‫‪Growth and‬‬

‫‪development‬‬

‫ﺟﻌﻠﻪ ﺍﻟﻠﻪ ﺻﺪﻗﺔ ﺟﺎﺭﻳﺔ ﻟﻲ ﻭﻟﻮﺍﻟﺪﻱ ﻭﻟﺬﺭﻳﺘﻲ‪.‬‬

‫ﺩﻋﻮﺍﺗﻜﻢ‬ ‫ﺭﻓﻌﻪ ﺩ‪ .‬ﻣﺎﺟﺪ ﺍﻟﻤﻨﺼﻮﺭ‪.‬‬

‫ﺍﻟﺪﻓﻌﺔ ﺍﻝ‪14‬‬
Page | 1 Illustrated Baby Nelson

Factors affecting growth

1. Prenatal factors
o Familial (genetic);children inherit their height pattern from their parents
o Racial; some races are shorter than others e.g. Chinese
o Constitutional
2. Factors operating during pregnancy (In Utero Exposures)
o Maternal diseases e.g. diabetes mellitus, hypertension
o Maternal exposures: Teratogens, infections e.g. TORCH, irradiations…
o Maternal nutritional state.
3. After birth
a. Age: Growth rate is more during infancy and adolescence.
b. Sex:
- Growth rate is nearly equal in males & females from birth till 11 years
- Girls grow faster between 11 – 14 years (due to earlier puberty)
- Boys grow faster than girls beyond 14 years (due to later puberty)
c. Nutritional status o Chronic under nutrition & malnutrition retard growth
d. Psychological and socioeconomic status
e. Health status o chronic diseases retard growth
4. Hormonal role: growth is controlled by hormones depending on the stage
Intrauterine Infancy & childhood Adolescence
1. Chorionic gonadotropines 1. Thyroxin Sex hormones
2. Placental lactogen 2. Growth hormone (Estrogen & androgen)
3. Insulin are responsible for
4. Thyroxin (skeletal growth) growth spurt during
puberty

So
o Newborn of diabetic mother whose mother has hyperglycemia during
pregnancy commonly have hyperinsulinemia and eventual macrosomia at
birth
o Newborn with congenital hypothyroidism usually has delayed bone age
screened for by plain radiograph on his knee that shows absent tibial and
femoral epiphyseal centers that normally present at birth
o Newborn with growth hormone deficiency usually has normal size at birth
simply because growth hormone actions operate after birth onwards

.‫ﺟﻌﻠﻪ ﺍﻟﻠﻪ ﺻﺪﻗﺔ ﺟﺎﺭﻳﺔ ﻟﻲ ﻭﻟﻮﺍﻟﺪﻱ ﻭﻟﺬﺭﻳﺘﻲ‬

‫ﺩﻋﻮﺍﺗﻜﻢ‬ .‫ ﻣﺎﺟﺪ ﺍﻟﻤﻨﺼﻮﺭ‬.‫ﺭﻓﻌﻪ ﺩ‬

14‫ﺍﻟﺪﻓﻌﺔ ﺍﻝ‬
Page | 2 Illustrated Baby Nelson

I. Anthropometric measures
1. Weight
* At birth o 3 - 3.5 kg
st
* During the 1 year:
- 1st 4 months o Weight n by ¾ kg per month.
So, weight at 4 months = 6 kg Ÿ double birth weight
- Next 4 months o Weight n by ½ kg per month
- Last 4 months o Weight n by ¼ kg per month.
So, weight at 1 year = 9 kg Ÿ triple birth weight
st
* Beyond the 1 year o Weight is calculated as: weight = age (in years) × 2 + 8
Physiologic weight loss:
* Initial weight loss usually occur during the first 3-4 days of life
* The baby loses about 10% of his birth weight due to:
- Scanty milk flow
- Poor suckling capacity
- Passage of meconium & urine
* This weight loss is usually regained by the 10th day of life

2. Length/Height
* At birth o 50 cm
* At 6 months o 68 cm
* At 1 year o 75 cm
* At 2 years o 87.5 cm
* After the 2nd year o Height = age in years × 5 + 80

How to measure?
o Under 2 years: Length is measured in supine position
o Over 2 years: Height is measured in standing position
3. Occipto Frontal head circumference (OFC)
Clinical value
- OFC reflects the rate of brain growth.
- Maximum rate of brain growth & OFC is during the 1st year
* At birth o 35 cm.
* At 6 month o 43 cm
* At 1 year o 45 cm
* At 12 years o 55 cm

.‫ﺟﻌﻠﻪ ﺍﻟﻠﻪ ﺻﺪﻗﺔ ﺟﺎﺭﻳﺔ ﻟﻲ ﻭﻟﻮﺍﻟﺪﻱ ﻭﻟﺬﺭﻳﺘﻲ‬

‫ﺩﻋﻮﺍﺗﻜﻢ‬ .‫ ﻣﺎﺟﺪ ﺍﻟﻤﻨﺼﻮﺭ‬.‫ﺭﻓﻌﻪ ﺩ‬

14‫ﺍﻟﺪﻓﻌﺔ ﺍﻝ‬
Page | 3 Illustrated Baby Nelson

4. OFC & chest circumference (CC) ratio

Chest circumference is measured at level of xiphiod process in mid inspiration
Age OFC/CC ratio
* At birth >1
* At 6 months Equal 1
* at 1 year <1
th
* At 5 year <1
Clinical value: Suspect malnutrition if OFC/C.C > 1 beyond 6 months

5. Mid arm circumference (MAC)

* In a baby 1- 4 years o MAC is > 14 cm
* In border line malnutrition o MAC is 12 – 14 cm
* In severe malnutrition o MAC is < 12.5 cm
Clinical value
o Early indicator of malnutrition; and is not affected by edema.
o Often used for screening for malnutrition in lieu of weight for height
o MUAC divided by OFC classifies malnutrition into; Mild < 0.31 , moderate
<0.28 , and severe < 0.25 ( Kanawati classification of malnutrition)
6. Skin fold thickness
Clinical value: Estimate total body fat;
* Measured by skin fold calipers
* Measured at left triceps or left subscapular regions
* Normal values: - 10 mm at 1 year
- 14 mm at 1- 4 years
8. The Arm span - Height relationship
* Span is shorter than height by 3 cm at 1-7 years.
* Span equals height at 8-12 years.

7. Proportions of upper segment & lower segment

* Upper segment (US) is measured from crown to symphysis pubis.
* Lower segment (LS) is measured from symphysis pubis to the floor.
* Proportions of US/LS:
o At birth o 1.7 /1
o At 3 years o 1.3 /1
o After 7 years o 1 /1
Clinical value: Help evaluation of short stature

.‫ﺟﻌﻠﻪ ﺍﻟﻠﻪ ﺻﺪﻗﺔ ﺟﺎﺭﻳﺔ ﻟﻲ ﻭﻟﻮﺍﻟﺪﻱ ﻭﻟﺬﺭﻳﺘﻲ‬

‫ﺩﻋﻮﺍﺗﻜﻢ‬ .‫ ﻣﺎﺟﺪ ﺍﻟﻤﻨﺼﻮﺭ‬.‫ﺭﻓﻌﻪ ﺩ‬

14‫ﺍﻟﺪﻓﻌﺔ ﺍﻝ‬
Page | 4 Illustrated Baby Nelson

II. Teething
Primary = Deciduous or Milky teeth Secondary (permanent) Teeth
Tooth Age (months) Tooth Age (years)
- Central incisor 6 - 9 - Central incisor 7
- Lateral incisor 9 - 12 - Lateral incisor 8
st
- 1 molar 12- 18 - Canine 10
st
- Canine 18- 24 - 1 premolar 11
nd nd
- 2 molar 24 - 2 premolar 12
st
- 1 molar 6
nd
- 2 molar 13
- Wisdom tooth 22
* Count : 20 teeth * Count : 32 teeth
* Teething starts at 6- 9 months and * Teething start at the 6th years and
completed at 24 months. completed at 22nd years
* The lower jaw incisors precedes the * Eruption follow exfoliation immediate or
upper jaw by one month may lag 4-5 months
Teething Eruption Abnormalities
1. Delayed teething: No eruption beyond 13 months of age.
Causes :
a. Idiopathic : the commonest cause
b. Local: e.g. supernumerary tooth, cysts, rigid gums
c. Generalized: (DACRO H2); Down syndrome, Achondroplasia, Congenital
hypothyroidism, Rickets, Osteogenesis imperfecta,
Hypopituitarism, Hypoparathyriodism
2. Premature teething is seen is:
x Natal teeth (should be extracted to avoid aspiration).
x Congenital syphilis
x Ellis Van Creveld syndrome:
- Disproportionate dwarfism (short stature with short limbs)
- Post axial polydactyly
- Ectodermal dysplasia(teeth and nail)
- Congenital heart disease (ASD)
- Narrow chest
3. Congenital missing or extra tooth

.‫ﺟﻌﻠﻪ ﺍﻟﻠﻪ ﺻﺪﻗﺔ ﺟﺎﺭﻳﺔ ﻟﻲ ﻭﻟﻮﺍﻟﺪﻱ ﻭﻟﺬﺭﻳﺘﻲ‬

‫ﺩﻋﻮﺍﺗﻜﻢ‬ .‫ ﻣﺎﺟﺪ ﺍﻟﻤﻨﺼﻮﺭ‬.‫ﺭﻓﻌﻪ ﺩ‬

14‫ﺍﻟﺪﻓﻌﺔ ﺍﻝ‬
Page | 5 Illustrated Baby Nelson

III. Fontanels
Posterior fontanel
– Normally: Closed at birth or opened < 0.5 cm and closes within 2 months
– Abnormally: Opened > 1 cm or Not closed within 4 months
Causes :
- Prematurity
- Increased intra cranial tension
- Mongolism
- Cretinism
Anterior fontanel: Clinical value
1. Assessment of growth
- At birth o 3 fingers (| 3- 4 cm).
- At 6 months o 2 fingers.
- At 12 months o 1 finger.
- At 18 months o closed.
2. Size
A- Large fontanel (delayed closure) in: (DACRO HI)
- Down syndrome
- Achondroplasia
- Congenital hypothyriodism
- Rickets
- Osteogenesis imperfecta
- Hypopituitarism
- Increased intra cranial tension
B- Small fontanel (premature closure; before 6 months) in: (2 C)
- Craniosynostosis
- Congenital hyperthyroidism
3. Surface : Normally it is smooth & continuous with the skull bones.
A- Bulging: with Ĺ intra cranial tension e.g. B- Depressed : in dehydration
- Intra cranial infections
- Hydrocephalus
- Intra cranial hemorrhage

.‫ﺟﻌﻠﻪ ﺍﻟﻠﻪ ﺻﺪﻗﺔ ﺟﺎﺭﻳﺔ ﻟﻲ ﻭﻟﻮﺍﻟﺪﻱ ﻭﻟﺬﺭﻳﺘﻲ‬

‫ﺩﻋﻮﺍﺗﻜﻢ‬ .‫ ﻣﺎﺟﺪ ﺍﻟﻤﻨﺼﻮﺭ‬.‫ﺭﻓﻌﻪ ﺩ‬

14‫ﺍﻟﺪﻓﻌﺔ ﺍﻝ‬
Page | 6 Illustrated Baby Nelson

IV. Osseous Growth

Normally; there are 5 secondary ossific centers at birth in
o Lower end of femur.
o Upper end of tibia.
o Calcaneus, talus & cuboid
“X ray knee in newborn help assess intrauterine
skeletal maturation ; it is a good screening
tool for congenital hypothyroidism”
Carpal bones start ossification after birth as follow
o The 1st carpal bone o ossifies at about 2nd month of age.
o The 2nd carpal bone o ossifies by the end of the first year.
o Later on, one carpal bone ossifies approximately each year till the 6th year;
the 8th bone usually ossifies at the 12th year of age.
Bone age
x Bone age is a measure of the degree of skeletal maturity of a child
x It is measured in years by the radiographic examination of ossification
centers; most often using the Greulich-Pyle bone age scale
- At > 6 month onwards o by x-ray over the left wrist
- In late childhood o by assessing fusion of epiphysis
Causes of Delayed Bone Age Causes of Advanced Bone Age
1- Hypothyroidism 1- Hyperthyriodism
2- Hypopituitarism 2- Hyper pituitarism
3- Delayed puberty. 3- Androgen excess (e.g. congenital
4- Cushing syndrome adrenal hyperplasia)
5- Chronic illness / under nutrition 4- Simple obesity.
Example for bone age estimation by Greulich-Pyle bone age scale

Average bone age 1 year Average bone age 2 years Average bone age 3 years

.‫ﺟﻌﻠﻪ ﺍﻟﻠﻪ ﺻﺪﻗﺔ ﺟﺎﺭﻳﺔ ﻟﻲ ﻭﻟﻮﺍﻟﺪﻱ ﻭﻟﺬﺭﻳﺘﻲ‬

‫ﺩﻋﻮﺍﺗﻜﻢ‬ .‫ ﻣﺎﺟﺪ ﺍﻟﻤﻨﺼﻮﺭ‬.‫ﺭﻓﻌﻪ ﺩ‬

14‫ﺍﻟﺪﻓﻌﺔ ﺍﻝ‬
Page | 10 Illustrated Baby Nelson

Assessment Of Development
Motor Milestones : (Locomotor development)

Head support ; no head lag Sit without support Crawls

3 months 6 months 9 months

Stands Walks Runs

10 months 12 months 18 months

Climbs stairs Rides a tricycle Dresses himself

2 years 3 years
Mental milestones
A. Social development

Social smile on x Recognizes mother x Recognizes father x Finger feeds

social contact x Excited at sight of food x Stranger awareness x Waves bye bye
2 months 4 months 9 months 12 months

.‫ﺟﻌﻠﻪ ﺍﻟﻠﻪ ﺻﺪﻗﺔ ﺟﺎﺭﻳﺔ ﻟﻲ ﻭﻟﻮﺍﻟﺪﻱ ﻭﻟﺬﺭﻳﺘﻲ‬

‫ﺩﻋﻮﺍﺗﻜﻢ‬ .‫ ﻣﺎﺟﺪ ﺍﻟﻤﻨﺼﻮﺭ‬.‫ﺭﻓﻌﻪ ﺩ‬

14‫ﺍﻟﺪﻓﻌﺔ ﺍﻝ‬
Page | 11 Illustrated Baby Nelson

B. Fine motor

x Play with hands in midline x Outreaches objects, x Pincer grip

x Grasp offered rattle mouth it and transfers it
4 months 6 months 9 months

x Tower of two cubes

x Casting x Scribbles x Turn pages in 2-3 pages
12 months 15 months 18 months

x Cut with scissors x Copies a cross & square x Copies a triangle

x Copies a circle x Recognize 3 colors x Draws man with six parts
3 years 4 years 5 years
C. Speech development
At - 10 months o Says Mama or Dada
- 1 year o Speaks first real 3 words
- 19 months o Speaks 2-word sentences (e.g., “Mommy shoe”)
- 2 years o Says 3 word sentences (phrases).
- 3 years o Says his name & age
- 5 years o Says clear speech
Criteria of speech delay
- No first words by 15 months.
- No real words by 18 months.
- No word combinations by 2 yrs
- Speech is difficult for others to understand at 3 years
D. School achievement

.‫ﺟﻌﻠﻪ ﺍﻟﻠﻪ ﺻﺪﻗﺔ ﺟﺎﺭﻳﺔ ﻟﻲ ﻭﻟﻮﺍﻟﺪﻱ ﻭﻟﺬﺭﻳﺘﻲ‬

‫ﺩﻋﻮﺍﺗﻜﻢ‬ .‫ ﻣﺎﺟﺪ ﺍﻟﻤﻨﺼﻮﺭ‬.‫ﺭﻓﻌﻪ ﺩ‬

14‫ﺍﻟﺪﻓﻌﺔ ﺍﻝ‬