Physical and Psycho-motor Development of

Children of Different Age Groups. Principles

and Methods of Assessment of Physical
Development of Children. Semiotics of
Physical and Psycho-motor Development of
Children.
 PLAN OF THE LECTURE
 Indications of physical development of mature and
premature child.
 Objective laws of increasing the mass and length of
the body, chest and head circumference in different
age periods.
 Semiotics of physical development disturbances.
 Notion about acceleration and deceleration.
 Psycho-motor development of children in different
ages.
 Semiotics of psycho-motor development disturbances.
 Physical development (PD)
is a dynamic process of growth (increase of the
mass and length of the body, different parts of
the body) and biological maturation of the child
in one or another period.
Physical development is a sum of morphological
and functional signs of the organism,
characterizing the height, mass, the shape of the
child’s body, its morpho-structural properties.
 Physical development
 World Health Organization (WHO) considers physical
development of a child as a summing indicator of the
condition of health of a separate child and a population,
and indications of physical development of early age
children as a criterion of assessment of social-economic
development of a definite region or a whole country.

 WHO considers monitoring a physical development of

early age children one of the most effective measures,
carried out by medical workers on the decreasing the
degree of mortality and morbidity of early age children.
 Sponsored

Medical Lecture Notes – All Subjects

USMLE Exam (America) – Practice

 Indications of physical
development of a newborn child
 Average body mass of boys at birth is 3200-
3400g, and that of the girls is 3100-3300g,
head circumference – 34-36cm, chest
circumference -32-34cm. The weigh of a
child is influenced by factors:
 the health of the mother, conditions of living,
food, work;
 the health of the fetus;
 constitutional and genetic factors.
Physiological loss of the body mass
 Develops in the first 4 days and is caused by:
 large extrarenal loss of water by evaporating through the skin,
through the lungs while breathing;
 discharge of the first feces and urine;
 vomiting of the swallowed around uterine waters;
 drying up of the umbilical remnant;
 starving in the first hours.
 There are 2 types of the mass increasing:
 “ideal” type – renovation of the body mass takes place on the
7-8th day (is noted in 20-25% of newborns);
 Slowed-up type – in 75-80% of children, slow gradual
reconstruction of the primary weight of the body during 14-15
days.
 Physiological is considered loss of 9% of primary body mass.
 Weighing of a child
 The body mass is measured on the scales for
weighing breast fed babies (shoot scale). For this
matter the scale is installed horizontally and evenly.
Then the wrap is weighed and put on the scale, a
naked baby by the head and shoulder blade is put
on the wide part and by the legs on the narrow part
of the scale. For determining the body mass from
the total weight is taken away the weight of the wrap.
The body mass of children older 3 years is
measured on medical scale. The child must stand
and step out from the scale under fixed unmovable
beam.
Objective laws of increasing the
body mass
 Up to 6 years:
 Body mass (BM) = Mass (M) at birth + 700xn
 After 6 months up to 1 year: BM= weight at 6
months+ 500x(n-6), where n – number of months.
 Doubling of body mass comes in 4-5 months,
three times – in 1 year.
 After 1 year up to 10 years: BM= 10+2n.
 After 10 years: BM = 30+4(n-10), where
n – number of years.
 Measuring the height
The length of the body under one year is measured with
horizontal height meter which represents a wide board
with a length up to 100cm and width – 40cm. Over the
board there is immovable oblique strip of wood, under the
board – movable plank, which easily moves. For
measuring the length of the body the baby is put on the
back, the top of the head being in touch with immovable
oblique plank. In this the head is fixed in the following way:
the upper end of external ear and the lower end of eye
orbit are in one vertical plane. The legs of the child must
be straight and stand close to the board of height meter.
The feet are bent under right angle, the movable board of
the height meter is taken close to them. The distance
between the planks presents the length of the body.


 Measuring the height
 The height of the children of older age is measured
with special height meter. The child stands on the
plane of the device and touches its vertical board,
which has 2 scales (for measuring the height in
sitting position to the right and for the height in
standing- to the left). The child must stand
straight, the arms hanging down, heels together,
touching with heels , buttocks, and shoulder-
blades the part of the board with divisions. The
head is held in the way that the lower end of eye
orbit and upper end of external ear are in one
plane. The plank of height meter is moved down
without pressure up to the head. The height is
accounted from the lower end of the plank.
 Objective laws of body length
increase
The medial body length of a mature newborn child
comprises 51-54 cm.
In the first year of life the speed of growth of a child
changes every quarter: in the first quarter the height
increases by 3cm every month, in the second –by 2,5cm
every month, in the third –by 2cm every year and in the
forth quarter – by 1-1,5 cm every month.
During the first 2-4 years of life the body length increases
by 8 cm every year and to the end of the 4th year it
comprises 100cm. From the 5th year and up to the
beginning of sexual maturation period the body length
increases in average by 6 cm, and in pubertal period –by
8-12 cm a year.
 Measuring the head
circumference
 Formeasuring the head circumference a
cm strip is put horizontally through the
occipital nodule in the back and on the
forehead over the eyebrows.
 Objective laws of increasing of
the head circumference
In a mature newborn child the head circumference
is an average 34-36 cm.
In the first half a year the head circumference
increases by 1,5 cm every month, in the second
– by 0,5 cm every month. In children at the age
from1 to 10 years the head circumference
increases by 1cm every year. So, the head
circumference of a child at the age of 6 months
comprises 43cm, 1 year – 46 cm, 5 years – 50
cm,10 years -55 cm.
 The chest circumference is measured in the state of
complete rest. A cm strip is put on the back under the
angle of shoulder blades, and in the front- along the
lower end near the nipple circles. In girls with developed
breast glands the cm strip is put on the level of upper
end of IY rib over the breast glands. The arms of the
child must be put down along the body. It is necessary to
follow that the child does not take up his shoulders, does
not take the arms in front or in the side.
 Objective laws of chest
circumference increase
At the time when a mature child is born the
chest circumference comprises 32-34cm,
during the first half a year it increases by 2
cm every month, second half a year – by
0,5cm a month. At the age of 2-10 years
this index increases by1,5 cm every year,
in pubertal period – by 3cm a year. So, the
chest circumference comprises: at the age
of 6 months-45 cm, 1 year -48cm, 5 years
-55 cm, 10 years – 63cm.
 Unevenness of child organism
growth in different age periods of
childhood is observed:

 1-4 years – the first period of roundness;

 The first period of stretching – 5-8 years;
 8-10 years – the second period of
roundness;
 The second period of stretching – 11-15
years.
 Change of body proportions
of a child’s body

Embryo 2 mths Embryo 4 mths Newborn 2 years 6 years 12 years 25 years

Picture 7. Stages of body growth of a man:

The first 2 –before the birth (antenatal); the following 5 –after the birth (postnatal); age
changes of proportions of different parts of the body (according to Skemmon).
 Assessment of physical
development
 is carried out by comparing of individual
indications of a child with normatives. The
first (fundamental), and in many cases the
only one method of assessment of physical
development of a child is carrying on
anthropometric research and assessment
of obtained data. In this 2 main methods
are used: oriented calculations and
anthropometric standards.
Method of oriented calculations
 is based on the knowledge of the main objective
laws of increase the body mass and length, the
head and chest circumferences. Corresponding
normative indices can be calculated for a child of
any age. Assumption interval of deviations of the
actual data from the calculated one comprises
+10% for average indications of physical
development. The method gives only approximate
picture about physical development of children and
is used by pediatrics, as a rule, in a case of giving
medical assistance at home.
 Method of anthropometric
standards
 is more accurate as individual anthropometric indications
are compared with normative ones corresponding to the
age and sex of achild. Regional tables of standards are of 2
types: sigmal and centile.

 While using the tables composed according to sigmal

standards method comparing of actual indications is carried
out with medial arithmetic value (M) for the given sign of
the same age-sex group, to which belongs the given child.
The obtained difference is expressed in sigmas (b – is the
medial quadratic deviation), determining the degree of
deviation of individual data from their medial value.
 Method of anthropometric
standards
 In using the tables, composed according to the
method of centile standards, it is necessary to
determine centile interval, to which belongs the
actual value of the sign, taking into account the
age and sex, and give the assessment. It is
simple in the use, does not require calculations,
makes it possible to assess interconnection
between different anthropometric indications and
is widely used.
 The scale of assessment of physical
development of children with different
methods
Assessment of Method of signal Method of centile
physical development standards standards
Very high - Over 97 centiles
High More than +δ 90-97 centiles
Higher than average From M+1,1δ to M+2δ 75-90 centiles
Average М± 1δ 25-75 centiles

Lower than average From М-1,1δ to М-2δ 25-10 centiles

Low From М – 2,1δ and 10-3 centiles

lower
Very low - Less than3 centiles
 ASSESSMENT OF PHYSICAL DEVELOPMENT
ORDER N 149 OF MPH OF UKRAINE “ABOUT
CONFIRMING CLI ICAL PROTOCOL OF MEDICA of
disturbances L CARE ABOUT A HEALTHY CHILD AT
THE AGE UP TO 3 YEARS”
 ASSESSMENT OF PHYSICAL DEVELOPMENT
ORDER N 149 OF MPH OF UKRAINE “ABOUT
CONFIRMING CLI ICAL PROTOCOL OF MEDICA of
disturbances L CARE ABOUT A HEALTHY CHILD AT
THE AGE UP TO 3 YEARS”
 ASSESSMENT OF PHYSICAL DEVELOPMENT
ORDER N 149 OF MPH OF UKRAINE “ABOUT
CONFIRMING CLI ICAL PROTOCOL OF MEDICA of
disturbances L CARE ABOUT A HEALTHY CHILD AT
THE AGE UP TO 3 YEARS”
Semiotics of height disturbances
Decrease of height can be caused by:
Diseases during pregnancy;
Hydrocephaly, microcephaly;
A number of diseases, when the nervous system and different organs
are disturbed;
Starvation, malabsorption;
Congenital heart and respiratory organs failure;
Kidney anomalies, tubulopathias;
Diseases connected with metabolism;
Endocrine diseases: hypothyrosis, hypophysial nanism, congenital
disturbances in the functions of adrenal glands- growing stops after 11-12
years;
Hereditary diseases (Dawn disease, Shereshevski-Terner disease);
Diseases of the bones: chondrodystrophy- short extremities with
shortened proximal parts, the body is of normal size;
Uncompleted osteogenesis – multiple fractures.
 Semiotics of height
disturbances
Semiotics of high stature
 Often such deviations are called acceleration, but in
acceleration the body structure is proportional, sexual
maturation has normal terms.
  
 - Giantism – overproduction of somatotrophic hormone
(STH) during the diseases of hypophysis. As a rule, in
parallel – hypofunction of sex glands (syndrome of
 Kleinfelter).
 Arachnodactilia (Morphan syndrome) –
mesodermadystrophy – high stature, thin body with long
and thin extremities. The arms spread is higher than the
length of the body, spiderlike fingers, chaotic joints.
 Semiotics of changing the body mass
 Dystrophy: hypotrophy or paratrophy.
 Hypotrophy – decrease of body mass in normal height.
Reasons of hypotrophy:
 Alimentary character.
 Malabsorption syndrome.
 In older children – anorexia (under neuro-arthritic diathesis).
 Nervous anorexia.
 Mucoviscidosis.
 Celiakia.
 Violation of metabolism –Diabetes mellitus, nonsugar diabetes,
thyrotoxicosis, galactosemia.
 Intestinal infections.
 Tumors.
 Gastrointestinal tract (GIT) development anomalies, anomalies of
cardiovascular system development.
 Semiotics of changing the
body mass
Degrees of hypotrophy
 1 degree -body mass deficit comprises 11-20%;
 2 degree - body mass deficit comprises 21-
30%;
 3 degree - body mass deficit comprises 31%
and more.
 Semiotics of changing the
body mass
 Paratrophy– increase of the body mass.
 Reason – overfeeding, diseases of
metabolism and endocrine system.
 Semiotics of changing the
body mass
 Hypostature – chronic violation of nutrition with steady
lacking of the child in body mass and in the stature. In
this nourishment of the baby can be totally satisfactory.
For hypostature is characteristic that the child in his
physical and psychomotor development is behind of the
same age children. Hypostature is typical for children
with congenital heart failure, grave encephalopathy
(diseases of central nervous system, arising in the
intrauterine period because of unsatisfactory conditions
for the development of fetus), endocrine violations,
some hereditary diseases. After the reason of
hypostature is eliminated the children can overtake the
same age healthy children in physical development.
 Physical culture and training the
children
 This is action of factors promoting increasing unspecific
reactivity and resistance and adaptation.
 Physiological basis of steeling the organism is stimulation of
defense reactions, active production of new conditioned
reflexes on steeling irritant. In this take part:
 The power of the epidermal layer.
 Blood supply, functions of sweat and sebaceous glands.
 The level of the main exchange.
 Skin temperature.
 Sympathetic adrenal system, protecting homeostasis.
 Integral effect of training is fitting the health of a person,
increasing the defense against catching cold and increasing
the labor ability.
 Principles of training the
organism:
 Gradualness;
 Individuality - taking into account the age, climatic conditions,
state of health;
 Systemness;
 Continuousness - training effect is achieved in 2 months,
disappears in 2-3 weeks;
 Diversity ( to warmness and cold (short time intensive cooling
trains the process of heat giving out, weak and medial - a
process of heat production.
 So there is necessity not only in different factors, but also in a
diversity of the same factor (different temperature regimens).
 Psychomotor development of a
child
 Expresses the becoming of different areas of the nervous
system of a child in particular periods of life. The assessment of
psychomotor development of a child is carried out during every
prophylactic check up using a table, in which age peculiarities of
psychomotor development of a child are given.
 Assessment of psychomotor development of a child is carried
out on the following criteria:
 Motorics -purposeful manipulation activity of a child ;
 Statics -fixation and holding of definite parts of the body in
necessary position;
 Sensory reactions - formation of corresponding reactions on
light, sound, pain, touch;
 Speech - expressive speech and understanding the speech;
 Psychic development - positive and negative emotions,
formation of social age.
Peculiarities of PMD of newborn
children
 For newborns are characteristic uncoordinated
athetoselike movements of extremities, rigidness
of muscles, physiological hypertonus of
muscles-benders, loud cry. Hearing is
decreased, feeling of pain is weakened.
Besides, neuro-psychic development of a
newborn child is characterized by the presence
of a number of unconditioned reflexes.
 Reflexes of newborn period
1) steady life long automatisms (exist during the whole life):
Swallowing;
Tendon reflexes of extremities;
Cornea;
Conjunctive;
Orbiculopalpebrale.

2) Transitory (exist after the birth and afterwards gradually

disappear):
Oral segmentary automatisms (swallowing, seeking, palm-oral-head
or Babkin reflex);
Spinal segmentary automatisms (defense, support, automatic
walking, catching reflex of Robinson, reflexes of Moro, Kernig,
crawling reflex of Bauer, reflexes of Babinski, Halant, Peres.
 Reflexes of newborn period
 Swallowing reflex lasts up to 10-12
months. It can be brought about putting a
baby’s dummy on a mouth of a newborn,
the baby makes swallowing movements.
 Reflexes of newborn period

 Seeking reflex - on stroking the baby’s skin in

the area of the angle of the mouth he moves
his head, moves down his lower lip and
moves his tongue to the irritant. Is kept by 3-
4 months.
 Reflexes of newborn period
 Palm-mouth-head reflex (Babkin) – in pressing
with big fingers on palms in the area of the
mounds of big fingers of a baby, he opens his
mouth and bend his head forward to the breasts.
Lasts 2-3 months.
 Defense reflex – if a newborn is put on his
abdomen he reflectory turns his head in side. Is
kept up to 2 months of life.
 Reflexes of newborn period
 A catching reflex - on touching the palms of the
baby with fingers he catches them and holds
firmly, in this the child can be lifted over the
plane. The reflex lasts for 3-4 months.
 Reflexes of newborn period

 Babinski reflex - on irritating

the sole of the baby on the
outside of the foot from the
heel to the base a big finger
slow straightening up of the
big finger and bending the
other fingers takes placer.
This reflex is supposed to
be physiological up to 2
years age.
 Reflexes of newborn period
 Supporting reflex acts in the
following way: the doctor holds
the baby with his
 armpit spaces from the back and
with the same fingers protects the
head. In lifting the baby in this
position he bends the legs in knee
and malleolus joints. On dropping
down the baby on some support
he presses on it with a whole foot.
This reflex is physiological up to 2
months period.
 Reflexes of newborn period
 Reflex of
 automatic walking - on
bending the baby’s
body in a position of
protecting reflex he
makes steps forward.
The reflex disappears
in 2 months.
Reflexes of newborn period

 Crawling reflex of Bauer -

in a position on the
abdolmen the baby tries to
lift his head and makes
crawling movements. If you
put your hands under the
baby’s feet he will actively
push off with legs from your
hands. The reflex lasts 4
months.
 Reflexes of newborn period
 Peres reflex - if the baby is put on
his side and move your hand from
the coccyx to the neck along the
bony parts of the spine this causes
short apnoe in the baby, then a
sharp cry, lordosis, bending of
extremities, hypertonus of the
muscles, sometimes defecation and
urination. This reflex is checked up
at the end of examination as it
causes pain in a baby. This reflex is
supposed to be physiological the
first 3-4 months of the baby’s life.
 Reflexes of newborn period
 the third group of reflexes, which are formed not at once
after the birth, but in the definite months of life. These
reflexes are called determining automatisms. This group
of reflexes includes the upper and lower posotonic
reflexes of Landau, simple cervical and trunk
determining reflexes, chain determining reflex from trunk
to trunk.
 The upper posotonic reflex of Landau - in a position of a
baby on the abdomen he rises his head, the upper part
of his trunk and, supporting with his hands, stays in this
position. This reflex appears at the age of 3-4 months.
 Psychomotor development
Age Motility Statics Sensory Speech Emotions
reactions and social
behavior
1 month Physiological Begins Appears Arising Reacts
hypertone of holding shorttime simgle negatively
muscles is the head looking on sounds on
decreased, for some around the at the strong
sound
atetoselike minutes surroundings end of
and light
movements in horizontal and hearing a month,
of extremities position, fixation. pronounce irritants.
fade. Expressed lies on the vowel Having seen
unconditioned abdomen sounds a new face,
at the end of he
reflexes. from ‘a’
the month. fixes on it
to ‘e’.
for a
moment.
 Psychomotor development

Age Motility Statics Sensory Speech Emotions

reactions and social
behavior
3 month Majority of Holds the In the Frequent, Answers
unconditioned head well. reaction on lasting with
reflexes begin sound sounds. complex of
to disappear irritants and The first excitement
(seeking, brilliant chains of on
Babkin, subjects sounds emotional
catching and appears “rrr”. communica
others). fixing up his tion. Social
Stretches out eyes on smile.
for a toy. them, active
Muscular tone reaction.
is normalized.
 Psychomotor development
Age Motility Statics Sensory Speech Emotions
reactions and social
behavior
4 month Appear In vertical A complex of Frequent, Loudly
directed position excitement lasting laughs in a
movements of appear the while singing reply to
arms: better first meeting like emotional
takes a toy. manifestati close different oral
Turns from ons of relatives. For sounds. appeal.
back to his supporting the first time Appear lip
side. by the begins to consonan
Disappear legs. In a recognize ts “m”,
most of position on the mother. “b”,
unconditioned the Looks shouts of
reflexes abdomen – attentively joy.
(Moro, confident on a toy in
crawling, support on the hand.
catching). the
forearms.
Age Motility Statics Sensory Speech Emotions
reactions and social
behavior
6 month Actively turns In a More Speaking: Emotions
from the back position on adequate consecuti are
to the the reaction on ve differentiat
abdomen, abdomen the connectin ed,
begins to turn he is appearance g of stretches
from the supported of the different his arms to
abdomen on by the mother, expresse be taken
the back. stretched father or a d on the
Catches arms or strange syllables hands.
purposefully a fully open person. with Differently
proposed toy, palms. Follows with changing behaves
puts it from Begins to the eyes the with close
one hand to sit down after a toy, strength people and
another. through which fell of sound strangers.
turning on down. and
the back stress of
leaning on the tone.
the arm.
 Psychomotor development
Age Motility Statics Sensory Speech Emotions
reactions and social
behavior
8 month Catches with Crawls on After definite Prattles Adequate
each hand a the bringing up with joy, emotional
brick and abdomen, shows with pronounc reactions
holds it firmly stretching hands “good es the on reply of
for some short the arms bye”, with a sounds conversatio
time. ahead. nod of the “ba”, n. Follows
Unassisted head gives a “ma”, the actions
sits down, sign of agree “yes”. of the other
lies down, -“yes” or children,
gets up. negation - laughs,
“no”. prattles.
 Psychomotor development
Age Motility Statics Sensory Speech Emotions
reactions and social
behavior
10 The number of He can be More The first Differentiat
month purposefull taken expressed words ed mimical
movements supported and enriched appear, movements
increases: on one are the which the , voice
composes a hand. indicated child reactions.
pyramid, puts Crawls on things. understands Reacts on
the toys in surfaces of Repeats the . In the everything
their places, different movements vocabulary new. Plays
etc. “Pincer” height, of adult there are with
catching - many people, some children
takes children “Speaks on words. with one
something can stand the phone”, Correctly toy.
with a thumb supported “Mixes the repeats the
and index with some porridge”. words said
finger. subject. Throws by an adult
away a toy. person.
 Psychomotor development
Age Motility Statics Sensory Speech Emotions and
reactions social behavior

12 Can play Walks Fulfills more The first words Gives a toy to
month with toys along the and more appear, which another child,
during furniture, complicated the child doing this he
an hour assisted demands or understands. In smiles or laughs
or more. on one requests, the vocabulary and prattles.
hand or understandin there are some Seeks the toys,
unassiste g them. words. which are
d at all. More and Correctly hidden. On
more repeats the request he
demonstratio words said by embraces the
ns of an adult parents, waits
reactions on person. for some praise,
the Voabulary - 8- confirming his
surrounding 10 words. success by a
s. close person.
 On the results of assessment of psychomotor
development of a child tactics is determined for
the following medical observation. If a child
fulfills all the actions characteristic for his age, it
is necessary to carry on consultation on the care
with the aim of development. If the child cannot
fulfill the proposed actions or there is delay in
appearing new skills, the mother must be taught
how to carry on studies with the child aimed at
development and how to use additional
stimulations for producing skills, which are
underdeveloped.
 The doctor’s tactics according to the results of a
child’s psychomotor development assessment
Results of assessment Tactics

The indices of psychomotor he following observation.

development are in
accordance with the child’s
age.
Determined delay of
developing skills in a child of
1 month in the first year of
life.
Consultation on the care with
the aim of development.
Consultation on the care
aimed at development and
carrying on correction
training. Repeated check up
in 1 month. If the revealed
delay lasts by the repeated
check up, there is a need in
of a children’s doctor-
neurologist’s consultation.
 The doctor’s tactics according to the results of a
child’s psychomotor development assessment
Results of assessment Tactics

Delay in arising the skills of 3 Consultation about the care aimed

months in children at the age
from 1 to 2 years.
Delay in arising the skills of 6
months in children at the age
from 2 to 3 years.
at development and carrying on
correction training.
Repeated check up in 1-3 months.
If determined the delay lasting,
there must be the children’s doctor-
neurologist’s consultation.
Consultation on the care aimed at
development.
Repeated check up in 2-6 months.
If the revealed delay is lasting, there
is a need in children’s doctor-
neurologist’s consultation.
Semiotics of psychomotor
development disturbances
Thank you for your attention