Don't shame the child when they
show their autonomy by spanking
them or making them doubt through
using reverse psychology, it will only
make them confused
● Teach the child what is right with no
agendas in order for them to know
what to in certain situations and in
order for them not to acquire the
negative values at that certain stage
Preschool
● Freud’s genital (phallic)/erikson’s
initiative vs guilt
● Sexual identity through awareness
of his/her genital
● They have a tendency to touch the
things that they are curious about so
there is a possibility that they will
touch their genitals at this stage
● Parents may reprimand their
children from doing this but it is
wrong and they may develop a fear
of castration complex (”wag mo ‘yan
hawakan. Puputulin ko yan.”)
● Initiative is the freedom to initiate do
small activities and appreciated for it
● Stage of “KUSA”
● Don't make the children go away
when they are showing initiative;
this will make them develop guilt; let
the child help by making them do
simple tasks
● Another technique would be to allow
the child to imitate you through
using their toys like while cooking
● Guilt develops if the child is made to
feel that his activity is bad or wrong
Schooler
● Freud’s latency/ erikson’s industry
vs inferiority
● The sexual drive (libido) is
controlled and dormant
● Interest on same sex only (normal
homosexual)
● Boys vs girls
● Learns how to do things well (their
own personal criteria)
● At this age, the child discovers
where they excel at (in sports,
academics, etc.)
● Achievement oriented years
● Wants to prove their best in school
Adolescent
● Freud’s genital/erikson’s identity vs
role confusion
● You want to blend in
● Resurgence of sexual drives,
develops sexual maturity
● Your hormones will also play a role
in this stage
● Relationships with the opposite sex
● “Who am I?”
● Learns who they are and what kind
of person they will be
● Need for feeling of belongingness
and acceptance by himself and
others
● The way we saw ourselves when
we were younger won't be the same
way we see ourselves as of the
moment
Piaget’s COGNITIVE DEVELOPMENT
● By John Piaget
● Explains how a child learns and
thinks
● Child reorganizes their thinking
process to bring them close to adult
thinking
● Shows the gradual development of
how you think from when you were
a baby up to how you are right now
Sensorimotor (0-2 years old)
● Learning by sensation
● Reflex activity to repetitive behavior
to imitate behavior
○ Baby is taught through
sensation such as “close
open”(making the baby close
and open their hands),”beautiful
eyes”(making the baby close
and open their eyes)
● “Cause and effect”/”trial and error”
○ Ex: when a child touches
something hot and they get hurt
from doing it, they wont do it
again
● Object permanence
○ When they see an object and it
gets out of their sight, they
realize that they don’t really
disappear but just goes from
one place to another
(peek-a-boo game)
Preoperational (2-7 years old)
● The stage before you are able to
use your brain fully enough
● Thought becomes more symbolic
○ You see things in your mind and
gradually you give meaning to
those things such as an
umbrella, you’ll know how it
looks like and more often you’ll
see that it is used when it is
raining so then it will be
registered in your brain as an
object that is used for that
purpose
● Unable to understand relationship of
size, weight, and volume
 ○ They’d still think that a tall glass
contains more than the smaller
glass even though both glasses
have equal volume
● Concept of time is now and distance
is only as far as the eyes can see
○ They don't know dates yet
○ “Market day”; “My birthday”
○ Their concept of time should be
in the concept of activity “Mama
kelan ang birthday ko?” “Apat na
tulog nalang birthday mo naa”
● Egocentrism (cannot take another’s
point of view)
○ They don't see the difference
between needs and wants
● Centering (attention on only one
feature of an object)
○ Ex:a child can only describe an
apple for its color which is red,
they can’t distinguish it yet if it is
a washington apple; they can
only focus on ONE characteristic
at a time
○ They don't have the ability to
think innovatively yet so they get
shocked when for example, a
cup, is not used for drinking but
instead as a pen holder
● Very imaginative (magical thinking)
○ They think that their words can
make things happen
○ Their dreams are powerful and
makes them think it is real
○ Children at this age are prone to
telling fabricated stories so it’s
important to investigate further
Concrete operations (7-12 years old)
● Thoughts become logical and
coherent, systematic reasoning
○ They are able to think in a more
scientific way like doing scientific
experiments
○ Children are given simple
scientific experiments at this age
● Capable of seriation (sorting
according to quality)
○ They can already sort things
from smaller to biggest
○ They can sort things through
quality like fruits belong with
fruits, clothes belong with
clothes etc.
○ Two objects may not be the
same physically but of the same
quality (ex: you can put atis and
ice cream together because they
are both sweet)
● Capable of conservation (volume,
weight and number remains the
same even if appearance changes)
○ They are able to understand that
1 kilo of feathers vs 1 kilo of
steel is just the same
● Capable of classification
○ They can now classify animals,
fruits, etc.
○ Different from seriation because
seriation focuses on “quality”
● Understands reversibility
○ When ice turns into water when
it melts and becomes ice again
once it is put back into the
freezer
● Inductive reasoning
○ You’ve learned in science
already that when it is hot, there
is a possibility that it will rain
anytime soon
○ You’ve learned that if you played
in the rain for too long, it is
possible that you may get sick
Formal operations (12 years old and
above)
● Can solve hypothetical problem with
scientific reasoning
○ At this age you’ll start doing
scientific projects that will
require you to come up with
hypothesis
● Adaptable and flexible
○ You are able to accept other
people’s perspective
● Deductive reasoning
○ From the general effect to cause
○ You can now think of the
numerous problems that caused
a certain event
● Can think in abstract terms
○ You are able to understand
metaphorical language
ASSESSMENT OF GROWTH
● Quantitative assessment
1. Physiologic loss of weight a couple
of weeks (2-3weeks) after birth:
5-10% of birthweight
- Usually, weight loss is seen as
an indication of sickness.
However, in this age it is normal.
- Weight loss more than this may
indicate a problem
- This is because a baby is
weighted as they are born. A
newborn baby is plump, their
bladder is full, their bowel starts
to accumulate called
“meconium” and these add up
to their weight. Once their body
has normalized and adapted,
their body waste is eliminated,
their weight will normally
decrease.
2. Most rapid during infancy and
adolescent stages
- 6 months - doubles birth weight
- 1 year - triples birth weight
- 2 years - quadruples birth weight
3. Toddlers, preschoolers, schoolers
are considered to be slow periods of
growth
- The child’s appetite lowers
Known birth weight
Less than 6 months
Age in months x 600 + birth weight in
grams = expected weight in grams
*1 lb = 454 grams
*1 kilo = 1000 grams
*1 kilo = 2.2 lbs
Above six months
Age in months x 500 + birth weight in
grams = expected weight in grams
Example: 5 months old infant with birth
weight of 3,200 gms. (approx 3.2 kilos)
5 x 600 +3,200 = 6,200 gms or 13.66
lbs
Unknown birth weight
Below 1 year
Age in months / 2+3 or 4 = weight (kg)
Above 1 year
Age in years x 2 + 8 = weight (kg)

Example: baby 4 months old with
unknown bwt. should weigh what?
4 / 2 + 3 or 5 = 5 to 6 kg (if in lbs. X 2.2
= 11 to 12 lbs.
Tannhauser’s Formula - weight for
height
Height in cm - 100 = weight in kg
(note: less 10% for Filipinos)
*1 inch = 2.54 cm
*1 ft = 12 inches
Example: 5 ft 2 inches tall
Convert height to cm = 5x12 inches =
60 inches + 2 = 62 inches x 2.54 =
157.48 less 100 = 57.48 (less 10%)
=51.7 kg or 113.47 lbs. (normal weight
for a Filipino with a height of 5 ft 2
inches)
but as they reach toddlerhood,
they start to have an idea of
“parents”
○ As they reach preschool, they’ll
start to recognize more family
members
○ Widening their scope of
relationship with others
● Language
○ The cries of a baby have
different sounds depending on
what they need but only the
mother is able to know what the
baby needs
○ The cries of a baby may change
at around 7 months and is called
“differential crying”
Developmental Milestones
● Gross motor skills - cephalocaudal

ASSESSMENT OF
DEVELOPMENT
● DDST - Denver Developmental
Screen Test
● MMDST - Metro Manila
Developmental Screen Test (PH
version of DDST)
Every two months:
Areas assessed:
○ 0 - no head control; always
● Gross motor skill - large muscle
support the baby’s head
skills
○ 2 - lifts head
○ Refers to the whole body as a
○ 4 - lifts head and chest
unit
○ 6 - sits with support; support =
○ Cephalocaudal
backrest
● Fine motor skill - small muscle skills
○ 8 sits alone or without support
○ proximodistal
○ 10 - stands with support
● Interpersonal - social skill
○ 12 - stands alone/walks with
○ Only the primary caregiver
support
(mother) is recognized at first
 ○ 14 - 15 - walks alone
● Fine motor skills - proximodistal
○ Neonate: strong grasp reflex
○ 3 months: grasp reflex is
gone/hands are held open;
“hand regard” = plays with
hands and often observes their
hands
○ 6 months: palmar grasp; holds
big object like feeding bottle with
2 hands
○ 9 months: pincer grasp; thumb
and finger to hold objects
○ 12 months: can hold big and
small objects; puts things in and
out of containers, throws objects
Q&A:
● Ma'am may question po ako:
Tungkol po dun sa growth stages
nung children po. Bakit po parang
mabilis po yung growth ng girls at
school age if supposedly na nasa
growth gap po sila? Basing lang
po sa observation na matangkad
yung girls sa boys po during these
stages
○ A: normally the
develop slowly because
their secondary
characteristics come on a
later time compared to a
girl who sometimes get
their menstruation as soon
as 9 or 11 years old; it’s
also because of
genetic makeup of the
child; it depends on the
development of their
secondary sexual
characteristics; sometimes
because f the
development of the other
parts of the body of the
girl, their height is left
behind
● It’s important for kids to be given
not only toys that are for “boys”
but also for girls in order for them
to learn how to properly socialize
with the other gender. This is
important for the child to learn
how to own up to their actions
towards the girls and know how to
treat them properly. This will mold
the boys into better father figures
in the future.
● Ma'am hanggang kailan po
pwedeng maging central focus ng
child yung play? Ano po yung
mangyayari if pinagbawalan natin
boys yung bata sa paglalaro? Kailan po
natin sila pwedeng pigilan?
○ Parents are only there to
sexual
regulate their play time not
to reprimand them to play
unless the play they like to
do is hurting someone
else or if it is starting to
become the real center of
their life and they aren’t
the doing their other routine.
Play is very powerful so
this is very important for
the children. However, this
 may be addictive that’s
why it should be
regulated. It is dangerous
to make them stop at an
early time because their
needs wont be satisfied at
that age and they would
keep on looking for it.
Safety is a priority but they
should be allowed to play
in order for them to learn.

● During pre-school stage po, sa

Phallic stage ni Freud, diba po
children may start to be curious of
his genitals. Should we allow
toddlers po to touch his genitals?
Ano po yung dapat gawin during
such situations?
○ Yes because this is in
order for them to learn the
differences between
genders. This is ok
because they are just
curious and it isn’t with
malice. They also
shouldnt be teased for it
because they will develop
guilt because of it.