GROWTH AND

DEVELOPMENT
By NK
Goals
■ Growth – definition and assessment
■ Factors affecting growth
■ Normal growth patterns
■ Development – definition and principles
■ Factors affecting development
■ Domains of development
■ Stages of Growth and development :-
• Newborns
• Infancy
• Toddler
• Pre-school
• School age
• Adolescents
 GROWTH
An increase in the size or mass of the tissues.
It is a quantitative change in the child’s body.
Can be measured in Kg, pounds, meters, inches etc.
FACTORS AFFECTING
GROWTH
Fetal growth
■ Genetic potential – For e.g.:- size of the head is more closely related to that of parents than that
hands & feet.
■ Sex – boys are generally taller and heavier than girls at birth.
■ Fetal hormones :–
• Thyroxine and insulin – regulates tissue accretion and differentiation in the fetus. Needed
during late gestation for normal G&D.
• Glucorticoids – influence the prepartum maturation of organs such as liver, lungs & GIT.
• Growth hormone – high levels n fetus but no influence on fetal growth.
■ Fetal growth factors :–
• Growth promoting factors - IGF-I and IGF-II, EGF, TGF-α, PDGF, FGF & nerve growth
factor
• Inhibitory factors – TGF-β, Mullerian inhibitory substance & inhibin/activin family of proteins.
■ Placental factors – with advancing gestation, weight of placenta increases for increased fetus
needs.
• Total villous surface area increases, diffusion distance decreases, fetal capillaries dilate &
resistance in fetoplacental vasculature falls – facilitates nutrient transport across placenta.
■ Maternal factors – mother’s own fetal & childhood growth; her nutrient intake & body
composition at conception & during pregnancy.
• Teenage or advanced age; recent pregnancy; high parity; anemia; intake of tobacco, drug or alcohol
abuse
• Obstetrical complications – pregnancy induced HTN; pre-eclampsia; multiple pregnancies.
• Chronic systemic disease – CHF; chronic renal failure; acquired infections (rubella, syphilis,
hepatitis B, HIV, CMV, toxoplasmosis)
Postnatal period

■ Genetic factors –
• Chromosomal disorders like Turner syndrome & Down syndrome – lead to short stature.
• Klinefelter syndrome & Sotos syndrome – tall stature.
• Mutations of single genes – inherited retardation of growth, e.g. Prader-Willi syndrome & Noonan
syndrome.
■ Intrauterine growth restriction (IUGR) – resulting in:-
• Low birth weight – risk for postnatal malnutrition & poor growth; increases stunting & wasting in first
5yr of life by 3 to 5 times..
• At 3-5 months, giving animal milk – infections lead to underweight & stunting – increases morbidity.
• Faulty complementary feeding practices along with poor hygiene – rise in rates of underweight &
stunting.
■ Hormonal influence :-
• Absence of growth hormone or thyroxine – dwarfism
• During adolescence, androgens & estrogens – affects growth spurt & final adult height.
■ Sex – pubertal growth spurt occurs in girls. Mean weight & height in girls less than those in boys
of same age.
■ Nutrition – PEM; anemia; vitamin deficiency; deficiency of Ca, iron, iodine, etc; overeating &
obesity.
■ Infections – persistent or recurrent diarrhea; RTI; systemic infections & parasitic infections, Risk
of stunting increases:-
• Before 2 yr - with each day of diarrhea
• At 2yr – with each episode of diarrhea
■ Chemical agents – androgenic hormones administration accelerates the skeletal growth initially
but cause premature closing of epiphyses of bones, leading to early cessation of bone growth.
■ Trauma – fracture at the end of bone may damage growing epiphysis – hamper skeletal growth.
Social factors
■ Socioeconomic level – high socioeconomic level, better hygienic living conditions
-better nutritional state and free of infections.
■ Poverty – hunger, undernutrition and infections
■ Natural resources – improved nutrition of children in community if there is high
gross national product & per capita income is high.
■ Climate – higher growth in spring & low in summer. Infections & infestations are
common in hot & humid climate. Also affects agricultural productivity, availability
of food & capacity for labor.
■ Emotional factors – low growth rate of children from broken homes and
orphanages. Anxiety, insecurity & lack of emotional support and love.
■ Cultural factors – methods of child rearing & infant feeding; religious taboos
■ Parental education – more educated mothers adopt appropriate health promoting
behaviors.
 ASSESSMENT OF
PHYSICAL GROWTH
Weight

■ Child in the nude or minima light clothing

■ Lever or electronic type of weighing scale.
■ Spring balances are less accurate
■ Minimum unit of weighing scale should be 100g.
■ Child placed in the middle of weighing pan
■ Machine should corrected for any zero error before measurement
Length

■ For under 2 yr of age.

■ Hairpins removed and braids undone.
■ Bulky diapers should be removed
■ Placed supine on a rigid measuring table or an infantometer
■ Head is held firmly against a fixed upright head board
■ Legs are straightened, keeping feet at right angles to legs, toes pointing upward. Free
feet board in contact with child’s heels.
■ Lying on mattress &/or using cloth tapes – inaccurate, not recommended.
Standing height

■ Stands upright, Heels slightly separated.

■ Weight is borne evenly on both feet
■ Heels, buttocks, shoulder blades and back of head in contact
with a vertical surface such as wall, height measuring rod or
a stadiometer.
■ Child looks directly forwards.
■ Head piece is kept firmly over the head of compress the hair.
Head circumference
■ Hair ornaments removed & braids undone
■ Maximum circumference - occipital protuberance to supraorbital ridges on
forehead recorded.
■ Crossed type method using firm pressure to compress hair

Chest circumference
■ At the level of nipples, midway between inspiration and expiration. Crossed
type method.

Mid upperarm circumference

■ First mark a point midway b/w tip od acromian process of scapula &
olecranon of ulna
■ Child holds left arm by his side
■ Crossed tape method. Just tight enough to avoid gap and avoid compression.
NORMAL GROWTH
Weight
■ Neonates – normal, 2.5 to 3.5 kg
■ First few days, newborn loses about 10% of the body weight and most infants regain the
birthweight by 10 days.
■ Gain of weight:-
• For 3 months – 25-30g per day
• For 4-12 months – 400g every month
• By 5 months – double of birthweight
• At 1 yr – triples
• 2 yr – quadraples (1.8-2.7Kg/yr)
• 3 yr – five times
• 5yr – multiplying birthweight by 6, 7yr by 7, at 10 yr by 10
• B/w 3 & 7 yr – about 2 kg every year on an average and
• 7yr till puberty – 3kg per yr ►
Length or Height
■ Approx 48-50 cm at birth
■ At 3 months - 60cm (3cm/month in 1-3 months)
■ At 6 months – 65cm (2cm/month in 4-6 months)
■ At 9 months – 70cm (1.5cm/month in 7-12 months)
■ 1yr – 75cm (increased by 50%)
■ 2yr – 90cm (1-2 yrs, 1cm/month & 10-12.5cm/yr)
■ 4yr – 100 cm (doubles birth length)
■ Until 12 yr – gains about 6 cm every yr
■ After this, increments vary according to age at onset of puberty

►
Head circumference

■ Head growth - Rapid, especially in first half of infancy; then slows

considerably.
■ 33-35cm at birth
■ For 3 months – 2cm per month
■ 3-6 month – 1cm per month
■ For rest of the 1st yr - 0.5cm per month

►
Chest circumference
■ About 3 cm less than the head circumference at birth
■ Almost equal by 1 yr
■ Then exceeds the head circumference.

Body mass index (BMI)

■ Formula – weight(kg)/height(m)2
■ More than 30 kg/m2 is obesity.

►
Dentition

►
DEVELOPMEN
T
Maturation of functions & acquisition of various skills for optimal
functioning of an individual.
Maturation of myelination of the nervous system is reflected in the
sequential attainment of developmental milestones.
Qualitative change in the child’s functioning.
Measured through observation.
Rules/Principles of development
■ Continuous process
■ Depends on the functional maturation of the nervous system
■ Sequence of attainment of milestones is the same in all children
■ Progresses in a cephalocaudal direction – head control precedes trunk control
■ Orderly or sequential process
■ Influences by environmental & genetic factor
■ Predictable
■ Proceeds from simple to complex, from general to specific
FACTORS AFFECTING
DEVELOPMENT
Prenatal factors
■ Genetic factors – intelligence of parents has direct relation on final IQ of the child.
• Chromosomal abnormalities (e.g Down syhndrome); mutations (X-linked mental
retardation); telomeric deletions; single gene disorders – lissencephaly and
phenylketonuria
 Maternal factors :-
• Maternal nutrition :– maternal malnutrition – adverse effect & nutrition
supplements – positive impact on birth weight & development.
• Exposure to drugs and toxins – maternal drug or alcohol abuse, antiepileptic
drugs & environment toxins
• Maternal diseases and infections – pregnancy induced HTN, hypothyroidism,
fetoplacental insufficiency; acquired infections (syphilis, AIDS, herpes, CMV, etc).
Exposure to free radicals and oxidants in utero (e.g. chorioamnionitis) – cerebral
palsy & development impairment.
Neonatal factors

■ Intrauterine growth restriction (IUGR) – constrains in fetal nutrition during a

crucial period for brain development mainly due to poor maternal nutrition and
infections.
■ Prematurity :– Born before 37 wks – more risk of developmental impairment &
Before 32 wks – highest risk due to complications like intracranial bleed, white
matter injury, hypoxia, hypoglycaemia, hyperbilirubinemia.
■ Perinatal asphyxia – occurs in approx. 2% of total births. Over 40% of
survivors of asphyxia suffer from major neurocongnitive disabilities.
Postnatal factors

■ Infant and child nutrition :–

• severe calorie deficiency due to multiple micro-nutrients & vitamins deficiency–
stunting, apathy, depressed affect decreased play & activities, insecure attachment.
• Linear growth retardation or stunting; early growth faltering (<24months).
• Macronutrient supplementation – developmental benefits.
■ Iron deficiency – delayed maturation; poor cognitive, motor and social emotional
development in infancy and early childhood.
■ Iodine deficiency – congenital hypothyroidism, irreversible mental retardation.
Growing in iodine deficient areas have an IQ 112.5 points lower.
■ Infectious disease – diarrhea, malaria, other parasitic infections, HIV – poor
neurodevelopment
■ Environmental toxins - Lead, arsenic, pesticides mercury & polycyclic aromatic
hydrocarbons exposed postnatally through breast milk, food, water, house dust or soil.
■ Acquired insults to brain – traumatic or infectious insults (meningitis, encephalitis,
cerebral malaria) and other factors (trauma, near drowning)
■ Associated impairments – impairments in sensory inputs from the eyes or ears.
Psychosocial factors
■ Parenting – cognitive stimulation, caregiver’s sensitivity and affection and
responsiveness, poverty, cultural values and practices, parental attitudes, involvement,
education & desire for the child.
■ Poverty – most common. Acts throughout the lifetime and also affects next generation.
Prevent child attaining their full potential & adult productivity.
■ Lack of stimulation – social & emotional deprivation & lack of adequate interaction
and stimulation.
■ Violence and abuse – domestic and community violence; physical and sexual child
abuse – psychological effect, attention & cognitive problem,
■ Maternal depression – negative effect on child development
■ Institutionalization – orphanage care – risk of poor growth, ill-health attachment
disorders, attention disorders, poor cognitive function, anxiety & autistic like behaviour.
Protective factors

In their presence, children attain their development potential. Timely intervention

can be helpful.
■ Breastfeeding – protective & promotive effect on childhood development.
■ Maternal education – protective factor reducing child mortality & promoting
early child development.
• Infant and young children of educated mothers – higher levels of cognitive
development.
 DOMAINS OF
DEVELOPMENT
Gross motor development
Fine motor skill development
Personal and social development & general understanding
Language
Vision & hearing
Gross Motor Development

Progresses in an orderly sequence to ultimate attainment of locomotion and more

complex motor tasks.
■ Supine and pull to sit :– infant is observed in supine, then gently pulled to
sitting position. Control of head and curvature of the spine is observed.
• Newborn – head completely lags behind, back is rounded
• 6 wks – head control develops & spine curvature also decreses accordingly
• 12 wks – slight head lag
• 20 wks – complete neck control. Baby loves to play with his feet & may take to
mouth as well.
• 5 months – infant lifts head from supine position when pulled. ►
■ Ventral suspension – child is held in prone position, then lifted from
couch, examiner supporting chest & abdomen with the palm.
• 4 wks – head flops down
• 6 wks – child holds head in horizontal plane
• 8 wks – maintain his position well
• 12 wks – lift his head above horizontal plane.

►
■ Prone position – at birth or within a few days, newborn turns the head to one
side.
• 2 wks – lies on the bed with high pelvis & knees drawn up
• 4 wks – lifts the chin up momentarily in midline
• 6wks – lies with flat pelvis and extended hips
• 8 wks – face is lefted up at 450
• 12 wks – can bear weight on forearms with chin & shoulder off the couch & face
at 450
• 6 months – lift his head & greater part of chest while supporting weight on the
extended arms.
• 4-6 months – learns to roll over, first from back to side then from back to
stomach
• 8 months – crawls with abdomen on ground
• 10 months – creeps, abdomen off the ground, weight on knees & hands. ►
■ Sitting :-
• 5 months – can sit steadily with support of pillows or examiner’s hands.
At first, back rounded but gradually straightens.
• 6-7months - sits independently with arms forward for support (tripod)
• 8 months – steady sitting without support
• 10-11 months – can pivot in sitting position to play around with toys.

►
■ Standing and walking :-
• 6 months – bear almost all his weight when made to stand
• 9 months – begins to stand holding onto furniture and pulls himself to stand
• 10-11 months – starts cruising around furniture
• 12-13 months – stand independently & walk with one hand held
• 13-15 months – starts walking independently
• 18 months – runs & crawls up or down stairs & pulls a doll or wheeled toy along
the floor.
• 2 yr – walks backwards & climbs upstairs with both feet on one step
• 3 yr – climbs upstairs with one foot per step & ride a tricycle
• 4 yr – moves down the stairs & can hop
• 5 yr - skip

►
Fine Motor Development
Development of fine manipulation skills & coordination with age.
■ Hand eye coordination :-
• 12-20 wks, observes his own hands very intently, k/a hand regard. Abnormal if persist
afte 20 wks.
• 3-4 months – hands come together in midline as he plays. Fixes his attention on
dangled red ring in front of him, then tries to reach for it. Initially, may overshoot but
eventually, gets it & brings to mouth.
Grasp assessment::- by giving cube, larger object,
• 6 month – holds the cube using ulnar aspect of his hand. 6-7 months – transfer objects
from one hand to other.
• 8-9 months – grasp from radial side of hand
• 1 yr – mature grasp, index finger & thumb
By giving pellets, smaller object :- 9-10 months – approaches by index finger & lifts it
using finger & thumb apposition, k/a pincer grasp. ►
■ Hand-to-mouth coordination :-
• 6 months – chews, can take biscuit to mouth & chew. Tends to mouth all
objects offered to him. This habit abates by 1 yr.
• 1 yr – tries to feed self from a cup but spills.
• 15 months – picks up a cup and drink without much spilling
• 18 months – can feed himself well using a spoon.

►
■ Advanced hand skills :-
• 15 months – turns 2-3 pages of a book & scribbles on a paper if given a pencil.
• 18 months – build a tower of 2-3 cubes & draw a stroke with pencil
• 2 yr – unscrew lids & turns door knobs & block skills advance. Draw a circular
stroke & turn pages of a book one at a time.
• 3 yr – tower of 9 blocks & copies circle.
• 4yr – copies cross, bridge with blocks
• 5 yr – copies triangle & gate with blocks

►
■ Dressing :-
• 1 yr – starts to pull off mittens, caps & socks
• 18 months – unzip, but fumbles with buttons
• 18-30 months/ 1.5-2.5 yr – eager to learn dressing skills. Undressing being
easier, learned before dressing.
• 2 yr – put on shoes or socks & can undress completely.
• 3 yr – dress & undress fully, if helped with buttons
• 5 yr tie his shoelaces.

►
 Personal and social development &
general understanding
■ 1 month – intently watches his mother when she talks to him
■ 6-8 wks – starts smiling back (social smile) when anyone talks or smile.
■ 3 months – enjoys looking around & recognizes his mother.
■ 6 months – vocalizes & smiles at his mirror image & imitates acts such as cough etc.
■ 6-7 months – stranger anxiety & inhibits to no.
■ 9 months – waves bye-bye & repeats any performance that evokes an appreciative response.
■ 1yr – understand simple questions, e.g. “where is papa”. Comes when called.
■ 15months- points to objects. 18months – follows simple orders & indulges in domestic mimicry
■ 2 yr – point to 5-6 familiar objects or body parts & name 2-3 objects. Ask for food, drink, toilet.
■ 3 yr – begins to count, identify 1-2 colors, sing simple rhymes, knows full name & gender.
■ 4 yr - left & right discrimination develops, plays cooperatively in group & goes to toilet alone.
■ 5 yr – follow 3 step commands, identify four colors & repeat four digits. Dresses & undresses.
►
Language
■ 6-8 wks – begins to vocalize with vowel sounds such as ‘ah, uh’
■ 3-4 months – squeals with delight & laughs loud.
■ 5 months – say ‘ah-goo”, ‘gaga”
■ 6 months – monosyllables (ba, da, pa).
■ 9 months - bisyllables (dada, baba, mama). 9-10 mon – imitate sounds of native
language
■ 1 yr – 1-2 words with meaning
■ 18 months – 8-10 words vocabulary
■ 2 yr – 2-3 sentences, use pronouns I, me, you.
■ 3 yr – asks questions & knows his full name & gender
■ 4 yr – say song or poem, tells stories
■ 5yr – asks meaning of words ►
Vision

■ At birth – fixate and follow a moving person or dangling ring held 8-10
inches away at 450, 900 by 4 wks & 1800 by 12 wks
■ 1 month – fixate on his mother as she talks
■ 3-4 months – fixates intently on an object shown (grasping with eye).
binocular vision well established which starts at 6 wks
■ 6 months – adjusts his position to follow objects of interest
■ 1 yr – follow rapidly moving objects

►
Hearing

■ Newborns – respond to sounds by startle, blink, cry, quieting or change in

ongoing activity.
■ 3-4 months – turns his head towards the source
■ 5-6 months – turns the head to one side & then downwards if a sound
made below the level of ears.
■ 7 months – localizes sounds made above level of ears
■ 10 months – looks at source of sound diagonally

►
 Different  New born
stages  Infancy

of  Toddler
 Pre-school
growth  School age
and  Adolescent
development
 NEWBORN
{FIRST 4WKS OR
FIRST MONTH}
Transitional period from intrauterine life to extra uterine
environment.
Physical growth
■ Weight :- Slide 16 ►
■ Height :- Slide 17 ►
■ Head circumference :- Slide 18 ►
■ Chest circumference :- Slide 19 ►
■ Head has two fontanels:-
1. Anterior fontanel – diamond shape. Junction of the sagittal, corneal & frontal
sutures form it.
• B/w 2 frontal & 2 parietal bones.
• 3-4cm in length & 2-3 cm width.
• Closes at 12-18 months of age.
2. Posterior fontanel – triangular, located b/w occipital & 2 parietal bones.
• Closes by the end of the 1st month of age.
Physiological growth
■ Temperature - 36.50 to 37.50 C
■ Pulse – 120-140 beats/min
■ Respiration – 35-40 times/min
■ BP – 60-70/40-50 mmHg

Senses
■ Touch – most highly developed sense. Mostly at lips, tongue, ears & forehead. Usually
comfortable with touch.
■ Vision – pupils react to light. Bright lights appear to be unpleasant to newborn infant.
Follow objects in line of vision. Slide 42 ►
■ Hearing – Slide 43 ►
■ Taste – well developed as bitter and sour fluids are resisted while sweet fluids are accepted.
■ Smell – only evidence in newborn’s search for the nipple, as he smell breast milk.
APGAR Scoring chart (at 1,5,10 min and 20 min if needed)
 Gross motor development
■ Newborn’s movements are randome, diffuse & uncoordinated.
■ Reflexes carry out body functions & responses to external stimuli.
■ Slide 31, 32, 33

Fine motor development

■ Holds hand in fist
■ When crying he draws arms & legs to body.

Cognitive development:- Difficult to understand or observe it.

Emotional development- Expresses his emotion just through cry for hunger, pain
or discomfort.

Social development Slide 40 ►

Reflexes
LOCAL GENERALISED
■ Rooting reflex ■ Moros reflex
■ Sucking reflex ■ Startle reflex
■ Swallowing reflex ■ Tonic neck reflex
■ Gag reflex ■ Stepping reflex or dancing
■ Coughing reflex reflex

■ Sneezing reflex ■ Babinskis reflex

■ Extrusion reflex
■ Blinking reflex
■ Dolls eye reflex
■ Grasp reflex
Pull to sit, complete head lag in newborn Ventral suspension; unable to hold neck in the line with
trunk at 4 weeks

1 month, the baby showing intent regard of his

Lies on the bed with high pelvis and knees mother's face as she talks to him
drawn up at 2 weeks
 INFANCY
{1MONTH-1YR}
Growth and development are rapid.
Physical growth Pull to sit; no head lag at 4 months
■ Weight :- Slide 16 ►
• Calculation :- age in months +9
2
■ Height :- Slide 17 ►
■ Head circumference :- Slide 18 ►
■ Chest circumference :- Slide 19 ► Pull to sit; flexes the head on to chest
at 5 months
■ Dentition :- Slide 20 ►

Physiological growth
■ Pulse – 110-150 beats/min
■ Breath through nose. Respiration – 35±10 times/min
■ BP – 75/50±20/10 mm/Hg
Gross Motor development Slide 31, 32, 33, 34, 35
Fine Motor development Slide 36, 37, 39
Infant lifts head from the supine
Social development Slide 40 ► position when about to be pulled
at 5 months
Language Slide 41 ►
Vision Slide 42 ►
Hearing Slide 43 ►
Emotional development
■ His emotions are instable, where it is rapidly changes from crying to laughter. His
affection for or love family members appears.
■ 10 months – expresses several beginning recognizable emotions, such as anger,
sadness, pleasure, jealousy, anxiety & affection.
■ 12 months – emotions are clearly distinguishable.
Ventral suspension; head in line with Ventral suspension; head in line with The infant lies with flat pelvis and
the trunk at 8-10 weeks the trunk at 12 weeks extended hips at 6 weeks

In prone: face lifted to about 45° at 8 In prone: face, head and chest off the In prone: weight on hands with
weeks couch at 3 months extended arms at 6 months
 Creep position at 10 months of age Sitting; back rounded but able to hold Sitting; back much straighter at 4
(abdomen off ground and weight on head at 8 weeks months
hands and knees)

Sitting with support of hands at 6 Sitting without support at 8 months Pivoting; turns around to pick up an
months object at 11 months
Bears almost entire weight at 6 Stands well at 12 months Hand regard (between 12 and 20
months weeks)

child brings hands in midline as he Bidextrous grasp approach to a Immature grasp at 6months (palmar
plays at 3 to 4 months of age dangling ring at 4 months grasp)
Intermediate grasp at 8 months, Mature grasp at 1 yr of age, note the Pincer grasp approach to small objects
beginning to use radial aspect of the use of thumb and index finger (index finger and thumb)
hand

child mouthing an object at 6 months Grasping 'with the eye' at 3 months Diagonal localization of the source of
of age sound at 10 months
TODDLER
{1-3 YRS}
Growth slows considerably.
Physical growth
■ Weight :- Slide 16 ►
• Formula to calculate weight over 1 yr of age :- [Age in years × 2] +8
■ Height :- Slide 17 ►
• Formula :- (Age in yrs × 5) + 80
■ Head circumference :- Head increases 10cm only from age of 1yr to adult age.
■ Chest circumference :- Slide 19 ►
■ Teething :- 2yr – 16 temporary teeth, 30months - 20 teeth. Slide 20 ►

Physiological growth
■ Pulse – 80-130 beats/min (average 110/min)
■ Respiration – 20-30times/min
■ Bowel & bladder control :- daytime control of bladder and bowel control by 24-30
months
 Gross motor development Slide 35 ►
Fine motor development Slide 37, 38, 39
Social development & cognitive development Slide
40 ►

Language Slide 41 ►
Child walking with one hand-held at Scribbles spontaneously at 15 months child makes tower of 5-6 cubes at 2
12-13 months yr of age
PRE-SCHOOL
{3-6YRS}
Growth is relatively slow.
Physical growth
■ Weight :- 1.8Kg/yr; Slide 16 ►
■ Height :- Slide 17 ►
■ Dentition :- Slide 20 ►

Physiological growth
■ Pulse – 80-120beat/min (average 100beats/min)
■ Respiration – 20-30times/min
■ Blood pressure – 100/67±24/25

Gross motor development Slide 35 ►

Fine motor development Slide 38, 39

Social development Slide 40 ►
■ Egocentric
■ Tolerates short separation & less dependant on parents
■ May have dreams & night mares
The child is able to walk upstairs and
■ More cooperative in play downstairs one foot per step at 4 yr

Emotional development
■ Fears dark
■ Tends to be impatient and selfish
■ Expresses aggression through physical & verbal
behaviors.
■ Show signs of jealousy of siblings.

Language Slide 41 ►
 SCHOOL AGE
{6-12YRS}
Growth and development is characterized by gradual
growth.
Physical growth
■ Weight :- Slide 16 ► 3.8 Kg/yr, boys gains slightly more than girls.
■ Formula – (age in yrs×7) – 5
2
■ Height :- Slide 17(5cm/yr) ►
■ Dentition :- permanent teeth erupt starting from 6 yrs usually in same order in
which primary teeth are lost. Acquires permanent molars, medial & lateral incisors.
Slide 20 ►

Physiological growth
■ Pulse – 90±15beats/min
■ Respiration – 21±3times/min (18-24)
■ Blood pressure – 100/60±16/10
Gross motor development
■ 6-8 yr :- Rides a bicycle, runs, jumps, climbs, hops, improved eye-hand
coordination, prints word & learn cursive writing, can brush & comb hair.
■ 8-10 yrs :- throws balls skilfully, participate in organized sports, team sports, use
both hand independently, handles eating utensils skilfully.
■ 10-12 yrs :- enjoy all physical activities, continues to improve his motor
coordination.

Fine motor development

■ Writing skills improve, fine motor with more focus on building models, sewing,
musical instrument, painting, typing skills, technology 0omputers.
Cognitive development
■ 7-11 yrs, concrete operational stage. Able to function on a higher level in his
mental ability. Greater ability to concentrate & participate in self-initiating quiet
activities that challenge cognitive skills, such as reading, playing, computer &
board games.

Emotional development
■ Fears injury to body & fear of dark; curious about everything; short bursts of
anger by 10 yrs but able to control anger by 12 yrs.

Social development
■ Continues to be egocentric; wants other children to play with him; insists on being
first in everything; becomes peer oriented; improves relationship with siblings;
greater self control, confident, sincere; respects parents & their role.
 ADOLESCENCE
{10-19 YR} [ACC. TO WHO]

A Stage of transition from childhood to adulthood.

Begins with appearance of secondary sex characteristics & ends when
somatic growth is completed.
1. Early (10-13 yr)
2. Mid (14-16yr)
3. Late (17-19yr)
 PHYSICAL ASPECTS
Gonadal sex steroids – secondary sexual characters ((breast development,
increase in penile, testicular size & menarche)
Adrenal androgens – development of sexual hair, acne & underarm odor.
Physical growth & nutritional requirements
■ Height :- by 13 yr, adolescent triples his birth length.
• Boys gain – 10-30cm. Peak growth velocity –later stages of puberty.
• Girls gain – 5-20cm. Peak growth velocity –before attainment of menarche.
• Growth in height ceases at 16 or 17yr in females in females & 18-20yr in males.
■ Weight :- growth spurt begins earlier in girls, 10-14yr while 12-16yr in boys.
• Boys gain 7-30Kg while girl gain 7-25Kg.
• Increase in muscle mass & bone diameter in boys.
• Lean body mass increases during early stages in both. Fat mass increases in girls
at later stages.
■ Increase in body structure is paralleled by increase in blood volume & muscle
mass.
■ Menstruation – high nutritional requirements of iron
Physiological growth
■ Pulse : reaches adult value 60-80 beats/min
■ Respiration : 16-20 times/min
■ Sebaceous glands of face, neck & chest become more active. When their
secretion accumulate under the skin in face, acne will appear.
Onset & sequence of puberty OR
Secondary sex characteristics
■ IN GIRLS, starts with breast development, thelarche at 8-13 yr; followed by
pubic hair, pubarche & menstruation, menarche at an average of 12 yr.
• Menarche occurs after 2-2.5 yr of thelarche. Breast buds may be tender.
Asymmetry in the breast size during early phases of puberty may be there.
• Adrenarche is maturation of cortex of adrenal glands. Gonadarche is earliest
gonadal changes, ovaries & testis begin to grow.
■ IN BOYS, first increase in testicular size (volume reach 4ml or length 2.5cm) – 9-
14 yr; followed by pubic, axillary, facial & chest hair & lengthening of the penis.
■ Early puberty – mild degree of breast enlargement in more than half of boys,
subsides over several months.
■ Production of sperms, spermarche – mid adolescence.
■ Laryngeal growth – cracking of voice, begins in mid puberty & deepening of
voice complete by the end of puberty.
Tanner stages - Sexual maturity rating (1-5) in boys
Tanner stages – Sexual maturity rating (1-5) in girls
COGNITIVE AND
SOCIAL
DEVELOPMENT
Early phase
■ ‘Concrete thinking model’ of childhood persists
■ Teens are impulsive.
■ Prefer same sex peers.
■ Excessively conscious of other people’s concerns about their appearance and
actions.
■ Curiosity about sexual anatomy and comparison with peers common.

Mid phase
■ Emotional autonomy.
■ Starts to think beyond self & beginning of abstract reasoning.
■ Able to question and analyse.
■ Tend to have detachment from family.
■ Acceptance by the peer group becomes very important)t.
■ Sexual experimentation such as masturbation usually starts.
Late phase
■ Most of the pubertal changes are already achieved.
■ Moral values and strong self identity.
■ Able to suppress impulsivity and are less affected by peer pressure.
■ Personal relations become more important.
■ Youth becomes career oriented and starts short and long term planning.
■ Many start engaging in sexual activity.
Emotional development
■ This period is accompanied usually by changes in emotional control.
■ Exhibits alternating & recurrent episodes of disturbed behaviour with periods of quite
one.
■ May become hostile or ready to fight, complain or resist every thing.

Adolescent teaching
■ Relationships
■ Sexxuality – STDs / AIDs
■ Substance use & abuse
■ Gang activity
■ Driving
■ Access to weapons
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