CHILD GROWTH AND

DEVELOPMENT

Department of Pediatrics
Soochow University Affiliated Children’s Hospital
‡Pediatrics focuses on the pattern of child
growth and development, child health
promotion, disease prevention and
treatment, and direct care of illness
children.
‡The children are often among the most
vulnerable or disadvantaged in society, and thus
their needs require special attention.
Pediatric worker aims at protecting children
from illness and injury, assisting them to attain
optimal levels of health.
 Characteristics of Pediatrics

‡There are significant differences between

children and adults.
‡The younger the children, the greater the
difference.
‡Health promotion, disease prevention,
treatment, and health care of children are
unique from that of adults.
Childhood is a critical period for physical,
psychological and behavioral development.
Compared with adult, child is relatively less
independent. Family, kindergarten, school, and
community are important settings for their
development. Health care should be planned
specifically based on their characteristics and
needs of children in different age group.
 Age stages

It is also significant for health worker to know that

there are characteristic health problems peculiar to
each major phase of development.
 Age stages
1st 2nd 3rd

Fetal
Period
28 W birth
birth
conception Perinatal
period

7D 14 D 28 D
Perinatal period Neonatal
(from 28 weeks gestination
to 7 days after birth)
early middle later
 Age stages
Toddler's School Age
Infancy Age Preschool Adolescence
Age

G B G B
Birth 1y 3y 6-7y 11y 13y 18y 20y

Biologic and personality maturation are accompanied by

physical and emotional turmoil, and there is redefining of
the self-concept.
‡Child growth and development is a complex process,
which includes not only physical growth, but also the
maturity of systems, development of functioning, The
process of growth and development is influenced by a
variety of internal and external factors.
‡Therefore it is one of the most important goals of
pediatric to monitor and improve child growth and
development,personality, and behaviors.
 Child growth and development

Growth
an increase in the number and, size of cells as
they divide and synthesize new proteins; results in
increased size and weight of the whole or any of its
parts.
can be viewed as a quantitative change.
Development
a gradual change and expansion;
advancement from a lower to a more
advanced stage of complexity the emerging
and expanding of the individual's, capacities
through growth, maturation, and learning
can be viewed as a qualitative change.
 Child growth and development

‡ Growth
quantitative change
‡Development
qualitative change
‡Matura-tion
an increase in competence and adaptability;
a change in the complexity of a structure
that makes it possible for that structure to
begin functioning to function at a higher
level.
All of these processes are interrelated,
simultaneous, and ongoing processes; none
occurs apart from the others. The processes
depend on a sequence of endocrine, genetic,
constitutional, environmental, and nutritional
influences. The child's body becomes larger
and more complex.
 Patterns of Growth and Development

There are definite and predictable patterns in

growth and development that are continuous,
orderly, and progressive. These patterns,
sometimes referred to as trends or principles,
are universal and basic to all human beings.
 Patterns of Growth and Development

1. Continuous and Sequential Trends

2. Directional Trends

Cephalocaudal or head-to-tail
The fist pattern is growth and development in the
cephalocaudal, or head-to-tail,
direction, and reflect the
physical development and
maturation of neuromuscular
function.
 Patterns of Growth and
Development
1. Continuous and Sequential Trends
2. Directional Trends
‡ Cephalocaudal or head-to-tail
‡ Proximodistal or near-to far
‡The second pattern is growth and
Development in the proximodistal, or
Near-to far, direction (midline to
periphery). In the infant, shoulder
Control precedes mastery of the hands, the entire hand
is used as a unit before the fingers can be manipulated.
 Patterns of Growth and Development

1. Continuous and Sequential Trends

2. Directional Trends differentiation

‡cephalocaudal or head-to-tail
‡proximodistal or near-to far
‡The third trend in directional growth, differentiation,
describes development from simple operations to more
complex activities and functions. Specific and refined
patterns of behavior emerge from very broad and global
patterns. All areas of development (physical, mental, social,
emotional) proceed in this direction.
 Patterns of Growth and Development
1. Continuous and Sequential Trends
2. Directional Trends
3. Developmental Pace

In both total body growth and growth of subsystems there

are periods of accelerated and of decelerated growth. The
very rapid growth rate
during infant gradually levels off
throughout early childhood. This rate
is relatively slow during middle childhood,
increases markedly at the beginning of
adolescence, and levels off in early
adulthood.
 Patterns of Growth and
Development
1. Continuous and Sequential Trends
2. Directional Trends
3. Developmental Pace Gender, nutrition,
4. Individual Differences environment are an
influential factors.
Each child grows in his or her own unique and personal way.
Great individual variation exists in the age at which
developmental milestones are reached. Rates of growth vary
from one individual to another. Children may grow quickly or
slowly during the spurt and may finish sooner or later than
other children.
 SELECTED FACTORS THAT INFLUENCE
GROWTH AND DEVELOPMENT
Heredity
Gender internal factors nature
Prenatal Influences
Nutrition
Diseases external factors
Interpersonal Relationships
Environmental Hazards nurture
Seasons and Climates
 Physical Growth and Development

Weight
Weight is the total of all organs, tissues and
fluid. It is an easily obtainable measurement
and a sensitive index reflecting the child's
overall growth and nutrition. In addition, weight
is a basis calculating dosage of medication in
clinic.
 Physical Growth and Development

Weight
Take the weight at the same time each day
(preferably before breakfast) on the same scale for
greatest accuracy.

measurement
 Physical Growth and
Development
Weight
3.0Kg
newborn

‡physiologic weight loss during the first week

after birth
‡infant may loss 3%-9% of their weight due to
the insufficient milk supply, water loss and
meconium excretion. < 10 %
‡which reaches the peak at 3 to 4 days after
birth and return to the level of birth weight at 7
to 10 days after birth. < 10 days
 Physical Growth and Development
Growth is very rapid during the
Weight first year of age, especially
during the initial 6 months.
newborn 3.0Kg
The younger the infant,
6 Mo 7.2Kg the more the weight gain.

Infants gain 600-800g per month until age 6 months,

when the birth weight has at least doubled.

The weight of child (1-6 months) can be

estimated by the formula:
Weight(kg)=Birth weight(kg)＋months×0.7(kg)
 Physical Growth and
Development
The younger the infant,
Weight the more the weight gain.
newborn 3.0Kg Weight gain decreases by half
6 Mo 7.5Kg that amount during the second 6
12 Mo 9.0Kg months.

By 1 year of age the infant's birth weight has

tripled, with an average weight of 9 kg.

The weight of child (7-12 months) can be

estimated
With Weight(kg)
= 6(kg) ＋month×0.25(kg)
 Physical Growth and
Development
Weight
Newborn 3. 0Kg
After this point the normal rate of
6 Mo 7.5Kg weight gain, assumes a steady
12 Mo 9.0Kg annual increase of approximately 2
2 ys 12.0Kg to 2.75 kg per year until the
5 ys 18.0Kg adolescent growth spurt.
10 ys 28.0Kg

The weight of child (2 yrs-12 yrs) can be

estimated With Weight(kg) = age×2＋8(kg)
 Physical Growth and
Development
Weight
Individual Differences is
Newborn 3. 0Kg within ± 10 %；
6 Mo 7.5Kg
If ＜ 15 % was
12 Mo 9.0Kg
2 ys 12.0Kg undernutrition
5 ys 18.0Kg
10 ys 28.0Kg
If ＞ 20 % was
overweight
 Physical Growth and
Development
Height
Height is the vertical distance of
two points between the top of the
head and heel of the feet.
 Physical Growth and
Development
Height measurement
The measuring varies with age:
(a) Children younger than age 3 years are
measures lying down in no shoes, socks and
cap;
(b) Children older than age 3 years are
measured by standing straight.
 Physical Growth and
Development
Height
Newborn 50cm At approximately 2 years of age the
6 Mo 66cm child begins a relalively stable and
steady growth rate of 5 to 6 cm per
12 Mo 75cm
year; this rage continues for the next
2 ys 85cm
10 years.
5 ys 105cm
10 ys 140cm

The Height of child (2 yrs-12 yrs) can be estimated

With Height(cm) = age×7＋70(cm)
 Physical Growth and
Development
Height
Newborn 50cm
6 Mo 66cm Individual Differences is
12 Mo 75cm
within ± 30 %；
2 ys 85cm
5 ys 105cm
10 ys 140cm
 Physical Growth and Development

Head Circumference
‡ head circumference is an important determinant of

brain growth and potential neurologic function.

‡ It is usually measured in children up to 2 years of age.
 Physical Growth and Development

Head Circumference measurement

The measurement is made by placing a tape

measure around the head just above the eyebrows
and around the most prominent portion of the back
of the skill.
 Physical Growth and
Development

Head Circumference Head growth is also rapid.

Newborn 34cm
6 Mo 42cm ‡The average head circumference is
12 Mo 46cm 33-34cm at birth.
2ys 48cm ‡During the first 6 months head
5ys 50cm circumference increases
approximately 1.5 cm per month but
decreases to only 0.5 cm per month
After 2 years of age during the second 6 months.
the growth is slowly.
‡Over-bulge of anterior fontanel indicates
increased intracranial pressure. Sunken
fontanel indicates dehydration.
‡Delayed close of anterior fontanel is
evidenced as children with rickets.
‡The posterior fontanel measures between
0.5 to 1 cm at its widest part and close at 6
- 8 weeks after birth.

Expanding head size reflects the growth

and differentiation of the nervous system.
 Physical Growth and
Development

Chest Circumference
The measurement of chest circumference is
made at the nippier line.
 Physical Growth and
Development
Head Chest The chest circumference at
birth is about 32 cm, less than
Newborn 34cm 32cm
the head circumference.
6 Mo 42cm 41cm
The chest circumference
12 Mo 46cm 46cm
approximately equals head
2ys 48cm 50cm circumference by the end of the
5ys 50cm 55cm first year.

They can be estimated after 1 years With

(chest one - head one ) = age (years)
 Physical Growth and
Development
External Proportions
Variations in the growth rate of different tissues and
organ systems produce significant changes in body
proportions during childhood.
 After the first year and extending to
puberty, the legs grow more rapidly than
any other part. However, with the onset of
puberty there is a marked alteration in
body proportion.
 Physical Growth and
Development
Skeletal Growth and Maturation Skeletal, or bone age
appears to correlated more closely with other measures
of physiologic maturity than with chronological age or
height. Bone age is determined by comparing the
mineralization of ossification centers and advancing
bony form to age-related standards.
radiographs of the hand and wrist provide the most
useful areas for screening to determine skeletal age,
especially before age 6 years.
 Physical Growth and
Development
Teething
‡There are totally 20 deciduous (primary) teeth.
The first deciduous tooth usually erupts at
around 4 to 10 months (average 6 months),
followed by a new one monthly.
‡All 20 deciduous teeth are generally present
by 2 to 2.5 years of age.
The first permanent (secondary) teeth erupt
at about 6 years of age, beginning with the
6-year molar.

The others appear in approximately the

same order as eruption of the primary teeth
and follow shedding of the deciduous teeth.
 Growth and Development
Bone
Growth Wt Ht Head Chest fontanel teeth
age

newborn

6 Mo

1y

2 ys

5 ys

rule
 Key Points of the Class

‡There are significant differences between children and

adults. They younger the children are, the greater the
difference is.
‡The stage of growth and development include fetal
period, neonatal period,infancy, toddler's age, preschool
age, school age, and adolesence.
‡Growth and development of children are strongly
influenced by genetic and environmental factors.
 Key Points of the Class
Growth and development follow predictable patterns in
direction, sequence, and pace.
Biologic growth is determined by height, weight, bone age,
and dentition.
Growth and development are affected by a variety of
conditions and circumstances, including heredity,
physiologic function, gender, disease, physical
environment, nutrition, and interpersonal relationships.
 Neurologic Maturotion

Two periods of rapid brain cell growth occur

during fetal life:
between 15 and 20 weeks of gestation, and 30
weeks of gestation to 1 year of age.
‡The nervous system development allows for
increasingly complex movement and behavior.
‡One half of postnatal brain growth is achieve
by 1 year of age, 75% by age 3, and 90% by
age 6.
 At birth the cortex is only about one half its
adult thickness, resulting in very little cortical
control over body movements.
 Myelinization （髓鞘化） of the various nerve
tracts in the central nervous system accelerates
rapidly after birth and follows the cephalocaudal
and proximodistal sequence which allows
progressively complex neuromotor function.
 The pathways concerned with sensation are
myelinated before the motor pathways. The
acquisition of motor skills depends on this
myelinization and maturation.
 Because the vertebral column（脊柱） and
the cord（脊髓） have different growth rates, the
cord in the newborn ends at the level of the third
and fourth lumbar vertebrae. As growth
continues, the cord becomes higher in relation to
the vertebrae until it ends at the level of the first
lumbar vertebrae in the adult.
 Sensor Changes
感觉发育
Development of vision 视觉
‡ Infants have a visual preference for looking at
the human face;
‡ 1mon Can follow in range of 90 degree
‡ 4-5 mon Looks at hand while sitting or lying
on back
‡ 6-7 mon Develop hand-eye coordination
‡ 11-12mon Can follow rapidly moving objects
 Sensor Changes
感觉发育

Development of Hearing 听觉
‡ 1mon Turns head to side when sound is make at
level of ear
‡ 4- 5 mon Locates sound by turning to side and then
looking up or down
‡ 6- 7 mon Responds to own name
‡ 11-12 mon Knows several words and their meaning
 Sensor Changes
感觉发育

Development of smell 味觉

The senses of smell and taste are well

developed at birth. Newborn babies can
response different to different taste such as
sweet, sore, and bitter.
 Sensor Changes
感觉发育

Development of Tactility 触觉
Newborn babies have well-developed sense of
tactility, particularly around the areas of eye, mouth,
hand, and foot.
 Sensor Changes
感觉发育

Development of Paining 痛觉
Younger infant are blunt to pain stimuli until 2
months.
 Sensor Changes
感觉发育

Development of Temperature 温度觉

Neonatal are sensitive to the change of
temperature, and they have obvious response to
cold stimuli.
 Motor Development
运动发育

A child's ability to perform motor functions

depends on the state of maturation of bones,
muscles, and the nervous system and follows the
patterns of development.
 Gross Motor Development
大运动

(a) Head Control. By 2 months of age infants can

hold their head well beyond the plane of the body.

(b) Rolling Over. The ability to willfully turn from

the abdomen to the back occurs at 4 months.
 Gross Motor Development
大运动
(c) Sitting. The convex lumbar curve appears
when the child begins to sit, at about age 6
months. As the spinal column straightens, the
infant can be propped in a sitting position.

(d) Locomotion. By 7 months of age they can

creep, and are able to bear all their weight on
their legs with assistance.
 Gross Motor Development
大运动

The motor development in one year is Months

2 lifts head, 4 rolling (from back to side), 6 sitting,
7 creeping (to bear all their weight), 8 Crawling,
one year walking
 Fine Motor Development
精细运动

Fine motor development includes the use of the

hands and fingers in the prehension of an object.
Grasping 一把抓
palmer grasp 尺侧抓
pincer grasp 指端抓
 Language Development
语言发育

Children are born with intact biologic structure of

the mechanism and capacity to develop speech

and language skills.

 Language Development
语言发育
Stages in Development of Language
‡ Paralinguistic stage（辅助语言）:
‡ Holophrastlc stage（单个词语）:
‡ Telegraphic stage（简略式）:
‡ Lengthy sentence （长句）:
‡ Refine language skills. （语言技巧）:
 Language Development
语言发育
The language kill under 7 years is:
‡ month 1 crying, 2 smiles, 4 make sound, 5
sound "yi", 6 "ya", 7 "baba" "mama",
‡ Years 1 understand words can say one
words,
‡ 2 talking, 4 singing, 7 reading and learn
writing