Knowledge of normal growth and

development of children

Is essential

for preventing and detecting disease by

recognizing overt deviations from normal
pattern
 GROWTH AND DEVELOPMENT

Many people use the terms “growth”

and “development” interchangeably

In reality they are different, though they

inseparable, neither take place alone
 GROWTH

Growth refers to quantitative changes

Increases in size and structure

Not only does the child become larger

physically, but the size and structure of the
internal organs and the brain increase
As result of the growth of the brain, the child
has a greater capacity of learning, for
remembering, and for reasoning
The child grows mentally as well as physically
 Development refers
DEVELOPMENT to quantitative and
qualitative changes
It may defined as a progressive series of
orderly, coherent changes
Progressive signifies that the changes are
directional, that they lead forward rather than
backward
Orderly and coherent suggest that there is a
definite relationship between the changes
taking place and those that preceded or will
follow them
Fig 1 . The interacting of development
Physical, intellectual, and psychosocial developments should
not be viewed as separate entities because they operate
interdependently, each strongly influencing the others
PRINCIPLES OF DEVELOPMENT

Development involves changes

Early development is more critical than
later development
Development is the product of maturation
and learning
The developmental pattern is predictable
The developmental pattern has
predictable characteristics
 There are individual differences
in development
There are periods in the developmental
pattern
There are social expectations for every
developmental period
Every area of development has
potential hazards

Hurlock EB. Child Development. Auckland : McGraw-Hill International

Book Co, 1978. P.22-47.
DEVELOPMENT INVOLVES CHANGES

Changes in size
Physical : height, weight, circumference,
internal organ
Mental : memory, reasoning, perception,
creative imagination
Changes in proportion
Physical : see Fig. 2
Mental : imaginative capacity is better
developed than reasoning
capacity; while the reverse is
true in adults
 1/2 1/3 1/4 1/5 1/6 1/7 1/8

2 mo (fetal) 5 mo Newborn 2 yr 6 yr 12 yr 25 yr

Fig 2. Changes in body proportions from the 2nd fetal mo to

adulthood. (From Robbins WJ, Brody S, Hogan AG, et al:
Growth New Haven, Yale University Press, 1928)
Disappearance of old features
Physical : thymus gland, baby hair and
teeth
Mental : babyish locomotion and speech
Acquisition of new features
Physical : second teeth, primary and
secondary sex characteristics
Mental : interest in sex, moral standards,
religious beliefs
EARLY DEVELOPMENT IS MORE
CRITICAL THAN LATER

Conditions affecting early foundations

a. Favorable interpersonal relationship

b. Emotional states
c. Child - training methods
d. Early role - playing
e. Childhood family structure
f. Environmental stimulation
 Fig 3. UNIVERSAL FACIAL EXPRESSIONS
Infants show these types of facial expressions relating to basic emotions,
regardless of the culture in which they are raised (Feldman RS, 2000)
DEVELOPMENT IS THE PRODUCT OF
MATURATION AND LEARNING
MATURATION

Intrinsic maturation.The unfolding of

characteristics potentially present in the
individual’s genetic endowment
Phylogenetic functions
Functions common to the race, such as
creeping, crawling, sitting and walking.
Development comes from maturation
Ontogenetic functions. Functions specific to
the individual, such as swimming, ball
throwing, riding bicycle, writing. Training is
essential
 Fig 4.
MILESTONES
OF MOTOR
DEVELOPMENT
….development is the product of maturation and learning

LEARNING

Learning is development that comes from

exercise and effort.
Through learning, children acquire
competence in using theirs hereditary
resources. They must have opportunity to
learn
Some learning comes from practice or the
mere repetition of an act
THE DEVELOPMENT PATTERN IS
PREDICTABLE

Developmental direction

Cephalocaudal - proximodistal law (fig.5)

Specific areas of development likewise

follow predictable patterns

Motor development, emotional behavior,

speech, social behavior, concept
development, goals, interests, and
identification with others
Fig 5. The laws of developmental direction
 THE DEVELOPMENT PATTERN HAS
PREDICTABLE CHARACTERISTICS

Similarity in developmental patterns

All children follow a similar developmental
pattern with one stage leading to the next
General pattern is not altered by individual
variations in the speed of development
Development proceeds from general to
specific responses
In mental as well as in motor responses, general
activity always precedes specific activity
In emotional behavior babies first response to
strange and usual objects with general fear
 …….the development pattern has predictable characteristics

Development is continuos

Development is continuous from the moment

of conception to death but it occurs at
different rates, sometimes slowly and
sometimes rapidly
Developmental changes donot always go
forward in straight line  but, in the end, the
changes lead forward
 …….the development pattern has predictable characteristics

Different areas develop at different rates

Fig 5. shows the pattern of development for four

different parts of the body (Brain and head,
General, Lymphoid, Reproduction)

There is correlation in development

When physical development is rapid, so in

mental development
 200
180 LYMPHOID TYPE

160
140
120
NEURALTYPE
100

80
GENERAL TYPE
60
40
GENITAL TYPE
20

0
0 4 8 12 16 20
AGE IN YEARS
Fig 6. Main types of postnatal growth of the various parts and organs of the
body. (After Scammon: The measurement of the body in childhood. In:
Harris B et al (eds): The Measurement of Man. Minneapolis, University of
Minnesota Press, 1930)
THERE ARE INDIVIDUAL DIFFERENCES IN
DEVELOPMENT

Although the pattern of development

is similar for all children

all children follow the predictable pattern

in their own way and at their own rate

all children do not reach the same point

of development at the same age
 ……there are individual differences in development

Causes of differences

Every person is indeed biologically and

genetically different from every other
No two people have identical environmental
influences, even identical twins
Individual differences are caused by both
internal and external conditions
 THERE ARE PERIODS IN
THE DEVELOPMENTAL PATTERN

There are five major developmental

periods in childhood (See Table 1)

Although eachperiod has its own

characteristic events and issues, the
ages given for each time span are only
approximate and somewhat arbitrary
Table 1 The Chronological Phases of Childhood and
Their Major Characteristics
PHASE TIME SPAN CHARACTERISTICS

Prenatal Conception to Child begins as a single cell and

period birth emerges 9 months later as a
multimillion-cell functioning
person

Infancy Birth to 18 Changes in brain functioning result

months from an increased number of
(up to 24 neural connections, leading to a
months) period of intense development of
motor abilities, language
acquisition, and socialization

Early 18 months to 6 Through exploration, play, and the

childhood years development of self-sufficiency,
children become increasingly
willful and independent
 PHASE TIME SPAN CHARACTERISTICS

Middle 6 to 11 years Emphasis is on learning the

childhood fundamental skills of reading,
writing, and mathematics; more
complex thinking and reasoning
abilities become evident, and
children become capable of logical
thought and of seeing the world
from the point of view of others

Adolescence 11 to 18 years Dramatic physical and

psychological changes occur; key
issues are separation,
independence, and peer
relationships
Tabel 2. Tahap-tahap Tumbuh Kembang Anak
1. Masa pranatal (Prenatal period)
a. Masa zigot / mudigah: konsepsi – 2 minggu
b. Masa embrio: 2 minggu – 8 / 12 minggu
c. Masa janin / fetus: 9 / 12 minggu – lahir
- Masa fetus dini: 9 minggu – trimester ke-2
- Masa fetus lanjut: trimester akhir kehamilan
2. Masa bayi (Infancy) : usia 0 – 1 tahun
a. Masa neonatal: usia 0 – 28 hari
- Masa neonatal dini: 0 – 7 hari
- Masa neonatal lanjut: 8 – 28 hari
b. Masa pasca neonatal: 29 hari – 12 / 15 bulan
3. Masa anak dini (Early childhood)
a. Toddlerhood: usia 1 – 3 tahun
b. Masa pra sekolah (Preschool period): usia 3 – 6 tahun
4. Masa sekolah (School period): usia 6 – 18 / 20 tahun
a. Masa pra remaja (Middle and late childhood): usia 6 – 11 tahun
b. Masa remaja (Adolescence):
1. Masa remaja dini (Early adolescence): 11 - 13 tahun
2. Masa remaja pertengahan (Middle adolescence): 14 – 17 tahun
3. Masa remaja lanjut (Late adolescence): 17 – 20 tahun
 THERE ARE SOCIAL EXPECTATIONS
FOR EVERY DEVELOPMENTAL PERIOD
Social expectations are known as
developmental task”
Factors influencing mastery of developmental
tasks
Aids to mastery
 Accelerated physical development
 Strength and energy above average to age
 Above average intelligence
 An environment that offers opportunities for
learning
 Guidance from parents and teachers in learning
 A strong motivation to learn
 Creativity accompanied by a willingness to be
different
…….there are social expectations for every developmental period

Obstacles to mastery

Retardation of developmental level

(physical or mental) Poor health
A handicapping physical defect
Lack of opportunity to learn
Lack guidance in learning
Lack motivation to learn
Fear of beeing different
 EVERY AREA OF DEVELOPMENT
HAS POTENTIAL HAZARD

Even when developmental pattern is

progressing normally, there are likely to be, at
every age, hazards in some areas of
development that interfere with this normal
pattern
Individual hazards arising from the child’s
genetic endowment or environment
Forewarning of potential hazards associated
with different areas of development is
important
 FISIK
BIOLOGI
MASYARAKAT

KELUARGA

INDIVIDU

SOSIAL DAN BUDAYA EKONOMI DAN POLITIK

Fig 7. The influence of environment on child growth and

development
Fig 8. Bronfenbrenner’s Chronosystem
 The pattern of developmental can be
interfered with either temporarily or
permanently, by environmental or physical
conditions

This interference may take the form of

delaying or accelerating the speed or it may
alter the pattern
 FURTHER READING

1. Soetjiningsih,Tumbuh Kembang Anak,

1995
2. Nelson Text book of Pediatrics, 2004
3. Rudolph’s Pediatrics, 2003
4. Soetjiningsih, Tumbuh Kembang Remaja
dan Permasalahannya, 2004
5. Hurlock EB, child Development, 1978