Growth and

Development
Group lll
 Group Members:
❖ Laishram Bikash
❖ Windy Arna Duguiang
❖ Juwish Joyce Ibasan
❖ Jc Dane Laking
❖ Vishal Ladumor
❖ Gopi Krish Marapaka
❖ Vijay Mor
CONTENT OUTLINE
❏ Anthropometric Measurements

l. Overview

ll. Interpretation

❏ Development

l. Introduction

ll. Developmental Milestones

ANTHROPOMETRIC MEASUREMENTS

● Anthropometric measurements are noninvasive quantitative

measurements of the body. It provides a valuable assessment of the
general health status, nutritional adequacy in both children and adults.

● The ideal method to determine if a neonate or child's anthropometric

measurements are within normal values is to use standardized charts
(e.g., WHO or CDC growth charts).
l. AVERAGE BIRTH MEASUREMENTS
Parameter At Birth Expected Values by the 1st Birthday

Weight 3000g 3x the birth weight 9-10 kg

Length 50cm 50% increase from 75cm

birth length

Head Circumference 35cm (32-37cm) Increase by 10 cm 45 cm

ll. WEIGHT
A. Expected Changes in Weight During the First Year of Life

● There is a 10% physiologic weight loss for normal full-term infant in the first week
of life
● Birth weight is regained or exceeded at the 2nd week of life.
● An average of 30 g (1 oz)/day is gained during the 1st month of life
● In the 3rd-4th month, weight gain is approximately 20 g/day.
● Birth weight is doubled at 4 months and tripled at 1 year
B. Formulas to Estimate Weight

Age Expected/ Estimated Weight

Parameter Formula

6months Weight in grams Age in months x 600 + Birth

Weight in grams

6 to 11 months Weight in grams Age in months x 500 + Birth

Weight in grams

1 to 6 years Weight in kg Age in years x 2 + 8

7 to 12 years Weight in kg (Age in years x 7) - 5 / 2

Ill. LENGTH
Average gain in 1st Year is 25 cm
Age
Expected Gain in Length Average Gain per Month

Birth-3 months +9cm 3 cm per month

3-6 months +8cm 2. 67cm per month

6 -9 months +5cm 1.67 cm per month

9-12 months +3cm 1 cm per month

2- 12 Years old Height in cm= Age in years x 6 + 77

● Position head so that an imaginary
vertical line from the ear canal to the
lower border of the eye is perpendicular
to the board.

● Make sure that the child lies supine,,

shoulders touching the board, and the
spine is not arched.

● Hold down the legs with one hand &

apply gentle pressure to straighten the
knees.

● Pull footboard against the child's feet

with both soles are flat against the
footboard & toes are pointing upwards.
● Stand on the baseboard with feet
slightly apart.
● Make sure that the back of the head,
shoulder blades, buttocks, calves and
heels are touching the vertical board
● Position the head so that the horizontal
line from the ear canal to the lower
border of the eyes run parallel to the
baseboard.
● Pull down the moveable headboard to
rest firmly on top of the head.
lV. HEAD CIRCUMFERENCE

● Head circumference(HC) is measured routinely

up to 3 years.
● HC is an indicator of brain growth
○ Small HC: may suggest a small brain or
microcephaly (HC <2 SD below the mean
○ Large HC: may suggest a large brain or
macrocephaly (HC >2 SD above the
mean)
 V. MID-UPPER ARM CIRCUMFERENCE
(MUAC)
● In infants, MUAC is an alternative method common used to determine wasting (
acute malnutrition)
● Procedure:
○ Place measuring tape from the tip of shoulder to the elbow
○ Mark the midpoint between the shoulder and the elbow
○ Measure the circumference at this mid-point, making sure that correct tape
tension is placed (not too tight and not too loose)
○ Record and interpret MUAC.
● Interpretation:
○ 115 to <125 mm = moderate acute malnutrition
○ <115 mm= severe acute malnutrition
 PARAMETERS AND INTERPRETATIONS
❏ Interpretations of anthropometric measurements using the WHO growth charts (Ideal method of
interpreting a child’s weight and height.
❏ Step 1 : Choose the appropriate chart
● Use the appropriate chart for the patient’s age, gender, and parameter to be interpreted (ex.
weight for age, length for age, weight for length
❏ Step 2 Plot the measurements in the chart
● Plot the variables in the X and Y axis of the chart

★ In general, the age is plotted based on completed months/years on a vertical line. (e.g.if a child is 4 1⁄2
months old, it is plotted at 4 months and not in between 4 and 5 months) o All other parameters are
plotted as precisely as possible (may plot in between lines) Mark the plotted point (intersection of the
lines extended from the X and Y axis values)
PARAMETERS AND INTERPRETATIONS

❏ STEP 3
● Determine the Z-score
● Read the Z-score based on the plotted point
● For Z-scores between 1 to -1, this is read as Z-score = 0 or median
● Plotted points above this range are read as "above"
● Plotted points below this range are read as "below"
❏ Step 4 : Interpret the z score
❏ Note that wasting is the most appropriate measure of severe acute malnutrition
INTERPRETATION
 DEVELOPMENT
I. PRINCIPLES OF DEVELOPMENT

● Development is a continuous process of reaching maturity with increase in

function and skills.

● Developmental sequence is orderly and predictable.

○ Progresses in a cephalocaudal manner and proximodistal pattern.
○ Responses proceed from generalized reflexes to discrete voluntary actions

● Rate varies from child to child and is affected by biologic and psychosocial
factors.
ll. DEVELOPMENTAL DOMAINS

● These developmental domains consist of gross motor, fine motor, social,

and language.

● Developmental milestones are present in each domain that serve as criteria

in deciding whether a child is developing accordingly.

● Developmental delay refers to a slower than acceptable rate of

development in at least 1 of the domains
 Ill. CLASSIC STAGE THEORIES OF
DEVELOPMENT
Infancy Toddler Preschool School age Adolescence
1)Freud(psychosexual development)

Oral Anal Phallic/ Oedipal Latency Genital

2)Piaget(cognitive development)

Sensorimotor (thinking is tied to Preoperational Concrete Formal

immediate sensations) (symbolic operations (use operations
thinking able to of logic (abstract
form mental and inductive thinking,
images reasoning deductive
reasoning &
hypothetical
thinking
 Infancy Toddler Preschool School age Adolescence

3) Erikson (Psychosocial development)

Trust versus Autonomy Initiative versus Industry Identity versus role

mistrust versus shame guilt versus diffusion
and doubt inferiority

4) Kohlberg (Moral Development)

Preconventional Conventional Conventional Postconventional:

(stage 1 & 2): (stage 3): (stage 4): law moral principles
avoid conformity and order
punishments/
obtain rewards
DEVELOPMENTAL MILESTONES DURING THE NEONATAL PERIOD

DOMAIN SKILLS
● Arms and legs are flexed while prone
● Head held below the body while in ventral suspension
Gross motor ● Arms and legs semi-flexed while in supine position
● Head lags when pulled to sit
● Legs extended when held upright

● Presence of grasp reflex, drop object immediately

Fine motor ● Hands remain fisted
● Sweeping movements towards object are observed

Language ● Crying / whimpering ( expressive language)

● Started by loud sound ( receptive language

Personal - Social ● Gaze at faces, bright lights, and colored objects

DEVELOPMENTAL MILESTONES DURING THE INFANCY PERIOD

DOMAIN AGE SKILLS

Gross motor ● 3 months ● Hold head without head leg

● 5 months ● Roll over
● 7 months ● Sit ( 6 months with support, 8 months without
support
● 9 months ● Pull himself / herself to stand
● 12 months ● Walk independently

Fine motor ● 3 months ● Observed to have unclenched hands

● 5 months ● Hands are brought to midline
● 7 months ● Transfer-object from one hand to another
● 9 months ● Pincer grasp
● 12 months ● Voluntary release of objects / able to throw
objects
 Language ● 3 months ● Alert to human voice
● 6 months ● Localize to sound
● 9 months ● Understand and follow the command ‘no’
● 12 months ● Follow 1 step command with gesture

Personal-social ● 2 months ● Social smile

● 3 months ● Coo
● 6 months ● Babble
● 9 months ● Say “mama/papa” but non-specific
● 12 months ● Speak single words with meaning
 TODDLERHOOD TO SCHOOL AGE
DOMAIN AGE SKILLS

15 months Run, pivot, walk backwards, and crawl upstairs

18 months Walk upstairs with rails and run stiffly

24 months Jump with both feet and run well, climb on furniture;
walk up and down the stairs 1 step at a time

30 months Jump forward and pedal a tricycle; goes upstairs with

alternating feet
Gross motor
3 years Ride a tricycle

4 years Hop; throws ball overhead; use scissors to cut out

pictures

5 years Skip

7 years Climb and run

 15 months Scribble spontaneously, make tower of 3 cubes

18 months Imitate stroke on paper; make tower of 4 cubes

24 months Imitate vertical lines; make tower of 7 cubes

30 months Draw circle with series of perseverating lines; make

Fine motor tower of 9 cubes

3 years Draw circle and a person with 2 body parts; make

tower of 10 cubes

3.5-4 years Draw a cross

4.4-5 years Draw a square

5 years Climb and triangle

6 years Copy letters but reverse some of1t; draw a person

with 12 parts

7 years Know right and left sides

DOMAIN AGE SKILLS

24 months Two-word phrases; follow 2-step commands;

know full name

3 years Speak 3-4 worded telegraphic sentences,

Language
4 years Speak complete sentences, tells story

5 years Understand concept of time, follow 3 step

commands

6 years Able to verbalize emotions, follow 3 serial

commands
 DOMAIN AGE SKILLS

12 months Corporate when being dressed by putting out limbs,

Egocentric symbolic play

15 months Indicate some desires by pointing, imitate chores,hug

18 months Feed self, seek help when in trouble

Personal-Social 24 months Handle a spoon, well, parallel play, toilet-trained by

day,listen to stories when shown pictures

30 months Help in simple tasks

3 years Dress under supervision, wash hands

4 years Dress independently, group play, go to toilet alone

5 years Do simple errands and help in household chores

6 years Dress up completely, tie shoelaces

SECOND YEAR OF LIFE TO MIDDLE CHILDHOOD
2 YEARS OLD 3-5 YEARS OLD 6-11 YEARS OLD
(PRESCHOOL YEARS) (MIDDLE CHILDHOOD)

Growth

● Growth rate slows ● Weight gain of about ● Gain of 3-3.5 kg and

down by the end of 2 kg per year 6-7 cm per year
the first year ● Growth of about 6-8 ● Head grows only 2-3
● 2nd year of life cm per year cm during this period
3-5 lbs weight gain ● Dentition
10-12 cm increase in 6 year old: loss of
height deciduous teeth
90% of adult head 9 year old: 8
size attained permanent incisors &
4 permanent molars
11-12 years old:
pre-morals erupt
 Other aspects

● Appetite declines ● Interest in sexuality ● Hypertrophy of

(physiologic anorexia) (may play with their lymphoid tissues
● Myelination of the genitals as a sign of ● Muscle strength,
brain is most rapid & normal curiosity) coordination, and
dramatic ● Make-believe games stamina increase
● Protuberant ● May make up stories • progressively
abdomen, baby fat, ● Encourage child to ● Issues of overweight
lordosis sleep in own bed from sedentary habits
● Emotional: temper ● Teach the child not to, ● Social:
tantrums; seeks talk to strangers Attachment to
independence but still parents decrease & to
relies on parental ties peer increase by 7
for confidence years of age
Reliance on peer
groups
Group loyalty,
commitment to best
friends by 9 years old
 ADOLESCENCE

• Adolescence is the transition from childhood to adulthood

• Rapid physical and sexual changes

- Growth spurt
- Sexual maturation
- Menarche
- EJaculation
SEXUAL MATURITY RATING (SMR)
 CHARACTERISTICS BEHAVIORS OF ADOLESCENTS
EARLY ADOLESCENCE
(10-13 years Old )
*Argumentative, disobedient and
tend to challenge family and
authority.
*Rejects things of childhood
*Display a growing need for
privacy
*Critical of and preoccupied with
physical appearance and change
*May be anxious about wet
dreams, masturbation, breast or
penis size
MIDDLE ADOLESCENCE LATE ADOLESCENCE
(14-17 Years Old ) (18-21 Years Old)
1)Autonomy
● Shows ambivalence on • Emancipation ( college,
emerging independence work, vocations, adopts an
which may lead to family adult lifestyle)
conflicts
2)Body Image
• Increased interest in making • Usually comfortable with body
body image more attractive image
• Excessive physical activity
alternating with lethargy can be
shown
 CHARACTERISTICS
EARLY ADOLESCENCE
(10-13 years Old )
• Focuses thinking on "here and
now" because of a lack of
understanding of consequence
despite concrete thinking
• Need for instant gratification
and a lack of impulse control, thus
engages in risk-taking behavior
*Emerging sexual feelings and
exploration
*Magnifies own problems and
thinks that "no one understands “
BEHAVIORS OF ADOLESCENTS
MIDDLE ADOLESCENCE LATE ADOLESCENCE
(14-17 Years Old )
3) Cognitive Development
• Emergence of formal
operations that lead to
effective planning
• Understands better the
consequences of behavior
• Feelings of omnipotence
and immortality are present
which may lead to
risk-taking behaviors
4) Identity Development
• Experimental (drugs,
alcohol, sex)
• Increased intellectual
ability and creativity
(18-21 Years Old)
• Emergence of abstract
reasoning
• Able to compromise as
they are able to engage with
their conscience
• Able to delay gratification
* Relates to family as adults
* Established ethical & moral
value system
* Realizes own limitations
* More capable of intimate
relationships.
 EARLY ADOLESCENCE
(10-13 years Old )
* Development of intense
friendships with the same sex
* Contact with opposite sex in
peer groups
* Resets priorities for social life
rather than study
* May have unrealistic academic
goal & frequently changes them
MIDDLE ADOLESCENCE
(14-17 Years Old )
5) Peer Group
* Formation of peer
allegiances
* Susceptible to peer
pressure
* bad behavior
* Emerging sexual drives
lead to exploration & ability
to attract a partner
6) Vocation
* Able to set more realistic
academic or vocational
goals
* Begins to realize
strengths & limitations
LATE ADOLESCENCE
(18-21 Years Old)
* Makes decision &
maintain values as they are
less influenced by peers
* Relaxes to individual
more than to peer group
* Select partner based on
individual preference
* Pursues realistic academic/
vocational goal with training or
actual employment
THANK YOU.