GROWTH AND DEVELOPMENT OF CHILD [Autosaved].pdf

BY – RAVI SHANKAR
Tuesday, 09 August 2022 1

Growth and development
➢ Growth : - the term growth refers to an increase in size of the body parts due to
multiplication of cells and increase in the intercellular substance.
➢ Development :- development refers to physiological maturation. It is progressive
increase in skill and capacity to function.
➢ Major developmental periods.
▪ Prenatal period - conception to birth
▪ Neonatal period - 4 birth to four weeks .
▪ Infancy - 4 four weeks to one year
▪ Toddler - 4 from one to three years
▪ Pre-school - 4 (early childhood) from three to six years
▪ School age - 4 (late childhood) from six to twelve years
▪ Adolescence - from puberty to the beginning of adulthood (13 years to 18 years)

Parameters of growth and development
(anthropometry)
 The best indication of good overall health in an infant is steadily increasing
weight, height, head and chest circumference.
 Other parameters are MUAC, dentition and suture.
❑1. weight :-
• The average new-born weight is about between 2.5 to 3.5 kg.
• The birth weight usually doubles by 5 months and triples by one year of age.
• After the first year weight gain levels off to approximately 4-6 lbs per year until
the pubertal growth spurt.
• The instrument used in weight measurement is weighing scale (electrical and
salter scale).

Parameters.………(continue)
• Formula for calculating weight –
• 1 to 12 months wt. = age (in months) +9
2
1 to 6 years. Wt. = {age (in years) x 2} + 8
7 yr. To 12 yr. Wt. = age (in yr.) x 7 – 5
2
❑Height / length : -
• The new born has an average length of 50 cm (18-20”).
• There is increase of 50% of the birth length by 12 month of age (75 cm ).
• The height of older child is taken when he is weighed. The infant is measured
while lying on a flat surface or on an infantometer.
• Height at 2yr – 87 cm , @3yr – 94 cm, @ 4yr – 100 cm ( double of birth height).

Parameters………….
❑ MUAC ( mid upper arm circumference) :-
• It taken up to age of 6 months to 59 months of age.
• Instrument is used in measurement – MUAC tape.
• Colour code in MUAC tape –
Red – less than 11.5 cm – SAM (severe acute malnutrition)
yellow – 11.5 to 12.4 cm - MAM ( moderate acute malnutrition)
green – more than 12.5 cm – normal range

Parameters………..
❑Head circumference : -
• Normal head circumference at birth is about 33cm.
• After one year of age head circumference is about 35 cm.
• Increase of ½ inch (1.3 – 1.5 cm) per month b/w age 1 to 6 month.
• Increase of ¼ inch (0.5 to 0.64 cm ) per month b/w ages of 6 month to 12
months. By the age of one year head circumference is 45 cm.
❑Chest circumference : -
• Normal chest circumference at birth is about 31 cm.
• At one year of age head and chest circumference equalize about 45 cm .
• Chest circumference is smaller than head circumference at birth.

Parameters……….
❑Dentition :-
• Teething is the period of eruption of primary teeth also called as the
deciduous teeth because they are shed off.
Average age of eruption
(in months)
Teeth average Age
(in months)
10 (8-12) Central incisor 8 (6-10)
11 (9-13) Lateral incisor 13 (10-16)
19 (16- 22) Canine 20 (17-23)
16 boys(13-19) girls (14-18) First molar 16 (14-18)
29 (25-53) Second molar 27 boys(23-31), girls(24-
30)

Parameters………
❑Suture (fontanel) : -
• The posterior fontanel measures 1x1 cm at birth and normally closed at
two months ( 1 ½ month) of age.
• The anterior fontanel measures 3.5 x 3.5 cm at birth and normally closed
at 18 months (1 ½ yrs.) of age.

Factors influencing growth & development
 Growth and development influenced by …
 1. Heredity
 2. environment
(i) intrauterine environment
(ii) social & economical condition
(iii) cultural influences
(iv) nutrition

Factors………
➢1. heredity factors : -
• Heredity refers to the genetic condition of an individual which is
established during conception.
• Color of the eyes, hair, facial features, structure of the body, physical
peculiarities, blood group are determined antiraly by heredity, sex is
determined at conception.
• Some congenital disorders due to heredity –
• Genetic disorders – haemophilia, colour blindness, phenylketonuria.
• Chromosomal disorders – down syndrome, tuner syndrome, Klinefelter
syndrome.

Factors…………
➢2. environmental factors : -
• Environment is a most important affecting factor of growth and
development of child.
❖(i) Intrauterine environment : -
• intrauterine environment is the function of maternal circulatory pattern
which provides nutritional and gas exchange.
• Harmful prenatal factors –
- nutritional deficiencies when the mother’s diet is insufficient in quality ,
anemia in the mother.
- mechanical problems like malposition in utero.

Factors……
- metabolic endocrine disturbance like diabetes.
- infectious disease during pregnancy – ToRCH
T – toxoplasmosis
o – other infections
R – rubella
C – cytomegalo virus
H – herpes simplex & syphilis
- smoking and use of alcohol and drugs may result in prematurity or
deformity of child.

Factors………
❖(ii) Social & economic conditions : -
• Poverty, crowded living conditions, ignorance and lack of interest on the
part of the parents may lead to retardation of the 6ormal growth and
development of children.
❖(iii) cultural influences : -
• The effect of a particular culture on a child begins the way a cultural group
takes care of the female children of its community and the women.
• Gender discrimination and other issues affects the growth of children.

Factors…….
❖(iv) Nutrition : -
• It has been established that prolonged malnutrition of the expectant
mother is one of the most common causes of low birth weight, fetal and
neonatal deaths and incurably damaged infants.
• Adolescent girls have the poorest diet in most cases because of their desire
to be slim.

Characteristics of development
 There are certain basic predictable characteristics of this basic blue print of
development. There are as follows : -
✓ Development is similar for all.
✓ Development proceeds from general to specific.
✓ Development is continues.
✓ There is co- ordination in development.
✓ Development proceeds at different rates.
✓ Development comes from maturation and learning.
✓ There are individual differences.
✓ Early development is more significant than later development.
✓ Development proceeds by stages such as fetal, infancy, babyhood and adolescent.
✓ There are predictable patterns of physical development.
- cephalocaudal,
- proximodistal

Milestones
Age (in
months)
Physical
development
Gross & fine
motor
Speech &
language
Vision Social /
emotion/
play
cognition
1 10% of body
weight is lost
during first 10
days.
Gross motor-
Turn head side to
side when prone.
Fine motor -
hands
predominantly
closed.
Responds to
human
voices.
Makes small
throaty
sounds.
Responds to
human
voices.
Cries when
Hungary or
uncomfortable.
-
2 Posterior fontanel
closed at 6 to 8
weeks.
Gross motor-
Start lifting head ,
occasionally while
on tummy.(45 )
Fine motor –
Open hand
intermediately.
Makes coos,
laugh, throaty
sounds like
gargling
cooing.
Can see large
objects.
Social smile
begins
responds to
mother’s facial
expressions
after being
talked.
Eye to eye
contact.

Milestones……..
4 -Drooling indicates
appearance of saliva.
-Moro’s reflex, tonic
neck reflex and
rooting reflex
disappears.
gross motor –
Holds head up, lifts
the head and chest
with support on
forearm, sitting with
support head held
standing.
Fine motor –
Reaches for and grasps
an object brings both
hands in mid line and
is able to play around
with both hands.
Turns eyes to
sound, laugh
aloud or
squeals with
laughter.
Eye can follows
the toy, stares
at own hand ,
no crossed eye.
While sitting in
mother’s lap,
smiles back at
mothers and
holds head
steadily.
Looks at
objects, it is
holding.
(observe the
toy).
6 Birth weight
doubles. (at 5
month.)
Two lower incisor
erupted.
Begin to bite and
chew.
Gross motor –
Able to sit with
support, can roll over
from prone to supine
Fine motor –
Holds objects using
thumb side (radial
palmer grasp), transfer
object from hand to
hand (begin).
Monosyllabic
early ‘ba’ ‘ba’
‘ma’.
Turns head to
sound.
Can look for a
dropped spoon,
shifts gaze from
one object to
another.
Stretches arm to
be picked up.
Moves to look
for a fallen
object, child
pays attention
to a person
and an object.

Milestone……..
9 -Being to show
pattern in bladder
and bowel
elimination.
- Eruption of
upper central
incisor.
Gross motor –
Sit without arm
support, reciprocal
(alternate hands
and legs movement)
Crawling.
Fine motor –
Holds objects like
marble b/w thumbs
and first two fingers.
Transfer objects
from hand to hand.
Polysyllabic
babbling ‘mama’,
‘baba’.
Non specific
mama ,dada etc.
Avoids
bumping
into objects
while
moving.
Plays peck a boo
responds to his/
her name.
Looks for a
toy that is
completely
covered.
12 - Birth weight
triples.
- Birth length
increased by
50%
- Has 6-8
deciduous
teeth.
Gross motor-
Able walk while
holding the parents
hand.
Fine motor –
Able to pick up
small objects with
thumb and finger
tip.
Can say at least
one meaningful
word clearly and
specifically like
‘papa’, ‘mama’,
‘dada’ ,
Understand the
word ‘no’.
Looks
alternately
at near and
far objects.
Waves good bye,
hugs Doll or any
one (express
emotions of
affection/ joy/
anger/ fear/ like
kissing, cuddling,
crying etc.)
Gives objects on
request able to
deliver toys to the
father or mother.
Looks for a
toy that is
completely
covered,
puts blokes
into cup.

Milestone………
15 Toddler adds
about 3.6 kg
weight each year
and increases
about 3 inches
in height.
There is
continued
eruption of
tooth.
Gross motor-
Begins to walk alone,
walking pattern is wide
based, creeps on the
stairs.
Fine motor –
Pointing with index
finger (where is bottle)
scribbles in imitation,
turns 3-4 pages at a time
and tower of 2 blocks,
manipulate, exploration
of toys in hand.
Points to
common
objects (in the
pictures
book) when
named, can
speak 4-6
words.
Can put a
circular shape
in a puzzle.
Looks for a
toy that was
displaced.
Pretends play
like feeding
the doll.
Follows
simple
instruction
– ‘give me
the ball’,
‘come here’,
‘sit down’.
18 Anterior
fontanel closed,
abdomen pro-
trudes, has
sphincter
control.
Gross motor-
Child walks steadily
even while holding or
pulling a toy begins
to run walks upstairs
with help.
Fine motor –
Spontaneously
scribbles, turns 2-3
pages at a time, build
tower of 3-4 blokes.
Has
expressive
vocabulary of
10 -20 words.
Can listen
and responds
to simple
directions.
- Usually play
beside other
children but
not with
them.
Identifies at
least one or
two body
parts when
asked.

Milestones…….
24 - Gross motor-
Runs well, able to jump,
walks up and down,
stairs without help (2feet
steps).
Fine motor –
Open the bottle by
turning cap, turn page
one at a time. Imitates
vertical stroke with
pencil, build tower of 7-
8 cubes.
Speaks in two
words
combination –
‘mama milk’.
Identifies a
picture in a
book or points
to his own
photo.
Imitates every
day activity
like sweeping,
washing
cloths.
Opens lid of
container to
obtain a
sweet, stack
rings on a
page in order,
mention six
body parts.
36 Child grows
about 1.8 kg each
year and 2+
inches taller each
year.
Gross motor –
Hops one to three times
on one foot, can climb
up and down stairs.
Able to go down stairs
with alternating feet
without holding.
Fine motor –
Mimic straight line and
circle, tower of 9 cubes
or bridge.
Is able to ask
‘what is this’ ,
speak simple
sentence and
three words
sentence.
Able to give the
name of one to
two colors.
Able to play
together with
other friends.
(cross play)
Matches
blocks that
are of same
colors, puts
square
triangle on
the form
board.
Differentiate
between cup
plate, big &
small.

Neonatal reflexes
 The inborn reflexes present at the time of birth and occur in a predictable
fashion.
 If these reflexes persists beyond the normal age limit indicates cerebral
damage or immaturity.
➢Moro’s reflex : -
• It is initiated by any sudden movement of the neck.
• It consists of rapid abduction and extension of upper limbs and opening
of hands, within the movements the arms comes together again.
• It begins at 28 weeks of gestation and disappears at the age of 4-5 months.

Reflexes………
➢Startle reflex :-
• It is initiated by sudden sound.
• It consists of rapid abduction and extension of upper limbs and opening
of hands, within the movements the arms comes together again.
➢Palmer grasp reflex : -
• Light touch on the palm produce reflex flexion of fingers.

Reflexes………
➢ Planter grasp reflex : -
• Placing objects or fingers beneath the toes causing the carling of toes around
the object.
• It present at the 32 wks. of gestation and disappear at age of 9-12 months.
➢ Dancing or stepping reflex : -
• When the sole of foot is pressed against the couch, baby tries to walk, its look
like as a baby is dancing.
• It present at birth and disappear at the age of 2-4 months.
➢ Doll’s eye reflex : -
• Passive turning of head the new-born leaves the eye behind.
• It present at the birth and disappears few weeks after birth.

Reflexes…………….
➢Tonic neck reflex : -
• In the supine position when the head and neck of the baby turn to a side
than limbs of same side become extend and the limbs of opposite side get
flexed.
• It present at the time of birth and disappear at the age of 2-3 months.
➢Babinski’s reflex : -
• When a firm painful stroke along the lateral border of sole from hill to toe
the response consist of flexion and extension of the big toe and the other
toes fanning outwards.
• It present at the time of birth and disappears at the age of 9-10 months.

Reflexes………
➢ Rooting reflex :-
• When the corner of mouth is touched the lower lip is lowered and tongue moves
towards stimuli.
• It is starts at the 28 wks. of gestation but well stablished at 32wks. of gestation
and disappears at the age of 3-4 months.
➢ Sucking & swallowing reflex : -
• starts at the 28 wks. of gestation but well stablished at 32-34 wks. of gestation
and disappears at the age of 12 months.
➢ Gag reflex : -
• It is the reflex contraction of back of the throat.
• It present at the time of birth and persists life time.

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