MODULE: CHILDREN’S HEALTH (MED 7710)

LECTURE:
GROWTH AND DEVELOPMENT I
 OBJECTIVES
• To differentiate growth from development
• Discuss the different aspects of development
in pediatrics (per age group) – Neonatal
Period, Infancy, Toddler, Preschool Period
• Integrate the developmental milestones of
pediatric patients
Growth
• Refers to an increase in physical size of the
whole body or any of its parts.

• It is simply a quantitative change in the child’s

body.
Child Growth (WHO)
Changes in bodily proportions with age
Development
• Refers to a progressive increase in skill and
capacity of function
• Qualitative change in the child’s functioning
• Occurs in an orderly and predictable manner
that is determined intrinsically.
 Growth vs Development
• Physical growth is an increase in size.
• Development is growth in function and
capability.
• Both processes highly depend on genetic,
nutritional, and environmental factors.
Development
• Proceeds from cephalic to caudal and
proximal to distal
• From generalized reactions to stimuli to
specific, goal-directed reactions that become
increasingly precise.
• Extrinsic forces can modulate the velocity and
quality of developmental progress.
Development proceeds from cephalic
to caudal and proximal to distal
• Arm movement comes under cortical direction
and visual guidance before leg movement.
– With this, the child progresses from hand-mouth
to foot-mouth play.
– The upper extremities become increasingly
accurate in reaching, grasping, transferring, and
manipulating.
– Distal development is seen when the infant can
isolate and use the index finger to poke and
explore object parts.
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.
Types of growth and development

Types of growth:
- Physical growth (Ht, Wt, head & chest circumference)
- Physiologic growth (vital signs …)

Types of development:
- Motor development
- Cognitive development
- Language development
- Emotional development
- Social/Behavioral development
 Stages of Growth and Development

• Infancy • Middle Childhood

– Neonate – School age
• Birth to 1 month
– 6 to 12 years
– Infancy
• 1 month to 1 year • Late Childhood
• Early Childhood – Adolescent
– Toddler – 13 years to approximately
• 1-3 years 18 years
– Preschool
• 3-6 years
Neonatal stage

Newborn stage is the first 4 weeks or

first month of life. It is a transitional
period from intrauterine life to extra
uterine environment.
 Normal Newborn Infant
Physical growth

- Weight = 2.700 – 4 kg
- Wt loss 5% -10% by 3-4 days after birth
- Wt gain by 10th day of life
- Gain ¾ kg by the end of the 1st month
Height/Length
• Boys average Lt = 50 cm
• Girls average Lt = 49 cm
• Normal range for both (47.5- 53.75 cm)

Head circumference
33-35 cm
Head is ¼ total body length
Skull has 2 fontanels (anterior & posterior)
Physiologic growth

Vital signs
- Temperature (36.5 to 37.5C)
- Pulse (120 to 160/min)
- Respiration (30 to 60/min)
Simulation for vital signs
Normal Newborn Infant
 Gross Motor Development

Motor development:
The newborn's movements are random,
diffuse and uncoordinated.
Reflexes carry out bodily functions and
responses to external stimuli.
Fine motor development

• Holds hand in fist

• When crying, he draws arms and legs to body

 NEONATAL PERIOD (1ST 4 WK)
• Prone: Lies in flexed attitude; turns head from
side to side; head sags on ventral suspension
• Supine: Generally flexed and a little stiff
• Visual: May fixate face on light in line of
vision; “doll’s-eye” movement of eyes on
turning of the body
• Reflex: Moro response active; stepping and
placing reflexes; grasp reflex active
• Social: Visual preference for human face
 Reflexes
• Swallowing

• Gagging

• Sucking

• Grasp

• Tonic-neck
One month-Reflexes
 Cognitive development

The cognitive development of

newborn infant is difficult to
understand or observe.
 Emotional development
The newborn infant expresses his
emotion just through cry for hunger,
pain or discomfort
Infancy
Infancy
It is the period which starts at the end
of the first month up to the end of
the first year of age.
Growth and development during this
period are rapid.
• Total brain volume doubles in the 1st yr of life
and increases by an additional 15% over the
2nd yr.
• Total brain volume at age 1 mo is
approximately 36% of adult volume but by age
1 yr is approximately 72% (83% by 2 yr)
• Myelination of the cortex begins at 7-8 mo
gestation and continues into adolescence and
young adulthood.
 2 to 6 MONTHS
• Between 3 and 4 mo of age, the rate of
growth slows to approximately 20 g/day.
• By age 4 months, birth weight is doubled.
• Increasing control of truncal flexion makes
intentional rolling possible.
 6 to 12 MONTHS
• Growth slows more
• By the 1st birthday, birth weight has tripled,
length has increased by 50%, and head
circumference has increased by 10 cm.
• The ability to sit unsupported (6-7 mo) and to
pivot while sitting (around 9-10 mo) provides
increasing opportunities to manipulate several
objects at a time and to experiment with
novel combinations of objects.
 6 to 12 MONTHS
• These explorations are aided by the
emergence of a thumb–finger grasp (8-9 mo)
and a neat pincer grasp by 12 mo.
• Motor achievements correlate with
increasing myelinization and cerebellar
growth.
 Physical growth of normal infant
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 weight by 4-5

months and triple it by 10-12 months of age
 Calculating infant’s ideal body weight

Infants from 3 to 12 months:

Weight = Age in months + 9

2
Dentition
Eruption of teeth starts by 5–6 months of
age. It is called "Milk teeth" or
"Deciduous teeth" or “temporary teeth".
 Gross motor development
• proceeds from a sequence of prone
milestones (beginning with head up and
ending with rolling), to sitting, and then
through a standing/ambulating sequence
 Fine Motor Development
• In the first year of life, fine motor
development is highlighted by the evolution
of a pincer grasp. In the early months, the
upper extremities assist with balance and
mobility.
• As balance in the sitting position improves and
the infant assumes biped mobility, the hands
become more available for manipulation of
objects—their ultimate function.
 AT 1 MONTH
• Prone: Legs more extended; holds chin up;
turns head; head lifted momentarily to plane
of body on ventral suspension
• Supine: Tonic neck posture predominates;
supple and relaxed; head lags when pulled to
sitting position
• Visual: Watches person; follows moving object
• Social: Body movements in cadence with voice
of other in social contact; beginning to smile
 AT 2 MONTHS
• Prone: Raises head slightly farther; head
sustained in plane of body on ventral
suspension
• Supine: Tonic neck posture predominates;
head lags when pulled to sitting position
• Visual: Follows moving object 180 degrees
• Social: Smiles on social contact; listens to
voice and coos
 Head Control

Newborn Age 6 months

 AT 4 MONTHS
• Prone: Lifts head and chest, with head
in approximately vertical axis; legs extended
• Supine: Symmetric posture predominates, hands in
midline; reaches and grasps objects and brings them to
mouth
• Sitting: No head lag when pulled to sitting position; head
steady, tipped forward; enjoys sitting with full truncal
support
• Standing: When held erect, pushes with feet
• Adaptive: Sees raisin, but makes no move to reach for it
• Social: Laughs out loud; may show displeasure if social
contact is broken; excited at sight of food
 At 5 months, the infant can:

• Balance head well when sitting.

• Sit with slight support.
• Pull feet up to mouth when supine.
• Grasp objects with whole hand (Rt. or Lt.).
• Hold one object while looking at another
 At 6 months, the infant can:
• Sit alone briefly.
• Turn completely over (abdomen to abdomen).
• Lift chest and upper abdomen when prone.
• Hold own bottle.
 AT 7 MONTHS
• Prone: Rolls over; pivots; crawls or creep-crawls (Knobloch)
• Supine: Lifts head; rolls over; squirms
• Sitting: Sits briefly, with support of pelvis; leans forward on
hands; back rounded
• Standing: May support most of weight; bounces actively
• Adaptive: Reaches out for and grasps large object; transfers
objects from hand to hand; grasp uses radial palm; rakes at
raisin
• Language: Forms polysyllabic vowel sounds
• Social: Prefers mother; babbles; enjoys mirror; responds to
changes in emotional content of social contact
 At 8 months, the infant can:
• Sit alone steadily.
• Drink from cup with assistance.
• Eat finger food that can be held in one hand.
 At 9 months, the infant can:
• Rise to sitting position alone.
• Crawl (i.e., pull body while in prone position).
• Hold one bottle with good hand-mouth
coordination
 AT 10 MONTHS
• Sitting: Sits up alone and indefinitely without support, with
back straight
• Standing: Pulls to standing position; “cruises” or walks
holding on to furniture
• Motor: Creeps or crawls
• Adaptive: Grasps objects with thumb and forefinger; pokes
at things with forefinger; picks up pellet with assisted
pincer movement;
• uncovers hidden toy; attempts to retrieve dropped object;
releases object grasped by other person
• Language: Repetitive consonant sounds (“mama,” “dada”)
• Social: Responds to sound of name; plays peek-a-boo or
pat-a-cake; waves bye-bye
 AT 1 YR
• Motor: Walks with one hand held; rises
independently, takes several steps (Knobloch)
• Adaptive: Picks up raisin with unassisted pincer
movement of forefinger and thumb; releases
object to other person on request or gesture
• Language: Says a few words besides “mama,”
“dada”
• Social: Plays simple ball game; makes postural
adjustment to dressing
 Emotional Development
• His emotions are instable, where it rapidly
changes from crying to laughter.
• His affection for or love family members
appears.
• By 10 months, he expresses several beginning
recognizable emotions, such as anger, sadness,
pleasure, jealousy, anxiety and affection.
• By 12 months of age, these emotions are clearly
distinguishable.
 Social development
• He learns that crying brings attention.
• The infant smiles in response to smile of
others.
• The infant shows fear of stranger (stranger
anxiety).
• He responds socially to his name.
 Language 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
TODDLER
Toddler
Toddlers
 Toddler Stage

• Between 1 to 3 years of age.

• During this period, growth slows
considerably.
 12 to 18 MONTHS
• The toddler continues to experience considerable
brain growth and myelination in the 2nd yr,
resulting in an increase in head circumference of
2 cm over the year
• Toddlers have relatively short legs and long
torsos, with exaggerated lumbar lordosis and
protruding abdomens.
• Growth in length continues at a steady rate
• Most children begin to walk independently at
around 12-15 mo of age.
 18 to 24 MONTHS
• Motor development during this period is
reflected in improvements in balance and agility
and the emergence of running and stair climbing.
• Height and weight increase at a steady rate
during this year, with a gain of 5 in and 5 lb.
• By 24 mo, children are about half of their
ultimate adult height.
• Head growth slows slightly.
• 85% of adult head circumference is achieved by
age 2 yr, with just an additional 5 cm gain over
the next few years
 Physical growth
Weight:
The toddler's average weight gain is 1.8 to 2.7
kg/year.
Formula to calculate normal weight of children
over 1 year of age:
(Age in years x 2) + 8 = ….. kg
Height:
During 1–2 years, the child's height increases
by 1cm/month.

The toddler's height increases about 10 to

12.5cm/year.
 Formula to calculate normal height

(Age in years x 5) + 80 = ____ cm.

e.g., the length of a 2 year old child

= (2 x 5) + 80 = 90cm
 Fine Motor Development
• During the second year of life, the infant
learns to use objects as tools during functional
play.
• Fine motor skills are assessed by observing the
manner in which the hands use objects as
tools (eg, blocks to build and crayons to draw).
 15 MONTHS
• Motor: Walks alone; crawls up stairs
• Adaptive: Makes tower of 3 cubes; makes a
line with crayon; inserts raisin in bottle
• Language: Jargon; follows simple commands;
may name a familiar object (e.g., ball);
responds to his/her name
• Social: Indicates some desires or needs by
pointing; hugs parents
 18 MONTHS
• Motor: Runs stiffly; sits on small chair; walks up
stairs with 1 hand held; explores drawers and
wastebaskets
• Adaptive: Makes tower of 4 cubes; imitates
scribbling; imitates vertical stroke; dumps raisin
from bottle
• Language: 10 words (average); names pictures;
identifies 1 or more parts of body
• Social: Feeds self; seeks help when in trouble;
may complain when wet or soiled; kisses parent
with pucker
 24 MONTHS
• Motor: Runs well, walks up and down stairs, 1
step at a time; opens doors; climbs on furniture;
jumps
• Adaptive: Makes tower of 7 cubes (6 at 21 mo);
scribbles in circular pattern; imitates horizontal
stroke; folds paper once imitatively
• Language: Puts 3 words together (subject, verb,
object)
• Social: Handles spoon well; often tells about
immediate experiences; helps to undress; listens
to stories when shown pictures
 30 MONTHS
• Motor: Goes up stairs alternating feet
• Adaptive: Makes tower of 9 cubes; makes
vertical and horizontal strokes, but generally
will not join them to make cross; imitates
circular stroke, forming closed figure
• Language: Refers to self by pronoun “I”;
knows full name
• Social: Helps put things away; pretends in play
 36 MONTHS
• Motor: Rides tricycle; stands momentarily on 1
foot
• Adaptive: Makes tower of 10 cubes; imitates
construction of “bridge” of 3 cubes; copies circle;
imitates cross
• Language: Knows age and sex; counts 3 objects
correctly; repeats 3 numbers or a sentence of 6
syllables; most of speech intelligible to strangers
• Social: Plays simple games (in “parallel” with
other children); helps in dressing (unbuttons
clothing and puts on shoes); washes hands
 Issues in parenting – toddler (Emotional
Development)
• Stranger anxiety – should dissipate 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
 Cognitive development

• Up to 2 years, the toddler uses his senses

and motor development to different self
from objects.
• The toddler from 2 to 3 years will be in the pre-
conceptual phase of cognitive development (2-4
years), where he is still egocentric and can not take
the point of view of other people.
 Social development
• The toddler is very social being but still
egocentric.
• He imitates parents.
• Notices sex differences and knows own sex.
• According to Erikson,
• The development of autonomy during this period
is centered around toddlers increasing abilities to
control their bodies, themselves and their
environment i.e., "I can do it myself".
Pre-School
 Preschool stage

Child is 3 to 6 years of age.

Growth during this period is
relatively slow.
 Physical Development
• Somatic and brain growth slows by the end of
the 2nd yr of life, with corresponding
decreases in nutritional requirements and
appetite, and the emergence of “picky” eating
habits.
• Increases of approximately 2 kg (4-5 lb) in
weight and 7-8 cm (2-3 in) in height per year
 Physical Development
• Birthweight quadruples by 2.5 yr of age.
• An average 4 yr old weighs 40 lb and is 40
inches tall. The head will grow only an
additional 5-6 cm between ages 3 and 18 yr.
Physical growth:

Weight: The preschooler gains

approximately 1.8kg/year.

Height: He doubles birth length by

4–5 years of age.
 48 MONTHS
• Motor: Hops on 1 foot; throws ball overhand;
uses scissors to cut out pictures; climbs well
• Adaptive: Copies bridge from model; imitates
construction of “gate” of 5 cubes; copies cross
and square; draws man with 2-4 parts besides
head; identifies longer of 2 lines
• Language: Counts 4 pennies accurately; tells story
• Social: Plays with several children, with beginning
of social interaction and role-playing; goes to
toilet alone
 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
 Fine motor and cognitive abilities
pre-school

• Buttoning clothing
• Holding a pencil
• Building with small blocks
• Using scissors
• Playing a board game
• Have child draw picture of himself
 60 MONTHS
• Motor: Skips
• Adaptive: Draws triangle from copy; names
heavier of 2 weights
• Language: Names 4 colors; repeats sentence
of 10 syllables; counts 10 pennies correctly
• Social: Dresses and undresses; asks questions
about meaning of words; engages in domestic
role-playing
Cognitive development

Preschooler up to 4 years of age is in the pre-

conceptual phase. He begins to be able to
give reasons for his belief and actions, but not
true cause-effect relationship.
Emotional Development of Preschooler

• Fears the dark

• Tends to be impatient and selfish
• Expresses aggression through physical and
verbal behaviors.
• Shows signs of jealousy of siblings.
 Social development in preschoolers
• Egocentric
• Tolerates short separation
• Less dependant on parents
• May have dreams & nightmares
• Attachment to opposite sex parent
• More cooperative in play
 Social development
According to Erikson theory:
• The preschooler is in the stage where he
develops a sense of initiative, Where he
wants to learn what to do for himself, learn
about the world And other people.
 REFERENCES
• Kliegman, Robert et al., Nelson Textbook of
Pediatrics 20th edition, 2015.
• Brown, Lloyd et al., Board Review Series (BRS)
Pediatrics 2nd edition, 2018.
 SUPPLEMENTAL READINGS
• Introduction to Growth and Development
https://www.msdmanuals.com/professional/pe
diatrics/growth-and-
development/introduction-to-growth-and-
development?query=growth%20and%20devel
opment
 INSTRUCTIONAL VIDEO
• Pediatrics - Growth and Development
Milestones Review
https://www.youtube.com/watch?v=ZG60nC3RJ
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