GROWTH AND DEVELOPMENT

Mohamed Abougabal
Lecturer in Pediatrics
 Growth
• Growth is the natural increase of size of the
body as a whole and of its separate parts.
• It results from:
1. Multiplication of cells
2. Increase in size of cells.
 Development
• Development means maturation of organs
and systems, acquisition of new skills and
functions as well as ability to adaptation and
assuming responsibilities.
 Factors influencing growth and
development
• Genetic factors (e.g. short stature caused by achondroplasia).
• Endocrine factors: growth hormone, thyroid and sex
hormones.
• Nutritional factors: maternal and child nutrition during
pregnancy and lactation.
• Environmental factors and socio-economic status
• Major congenital anomalies.
• Chronic infections (e.g. Tuberculosis) and debilitating
diseases.
• Physical activity: bed-ridden children do not grow normally.
 STAGES OF HUMAN GROWTH AND
DEVELOPMENT
• Prenatal:
• Embryonic stage: it starts by postconceptual
implantation to the end of 8th week.
Rudiments (basic structure) of all major
systems have developed.
• Fetal stage: from the 9th week up to full term.
 STAGES OF HUMAN GROWTH AND
DEVELOPMENT
• Perinatal:
It starts at 28th week of gestation up to 7th day
after birth.
 STAGES OF HUMAN GROWTH AND
DEVELOPMENT
• Postnatal:
• Neonatal period: first 4 weeks after birth.
• Infancy: from 1 - 12 months
• Early Childhood (Toddler age or Preschool
age): 1 ‑ 4 years
• Late childhood (School age): 5 ‑ 12 years
• Adolescence: 12-20 years
ASSESSMENT OF GROWTH
 How can you assess physical growth?

• Get an accurate body measurement e.g. weight,

height, head circumference, etc.

• Compare this measurement with growth standards

obtained from normal individuals of same age, sex
and community.
a) Comparison of this single measurement with
average for age and sex.
b) Plot this measurement on percentile charts/tables.
 Weight

• Average weight at birth is 3 - 3.5 kg

• During infancy, weight increases as follows:
- 750 g / month (3/4 kg) for the 1st 4 months (wt
= 6 kg at 4 months).
- 500 g / month (1/2 kg) for the 2nd 4 months (wt
= 8 kg at 8 months).
- 250 g / month (1/4 kg) for the 3rd 4 months
(wt = 9 kg at 12 months).
 Weight

• During early childhood (from 1-6 years) : 2

kg / year .
Weight in kg = (Age in years X 2) + 8

• During late childhood (from 7 - 12 years): 2.5

kg / year
Weight in kg = (Age in years X 7) - 5_
2
 Length / Height:
• Length (recumbent supine length) is taken for
infants and children less than 2 years old.

• Height (standing)is measured for children

more than 2 years old.
 Length / Height:
• Birth length : 50 cm.
• First 3 months : increases 3 cm / month (length
at 3 months = 59 cm).
• Second 3 months: increases 2 cm / month
(length at 6 months = 65 cm).
• From 7-12 months: increases 1.5 cm /month
(length at 12 months =75 cm).
• From 1 - 2 years : increases 1 cm /month
(length at 2 years = 87 cm).
 Length / Height
• After 2 years use the following formula to
calculate height:
• Height in cm = (Age in years X 5) + 80

• Height at 4 years = Birth length X 2.

• Height at 12 years = Birth length X 3.

 Head circumference
• The size of the skull depends on the growth of
the brain. If the brain does not grow
adequately, the skull will be small
(microcephaly).

• Occipito-Frontal circumference is the widest

circumference of the skull.
 Head circumference
• To measure the skull, the tape is applied firmly
over the glabella and supraorbital ridges
anteriorly, and posteriorly over most
prominent point on the occiput.
 Head circumference
• Rate of growth of head:

During 1st year (average):

First 3 months : 2 cm / month
Next 9 months : 0.5 cm / month
Rest of life :
From end of 1st year to adulthood head
circumference increases only 10 cm.
 Head circumference
Anterior fontanel: at birth 2.5 X 2.5 cm,
closes between 6 and 18 months
Posterior fontanel: about 0.5 cm in diameter at
birth, closes before 2 months age.
 TEETHING
• Eruption of the teeth follows a special pattern
and its retardation may indicate retardation in
osseous development.
• In most Egyptian children the deciduous teeth
(20 in number) and permanent teeth (32 in
number) erupt As following:
 TEETHING
DECIDUOUS (MILK) TEETH   PERMANENT TEETH

Lower central incisors 7 - 8 months   First molar 6 - 7 years

Upper central incisors 8 - 9 months   Central incisors 6 - 8 years

Upper lateral incisors 10-11 months   Lateral incisors 7 - 9 years

Lower lateral incisors 11-12 months   Canines 9 -11 years

First molars 13-14 months   First premolars 10-12 years

Canines 17-19 months   Second premolars 11-13 years

Second molars 19-25 months   Second molar 12-13 years

      Third molar(wisdom tooth) 17-22 years

ASSESSMENT OF DEVELOPMENT
• Development is a continuous process from conception to
maturity.

• The three main processes occuring during development

are:
Loss of early primitive reflexes.
Acquisition of postural reactions.
Acquisition of new skills (developmental milestones).

• The direction of development is cephalocaudal, i.e. the

infant controls his head before he can sit, and crawls
before he can walk.
Development is assessed in 4 major
fields
– Gross motor (locomotion): includes posture and large
body movements e.g. head control, sitting, standing, etc.
– Fine motor (sensori-motor or manipulative): e.g.
coordination of hands and eyes, using fingers for
reaching, grasping and manipulating objects.
– Personal-social (adaptive) i.e. social reaction of child
with his surroundings and relatives and his adaptation to
the environment e.g. play, self-care, etc.
– Language (communication): the ability to communicate
verbally (requires intact hearing, oral musculature and
speech centers) and non-verbally (use of gestures, facial
expressions and body language).
 Gross motor
Age
(Months)
  1
  2
Supports head when held erect
Supports weight on forearm and raises his chest when in prone 3
position
Pushes with feet 4
Sits momentary, supported by his arms 6
Sits (without support) 7
Rolls from back to stomach (from supine to prone)
Sits alone, back straight 8
Creeps or Crawls 9
Walks supported (with one hand held)
12
(Walks alone at 13- 15 months)
Walks upstairs with one hand held
18
Seats himself in a small chair
Runs well
24
Walks up and down stairs alone, one step at a time
Walks upstairs alone, alternating feet 30
Rides and pedals tricycle,
Climbs up stairs well 36
Jumps on spot
Hops on one foot 60
Walks heel to toe along a line
 Fine motor
Age
(Months)
  1
  2
Opens hands spontaneously 3
Grasps toy 4
Transfers objects from hand to hand 6
  7
8
Pincer grasp (uses thumb & fingers to grasp objects)
9
Releases an object on command 12
Feeds from a spoon 18

Builds a tower of 6 blocks 24

30
Builds a tower of 8 cubes
36

Draws a man (6 parts) with pencil 60

 Social skills
Age
(Months)
Follows moving objects or light 1
Stares momentarily at spot 2
Smiles appropriately on social contact 3
Stares at his own hand 4
Shows likes and dislikes 6
  7

Plays peek-a-boo (i.e. Hiding the face, then suddenly uncovering it) 8
9
Comes when called
Plays simple ball game 12
Mimics action of others 18

Plays with others 24

30
Eats with knife and fork
Goes to toilet alone 36
Chooses own friends 60
Dramatic group play
 Language
Age
(Months)
Crying is the only language he knows 1
Smiles in response to face or voice 2
Coos (makes sounds like pigeon)
Says “aah, ngah ” 3
Laughs aloud
  4
Babbles (“ba, ba” sounds) 6
  7
Repetitive sounds “mama, dada “ 8
Imitates sounds 9
1-2 meaningful words 12
At least 6 words 18

Sentences of 2-3 words 24

Uses prepositions 30
Sentences of 4 words
Recognizes 4 colors 36
Gives full name, age, and sex
Fluent speech 60
Asking about meaning of words and things
• It should be remembered that the ages
mentioned in the above tables are “average”
and are influenced by the factors affecting
growth & development for example, a
normal child can join words together as early
as 18th month or as late as 5 years
Thank you