GROWTH AND

DEVELOPMENT
 GROWTH &
DEVELOPMENT
 Begins at conception; Ends at

maturity
 Terms ‘growth & development used

together normally
 They progress together

 Growth is not development

 GROWTH MEANS
INCREASE IN SIZE DUE TO..
 Increased number of cells
 Increase in their size

 Increase in intercellular substances

The increase can be seen and measured

accurately
 Patterns of Growth and
Development
 Growth and development are directional
and follow detectable pattern.
1.Cephalo-caudal- meaning that growth
and development proceeds from head to
tail.
 Structures and functions originating in

the head develop before those in the

lower parts of the body. Fetal head
initially grows fastest, then trunk and
later the legs.
 At birth the head is larger, trunk is
long, and arms are larger than legs.
 As the child matures, his body
proportions gradually change and by
adulthood, the legs have increased
in size from 38% to 50% of total
body weight.
2.Proximal distal pattern- from center
outwards
In the respiratory system, the trachea

develops first in the embryo, followed by

branching and growth outwards in the
bronchi, bronchioles and alveoli in the
fetus and infant.
Motor control of the arms comes before

control of the hands and hands control

comes before finger control.
 Growth
 Growth
 Physical increase in whole or

any of its part

 Parameters of a child’s growth

can be easily measured with

accuracy through the following:
 Weight

 Head circumference
 Length or height

 Dentition
 Growth
 Weight
 Important indicator of child’s

nutritional status and

general growth
 Used to calculate medication

dosages for children

 Should be measured at every

visit
 Growth
 Head circumference
 Related to intracranial

volume
 Normal brain growth =

expected rate of increase in

head circumference
 Abnormal lags may indicate

serious problems
 Growth
 Length or height
 Compared with head

circumference and weight

measurement for overall
indicator of physical growth
 Measure infant from crown of

head to heel
 Standing height measurement

for children three years or older

 Growth
 Dentition
 Refers to eruption of teeth and

follows sequential pattern

 Eruption of primary teeth: 6-30

months
Twenty primary teeth

 Eruption of permanent teeth:

around 6 years of age

Normally 32 permanent teeth
 ASSESSMENT OF GROWTH
 Anthropometry
Includes – weight, height, measurement of
head, chest, abdomen, pelvis etc.
 Tissue growth

Skin fold thickness – measuring

subcutaneous fat & measuring muscle mass
 Radiography - appearance and fusion of
various epiphyseal centres
 Dental age
 ANTHROPOMETRY
Most commonly used in day to day practice
 Length:
 most important parameter not altered by

acute episodic illnesses e.g. Acute

diarrhea
 Referred as length when measured in
lying down position on infantometer.
 Height: measured in erect standing position
on stadiometer
 ANTHROPOMETRY
 Weight
 Most Common & important

 Accuracy is important

 Acute variation due to acute illnesses must

be considered
 Head circumference: important in first 2 years
of life.
 ANTHROPOMETRY

 Chest circumference: important in first

year of life especially when compared to
the head.
 Mid upper arm circumference( MUAC):

important during field practice when

weighing scales may not be available
 ANTHROPOMETRY
Body Mass Index (BMI) = Wt. IN KG
Ht IN M2

BMI Value is useful in assessing the nutritional

status
Normal Value = 0.25

Weight For Height

Age Independent Index To Assess Nutrition
Different types of malnutrition can be assessed
such as acute vs chronic
 TISSUE GROWTH
 Not useful in routine practice.
 Needs special instrument (caliper) it

assesses skinfold thickness measured

over triceps, subscapular region, biceps
region.
 Assesses amount of subcutaneous fat
BONE AGE AND SKELETAL MATURITY
 Epiphyseal centres appear at specific ages in
Specific Bones. X-rays of wrist, elbow, knee,
ankle and pelvis are useful.
 X-ray of wrist commonly used up to 6-8 years
of age and at puberty
 Fusion of epiphyseal centres also occurs at
specific age in special sequence.
 Dependence upon age of the child and purpose
of assessment, various x-rays are used.
 DENTAL DEVELOPMENT
 Eruption of teeth follow definite pattern.
 Useful for assessment of age.

TEETH – Two sets

 TEMPORARY
 PERMANENT
 TEMPORARY

 20 in number
 All replaced by permanent teeth
 Eruption begins at 6-10 months of age
 Completed 24 – 30 months of age
PERMANENT

CI LI M1

1 2 3 4 5 6 7 8
7 8 11 9 10 6 12 17
 GROWTH CHARTS
 Standard charts contain Wt / Ht / HC
 For convenience they are grouped
 Birth - 2 years : separate for boys & girls
 2 years – 20 years : separate for boys & girls

 Also described as ‘road to health’ , WHO

has accepted charts of national centre for
health statistics (NCHS) USA, for
international use
 GROWTH – BIRTH TO PUBERTY
Phases Of Growth

Intrauterine Extrauterine

Ovum Embryo Foetus

Concpt To 2wks To 8 8 Wks To
2 Wks Wks 40 Wks
 Extra uterine Period
 Perinatal Period - 1st Week of Life
 Neonatal Period - 1st Month of Life
 Infancy - 1st Year of Life
 Toddler - 1-3 Years
 Preschool / School Age - 3- 10 Yrs
 Adolescent
 Girls 10 To 17 Yrs
 Boys 12 To 18 Yrs
 NEONATAL PERIOD
 Normal Mature Newborn Wt. More Than 2.5 Kg
 Average 3.5kg
 Large New Born Wt. >3.5 Kg
 Low Birth Wt < 2.5kg
 Loss Of Wt During First Wk Regained By 10 Days Of Life
 WT – increase 20-30 gm / Day FROM 10 DAYS TO 90
Days of life
 End Of First Month - Birth Wt. + 400-500gms
 Length- 50 - 52 Cm
 HEAD : 33 - 37 Cm
 INFANCY
 Weight
 Wt. INCREASE 20-30gm/day UPTO 90 DAYS OR 3
MONTHS
 End of 5- 6months double the birth wt.
 End of 1 year triple the birth wt.
 Height
 Ht. Increases by 2.5 cm/month UPTO 6 MONTHS
 6 MONTHS TO 1 YEAR - 1.5 cm/month
 AT 1 YEAR HT= 72-75 cm
 Head Circumference
 33-37 cm AT BIRTH, INCREASES BY 2.cm/months x3,
0.5cm/month x 6
 6 months = 42-47 cm
 1 YEAR= 45-49cm
 Chest - Same as head at 1 year
 PRESCHOOL PERIOD
 Wt.
 3kg/ yr in second year
 2 - 2.5kg/ yr 3 to 10 years
 Ht.
 10cm in second year
 6 - 7.5cm/ yr 3 to 10 years
 Head Circumference
 3 - 4 cm in second year
 2 - 3 cm in third year
 Chest - more than head in second year
 If less – indicates malnutrition
 SCHOOL PERIOD
 Growth slows down after the second year

 WT. GAIN 2.5 Kg/ yr

 HT. GAIN 5 - 7cm/ yr

 Head 2-3 cm are added during the whole

period upto adolescence
GROWTH DURING ADOLESCENCE
PERIOD EXTENDS
 10-16 years in girls and 12-18 years in boys

 Puberty - onset of menstruation in girls 11-14 years

 2nd GROWTH SPURT - i.e., Acceleration of weight

& height, starts at 10 – 12 years, early in girls

 Other changes include-

 Sex maturation – measured as SMR (sex maturation rate)
 Psychological changes
 Metabolic changes
 Emotional changes
 BONE AGE
 Useful to assess maturity of newborn
especially in some medicolegal situations

 Some endocrine disorders like

hypothyroidism – bone age delayed
 BONE AGE – RADIOLOGY
 At birth - x -ray of knee & epiphyseal centres Present
include –
 Distal end of femur
 Proximal end of tibia
 Head of humerus
 Calcaneus, talus & cuboid
 X-ray wrist-
 Carpal centres start appearing at 2 months
 End of 1 year 2 carpal centres
 Till 6 years 1 centre is added each year
 Pisiform 8th carpal centre appears approx 1 year
before puberty
DEVELOPMENT
 Child Development
 Definition:
 Change in the child that occurs over time.
Changes follow an orderly pattern that
moves toward greater complexity and
enhances survival.
 Periods of development:
 Prenatal period: from conception to birth
 Infancy and toddlerhood: birth to 2 years
 Early childhood: 2-6 years old
 Middle childhood: 6-12 years old
 Adolescence: 12-19 years old
 DEVELOPMENT
 Development means maturation of functions,
especially of nervous system. It is a
continuous process.
 Development delay means failure to reach
desired level of milestone at a particular given
age. Detection of delay at the earliest age is
important.
 However disorders of speech, learning
disabilities cannot be diagnosed before 3 years
of age
 Domains of Development
Development is described in three domains, but
growth
in one domain influences the other domains.
 Physical Domain:
 body size, body proportions, appearance, brain development,
motor development, perception capacities, physical health.
 Cognitive Domain:
 thought processes and intellectual abilities including attention,
memory, problem solving, imagination, creativity, academic and
everyday knowledge, metacognition, and language.
 Social/Emotional Domain:
 self-knowledge (self-esteem, metacognition, sexual identity,
ethnic identity), moral reasoning, understanding and expression
of emotions, self-regulation, temperament, understanding
others, interpersonal skills, and friendships.
 Areas of Child
Development
 Motor or Physical Development
(Body Movement)
 Cognitive Development
(Thinking and Learning)
 Language Development
(Receptive and Expressive)
 Sensory Development
(Seeing, Hearing, Touching, etc.)
 Social and Emotional Development
(Getting Along with Others, Feelings About Self, etc.)
 Self-Care Development
(Dressing, Feeding, Washing, etc.)
ASSESSMENT OF DEVELOPMENT
 Subjective & difficult process

Criteria to assess
 Motor activity
 Gross motor
 Fine motor
 Language
 Speech
 Hearing & understanding
 Personal social behavior
 MOTOR ACTIVITY
Include gross motor
achievement  Walking - 12 to 15 mos
 Supporting the head - 2 
Climbing up the staircase –
to 3 mos 15 months
 Turning over - 3 to 4 mos
 Sitting up (when made to )
 Climbing down the
- 5 to 6 mos staircase - 18 to 24 mos
 Sitting up by self - 6 to  Kicking a ball - 2 to 3 yrs
7 mos  Standing on one foot - 3
 Standing up holding
to 4 yrs
objects - 7 to 9 mos
 Standing up by self - 10  Hopping - 5 to 6 yrs
to 12 months  Skipping a rope - 7 t 8 yrs
Ventral suspension
6 months
Crawl 7-8mo
Creep
16 mos
2 yrs

49
18 months
Tower of cubes
 FINE MOTOR ACTIVITY

 Pincer grasp - picking up objects with apposition of

thumb and fingers - 9 months

 Holding a pen - 2 years

 Writing - 2 years onwards

 Painting - 3 to 5 years
 LANGUAGE
 First two years of a child’s life are spent in
hearing and understanding the language
spoken by the family.

 In 2nd year the child tries to reproduce some

syllables and speaks 1 – 3 words.

 After 2 years, proper speech is developed and

child learns to speak sentences.
 PERSONAL SOCIAL
DEVELOPMENT
 Reaction of child towards persons and its social
activities

 1 month old child will recognize mother’s voice and

will become quiet if crying

 2 to 3 months old will recognize mother

 6 to 7 months old recognizes strangers… and so on.

 SOCIAL ACTIVITIES INCLUDE
 Sleep pattern
 Eating habits
 Control over bowel & bladder
 Bowel control is acquired at 1 year
 Bladder control is acquired at 2 years
 Night bed wetting should stop by 2 1/2 to 3
years
 EATING
 Child learns to eat by self after 1 year.
SLEEP
 During first month of life, child sleeps 18 to 20
hours
 At 6 months will have 2 to 3 sleep intervals.
 At 1 year will have 1 or 2 sleep intervals.
 At 2 to 3 years may sleep in the afternoon
 Factors influencing
growth and development
Pre-natal environment
1-Factors related to mothers during
pregnancy:

 Maternal nutrition . Dietary insufficiency

and anaemia lead to intra uterine growth
retardation, low birth and preterm babies
 Infections e.g. HIV, Hep B,STORCH
 Substance abuse like alcohol & smoking
 Medical conditions like
hypertension ,anaemia, hypothyroidism,
diabetes
 Fetal related factors in
utero
 Abnormal placentation
 Placenta insufficiency
 Intra natal
circumstances

• Mode of delivery, esp. assisted

deliveries

• Condition of baby at birth e.g birth

asphyxia, presence of congenital
infections or abnormalities
 Post-Natal Environment

I - External environment:
- socio-economic status of the
family
- child’s nutrition
- climate and season
- child’s ordinal position in the
family/birth order
- Number of siblings in the family
- Family structure (single parent
or extended family … )
 Genetics (heredity): Genetical
predisposition is the important factor
which influences the growth and
development of children. Different
characteristics such as height, body
structure, color of skin, eyes and hair
depend upon inherited genes from parents.
Thus tall parents have tall children and
parents with high intelligence are more
likely to have children with high level of
inherent intelligence (I.Q).
 Cultural influences: Growth and
development of a child is influenced by
the culture in which he/she grows from.
The child rearing practices, food habit,
traditional beliefs, social taboos, attitude
towards health, standard of living,
educational level etc, influence the
child’s growth and development. The
child learns standards of traits like
honesty, discipline,
• Sex.
At birth , male babies are heavier and
longer than females. Boys maintain
this superiority until about 11 years.
Girls mature earlier than boys and
bone development is more advanced
in girls
• Race and nationality.
Height and stature of Americans and
Indians are usually differ because of
the differences in growth patterns.
 Nutrition is necessary for brain growth
prenatally and in the first year of life.
Balanced amounts of essential nutrients
have a great significant role in growth
and development. Both quantitative and
qualitative supply of nutrition i.e.
proteins, fat carbohydrates, vitamins,
water and minerals in the daily diet are
necessary for promotion of growth and
development in children.
 Socio-economic status: Children
from families with good socio-
economic status tend to grow well
due to the readily available
essentials for diet, health care and
psychologically supportive family
compared to their counterparts from
economically struggling families.
 Infections: such as malaria, syphilis
among others can affect the delivery
of nutrients, hormones, oxygen to
some organs and body tissues thus
hindering the growth and
development of children especially
during the intrauterine life.
 Intelligence.

Influences mental and social

development.
development A child with higher
intelligence adjusts with environment
promptly and fulfill own needs and
demands, whereas a child with low level
of intelligence fails to do that.
Intelligence is correlated to some
degree with physical development.

Hormonal influences.
This is an important aspect of internal
environment. All hormones in the
body affect Growth and development
of children e.g. thyroxin, growth
hormone
 Play: Is most frequent during periods of
rapid growth and development and may be
related directly to expanding, intellectual,
motor, language and social development.
 Immunization: Children free from diseases
always have good growth and development
than the children with repeated attacks of
infection. Immunization protects children
from diseases that affect growth and
development.

Family planning:


Well spaced children get good period

of care due to enough time spent on
them by the parents before the
coming of the next child.
Language training:
Parents should encourage their
children to speak out what they are
thinking, correct and guide them
where necessary. This helps the
child to develop socially and
intellectually.
 Differences between growth &
S/N GROWTH
development
DEVELOPMENT

1 Growth is defined as the development On the other hand, development is defined as

of a person in weight, age, size, and the process wherein a person's growth is visible
habits. in relation to the physical, environmental, and
social factors.
2 Growth is a process that focuses on Development focuses on both qualitative and
quantitative improvement. For quantitative refinement. For instance, a child's
instance, a child visibly grows in IQ increases with the growing age.
weight and height.
3 Growth is limited to a certain level, On the other hand, a person is developing every
i.e., a person's height grows till a single day in terms of his/ her habits, maturity
certain age. level, IQ, etc.
4 Growth depends upon the cellular Development is basically dependent upon
changes, i.e., a child grows into an organizational growth, i.e., the environment in
adult. The child undergoes many which a child lives or studies affect them
changes throughout his/ her childhood immensely. The skill-set of a child changes in
to adulthood. such an environment. For instance, a child
develops reading habits or acquires an interest
in the abacus.
 GROWTH DEVELOPMENT

5 Growth is an external Development is an internal

process. process.
6 Growth changes the On the other hand, development
physical changes of a changes the character of a
person. person.
7 Growth is limited, i.e., it Development takes place
happens till a particular throughout life, i.e., it doesn't
point in time. depend upon time or age.
8 Growth focuses on only Development focuses on various
one aspect, i.e., an aspects like interpersonal skills,
increase in the child's intelligence, etc.
size.
9 Growth is structural. Development is considered as
 GROWTH DEVELOPMENT

10 Growth can be considered On the other hand, development

as physical growth that is is considered as a gradual
seen from one stage to change in skill-sets, behaviour,
another. habits, etc.
11 Growth is influenced by Development is not dependent
development. upon growth.
 Relationship between chest and head
circumference
 The relationship of the
circumference of the head to the
circumference of the chest in infants
and children changes with age.
These measurements are routinely
taken by the pediatrician and can
alert him or her to abnormalities in
the brain or in overall body growth.
 A newborn's head circumference measures 33-35cm
and is approximately two to three centimeters larger
than the chest circumference which, when measured
at the nipple line, is between 30 and 33 centimeters
 Between the ages of six months and two years,
measurements of head circumference and chest
circumference are equal.
 As the child gets older, chest circumference exceeds
head
 Abnormal Head
 When theCircumference
head circumference is large and more than
four centimeters greater than chest circumference, the
infant's head is growing too fast. This indicates either
an inherited or acquired disorder of the brain, or fluid
accumulation around or within the brain --
hydrocephalus--. In families where there is a
tendency towards a large head size -- benign familial
macrocephaly -- a large head circumference may be
normal. If head circumference is less than 32
centimeters, the brain is too small -- microcephaly.
Microcephaly is associated with fetal infection,
chromosomal disorders and congenital
malformations.
 Abnormal Chest
Circumference
 A small chest circumference and normal head
circumference in a newborn baby, called asymmetric
growth restriction, may be seen in babies whose mothers
have high blood pressure or kidney disease . Since
normal growth requires adequate nutrition, chest
circumference is also useful in assessing malnutrition. It
is recommended as a measure of poor nutrition by The
World Health Organization. Chest circumference and has
been shown be low not only in obviously malnourished
children but also in children from lower socioeconomic
groups.
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