GROWTH AND

DEVELOPMENT IN
CHILDREN
 Objectives
• Define growth and development.
• Identify the importance of growth and
development.
• *Outline the principles of growth and
development.
• *List factors affecting growth and
development.
• Outline the types of growth and development.
• Identify the stages of development.
 Growth
Growth refers to an increase in
physical size of the whole body or
any of its parts.
It is a quantitative change in the
child’s body.
It can be measured in Kg, pounds,
meters, inches, ….. etc
Child Growth (Image: WHO)
Changes in bodily proportions with
age.
 Development
• Development refers to a progressive
increase in skill and capacity of
function.
• It is a qualitative change in the
child’s functioning.
• It can be measured through
observation.
 Importance of Growth and
development
• Knowing what to expect of a particular
child at any given age helps identify
problems when they arise.
• Helps in understanding how illnesses
affect growth and development.
• Helping in formulating the plan of care.
• Helping in parents’ education in order to
achieve optimal growth & development
at each stage.
 Factors affecting growth and
development:
• Hereditary
• Environmental factors
Stages of Growth and Development
–Neonate • Early Childhood
• Birth to 1 –Toddler
month • 1-3 years
–Infancy –Preschool
• 1 month to 1 • 3-6 years
year
 Cont..
• Middle Childhood
–School age
–6 to 12 years
• Late Childhood
–Adolescent
–13 years to approximately 18 years
Growth Pattern
 Growth Patterns
• The child’s pattern of growth is in a
head-to-toe direction, or
cephalocaudal, and in an inward to
outward pattern called
proximodistal.
 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.
 Normal newborn
Physical growth
- Weight = 2.5 – 4 kg
- Wt loss 5% -10% by 3-4 days after birth
- Wt gain by 10th days for term babies and
by 14 days for preterms
- Gain ¾ kg by the end of the 1st month
 LENGTH
• Boys average Lt = 50 cm
• Girls average Lt = 49 cm
• Normal range for both (47.5- 53.75 cm)
Head circumference
33-37 cm
Head is ¼ total body length
Skull has 2 fontanels (anterior & posterior)
 Cont .. Head circumference
• It increases about 2 cm /month during
the 1st 3 months,
• Then, 1 cm/month during the next 3
months and lastly 0.5cm/month in the
last 6 months.
• Posterior fontanel closes by 6-8 w of age.
• Anterior fontanel closes by 12-18 months
of age.
 Gross Motor Development
• Newborn: barely able to lift head
• 6 months: easily lifts head, chest and
upper abdomen and can bear weight
on arms
 Head Control

Newborn Age 6 months

 Neonatal reflexes
Are primitive responses present in the normal
newborn and occur as responses to specific
stimuli and depend on level of the baby’s
wakefulness.
They disappear at different times up to the age
of 4 months, and persistence may denote
developmental delay.
Absence may be due to a brain or localized limb
abnormality.
 Neonatal reflexes cont..
• Rooting
• Sucking
• Swallowing
• Palmar and plantar grasp
• Tonic-neck
• Startle/ moro reflex
• Stepping /walking
One month-Reflexes
 Infancy
• It is the period which starts at the
end of the first month up to the end
of the first year of age.
• Infant's growth and development
during this period are rapid.
 Growth
Weight : the infant gains :
- Birth to 4 months → ¾ kg /month
- 5 to 8 months → ½ kg / month
- 9 to 12 months → ¼ kg /month
The infant will double his birth wt by 6
months and triple it by 12 months of
age.
 Infant weight calculation
Infants from 3 to 12 months
Weight = Age in months + 9
2
Wt of 7 months old infant = 7+9 =
16/2 = 8 kg
 Sitting up
• 2months old: needs assistance
• 6 months old: can sit alone in the
tripod position
• 8 months old: can sit without
support and engage in play
 Sitting Up

Age 2 months Age 8 months

 Ambulation
• 9 month old: crawl
• 1 year: stand independently from a
crawl position
• 13 month old: walk and toddle
quickly
• 15 month old: can run
 Ambulation

13 month old
Nine to 12-months
 Fine Motor - Infant
• Newborn has very little control.
Objects will be involuntarily grasped
and dropped without notice.
• 6 month old: palmar grasp – uses
entire hand to pick up an object
• 9 month old: pincer grasp – can
grasp small objects using thumb and
forefinger
 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
 Average age for teeth eruption:
• Lower central incisors • Erupt at 6 months
• Upper central incisors • Erupt at 7.5 months
• Upper lateral incisors • Erupt at 9 months
• Lower lateral incisors • Erupt at 11 months
• Lower first molars • Erupt at 12 months
• Upper first molars • Erupt at 14 months
• Lower cuspids • Erupt at 16 months
• Upper cuspids • Erupt at 18 months
• Lower 2nd molars • Erupt at 20months
• Upper 2nd molars • Erupt at 24 months.
Cont..
 Fine Motor Development

6-month-old

12-month-old
 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.
 Toddler growth - Weight
• During the toddler stage growth slows
considerably.
• Formula to calculate normal weight of
children over 1 year of age is
• Age in years X 2+8 = ….. kg.
• e.g., The weight of a child aged 4 years
4 X 2 + 8 = 16
NB: Daytime bladder and bowel control by
24–30 months
 Fine Motor - toddler
• 1 year old: transfer objects from hand to
hand
• 2 year old: can hold a crayon and color
vertical strokes
–Turn the page of a book
–Build a tower of six blocks
 Fine Motor – Older Toddler
• 3 year old: copy a circle and a cross –
build using small blocks
• 4 year old: use scissors, color within the
borders
• 5 year old: write some letters and draw a
person with body parts
Toddler
 Issues in parenting - toddlers
• Stranger anxiety – should disappear by
age 2 ½ to 3 years
• Temper tantrums: occur weekly in 50 to
80% of children – peak incidence 18
months – most disappear by age 3
• Sibling rivalry: aggressive behavior
towards new infant: peak between 1 to 2
years but may be prolonged indefinitely
• Thumb sucking
• Toilet Training
 Summary of milestones(birth to
1.5yrs)
• Social smile: 4-6 weeks
• Neck support: 3-4 months
• Sitting with support: 4-5 months
• Sitting without support: 6-7months (Palmar grasp (6
months)

• Crawling: 9 months + (pincer grasp)

• Pulling to stand: 10 months
• Walking with support: 11-12 months
• Walking without support: 12 months to 15
months
Pre-School
 Preschooler growth
Weight:
The preschooler gains approximately
1.8kg/year.
Height:
He doubles birth length by 4–5 years of
age.
 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
 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
School-Age
 School age
Weight:
• School–age child gains about 3.8kg/year.
• Boys tend to gain slightly more weight through
12 years.
• Weight Formula for 7 - 12 yrs
= (age in yrs x 7 )– 5
2
Height:
• The child gains about 5cm/year.
 School Years: fine motor
• Writing skills improve
• Fine motor is refined
• Fine motor with more focus
– Building: models
– Sewing
– Musical instrument
– Painting
– Typing skills
– Technology: computers
 School performance
• Ask about favorite subject
• How they are doing in school
• Do they like school
• By parent report: any learning difficulties,
attention problems, homework
• Parental expectations
 Red flags: school age
• School failure
• Lack of friends
• Social isolation
• Aggressive behavior: fights, fire
setting, animal abuse
 School Age: gross motor
• 8 to 10 years: team sports
• Age ten: match sport to the physical and
emotional development
School Age
 School Age: cognitive
• Greater ability to concentrate and
participate in self-initiating quiet
activities that challenge cognitive skills,
such as reading, playing computer and
board games.
 Adolescent
• As teenagers gain independence they
begin to challenge values
• Critical of adult authority
• Relies on peer relationship
• Mood swings especially in early
adolescents
 Adolescent
Weight:
• Growth spurt begins earlier in girls (10–14
years, while it is 12–16 in boys).
• Males gains 7 to 30kg, while female gains 7 to
25kg.
Height:
• By the age of 13, the adolescent triples his
birth length.
 Cont.. height
• Males gains 10 to 30cm in height.
• Females gains less height than males as
they gain 5 to 20cm.
• Growth in height ceases at 16 or 17 years
in females and 18 to 20 in males
13 to 18 Year Old
 Adolescent behavioral problems
• Anorexia
• Attention deficit
• Anger issues
• Suicide
Adolescents
 Adolescent Teaching
• Relationships
• Sexuality – STD’s / AIDS
• Substance use and abuse
• Gang activity
• Driving
• Access to weapons
 Questions
• ?????
Adolescents