Growth and Development of NEWBORN

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1 Physical Development
Biological Development
Temperature – 36.5 F
Pulse – 120-160 bpm
Respiration – 30-60 brpm
Blood Pressure
Systolic – 70-90 mm of hg
Diastolic – 4.-60 mm of hg
Weight – 2.5 to 3.5 kg
Length – 50 cm at birth
Head Circumference – 33-35 cm
Chest Circumference – 31-33 cm

2 Skin
Appearance
Soft, smooth and opaque and colour pink

Vernix Caseosa
Whitish greasy material covered the skin

Milia
Pearl whitish spots on chin, nose, fore head and cheeks

Erythema Toxicum
Skin with red, yellowish white papule in centre of the body

Mangolian Spot
Dark blue and purple macular spots

Head
Should turn as far as the shoulder in both directions

1.Fontenells
Anterior
Diamond Shape 4-6 cm diameters
Posterior
Triangular in shape
2.Catput Succendaneum
A diffuse oedematous swelling of the soft tissue of the
catput may extend the suture line

3. Cephal Hematoma
A subperital hemorrhage that never extends across the
suture line

Hair
Light coloured, sparse, soft textured

Face
Eyes
Symmetrical
White sclera
Symmetry of movements
Usually dark iris for 3-6 months

Ears
Position should be same on both sides
Location is determined by drawing a horizontal line from
inner canthus of the eyes perpendicular to the vertical axis
of the head
Hearing
Alert and stops movement in the direction of the sound

Nose
Symmetrical and patent

Mouth & Chin

It should open at equal angels bilaterally

Chest
Bell Shape
Mildly Protruberent
One inch less than head circumference

Abdomen
Soft
Umbilicus-
Normally positioned midway between the xiphoid process
and pubis
Cord should contain 2 arteries and 1 vein

Genetalia and Anus

Female
Term baby- Labia majora covers labia minora
Pre term- clitoris is prominent
Vaginal orifice is pink, glistening and patent
Male
The glans is completely covered by the fore skin at birth
The penis is 2.5-3.5 cm
Testes is descended
Scrotum is highly pigmented
Anus and rectum patent

Musculoskeletal System
Spine id normal curvature
Extremities are symmetrical in position and presence of
normal active and passive motions
Resting posture- the term newborn lies with hips abducted
and partially flexed and knees flexed.

Central Nervous System

Routing Reflex
When the cheek or corner of the mouth is stroked the infant
head should turn towards the stimulus and moth should
open.

Sucking Reflex
When touching or stroking the lips, the mouth opens and
sucking movements begin

Swallowing Reflex
The passage of food from the posterior aspect of the mouth
to stomach

Gagging Reflex
When the posterior pharynx is stimulated with food there is
a immediate return of undigested food.

Extrusion
When substance placed on anterior position of tongue will
be expelled out

Blinking
Protection of the eye by rapid eye lid closure when the eyes
are exposed to bright light
Doll’s Eye
Normally the eyes do not move when the newborn head
slowly turn to right or left side.

Palmar grasp
When the objects are placed in the newborn palm, the
newborn grasp

Plantar Grasp
When the objects touch the sole of the foot at the base of
the toes,toes grasp around very small objects.

Dancing/ stepping Reflex

Hold the neonate in vertical position with the feet touching
the flat, firm surface there will be rapid alternating flexion
and extension of legs

Babinski Reflex
Stroking the lateral aspect of the sole of the foot with a
relatively sharp object from the heel up towards the little
toe and across the foot towards the big toe, there will be
fanning of toes.

Tonic neck reflex

Turning the head quickly to one side while the infant is
supine, arm and leg on the side of the head is turned
towards extend. Arm and leg on the opposite side flex.

Moro/ Startling Reflex

The newborn head is suddenly allowed to drop backward
an inch, there will be symmetric abduction and extension
of the arms and legs with fanning of fingers.

Nutrition
Calories – 120 kcal/kg/day
Fat – 30gm/kg/day
Protein -2.5-3.5 gm/kg/day
Iron - 0.27 mg/kg/day
Calcium – 200 mg/day
Vitamin D – 400 IU daily
Vitamin C – 50 mg/day
Fluids - 120 ml/kg/day
Needs of newborn
 Love and affection
 Need for human contact
 Sensory stimulation
 Sucking
 Breast feeding every 2-3 hrs (When Needed)
 Demand feed 8-10 per day
 Maintain body temperature
 Hygienic needs
 Prevention of injuries/ accidents
 Provision of optimal nutrition
 Prevention of infection or injury
 Provision of optimal nutrition
 Monitoring weight, vital signs,output (1ml/kg/hour)
 Observation of body temperature, hydration status
 Watch for danger signs of newborn like
hypothermia, hypoglycemia, jaundice, apnoea, etc..
 Growth and Development of INFANT

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1 Physical Development
Biological Development
Temperature – 36.5 F
Pulse – 100-150 bpm
Respiration – 25-45 brpm
Blood Pressure – 80/60 + 20/10 mm of hg
Weight – Age in month + 9/2
1-6 months – 30 gm/day
7-12 months- 15 gm/day
Height
<6 months- 2.5 cm/month
7-12 months- 1.5 cm/month
Height at 1 year -75 cm
Head Circumference
Increase 1.5 cm per month during first 6 months
0.5 cm in next 6 months
Chest Circumference
Usually 1-2 cm lesser than HC
HC and CC will be equal by 1 year
2 Mile Stones

1 month – Social Smile

2 month – Coos/Vocalizes
3 month - Head Control
4 month – Hand Control
5 month – Turns over
6 month – sits alone
7 month - crawls
 8 month - Creeping
9 month – Stands with support
10 month – walks with support
11 month – Stands alone
12 month – Walks alone
3 Gross Motor Skills- Eg- 1 month turns head to one
side on prone
4 Fine motor Skills
5th month – holds a rattle
6th month- Reaches for object
7th month- Holds feeding cup
8th month- Eats finger foods, drinks water from cup
9th month- Picks up objects
12th months- holds crayons
5 Psychosocial –(Erick Ericson)
Sense of trust VS mistrust
Complete dependence on care giver
6 Psycho sexual
Oral stage- need for sucking pleasure
7 Spiritual development- Fowlers
Undifferentiated faith- feeling of trust warmth and
security from the foundation for later development
of faith
8 Intellectual development- Jean piaget
Sensory motor ( 0-2 years)
Stimuli are recognized absorbed and incorporated
into existing action
9 Moral Development – Kohlburg
Preconventional morality stage -0
Unable to understand good and bad
Good is what I like
10 Language/Speech development
Receptive languages
 Responds to human voices
Expressive language
Cries when hungry or uncomfortable
6-8 words at one year
Growth and Development of TODDLER

Sl No Book Picture (Growth & Development) Patient Picture Remarks

1 Physical Development
Biological Development
Temperature – 36.5 C
Pulse – 90- 130 bpm
Respiration – 26-28 brpm
Blood Pressure – 100/60 + 20/20 mm of hg
Weight – Age in years X 2+8 kgs
2 years-12kgs
2.5 years- 4 times to birth weight
Height- Age in years X 6 +77 cm
2 years -85cm

Dentition
2 years-16 teeth
2.5 yrs- 20 teeth ( Primary teeth Completes)

2 Gross motor (Mile Stones)

15 months
Assumes standing position
Walks without support
Creeps on stairs
18 months
Walks quickly
Runs,often falls
Wlaks upstairs by holding one hand
24 months
Throws a ball over hand without falling
Steady gait
Can walk heel-toe gait
 Can walk backwards
Imitates well
Can walk up and down stairs
3 Fine Motor Skills
15 months
Builds a tower of 2-3 cubes
Open boxes and put fingers in holes
Scribbles spontaneously
Stretch out arm and legs to help out in dressing
18 months
Holds cup with both hands
Eats with spoon but spills frequently
Makes line with crayons
Begins to turn pages
Builds a tower of 3-4 cubes
Transfer objects from one place to another
Removes simple garments
24 months
Builds a tower of 6-8 cubes
Makes cubes in train
Imitates a circular or horizontal stroke
Pulls on own simple garments
Turns pages of books one at a time
Drinks well in one hand
30 months
Self feeding with occasional spilling
Buttons and unbuttons large front buttons
4 Psychosocial development- Eric Erickson
Sense of autonomy VS Shame and doubt
Focused on developing self control
Failing to develop self control by parentral control
will develop shame and doubt
5 Psycho sexual – Freud
Anal Stage
Obtain pleasure from feeling of a distended bladder
from masses of faeces in the rectum and from the
release contents from those organs
6 Spiritual Development
Intuitive Projective - Imitates religious behaviors
such as bowing the head in prayer,but does not
understand the meaning
7 Intellectual development (Jean Piaget)
Preoperational (2-7 year)
Beginning of mental representation of events and
differentiate past and present
8 Moral development (Kholberg)
Pre conventional morality stage-1
Child if punished is wrong, if not punished it is right
9 Language/speech development
1 yr- 6-8 words
2 yrs- 300 words
3 yrs- 900 words
10 Play ( New hall)
Parallel play-
playing beside and watching each other but not
interacting directly
11 Nutrition
Calories – 1300-1500 kcal/day
Protein – 1.7-2 gm/kg/day
Fat – 4-5 gm/kg/day
Iron – 15-20 mg/day
Calcium – 500 mg/day
Fluids – 90-100 ml/kg/day
12 Behavioral characteristics
Negativism- doing opposite things
Temper tantrums- roll on floors, shouting, asking
aloud, holding breath etc
Ritualistic behavior- particular activity is performed
in particular manner only
Ambivalence- demonstrating love and hatred towards
same person at same time
Curiosity- interested to know more things
Dawdling- slowness in doing things
Ego centric- think that everything belongs to them
13 Needs of the toddler
 Love and security
 Security blanket- toys/articles of parents
 Toilet training (2 yrs- day time bladder control,
2.5 yrs night time bladder control)
 Development of self esteem
 Dental care
 Setting of limitations- rules and guidelines
 Encouragement for independence
 Feeding, dressing, toileting and grooming
14 Health promotion and anticipatory guidance
 Nutrition
 Accident prevention
 Immunization
 Dental care
 Growth and Development of PRE-SCHLOOR (3-6 years)

Sl No Book Picture (Growth & Development) Patient Picture Remarks

1 Physical Development
Biological Development
Temperature – 36.5 C
Pulse – 90- 110 bpm
Respiration – 26 + 5 brpm
Blood Pressure
Systolic-95-105 mm of hg
Diastolic-55-65 mm of hg
Weight – Age in years X 2+8 kgs
Height- Age in years X 6 +77 cm
3 years- 90.5-101.5 cm
4 years- 95-109 cm
5 years- 103-115 cm
Dentition-
No. Of teeth -
2 Gross Motor Development (Mile Stones)
3 years
Walks on a straight line
Walks backward
Runs without looking at feet
4 years
Kicks a ball
Rides a tricycle
Runs on tiptoes
Balances on one feet for 3-5 seconds
5 years
 Jumps from greater heights
Climbs ladder
Alternates stairs when descending stairs
Balances on one foot for 8-10 seconds
3 Fine Motor Skills
3 years
Builds a tower of 9-10 blocks
Copies a circle
Uses scissors with one hand to cut
Shows preferences to handedness
4 years
Can help with simple household tasks
Copies a square
Draws a simple face
5years
Copies a triangle
Crosses vertical lines
Copies letters, may be able to write own name
Draws a three body parts of human being
4 Psycho social theory (Eric Erickson)
Sense initiative VS Guilt
Independent and trustworthy. They are ready to
find out what they can do
5 Psycho sexual (Freud)
Phallic Stage
Oedipus complex- boys desire their mothers
while expressing extreme hostility towards fathers
Electra complex- girls desire their fathers while
expressing extreme hostility towards mothers
6 Spiritual development (Fowlers)
Intuitive Projective-
 Imitates religious behaviors such as bowing the
head in prayer,but does not understand the
meaning
7 Intellectual development (Jean piaget)
Children can repeat events occurred few hours ago
or few days ago
Unable to accomplish true inductive and deductive
reasoning
Believes all objects in environment are to satisfy
their needs
8 Moral Development (Kohlberg)
Preconventional morality stage-2
Confirm to rules strictly for the purpose of self
interest that to avoid punishments and to have
favors in return
9 Language / Speech development
3 yrs-900 words
4 yrs-1500 words
5 yrs- 2100 words
10 Play (Newhall)
Cooperative play
Children begin to exchange ideas with other
children and gradually interact with them in play
activities
11 Nutrition
Calories – 1300-1500 kcal/day
Protein – 3 gm/kg/day
Fat – 4-5 gm/kg/day
Iron – 10 mg/day
Calcium – 500 mg/day
Fluids – 90-100 ml/kg/day
12 Developmental problems
 Selfishness
 Hurting others
 Destructiveness
 Enuresis
 Encopresis
 Bad language
 Sibling rivelry
 Masturbation
Health problems
 Dental caries
 Malnutrition
 worm infestation
13 Needs of Preschloor
 love and security
 independence
 management of the bedtime problems
 Discipline leading to self control
 Meeting the nutritional needs
 Accident prevention
 Respect individuality of children
 Help to extend their skill
 Mastery of self control
 Provide sense of initiation
 Set limits to children behavior
 Health practices
 Dental hygiene
 Play indoor and outdoor games
 Optional vaccinations
 Growth and Development of SCHOOL AGE (6-12 years)

Sl No Book Picture (Growth & Development) Patient Picture Remarks

1 Physical Development
Biological Development
Temperature – 36.5 C
Pulse – 75- 95 bpm
Respiration – 18-24 brpm
Blood Pressure – 100/60 + 16/10 mm of hg
Weight – Age in years X 2+8 kg
12 years-40kg
(Increases 2-3 kg/year)
Height- Age in years X 6 +77 cm
6 yrs- 116 cm
12 yrs-150 cm
(Increase of 5cm per year)
2 Gross Motor Development
Refine acquired skills
Regular exercises
Runs,hops,jumps
3 Psychosocial development (Eric Erickson)
Sense of Industry VS Inferiority
Engage in real world task
Highly motivate in purposeful activity (Eg-Include
them in menu planning)
Encourage the child to identify his potentials
4 Psychosexual (Freud)
Latent Phase
 Associate with same sex
Peers ignore opposite sex
5 Spiritual Development (Fowlers)
Mythical literal Faith
Follows the rituals in the family/society
Believes others, differentiate their thinking
6 Intellectual Development (Jean Piaget)
Concrete operational stage
Able to understand, read, write and do arithmetic
Able to develop problem solving skills
Asks questions
7 Language/ Speech Development
20,000-30,000 words
8 Play (Newhall)
Social or Competitive Play
Girls
Cooking, Grooming, Teaching
Boys
Kites, Cycling and group sports
9 Nutrition
Calories – 1600-2200 kcal/day
Protein – 3-4 gm/kg/day
Fat – 4-5 gm/kg/day
Iron – 15-20 mg/day
Vitamin A-5000 IU
10 Dentition
Shredding of deciduous teeth and eruption of
permanent teeth at 6-7 years
11 Problems
Health Problems
 Dental Caries
 Disorders of Continence
 Motor Vehicle Injuries
 Drowning
 Burns
 Poisoning
 Bodily injuries like skin lesions, wounds,
scabies
 Developmental Problems
 Truancy
 Fear of dark
 Juvenile delinquency
 School Phobia
 Stealing
 Nail biting, Teeth grinding
 Lying
 Tics
 Hurting others
12 Needs of School Age
 Nutrition (Eating Habits)
 Dental Hygiene
 Exercise
 Sex Education
 Accident Prevention
 Love And Security
 Meeting Emotional Needs
 Immunization
 Parental Guidance
 Growth and Development of ADOLSCENT (12- 18 years)

Sl No Book Picture (Growth & Development) Patient Picture Remarks

1 Physical Development
Biological Development
Temperature – 36.5 C
Pulse – 60-80 bpm
Respiration – 14-20 brpm
Blood Pressure-100/70 – 120/80 mm of hg
Weight – Age in years X 2+8 kg
Boys-36.9 kg
Girls-38.5 kg
Height- Age in years X 6 +77 cm
Boys- 149.8 cm
Girls-150.7 cm
2 Secondary Development
Boys
Broadening of shoulders at the age of 13 yrs
Increase in size of chest
Increase in size of genitalia
Growth of pubic, axillary, chest and facial hair
Deepening of voice
Production of spermatozoa
Girls
Broadening of hips
 Increasing of breast
Growth of pubic and axillary hair
Attained menarche
Menstrual cycle- regular
Change in vaginal secretions
3 Fine motor Skills
Able to perform all activities like adults
4 Psychosocial (Eric Erickson)
Early – Identity VS Role Confusion
Who am I? (Adult/Child)
Intense loyalty to peer group
Separation from parents
Late- Intimacy VS Isolation
Develop intimacy with self and others of both
sexes
5 Psycho sexual (Freud)
Genital Phase
Masturbation and sexual fantasies are common
6 Spiritual Development (Fowler)
Conventional Faith-
Personal social values evolved to support their
identity
Explore religious affiliations
7 Intellectual Development (Jean Piaget)\
Formal operational stage
Thinking is oriented to things and events that can
observe directly
8 Moral Development (Kohlberg)
Post conventional morality
Able to differentiate right and wrong
9 Language/ Speech development
Continues to learn new concepts
10 Play (Newhall)
Social or Competitive Play
Such as sports, parties, telephonic conversations,
computer games etc.
11 Nutrition
Calories – 2200-2600 kcal/day
Protein – 1 gm/kg/day
Fat – 4-5 gm/kg/day
Iron – 15-20 mg/day
Calcium- 600-700mg/day
Vitamin A-5000 IU/day
12 Problems
Risk for parenting and family maladjustment
Risk for intentional or unintentional injuries
Dietary habits
Sexual and emotional abuse
Risk for depression and suicide
Learning and school problems
Hero worship
Teenage pregnancy
Health problems
Hypertension
Hyperlipidemia
STDs
Infectious diseases
Anemia
Drug and alcohol abuse
Dysmenorrhoea
13 Needs for adolescents
Self care- supervision of health problem,
promotion, disease detection and treatment (Breast
self examination, testicular examination)
Sex education
Prevention of anemia
Accident prevention
Dental hygiene
Prevention of addictive behavior
Communication
Trusting and productive relationships
Opportunities to exchange thoughts and ideas