Growth and

development

Dr Amal Abdel bagi

Consultant Pediatrician

Nov,9 2014 1
 Growth and development
Terms GROWTH AND DEVELOPMENTS

denotes two different facets of dynamic

of changes ( those of QUANTITY AND

QUALITY )

Nov,9 2014 2
 Growth and development
:Definitions

Growth: increase in NUMBER AND SIZE OF CELL

( quantative )

Development : ACQUISITION OF FUNCTION DUE

TO MATURATION OF CELLS (qualitative)

Nov,9 2014 3
Growth and development
:growth is an indicator for

overall well-being •

 chronic disease

Interpersonal and psychological stress.

Nov,9 2014 4
 Overview
Growth and development need

to be assessed and monitored

so delays can be anticipated

and identified( see red flags)

Nov,9 2014 5
Influences on growth and
development
Influences AFFECT growth and
development from early pregnancy
:through out life .They include

a. Biologic influences ( eg:DM,genetic)

b. Psychological influence (eg: maternal
depression )
c. Social /environmental influences
(eg :socioeconomic status , addiction)
Nov,9 2014 6
 Factors affecting growth
Fetal :insulin and insulin like growth

factor
Infancy : nutrition

Childhood: growth hormone –insulin like

growth factor and thyroid hormone

Puberty :hypothalmo-pituitary –gonadal

axis
Nov,9 2014 7
 Periods of growth
There are periods where growth is

accelerated(first years of life and

puberty )

Steady(childhood ) or decelerated

Nov,9 2014 8
Stages of Growth and
Development(important)

Infancy Middle Childhood

Neonate School age
Birth to 1 month
to 12 years 6
Infancy
month to 1 year 1 Late Childhood
Early Childhood Adolescent
Toddler years to 13
years 1-3 approximately 18
Preschool years
years 3-6

Nov,9 2014 9
Principles of Growth and
Development
Growth is an orderly process, occurring
.in systematic fashion
Rates and patterns of growth are specific
.to certain parts of the body

Nov,9 2014 10
Principles of growth and
development
Development occurs as a whole

Development is cumulative and

recapitulatory

rate of development is different between

male and female children

Nov,9 2014 11
Principles of Growth and
Development

Wide individual differences exist in

.growth and development rates

Nov,9 2014 12
Principles Continued
development is a continuous process from

conception to maturity and implies maturation of

neurological function . It proceeds from the simple

.to the complex and from the general to the specific

Development occurs in a cephalocaudal and a

. proximodistal order
Nov,9 2014 13
Growth Pattern

Nov,9 2014 14
 : Growth assessment
Weight

Height /length

Body circumferences (head,,chest,midarm ,etc)

Skinfolds

Body proportion

Body mass index

Velocity of growth

Nov,9 2014 It reflect nutritional status 15

 Weight
Age Weight gain( grams/day)
months 0-3 grams/day 30
months 3-6 grams /day 15-20
months 6-9 grams/day 10-15
months 9-12 grams/day 8-12
years 1-3 grams /day 6-8

Nov,9 2014 16
 Weight assessment
10 % of birth weight will be lost during

the first 7 days of life and birth weight

will be gained after 10 days of life,
Child will double ,triples and quadruples

his birth weight by 5 months ,one year

and 2 years respectively

Nov,9 2014 17
Formulae for rough weight estimations

3-12 months :( age in months +9)/2

1-6 years :2( age in years) +8

7-12 years :{7(age in years)-5}/2

Nov,9 2014 18
 Stature

Is ascertained by measuring:
 the length in children less than 2 years
 height in children more than 2 years

 A term newborn will measures 50 cm

By one year length is 75 cm
By 2 years it is 90 cm
Thereafter till onset of adolescent child
will grow at a rate of 4-5
cm/year( height velocity)
Nov,9 2014 19
 Head circumference
Is recorded between birth and six years

Normally at birth it is 35 cm

The head circumference grows by 10-12

cm in the first year of life

2 cm during the second year of life

Then 0.5 cm /year till 8 years of life.

Nov,9 2014 20
Interpretation of growth
parameters
Weight ,height and head circumference
when measured for the first and subsequent
times need to be assessed and interoperated
as normal or abnormal using growth chart
Percentiles indicates the position a
measurement would hold in a typical series 0f
100 arranged in ascending order.
Who growth charts shows values for 3rd 5th
15th 25th 75th 95th and 97th percentile
Values less than 3rd or above 97th
percentile are interpretated as abnormal.
Nov,9 2014 21
 Developmental theories

Nov,9 2014 22
Areas of development
GROSS MOTOR

FINE MOTOR

SOCIAL /ADAPTIVE

LANGUAGE

Nov,9 2014 23
Gross Motor Skills
The acquisition of gross motor skill precedes

the development of fine motor skills.

Both processes occur in a CEPHALOCAUDAL

fashion
Head control preceding arm and hand control

Followed by leg and foot control.

Nov,9 2014 24
Gross Motor Development

Newborn: barely able to lift head

months: easily lifts head, chest and upper 6
abdomen and can bear weight on arms

Nov,9 2014 25
Fine Motor - Infant
Newborn has very little control. Objects
will be involuntarily grasped and dropped
.without notice

month old: palmar grasp – uses entire 6

hand to pick up an object

month old: pincer grasp – can grasp 9

small objects using thumb and forefinger
Nov,9 2014 26
Nov,9 2014 27
Fine Motor Development

6-month-old
12-month-old

Development from general

to specific responses
Nov,9 2014 28
 Assessment of growth
ANTHROPOMETRIC MEASUREMENTS
WEIGHT
LENGTH/HIGHT
HEAD CIRCUMFERENCE
MUAC
REFLECTION OF NUTRTIONAL STATUS
Nov,9 2014 29
 Assessment of
development(denever ii)

Nov,9 2014 30
Head Control

Newborn Age 6 months

Nov,9 2014 31
Sitting Up

Age 2 months
Age 8 months
Nov,9 2014 32
Ambulation
month old: crawl 9
year: stand independently from a crawl 1
position
month old: walk and toddle quickly 13
month old: can run 15

Nov,9 2014 33
Ambulation

13 month old
Nine to 12-months
Nov,9 2014 34
Speech Milestones
1-2 months: coos
2-6 months: laughs and squeals
8-9 months babbles: mama/dada as
sounds
10-12 months: “mama/dada specific
18-20 months: 20 to 30 words – 50%
understood by strangers
22-24 months: two word sentences,
>50 words, 75% understood by
strangers
30-36 months: Almost all speech
understood by strangers
Nov,9 2014 35
teething

Nov,9 2014 36
Hearing

BAER ( Brain Auidatory Evoked

resonance)hearing test done at birth
Ability to hear correlates with ability
enunciate words properly
Always ask about history of otitis media
Repeat hearing screening test

Nov,9 2014 37
Red Flags in infant
development
Unable to sit alone by age 9 months

Unable to transfer objects from hand to hand by

age 1 year

Abnormal pincer grip or grasp by age 15 months

Unable to walk alone by 18 months

.Failure to speak recognizable words by 2 years

Nov,9 2014 38
Fine Motor - toddler
year old: transfer objects from hand to 1
hand
year old: can hold a crayon and color 2
vertical strokes
Turn the page of a book
Build a tower of six blocks

Nov,9 2014 39
Toddler

Adele Piliterri, Child Health Nursing, Lippincott

Nov,9 2014 40
Toddler

Safety becomes a problem as

the toddler becomes more
mobile.
Pilliterri, Lippincott
Nov,9 2014 41
Pre-School

Nov,9 2014 42
Fine motor and cognitive abilities
Buttoning clothing
Holding a crayon / pencil
Building with small blocks
Using scissors
Playing a board game
Have child draw picture of himself

Pre-school tasks 

Nov,9 2014 43
Red flags: preschool
Inability to perform self-care tasks, hand
washing simple dressing, daytime toileting

Lack of socialization

Unable to play with other children

Able to follow directions during exam

Performance evaluation of pre-school

teacher for kindergarten readiness
Nov,9 2014 44
School-Age

Nov,9 2014 45
School Years: fine motor

 Writing skills improve

 Fine motor is refined

 Fine motor with more focus

 Building: models – legos

 Sewing

 Musical instrument

 Painting

 Typing skills

 Technology: computers
Nov,9 2014 46
Red flags: school age

School failure
Lack of friends
Social isolation
Aggressive behavior: fights, fire setting,
animal abuse

Nov,9 2014 47
13 to 18 Year Old

Nov,9 2014 48
Adolescent
As teenagers gain independence they begin

to challenge values

Critical of adult authority

Relies on peer relationship

Mood swings especially in early adolescents

Nov,9 2014 49
Adolescent behavioral
problems

Anorexia

Attention deficit

Anger issues

Suicide
Nov,9 2014 50
 Abnormal growth patterns

Large heads ( macrocephaly)

Small heads ( microcephaly)
Short stature
Long stature
Malnutrition
Obesity
Nov,9 2014 51
Abnormal developmental
patterns

Autism Failure to acquire language

Temper tantrum

Nocturnal enuresis

Nov,9 2014 52
 Thank you

Nov,9 2014 53