Tahap Tumbuh

Kembang & Evaluasi

Tumbuh Kembang
Anak Normal Tahap
Stimulasi
Tumbuh
Yudianita Kesuma Kembang
Divisi Tumbuh Kembang- Pediatri Balita
Sosial
FK UNSRI – RSMH
@2022

Stimulasi Tumbuh Kembang Balita | 1

 General Objective:
By the end of this lecture, the student will be able to discuss
growth and development stages of children.
 Specific Objectives:
By the end of this lecture, the student will be able
to:

• Identify the importance of growth and

development.
• Define growth and development.
• Mention the principles of growth and
development.
• List factors affecting growth and development.
• Mention types of growth and development.
• Identify the stages of development.
 Types of Growth & Development
● Types of growth:
- Physical growth (Ht, Wt, head & chest circumference)
- Physiological growth (vital signs …)

● Types of development:
- Motor development
- Cognitive development
- Emotional development
- Social development
 Stages of Growth & Development

01 02
Prenatal Period Neonatal Period
• Embryonic period Newborn
Conception – 8 w of gestational 0 – 28 days
• Fetal period
8 week - birth

03 04
Infant Period Childhood Period
1-2 years • Preschool age: 2-5 y
• School age/middle
childhood: 6-11 Y
• Adolescent: 10-18 Y
01
Prenatal Period
Growth & Development
 Embryonic period: conception – 8 weeks

conceptus
2017 4 weeks 6 weeks 8 weeks
2020
4-5 weeks
Fertilization conceptus
6 – 7 Weeks(3 mm) Mercury
Ends

1w: Implantation 4 weeks 6 W: Primitive nose, Ovaries and testes

Neural fold fuse philtrum, primary
2w: Endoderm & ectoderm Folding of embrio into
distinguishable
3w: Mesoderm, somite begin palate 9 grams
human like shape 7W: eyelids begin
to form Arm and leg bud appear 5 cm
5 Weeks
Lens placodes, primitive
mouth, digital rays on
hand
 Fetal period

10-13 17-20 21-28

Weeks 38 W
Weeks Weeks

10 W: the face recognizably 17 W: graps reflex Eyes open

Aterm weight
human 20 W: primitive Turns head down
2500-4500 grams
12 W: external genital alveoli and Full range
Length 45-55 cm
distinguabable surfactant movement
13 W: breathing and producton 3rs trimester:
swallong motion respond to
external stimuli
02
Neonatal Period
Growth & Development
 The newborn (Neonatal period) (0-28 days of age)

1. Transition from Intrauterine to extrauterin

2. Soon after birth, alert and ready to interact
3. After 40 minutes period of alertness, follow by somnolence, and sleep
4. Skin-to-skin contact between mother and infant immediately, increased rate and longer duration of
breast-feeding
5. Nearsighted, 8 – 12 inc
6. Hearing is well developed
 Age 0-28 Days (Neonatal Period)
PHYSICAL GROWTH PHYSIOLOGICAL GROWTH

• Birth weight for full term baby : 2.500 – 4.000 g • Vital signs
Low birth weight : < 2.500 g - Temperature (36.3 to37.2°C ).
- Pulse ( 120 to 160 b/min ).
• 1st week: weight may decreased (< 10%) - Respiration ( 35 to 50C/min) .
§ Withdrawal of hormones from mother.
§ Loss of excessive extra cellular fluid.
§ Passage of meconium (feces) and urine.
§ Limited food intake.

• 2nd weeks: regain or exceed birthweight

• Grow + 30 g/day in 1st month
• Height:
• Boys average Ht = 50 cm
• Girls average Ht = 49 cm
• Normal range for both (47.5- 53.75 cm)

Head circumference
• 33-35 cm
• Head is ¼ total body length
• Skull has 2 fontanels (anterior & posterior)
03
FIRST Year Period
Growth & Development
The first year

0 - 2 months
2 - 6 months
6 - 12 months
 Age 0 - 2 months
´ 1 st wk, weight may decrease (< 10 %)
´ 2 nd wk, regain or exceed birthweight
´ Grow + 30 g/day during the 1 st mo
´ Limb movements uncontrolled
´ Primitive reflexes ex. rooting reflex
´ Smilling involuntarily
´ Eye gaze, head turning, sucking are under better control
´ Crying in response to stimuli
´ Recognize facial expression as similar, even on different faces
 Age 2 – 6 months
Physical development :
1. 3-4 mo, growth solws, + 20 g/day
2. Primitive reflexes gone
3. No head lag, rolling
4. 3 mo, asymmetric tonic reflex gone, manipulate object with
2 hands in the midline
5. 4 mo, graspes rattle, palmar grasp gone, reaches for object
 Cognitive Development

Cognitive development:
Explore their own body
Vocalizing, blowing bubbles

Social & communication development :

Primary emotions of anger, joy, interest, fear,
disgust and surprise appear in facial expressions
 Age 6 – 12 months
Physical development :
1. Growth slows more (15 g/day)

2. 7 mo, sit unsupported

3. 8 mo, crawling

4. 9 mo, pincer grasp

5. 12 mo, walks alone

Cognitive development :
´ Novel objects are picked up, inspected, passed hand to

hand, banged, dropped, and then mouthed.

´ 9 mo, object constancy, understanding that objects continue

to exist even when not seen

Emotional development :
1. Look back and forth between strangers and parents àmay
cling or cry anxiously
2. Separation become more difficult
3. A new demand for autonomy emerges à self feeding,
tantrum
Communication :
1. 6 mo, babbling with many syllables (ma, da, ba)
2. 10 mo, repetitive consonant sounds (mama, papa, dada)
04
SECOND Year Period
Growth & Development
 The second year
1. 12 – 18 months
2. 18 – 24months
 Age 12 – 18 months
Physical development :
´ The growth rate solws further, appetite declines
´ Walks independently
Cognitive development :
´ Reaching, grasping, releasing, and greater mobility à gives
them access to more and more object, exploration increases
´ Imitation of parents and older children is an important mode
of learning
´ Play centers on the child’s own body
( ex. pretending to drink from an empty cup)
Emotional development :
´ Infant may be irritable
´ Toddler as “intoxicated” with their new ability and the power to
control the distance between themselves and their parents
Communication development :
´ Receptive language precedes expresive
´ 12 mo, speaks the first word
´ Respond appropriately to simples statements (no, bye-bye, give
me)
´ 15 mo, points to major body parts
´ Uses 4 – 6 words spontaneously and correctly
 Age of 18 – 24 months
Physical develompent :
´ Height and weight increase at a steady rate
´ Head growth slows slightly
´ Motor development is incremental, improvement in balance
and agility, running, stair climbing
Cognitive development :
´ Object permanence
´ Cause and effect are better understood
´ Symbolic transformation in play (ex. feeding the doll from
the empty plate)
Emotional development :
1. Increased clinginess, separation at bed-time are often difficult
2. Many children use transisional object (ex. special blanket or stufled
toys)
Communication :
1. 18 mo, 10 – 15 words
2. 2 yr, 100 words or more, to make simple sentences
3. Understand two-step commands
05
PRESCHOOL Period
Growth & Development
 Preschool years (2-5 yr of age)
Physical development :
´ Somatic and brain growth slows
´ Average child gain + 2 kg/yr, and 7 cm/yr
´ Nutritional requirement and appettite decreases
´ 3 yr, visual acuity 20/30, all primary teeth have erupted
´ Throwing, catching and kicking balls, riding on bicycles
´ Handedness
´ Bowel and bladder control
Communication :
● Vocabulary 100 to more than 2.000 words
● 21/2 yr, using possessives, progressives, guestions and negatives tenses
● 4 yr, count to 4, and use the past tense
● 5 yr, use the future tense
Cognitive development :
● Magical thinking
● Egocentrism
● Thinking that is dominated by perception
Play :
´ Increasing complexity and imagination
´ 2 – 3 yr, simple scripts (ex. shopping and putting baby to
bed)
´ 3 – 4 yr, more extended scenario (ex. going to the zoo, going
on a trip)
´ 4 – 5 yr, creation of scenario (ex. flying to the moon)
´ Socialization from minimal social interaction to cooperative play
´ 1 – 2 yr, solo or parallel play
´ 3 – 4 yr, cooperative play, together, sharing
´ 5 yr, recognition the rules
Emotional development :
1. 2 yr, behavioral limits are predominantly external
2. 5 yr, these controls need to be internalized

3. Young children cannot control many aspects of their life à

temper tantrums
06
SCHOOL AGE Period
Growth & Development
 School Aged
Physical development :
´ Growth 3 – 3,5 kg/yr, and 6 cm/yr

´ Head grows 2 – 3 cm

´ Loss of deciduous teeth, replacement by adult teeth

´ Lymphoid tissue hypertrophy

´ Muscular strength, coordination & stamina increase

progressively
´ Sexual organ physically immature, but interest in gender

differences
Cognitive & language development :
´ Reading, writing, and basic mathematics skills

´ Enjoy strategic games and word play

Social & emosional development :

´ Social & emotional development proceeds in 3 contexts :

home, school & neighborhood

´ Separation from the family and the increasing importance of

teacher & peer relationships.

07
Adolescence
Growth & Development
 Adolescence
1. Rapid changes in body size, shape, physiology, psychologic, ans social
functioning
2. Hormones set the development agenda
3. Transition from childhood to adult
4. Three distinct periods : early, middle, and late
 Early adolescence
Biologic development :
´ Production of androgen à development of underarm odor

and genital hair (adrenarche)

´ GnRH, LH, FSH, androgen and estrogen increases

´ Somatic & physiologic changes gives rise to the Sexual

Maturity Rating (SMR) or Tanner stages à key stages of
breast, pubic hair, and testicle and penile development
Physical development at puberty
Perkembangan bentuk dan ukuran payudara (Dikutip dari Fig.14-
2, Behrman et al, Nelson textbook of Pediatrics, 2000, hal.54)
Perkembangan rambut pubis (Dikutip dari Fig.14-1, Behrman et al,
Nelson textbook of Pediatrics, 2000, hal.53)
Perkembangan bentuk dan ukuran genitalia (Dikutip dari Fig.18-
14, Vaughan & Litt: Child Adolescent Development: Clinical
Implication, 1990, hal.250)
Girls :
1. 8 – 13 yr, the first visible sign of puberty is the appearance of breast
bud
2. 9 – 16 yr, menarche, around the peak in height velocity
Boys :
1. 91/2 yr, testicular enlargement
2. Breast hypertrophy occurs in 40 – 65% of pubertal boys
1. Growth acceleration begin in early adolescence, but peak
growth velocities are not reached until SMR 3 or 4.
2. Boys typically peak 2-3 yr later than girls, and continue their
linear growth for + 2-3 yr after girls have stopped
3. Adrenal adrogens stimulate the sebaceous glands à
development of acne.
Sexuality :
1. Interest in sex increases

2. Ejaculation (during masturbation, and spontaneously)

Cognitive development :
1. Transition from the concrete preoperasional thinking to

formal logical operations

Self-concept :
1. Self-awareness tends to center on external characteristics
Relationship with family, peers, and society:
1. Trend toward separation from family with increasing involvement in
peer activities
2. Socialize in same-sex peer groups
3. Relationship to society centers on school
4. Ready access to pornography on the internet may increase the risk of
premature sexual activity or exploitation
 Middle Adolescence
Biologic development :
1. Growth accelerates, rate of 6-7 cm/yr

2. In girls, the growth spurt peaks at 11,5 yr at a top velocity of

8,3 cm/yr, and then slows to a stop at 16 yr.

3. In boys, the growth spurt starts later, peaks at 13,5 yr at 9,5

cm/yr, and then slows to a stop at 18 yr.

´ Weight gain parallels linear growth
´ Muscle mass increases, follow by an increase in strength
´ Menarche,
in 30% of girls by SMR3 (+ 12-14 yr), and
in 90% by SMR4 (+ 13-15 yr)
Sexuality :
´ Dating becomes a normative activity
´ High testosterone and low religiosity together may predict
which boys become sexually active
Cognitive and moral development :
1. With the transition to formal operational thought, they question and
analyze extensively

Self-concept :
1. Often experiment with different personae, changing style of dress,
groups of friends, and interests from month to month
 Relationship with family, peer & society:
1. Adolescents may become distance from parent, redirecting emotional
& sexual energies toward peer relationships
2. Dating increases, the need to belong to same-sex groups declines
3. Often begin thinking seriously about what want to do as adults
 Late Adolescence
Biologic development :
1. The somatic changes are modest by comparison
2. The final stages of breast, penile, and pubic hair occur by 17-18 yr of
age in 95% adolescents
Psychosocial development :
´ Sexual experiment decreases as adolescents adopt more
stable sexual identities
´ Cognition tends to be less self-centered, increasing thoughts
about justice, patriotism and history
´ Often idealistic, but also may absolutist and intolerant of
opposing views
´ Dating relationship increasingly involve love and
commitment
´ Career decision become pressing
Ada Pertanyaan?

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