GROWTH AND DEVELOPMENT

Growth – it is the process of physical

maturation resulting in the increase in size or
mass of the tissues. It occurs by multiplication
of cells and increase in the intracellular
substance. It is quantitative change of the body
which can be measured in kilograms, inches,
centimeters or pounds.
Development – it is the process of
functional or physiological maturation of
the individual. It is progressive increase in
skills and capacity to function. It is the
qualitative change in child’s functioning
and is difficult to measure. Development is
the result of the maturation and learning.
Maturation – it is an increase in
competence and change in behavior and
ability to function at a higher level
depending upon the genetic inheritance.
FACTORS AFFECTING GROWTH &
DEVELOPMENT

Heredity
Environment
1.Heredity/ Genetic Factors:

 Heredity
 Race and Nationality
 Sex
 Biorhythm and maturation
 Genetic disorders
2. Environmental Factors

Prenatal environment
Postnatal environment
Prenatal environment

Nutritional deficiency in mother

Obstetric disorders
Metabolic disorders in mother
Infections
Administration of certain drugs
Influence of maternal hormones
Postnatal environment

 Nutrition
 Infections and infestations
 Trauma
 Chronic illness
3.Other factors –

Socio-economic condition
Cultural
Ordinal position in the family
Growth potential
PATTERNS OF GROWTH & DEVELOPMENT

1. Directional trends –
Cephalocaudal direction
Proximodistal direction
Differentiation

2. Sequential trends
3. Developmental pace
 PRINCIPLES OF GROWTH AND DEVELOPMENT

Children’s development is multidimensional

Children’s development occurs in predictable sequence
Different children pass through the predictable stages at
different rates
All body system do not develop at the same rate
Development is cephalocaudal
Development proceeds from proximal to distal parts
 Cont…
 Development proceeds from gross to refined motor skills
 Children’s development is affected by early experiences
 Children’s development occurs in a broader context
 Children’sdevelopment depends on the interplay between
genes and environment
 There is an optimum time for initiation of experiences or
learning.
 Neonatal reflexes must be lost before development can
proceed.
STAGES OF GROWTH AND DEVELOPMENT

Prenatal Neonatal Infancy Toddler

Conception Birth to 28 Birth to 1
to days 1-3 years
year of age
birth

Adolescence School age Preschool

13-19 years 6-12 years 3-6 years

ASPECTS OF GROWTH AND DEVELOPMENT
Growth

Biologic growth Sensory growth Motor growth

Development

Intellectual Moral Emotional Sexual Social Language

BIOLOGICAL GROWTH:

1. General body growth

2. Neural growth
3. Lymphoid growth
4. Genital growth

2 4 6 8 10 12 14 16 18 20
The parameters of biological growth assessment:-

Length or height- At birth average length is 45 – 50 cm

- increases at the rate of 2- 2.5 cm/ month for the first six months
- then 1.25cm/ month during the next six months.
- At the age of 1 year length is 75cm.
- height doubles at the age of 4 years and triples at 13 yrs.

Weight – At birth average weight is 2.5 – 3 kg.

- baby loses 10%weight during the first 10 days of life
- Then after it gains weight about 30gm/day for 5-6 months.
- Weight doubles at 6 months of age, triples at 1 year and four times by 2yrs.
Head Circumference – At birth it is 33 -35 cm approx.
- increases at the rate of about ½ inch/month during first 6
months and by ¼ inch/month during next 6 months.
- it is 40cm at 3 months, 45 cm at 1year, 50 cm at7 years and
at 12 years it is 52 cm almost same as an adult.

Chest Circumference – At birth it is 2-3 cm less than head circumference.

- At 6 – 12 months of age both becomes equal.
- After 1st year of age, chest circumference is greater than the
head circumference by 2.5 cm .

Mid upper arm circumference (MUAC) –

- At birth is 11 – 12 cm approx.
- At 1 year it is 12 – 16 cm.
- 1-5 yrs it is 16 – 17 cm ,at 12 yrs it is 17–18 cm
and at 15 years it is 20 -21 cm.
2. Motor growth-

 Gross Motor - gross motor development involves control of the child over
his/her body by increasing mobility. It includes turning, sitting, standing and
walking.
 Fine Motor – fine motor developments leads to acquisition of motor dexterity
like use of hand and fingers, palmer grasp and release , etc.

3. Sensory growth - the child gradually learns the process of associating meaning
with a perceived stimulus.
Assessment of physical growth –

Weight
Length and height – it indicates skeletal growth
Head circumference – indicates the brain growth and
development of intracranial volume.
Chest circumference- it also indicated the growth and
nutritional status of the child.
Mid upper arm circumference – helps to assess the nutritional status
of the younger children.
 Body Mass Index(BMI)- helps in assessment of normal growth or
deviations i.e, malnutrition or obesity.
BMI = Weight in kg
Height in (meter)²
BMI remains constant upto the age of 5 years. If the BMI is
more than 30 kg/m², it indicates obesity and if its is less than 15 kg /
m²\it indicates malnutrition
BMI Categories

Underweight = <18.5
Normal weight = 18.5 – 24.9
Overweight = 25 -29.9
Obesity = BMI of 30 or greater
GROWTH AND DEVELOPMENTAL
MILESTONES
Physical development
Motor development – gross motor and fine motor
Sensory development
Cognitive development
Language development
Social development
 GROWTH AND DEVELOPMENT FROM BIRTH TO 1 YEAR

 NEWBORN
Motor development –
a) Gross motor-
• Lies in flexed position with hands clenched.
• Turns head when in prone position.
• Head lags behind when baby is pulled up
from supine to sitting position

b) Fine motor –
•hands tightly fisted
•Baby can grasp an object placed in hand
but drops immediately.
2 MONTHS
1. Physical development-
• Posterior fontanel closes at 6-8 weeks
age.
• Tears start appearing.
• Drooling begins
2. Motor development –
a) Gross motor –
• Less fixed prone position- Arms flexed,
hip flat and legs extended.
• Lifts head almost to 45⁰ above the flat
surface when lying prone.
b) Fine motor-
• Hands may be open.
3 MONTHS
1.Physical Development- Flexion posture is
reduced
2. Motor development-
a)Gross motor –
• Able to hold head erect.
• Rolls over from back to side.
b) Fine motor –
• Can grasp a toy but lacks firm hold.
• Carries objects and hands to mouth at will.
4 MONTHS
1. Physical development –
• Tonic neck and rooting reflex disappears.

2. Motor development –
a) Gross motor –
• Holds head erect and steady when placed
in sitting position
• Sits for short time with adequate support
b) Fine motor –
• Brings hands together in midline and
plays with fingers.
• Reaches for objects.
5 MONTHS
Motor development-
a) Gross motor –
• Sits with slight support.
• Pulls feet up to mouth when in supine.
• Rolls from back to abdomen.
b) Fine motor.
• Graps objects voluntarily with palmer grasp.
• Can hold one object while looking at another.
• Pincer grasp begins to appear.
6 MONTHS
1. Physical development –
• Teeth eruption starts with lower two
central incisors.
2. Motor development –
a) Gross motor –
• Sits leaning forward on both hands.
• Moves from place to place by rolling.
b) Fine motor-
• Begins to transfer objects from one hand
to another.
• Bangs objects that are held.
7 MONTHS
1. Physical development –
 Parachute reflex appears.
 Ultimate color of iris is established.
1. Motor development –
a) Gross motor –
 Lifts head as if trying to sit-up when in supine
position.
 Sustains all weight on feet when held in standing
position.
 Early stepping movements.
a) Fine motor –
 Holds two toys together.
 Transfers a toy from one hand to another.
8 MONTHS.
1.Physical development –
 Eruption of upper central incisors.
1.Motor development –
a)Gross motor-
 Pulls to standing position with help.
 Palmar grasp disappears.
a)Fine motor
 Uses index finger and thumb like pincers.
 Feeds self with finger foods
• Drinks from cup with assistance
9. MONTHS
a. Physical development –
• Eruption of upper lateral incisors
b. Motor development –
Gross motor –
• Sits down.
• Drinks from cup or glass with help.
• Crawls and creeps.
• Holds own bottle.
b. Fine motor –
• Shows preference of use of dominant hand
• Holds bottle with hand to mouth coordination
10. MONTHS
Motor development-
Gross motor –
• Walking skill development continues.
• Creeps and cruises well.
• Doesnot want to lie down unless sleepy.
• Makes stepping movements forward
when two hands are held.
Fine motor –
• Fine pincer grasp of tiny objects.
• Brings hands together and plays.
• Bangs two cubes together
11 MONTHS
1.Physical development-
 Sleeps 14 – 16 hours per day and still naps.
2. Motor development-
a)Gross motor –
 Stands erect with minimum support.
 Walks holding on to furniture.
 Pushes toys.
a)Fine motor –
 Explore objects carefully.
 Removes covers from boxes and
takes toys out of box.
 Beginning to hold pen and make marks on paper .
12 MONTHS
Motor development –
a.Gross motor –
• Stands alone for variable length of time.
• Walks few steps with help or alone.

b. Fine motor –
• Good pincer grasp.
• Picks up small piece of food and
transfer to mouth.
• Can drink himself with cup.
• Tries to fed himself/ herself with spoon
but spills contents.
Age in months Sensory development

newborn Stares indefinite at surroundings.

Notices faces and bright objects but only if they are in line of vision
2-3 months Eyes follow moving objects and persons nearby.
Visual acuity is hyper optic.Beginning of ability to coordinate various
sensory stimuli
4-5 months Follows objects to 180⁰. Beginning of hand-eye coordination
Looks in different of sound made below ear

6-7 months Enjoys more complex visual stimuli. Moves in order to see an object.
Has preference in taste for food
8-10 months Depth perception is developing. Head turns directly to source of sound.
Searches for a lost toy
11- 12 months Can follow rapidly moving objects. Full binocular vision well – established
Age in months Language development Social development

Newborn Startles to loud noises . Begins to Coo Responds to human voices

2 months Differentiated cries, varying with reason
Single vowel sounds such as ‘ah’ and ‘eh’
3- 4 months Chuckles and Coos. Responds differently to
pleasant and angry voice
5-6 months Responds to his/ her name. Vocalizes
monosyllable like ma, da, ba . Talks to own
image in mirror
7-8 months Vocalizes ‘ baba ‘ ‘dada’with no specific
meaning .Begins to understand the meaning of Dislike dressing.
‘NO’
9-10 months Stops activity in response to “NO”.
Says dada, mama with meaning
11- 12 Responds to simple questions.
months Vocalization decreases as walking increases.
Smiles to mother/ caregiver
Initial social play by smiling.
Recognizes parents.
Extends arms to be picked.
Shows fear of strangers.
Cries when scolded.
Plays social games with adults
Reacts to restrictions with
frustration. Cooperates in dressing.
TODDLERS (1 – 3 YEARS )
15 MONTHS
Motor development –
Gross motor –
• Walks well.
• Creep up stairs.
Fine motor –
• Scribbles
• Builds tower of 2 blocks.
18 MONTHS
1. Physical development –
 Anterior fontanel closes.
 10 – 14 deciduous teeth present.
 Toilet training may begin.
1. Motor development –
a) Gross motor –
 Wild gait.
 Walk upstairs.
a) Fine motor
 Can make tower of 3- 4 cubes.
 Turns 2-3 pages at a time.
 Can eat with spoon.
 Removes simple garments.
24 MONTHS.
1.Physical development –
 Has 16 temporary teeth.
2. Motor development –
a. Gross motor –
• Steady gait.
• Walks on heel-toe.
• Walks up and down stairs holding wall.
b. Fine motor –
• Can build tower of 6 – 7 cubes.
• Imitates vertical line.
• Turns pages one at a time.
• Drinks with glass
30 MONTHS
Motor development –
a. Gross motor –
• Can stand on one foot.
• Jumps well.
b. Fine motor-
• Can make tower of 6-8 cubes.
• Can feed self.
• Can throw large ball overhead.
• Can button and unbutton clothes.
• Places simple shapes in correct holes
Age in months Language development Social development

15 months Comprehends more than communicating. Egocentric.

Recognizes names of body parts. Imitates parents.
Responds to simple commands.
18 months Uses gestures more than words to make Imitates house work.
needs known. Enjoys solitary play.
Use of words may be quite inconsistent.

24 months Enjoys story. Enjoys parallel play.

Know at least 4 body parts.
Has vocabulary of 300 words.
Refers to self by name.
30 months  Knows at least 5 body parts. Knows own sex
 Can speak sentence of 4 – 5 words. Parallel play continues.
 Ask “Why” Shows temper tantrum
PRESCHOOL CHILD (3-6 YEARS)
3 YEARS
Motor development –
a. Gross motor –
• Rides tricycle.
• Catches soft objects with both hands.
• Goes upstairs using alternate feet but
may still come down by placing both
feet on each step.
• Fine motor –
• Can build tower of 9- 10 cubes.
• Puts beads on string.
• Copies a circle
4 YEARS
Motor development –
a. Gross motor –
• Skips and hops on foot.
• Catches bounced ball.
• Dresses without supervision.
• Walks downstairs using alternate feet.
b. Fine motor-
• Cuts pictures with scissors.
• Copies a square.
5 YEARS.
1. Physical development –
 It is half an adult height
 Tooth decay may be present.
1. Motor development –
a) Gross motor-
 Walks backward heel to toe
 Throws and catches ball.
 Jumps rope.
a) Fine motor –
 Copies a square, triangle and diamond shape.
 Ties shoe laces.
 Uses scissors and simple tools.
6 YEARS
1. Physical development –
 Average weight is 20 kg.
 Begins to loose deciduous teeth, first
permanent teeth erupts.
 Brain is 90% of adult size.
2. Motor development –
a) Gross motor-
 Rides bicycle.
 Jumps, runs, climbs and hops.
a) Fine motor –
 Improved hand and eye coordination.
 Draws a man with 6 parts.
 Can brush teeth, comb hair and dress self.
Age Cognitive development Language
development
3 years Egocentric. Vocabulary of 800 – 1000 words.
Omnipotence Asks many questions.
Centration Names body parts. Recognizes colors.
4 years Highly imaginative. Uses sentences of 4- 6 words.
Obeys commands because of parents Questioning is at peak.
fear Tells exaggerated stories.
Knows nursery rhymes and simple songs.
5 years Accurately describes events. Describes pictures with much comments
Classify objects according to and description
relationships that are similar.
Time orientation present.
6 years Response to praise and recognition. Counts numbers. Recognizes shapes
Follows commands. Enjoys telling jokes. Uses all form of
sentences.
Age Psychosocial development
3 years Separates easily from mother.
Knows own sex and that of other.
Begins to share.
Learns simple games but follows own rules.
4 years Very independent. Tends to be selfish and impatient.
Is aggressive. Tells family talks to others without any restraints.
Sibling rivalry present.
5 years Play is associative. Tries to follow rules but may cheat to avoid
losing.
Very industrious. Independent and looks for parental support and
encouragement.
6 years Bossy. Insist on being first in everything,
Jealous of siblings.
Loves active and group play.
SCHOOL AGED CHILDREN (6- 11 YEARS)
6-8 YEARS
1. Physical development –
• Starts losing temporary teeth and acquires the first
permanent molars, medial incisors, lateral incisors
2. Motor development –
a.Gross motor-
• Rides bicycles without training wheels.
• Constantly keeps moving, runs, climbs, hops.
b. Fine motor –
• Has improved hand eye coordination.
• Bathes self unassisted.
• Learns cursive writing.
• Can brush and comb hair.
8- 10 YEARS
1. Motor development –
a) Gross motor –
 Performs tricks on bicycle.
 Races.
 Throws a ball skillfully.
a) Fine motor –
 Uses both hands independently.
 Cursive writing improved.
 Handles eating utensils skillfully.
• Dresses self- completely
10 – 12 YEARS .
1. Physical development –
• Molars teeth erupt
 Secondary sex characteristics begin to develop
2. Motor development –
a) Gross motor –
 Enjoys all physical activities.
 Balances on one leg with eyes closed.
 Catches tennis ball with one hand.
a) Fine motor –
 Dressing and grooming skills develop.
 Bathes frequently & unassisted.
 Movements are more graceful.
Age Cognitive development Language Psycho-social development
development
6 – 8 Attention span increases. Can follow series of 3 Continues to be egocentric and
years Concept of cause and effect is commands. bossy. Has a “know it all “
improving. Learning to read. Response is dependent attitude. Insist on being first in
Follows rules to avoid on mood. Responds to everything. Return of temper
punishment praise and recognition. tantrums may use physical or
verbal attack.
8-10 Learns to understand and use Follows suggestions Sense of industry is present
years abstract symbols and carries better than commands Curious about everything.
out mental operations. Becomes peer – oriented.
Ashamed of failures. Begins hero worship.
Interested in school Relationship with sibling
work.Memory span increasing. improved.
10 - Uses problem – solving Uses parts of speech Is sincere and confident.
12 method. Can define abstract correctly. Has greater self control.
terms. Interested in “why” and Enjoys riddles. Respects parents and their role.
years “how”.Short interest span. Has short burst of anger.
ADOLESCENTS (12- 18 YEARS)
12- 13 YEARS (EARLY ADOLESCENCE)
Physical Development –
Eruption of second molars.
Secondary sex characteristics develop
Motor development –
Clumsiness due to rapid physical growth.
Motor functions comparable to adults.
Intellectual development-
Formal operational thoughts.
Generates hypotheses.
Uses scientific method for problem – solving.
Cont…
Language development –
Uses slangs within and outside peer group.
Uses distinct meanings for words.
Psychosocial development-
Beginning of development of sense of identity.
Has intense loyalty to peer group.
Shows mood swings and extremes of behavior.
Masturbation starts.
14- 16 YEARS
1.Physical development-
 Weight – approx.. 50 – 60 kg(males) & approx.. 42 -64
kg(females)
 Height- approx.. 164 – 180 cm (males) & 155 – 169 cm (females)
2. Motor development –
 Same as adult.
3. Intellectual development –
 Expresses concern for education and vocation.
Contd…..
4. Psychological development –
 Sense of identity develops.
 Egocentrism diminishes.
 Heterosexual relationships are common.
 Verbally attacks parent’s beliefs and values.

5. Moral development –
 Fixed rules in molar decisions.
 Obligation to do no harm and to do duty.
17- 20 YEARS –
1.Physical development –
 Weight – approx.. 56 – 80 kg(males) & 48 – 72 kg(females)
 Height – approx.. 63 – 182 cm (males) & approx.. 156 – 170 cm
(females)
 Eruption of third molars.(wisdom teeth)
2. Motor development –
 Possesses manual dexterity
3. Intellectual development –
 Pursues further education or enters job market.
Contd….
5. Psychosocial development –
 Severs ties with parents.
 Establishes interdependent relationship with parents.
 Have fewer but close friends.
 Heterosexual relationship are the rule.
6. Moral development –
 Social contracts understood and formulated.
 Laws recognized as changeable.
 Correct actions depend on standards and individual rights.
 Sexual development during Adolescence-
 Girls attain puberty around 10 – 15 years of age.
• Boys attain puberty between 12 – 16 years of age.
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