ASSESSMENT OF GROWTH AND DEVELOPMENT OF

PEDIATRIC CLIENTS FACTORS EFFECTING GROWTH

AND DEVELOPMENT

INTRODUCTION:

Human life starts from a single fertilized cell. This cell is under
constant interaction with the environment in the mother’s womb
and after birth with the outside world. This interaction leads to the
Growth and Development of the child. The increasing of an organ
or limb of the baby, in size and weight is Growth. Division of each
cell and their growing into thousands in number, or their changing
tissues, blood or bone, is part of the process of Development.

The primary purpose of studying the growth and development of

children is to understand them better. As a nurse, we can manage
children more effectively if we are aware of how they grow and
develop in a systematic manner right from the moment of
conception. An orderly pattern is found in the growth of every
organ of the body and area of development.

Although the development process is continuous, the rate or speed

of development varies at different ages of the child. For example,
children grow most rapidly during the first three years of life. In
their middle childhood, i.e., from 6 - 12 years, their rate of growth
is comparatively slow whereas it is accelerated again when they
approach adolescence. A knowledge of the trends and patterns of
growth and development will enable you to know how children
grow and develop; when and what to expect from them, how to
guide them in each stage and provide the environment for their
optimum-development.

Meaning of growth and development

‘Growth’ and ‘Development’ are often used as synonymous terms.

But, in fact, growth is different from development. Growth means
an increase in size, height, weight, length etc. which can be
measured. Development, on the other hand, implies change in
shape, form or structure resulting in improved working or in
functioning. Improved functioning implies certain qualitative
changes leading to maturity. Growth and Development are the
important characteristics of a living organism. Development
involves a series of progressive, orderly and meaningful changes
leading to the goals of maturity. Normally Growth contributes to
Development. In reality though ‘Growth and Development’ are
different, but they are inseparable. Generally process of Growth
and Development goes on simultaneously.

Importance of leaning growth and development

 To learn what to expect from a particular child at a particular

age
 To assess the normal Growth and development of children
 To detect deviations from normal growth and development
and understand the reasons for particular conditions.
 To ascertain the needs of the child according to the growth
and development.
 To teach and guide the parents and care giver to anticipate
the problems and to render tender loving care to the children.
Definition of Growth and development:

Growth: It refers to an increase in physical size of the whole or

any of its parts and can be measured in inches or centimeters and in
pounds or kilograms. By. Dorothy R.Marlow.

Development: It refers to a progressive increase in skill and

capacity to function .It causes qualitative changes in the child’s
functioning. By. Dorothy R.Marlow.

According to Hurlock . Growth is change in size, in proportion,

disappearance of old features and acquisition of new ones

According to Crow and Crow (1962) • Growth refers to

structural and physiological changes

According to Hurlock(1959) • Development means a progressive

series of changes that occur in an orderly predictable pattern as a
result of maturation and experience.

According to J.E. Anderson(1950) • Development is concerned

with growth as well as those changes in behavior which results
from environmental situations.

According to Liebert, Poulos and Marmor (1979) •

Development refers to a process of change in growth and
capability over time, as function of both maturation and interaction
with the environment Developmental age periods

Neonate Birth to 1 month

Infancy 1 month to 1 year

 Toddler 1-3 years

Preschool 3-6 years

School age 6 to 12 years

Adolescent 13 years to approximately 18 years from puberty

to adulthood

Prepubescent 10-12 years in girls

12- 14 years in boys

Pubescent 12-14 years in girls

14- 16 years in boys

Post pubescent 14-18 years in girls

16-20 in boys

Assessment of Growth:

Assessment of physical growth can be done by anthropometric

measurement and the study of velocity of physical growth
Measurement of different growth parameters is the importance
nursing responsibility in child care.

A weighing sling (spring balance), also called the ‘Salter Scale’ is

used for measuring the weight of children under two years old, to
the nearest 0.1 kg. In children over two years a beam balance is
used and the measurement is also to the nearest 0.1 kg. In both
cases a digital electronic scale can be used. Re-adjust the scale to
zero before each weighing we also need to check whether our scale
is measuring correctly by weighing an object of known weight.
 If the child is above 2years make the child to stand on the weighing
scale and note the readings. If the child is not co-operative ask the
mother to stand along with the baby on the weighing scale and again
check the weight of the mother without child now subtract the second
weight from first we will get baby weight.

Growth Velocity:
Weechs formula weight (kg)
Infant 0-1 year Age in months + 9
2
1 – 6 years Age in years *2+8
7 – 12 years Age in years (7-5)
2
0-4 months 1.0kg/month(30g/day)
5-8 months 0.75kg/month(20gm/day)
9-12 months 0.50kg/month(15g/day)
1-3 years 2.25kg/yr
4-9 years 2.75 kg/yr
10-18 years 5.0-6.0kg/yr
(0.5kg/month)
Length:

A wooden measuring board (also called sliding board) is used for measuring
the length of children under two years old to the nearest millimeter.
Measuring the child lying down always gives readings greater than the
child’s actual height by 1-2 cm.

2. Height:
This is measured with the child or adult in a standing position (usually
children who are two years old or more). The head should be in
the Frankfurt position (a position where the line passing from the
 external ear hole to the lower eye lid is parallel to the floor) during
measurement, and the shoulders, buttocks and the heels should touch
the vertical stand. Either a stadiometer or a portable anthrop meter can
be used for measuring. Measurements are recorded to the nearest
millimeter.

Height Velocity: Height (cm) Weech’s

2 -12 years - Age in years*6+77
At birth 50cms
Gain during 1st year 25cms
Gain during 2nd year 12.5cms
Gain during 3rd year 7.5 to 10cms
Gain during 3 – 12 years 5 to 7.5cms
Adolescence 8cms/yr for girls during 12 to 16 years and 10cms/yr for boys
during 14 to 18 years

Head circumference:

Head circumference (cm) (Dine’s) Infant ( Length +9.5) +2.5

The head circumference (HC) is the measurement of the head along

the supra orbital ridge (forehead) anteriorly and occipital prominence (the
prominent area on the back part of the head) posteriorly. It is measured to
the nearest millimeter using flexible, non-stretchable measuring tape around
0.6cm wide. HC is useful in assessing chronic nutritional problems in
children under two years old as the brain grows faster during the first two
years of life. But after two years the growth of the brain is more sluggish
and HC is not useful.

Expected head circumference in children Age Head circumference (cm)

 At birth 34 – 35

2 months 38

3 months 40

4 months 41

6 months 42 - 43

1 year 45 - 46

2 years 47 - 48

5 years 50 - 51

Mid Upper Arm Circumference (MUAC):

It is conventionally measured over the left upper arm , at a point marked

midway between acromion (shoulder) and olecranon (elbow) with arm bent
at right angle The mid-arm point is determined by measuring the distance
from the shoulder tip to the elbow and dividing it by two.

During 1-5 Yrs of age it remains reasonably static between 15-17cms

among healthy children

• If it is less than 12.5 cm it is suggestive of severe malnutrition.

• If it is between 12.5 -13.5 cm it is indicative of moderate malnutrition

Skin fold thickness:

Measured with Herpenden’s caliper in the Triceps or sub scapular region

• The skin fold with subcutaneous fat is picked up with thumb and
index finger, and caliper is applied beyond the pinch.
• Fat thickness >10mm - healthy children 1-6 years <6mm - is
indicative of moderate to severe degree of malnutrition

Abdominal Circumference:

Keep the child in recumbent position. Place the tape measure at the
level of umbilicus at right angles to the vertebral column. Check the
measurements as indicated. Abdomen of children upto 3 years of age
who have chronic intestinal problems are measured

Upper body and lower body Proportions:

The upper-to-lower body segment ratio is to measure the upper body

segment (sitting height). The sitting height is subtracted from the
patient's standing height to obtain the lower body segment value. Body
proportions vary during childhood. The average upper-to-lower body
segment ratio is 1.7 at birth and decreases to 1.0 at 10 years of age with
leg growth. It is an important criteria which helps to assess the normal
growth or its deviations i.e. malnutrition or obesity.

BODY MASS INDEX:

The Broca Index is an estimation of ideal body weight using a height
measurement only. The Broca Index was developed by Paul Broca, a
French surgeon who lived between 1824 and 1880. The Broca index
is only a rough estimate and applies to the range of middle body sizes
best

BI uses just a single measurement of height in cm. To get the

recommended standard weight, you take away 100 from the height in
cm. For example, a man 182 cm tall will have a standard weight of 82
kg. For females, the standard weight is 10% less. For example, a
woman 182 cm tall will have a standard weight of 73.8 kg (0.9 x 82).
 Standard Weight (kg) = Ht (cm) – 100

or

BMI = Weight in Kg / (Height in meter) 2

BMI remains content up to the age of 5 years.

If the BMI is more than 30 kg/m2, it indicates obesity and if it is less then
15Kg/m2 , it indicates malnutrition.

BMI Categories:- –Underweight = <18.5 –Normal weight = 18.5–24.9 –

Overweight = 25–29.9 –Obesity = BMI of 30 or greater 30

Fontanels Closure

At birth, anterior and posterior fontanels are usually present.

Posterior fontanels close early few weeks (6-8week) of age.

The anterior fontanels normally close by 12- 18 months of age.

Early closure of fontanels indicates craniostenosis due to premature closure

of skull sutures.

Late clouser of fontanels Downs syndrome

Bossing of forehead Fragile X syndrome

Microcephaly Trisomy 18 trisomy 13

Eruption of teeth:

There is a variation for the time of eruption of teeth. First teeth commonly
the lower central incision may appear in 6 to 7 months of age
It can be delayed even up to 15 months, which also can be considered within
the normal range of time for teething.

So dentition is not dependable parameters for assessment of growth.

There are ‘two sets of teeth, temporary teeth bigger in size for two sets of
teeth.

Total number of teeth Temporary teething 6 – 12 months Incisors(central

and lateral) 2-8

12 – 15 months First moral 8- 12

15 – 24 months Canines( cuspids) 12 – 16

24 – 30 months Secondary moral 16 - 20

Permanent teething 6 -7 years

First permanent molars 24 7 -10 years

Replacement of temporary 10 -12 years

Replacement of temporary molar by premolars 12 – 15 years

Secondary permanent molars 28 16 years.

Arm span:

The arm span is the distance between the tips of the left and right middle
fingers when a child is standing against a flat wall with arms outstretched as
far as possible, creating a 90 degree angle with the torso. In girls and boys,
the arm span is shorter than height before puberty and greater than height
after midpuberty. Arm span exceeds height by 5.3 cm (2.1 in) in the average
adult man and by 1.2 cm (0.5 in) in the average adult woman.4 Scoliosis and
related conditions can lead to shortened vertebral growth and an arm span
disproportionate to height.

ASSESSMENT OF DEVELOPMENT

Compare the achievements for normal children with developmental history

and physical examination findings.Children are observed for their activities.

There areas of development are

 Physical

 Psychosexual

 Cognitive

 Temperament

 Psyco Social

 Emotional

 Moral

Data collection

Assessment of development can be done by comparing the achievement

listed for normal children with the history and physical findings of the child.

If any impairment, disability or handicaps, which are disorders of

development, exist, they should be noted in the history.

For preterm babies, the corrected age must be taken into account.
Parents also can be made to assist the nurse while doing the assessment

They can observe the child daily and give relevant information to the nurse
as needed.

Behavior made by the child should be recorded accurately and specifically.

After the baseline data is collected, compare it with subsequent

examinations.

Assessment tools:

Standardized tools are used for screening developmental changes in a

systematic way. Several assessment tools are used.

Gesell Development Schedule: This scale by Gesell provides an estimate in

four major areas of development, such as motor, adaptive, language and
personal social. During the first year, development is assessed every week,
then every two weeks till two years and every six months till five years of
age. Scale gives development quotient (DQ) for each area separately and it
also gives overall DQ. DQ = Maturity age X 100 Chronological age Child
with DQ between 65 and 75 is at risk for development delay. It can be
applied for handicapped children satisfactorily

Denver Developmental Screening Test (DDST) (Age Range 2 Weeks To 6

Years) It was originally developed by Frankenburg and Dodds, which is
revised recently. It is simple, economic and useful test for screening
developmental delay during infancy and preschool period. It is a screening
tool. It is not an intelligence test. Assessment is done in four areas. Social,
fine motor, language and gross motor skills. While using the test, make each
child comfortable. Explain the tasks at the child’s level of understanding.
Make sure the child listens and pays attention to each task. After scoring the
test, interpret the results .

The Brazelton Neonatal Behavioral Assessment Scale :It was developed

by T Berry Brazelton for assessing newborn behavior during the first month
of age. It records individual differences in the baby. This tool can be used
for normal as well as high – risk neonates such as premature babies.

The Bayley scale of infant development It is used to evaluate children

between 6 and 30 months of age. Three general areas such as mental,
psychomotor and behavioral development are evaluated.

Trivandrum development screening chart (TDSC) This test is developed

at Trivandrum (Child Development Centre, Medical College Hospital). It is
a simplified version of Bayley scale of infant development. Since the norms
for TDSC are taken from Bayley scale, which is a universally accepted
developmental scale for children up to 30 months of age, it can be used in
other states also.

The Denver Articulation Screening Examination (DASE) Language and

speech development can be assessed by evaluating child’s verbal ability by
direct observation and by testing. DASE is a tool to test the child’s ability to
imitate vocal sounds. This test is easy to administer as the child is only
asked to repeat 30 sound elements.

Developmental Assessment Scale for Indian Infants(DASII) This tool is

also based on Bayley scale of infant development. Age range is till 2.5
years. DASII consists of two scales – mental scale and motor scale
DEVELOPMENTAL MILESTONES:-

 Social Smile - 6 to 8
weeks
 Head holding - 3 months
 Sitting with support - 5 to 6
months
 Sitting without support - 7 to 8
months
 Reaches out to an object and hold it - 5 to 6
months
 Transfer object from one hand to another - 6 to 7
months
 Holding small object between index finger and thumb - 9 months
 Creeping - 10 to 11
months
 Standing with support - 9 months
 Standing without support - 10 to 12
months
 Feeding self with spoon - 12 to 15
months
 Running - 18 months
 Climbing upstairs - 20 to 24
months
 Says bysyllables words (da-da, ba-ba) - 8 to 9
months
 Says two words with meaning - 12 months
 Says ten words with meaning - 18 months
  Says simple sentence - 24 months
 Tells story - 36 months
 Takes shoe and socks off - 15 to 18
months
 Puts shoes and socks on - 24 months
 Dresses own self fully - 3 to 4 years
 Controls bladder and bowel at day time - 2 years

GROSS MOTOR MILESTONES:-

4 MONTHS: Stable head control, rolls over body weight supported

on forearms in prone positions

6 MONTHS: Sits with support and round back

8 MONTHS: Sits without support and straight back

10 MONTHS: Climbs and stands with support

12 MONTHS: Stands without support

15 MONTHS: Walks without support and creeps upstairs

18 MONTHS: Runs, throws a ball while standing, searches drawers

2 YEARS: Jumps, walks up and downstairs with two feet on one step

3 YEARS: Rides tricycle, goes upstair with one step on each step.

4 YEARS: Hop and skip on one foot, comes downstairs with one step
on each stair
 5 YEARS: Skips on both feet, can jump over low obstacles

FINE MOTOR MILESTONES:-

3 MONTHS: Hands mostly open, holds a rattle when placed in hand

4 MONTHS: Reaches for objects with both (bi-dexterous)

6 MONTHS: Approaches objects with one hand, transfers rattle from

one hand to the other hand

9 MONTHS: Immature or crude finger thumb pincer grasp

1 YEAR: Fine finger-thumb pincer grasp, mouthing is reduced

15 MONTHS: Self feeds with a cup, imitates scribbling, build tower

of 2 -3 cubes

18 MONTHS: Self feeds with a spoon, makes a tower of 3 - 4 cubes,

turns 2 – 3 pages of a book at a time

2 YEARS: Can make a tower of 6 – 7 blocks, can turn one page at a

time, can imitate vertical and circular strokes

3 YEARS: Can make a tower of 9 – 10 blocks, can dress and undress,

can draw a circle

4 YEARS: Can make a bridge with blocks, can copy a square and
cross, can button and unbutton.

5 YEARS: Can copy a triangle, can tie shoe lace

SOCIAL AND ADAPTIVE MILESTONES:-

2 MONTHS: Social and interactive smile

3 MONTHS: Hand regard, recognizes mother, anticipates feeds

excited to see a toy.

6 MONTHS: Stranger anxiety, pats mirror image, enjoys to play

peek-a-boo and pat-a-cake games

9 MONTHS: Waves bye bye, repeats performance when appreciated.

12 MONTHS: Responds to name, imitates actions, shakes head for

“No”

15 MONTHS: Jargon speech

18 MONTHS: Imitates house hold tasks

2 YEARS: Asks for food and drink and tells need for toilet

3 YEARS: Knows name, age and gender, shares toys

4 YEARS: Toilet trained, plays cooperatively in a group

5 YEARS: Dresses and undresses, helps in household tasks

LANGUAGE MILESTONES:-

1 MONTHS: Quietness or alerts to sound

3 MONTHS: Babbles and coos when spoke to

 4 MONTHS: Laughs loud, turns towards the sound

6 MONTHS: Speaks monosyllables like ba, da, pa, ma, and ah-goo
sounds

9 MONTHS: Utters dissyllables like mama, papa, dada

12 MONTHS: Speaks 2 – 3 words with meaning

18 MONTHS: Jargon speech with 7 – 10 words vocabulary

2 YEARS: Can make 2 – 3 word sentences and has vocabulary of 50

words can repeat what is said, use pronouns ‘I” , “me” , “you”

3 YEARS: Can make 3 word sentences and has vocabulary of 250

words, normal speech, asks questions

4 YEARS: Can tell a story, recite a poem or sing a song, inquisitive

5 YEARS: Chatter box and asks meaning of words

RED ALERTS:-

 Lack of social smile by 2 months

 Absence of stable head control by 4 months
 Inability to recognize mother by 6 months
 Inability to sit when pulled to sit by 6 months and lack of independent
sitting without support by 8 months
 Lack of creeping by 9 months
 Inability to stand without support by one year
 Inability to walk without support by 18 months
 Lack of pincer grasp by the age of one year
  Inability to play interactive games (peek-a-boo, pat-a-cake) by the age
of one year
 Absence of syllabic babbling by the age of one year and failure to
make meaningful sentences by 3 years of age

Factor influencing Growth and Development

Growth and development depend upon multiple factors or

determinates They influence directly or indirectly by promoting or
hindering the process

1.Genetic factors:

Genetic predisposition is the importance factors which influence

the growth and development of children Heredity is the
transmission of physical characters from parents to children
through their genes. It influences all aspects of physical appearance
such as height, weight, body structure, the colour of the eye, the
texture of the hair and even intelligence and aptitudes. Diseases are
also passed through the genes such as heart disease,
diabetes, obesity etc and these genetic factors can adversely affect
the growth of a child. However, environmental factors and
nurturing can bring the best out of the already present qualities in
the genes.

2. Environment

Environment plays a critical role in the development of children and it

represents the sum total of physical and psychological stimulations the child
receives. Some of the environmental factors influencing early childhood
development involve the physical surroundings, geographical conditions,
social environment and relationships with family and peers. It is observable
that a well-nurtured child does better than a deprived one and the
environment they are constantly immersed in contributes to this. A good
school and loving family builds in them strong social and interpersonal
skills while excelling in other areas such as academics and extracurricular
activities. It is different for children who are raised in stressful environments
such as poverty and broken families.

Prenatal factors:

Intrauterine environment is an important predominant factor of growth and

development. Various conditions influence the fetal growth in
uterus.

Maternal malnutrition: e.g: High risk of maternal mortality

Intra Uterine growth Retardation

Maternal infections e.g: Cytomegalovirus leads to Birth

defects,developmental disorders and low birth wight.

HIV- low birth weight,child hood cancer

HPV– Miscarriage

Rubella –Birth defects

Maternal substance abuse : Damages the CNS ,physical birth
defects,microcephaly,miscarriages mental retardation,IUGR and
Heart defects.

Maternal illness : Hypertension,D.M – IUGR,lowbirth weight

Postnatal factors:

• Nutrition : The nutritents mother is expected to eat during

postnatal period is culturally determined.

The nutritional needs of the child depend on the age ,gender,rate of

growth and level of activity. The effect of in adequate nutrition is
espically apperent when there is faulty absorption and assimilation
of food.

• Childhood illness: Long term effect of lower respiratory tract

infections in early child hood, ischemic heart diseases.

• Physical environment: It influences child development

behavioral toxology noise, crowding, housing, neighbourhood,
schooling,day care setting.

• Psychological environment : Maternal psychological distress is

one of the most common prenatal complications effecting up to
25% of pregnant and post partum women

• Cultural influence: There's a vast array of cultural differences in

children's beliefs and behaviour. language is one of the many ways
through which culture affects development this early
exposure affects the way children attend to themselves or to their
relationship with others – forming their self image and identity .
Socio economic status : Specifically, children at the lower end of
the SES spectrum tend to receive significantly less high-quantity
and high-quality language experience, which affects
their development of vocabulary, grammar,
and language processing

• Climate and season: The changes in temperature, precipitation,

sea level, and weather patterns the Earth is now
experiencing could have unique effects on the health of children

• Play and exercise: play is an essential activity of early childhood

as it contributes to the cognitive, social, and emotional
development of children. 'parents directly affect the behaviour of
their young children when they engage the children in play. ..

• Birth order of the child: Birth order has a powerful impact upon
children's emotions, behavior and personality development.

• Intelligence: Intelligence quotient is determined by a number of

factors which includeboth genetic as well as non genetic factors.
Even though genetic factors play themajor role in determining IQ,

• Hormonal influence: Thyroid Stimulating Hormone (TSH) –

causes the thyroid gland to produce thyroidhormone, which
regulates body metabolism and is essential for normal growth.
Adrenocorticotropic Hormone (ACTH) – causes the adrenal glands
to produce cortisol (stress hormone) and other hormones that
enable the body to respond to stress.

. • Sex: Sex is a very important factor

which influences human growth and development. There is lot of
difference in growth and development between girls and boys.
Physical growth of girls in teens is faster than boys.

• Race and Nationality : Race and ethnicity can also impact

attitudes. Many people feel a strong sense of pride based on
their ethnicity, and this is an important part of their attitudinal
approach to the world and to other people. ... Culture, race, and
ethnicity can influence the attitudes of people in many ways.
Objectives

General Objectives: By the end of the presentation the group will

be able to gain in depth knowledge and skills regarding Growth
and development assessment.

Specific Objectives:

Define the terms growth and development

Discuss the anthropometric measurements to assess the growth

Enlist developmental screening and assessment tools used

List the factors influencing growth and development

Summary: Generally process of Growth and Development goes on
simultaneously. . But, in fact, growth is different from
development. Growth means an increase in size, height, weight,
length etc. which can be measured. Development, on the other
hand, implies change in shape, form or structure resulting in
improved working or in functioning. Improved functioning implies
certain qualitative changes leading to maturity. We have seen
what to expect from a particular child at a particular age. And how
to assess the normal Growth and development of children
identifying deviations from normal growth and development and
understand the reasons for particular conditions.

Conclusion: Growth and development process is continuous, the

rate or speed of development varies at different ages of the child as
a nurse we should ascertain the needs of the child according to the
growth and development teach and guide the parents and care giver
to anticipate the problems and to render tender loving care to the
children.
Name of the student : S. Krupa Jyothirmai.

Subject : Child Health Nursing

Topic : Nutritional Assessment

No. of Students : 4

Place : Child Health Lab

Date : 26..03.2109.

Time :

Duration : 1hour 30minutes

Method of Teaching : Lecture cum Discussion

Supervised by : Mrs. G. Kamala Madam

Assistant Professor
Govt College of Nursing
Mrs.CH.Roja Rani Madam
Lecturer
Govt College of Nursing.
Bibliography:

1. Marlow ,Textbook of child health nursing.3rd edition, published by

jaypee brothers medical publications.

2. Achara, textbook of child health nursing 5thedition published by

orientlongman publications

3. Padmaja textbook of child health nursing published by jaypee

brothers medical publications.

4. Myles Text book for Midwives International edition Harcourt

publishers limited.

Journals:

Journal of Pediatric Health Care and Medicine

by JP Wong - 2017

https://www.pulsus.com/journal-pediatric-health-care-medicine.html
Research Article

The Development and Growth of Children Aged under 5 years in

Northeastern Thailand: a Cross-Sectional Study

Rukmanee Butchon and Tippawan Liabsuetrakul

A cross-sectional survey was conducted in the Northeast of Thailand during

April-September 2014. Seventy Thai mothers aged less than 34 years who
were admitted to the postpartum ward of a regional hospital and their first
child were included. Developmental delay among their first children was
assessed

Among the 70 children, 22.9% were suspected to have delayed development

with delays in language (14.3%), gross motor (10.0%), personal-social
(5.7%) and fine motor (2.9%) skills being the most common domains
detected. A higher prevalence of language delay was found in boys (21.4%)
compared to girls (9.5%) but the difference was not statistically significant.
Children aged 36-62 months showed a higher delayed development,
especially in the gross motor domain. The prevalence of underweight and
stunting were common among children aged 12-35 months (6.2% and
15.6%, respectively) and wasting was higher among those aged 36-62
months (5.3%). Hyperactivity and showing anger when displeased were
common.

A high prevalence of suspected delay was found among children aged 36-62
months. Suboptimal growth was common among those 12-35 months. Early
identification of developmental delay and early interventions may have a
substantial impact on financial, educational, and social costs in the future.