Growth and Development:

Preschool Years and Middle

Childhood

Monette R. Faner, MD, DPPS

 Outline
• Definitions
• Periods of Development
• Preschool Years
• Middle Childhood
 Definition: GROWTH
• Growth
– Increase in the physical size and mass of
an individual or a single organ
– Begins at conception and continues at a
rate that depends on a variety of factors

Fundamentals of Pediatrics Vol 1, Chapter 8

 Definition:
DEVELOPMENT
• Development
– Process of acquiring skills in an orderly
and predictable manner
– Involves refinement and specialization
of functions, resulting in the
achievement of increasingly complex
abilities

Fundamentals of Pediatrics Vol 1, Chapter 8

Image from nurselabs.com
 Growth and development are
significant determinants of the health
and well-being of children

Fundamentals of Pediatrics Vol 1, Chapter 8

 Philippine Laws
• Republic Act 6972
– Barangay-level Total
Development and
Protection of Children Act
– Establish at least one
day-care center in every
barangay in the country
which promotes growth
and nutrition monitoring,
intellectual and mental
stimulation, and
supervised group play,
among other tasks

Fundamentals of Pediatrics Vol 1, Chapter 8

Image from Unicef Philippines
Philippine Laws
– Comprehensive range of
health, nutrition, early
education, and social
services that cater to
the holistic needs of
children 0-6 years old,
and
– an integrated approach
in the planning,
management, and
monitoring of early
childhood care and
primary education in the
country

Fundamentals of Pediatrics Vol 1, Chapter 8

Image from Unicef Philippines
 Periods of Development
• Prenatal period • Postnatal period
– Ovular - 0-14th day – Infancy - birth-1 year
– Embryo - 14th day – – Toddler - 1-3 years
8th week – Childhood
– Fetal - 9th week - • Early – 3-5 years
birth • Middle – 6-8 years
• Late – 9-10 years
– Adolescence
• Early – 10-13 years
• Middle – 14-16 years
• Late – 16-19 years
 Nelson textbook of Pediatrics 20th ed, Chapter 12
Fundamentals of Pediatrics Vol 1, Chapter 8

PRE-SCHOOL YEARS
 Structural Development of the
Brain
• Dramatic changes in its anatomical
and physiologic characteristics
– Increases in cortical area
Not
– Decreases in cortical thickness
uniform;
– Changing cortical volume vary by
region
 Physical Development
• Somatic and brain growth slows by the end of
the 2nd year of life -> decreases in nutritional
requirements and appetite (PICKY EATING
HABITS)
• WEIGHT: increase by 2kg (4-5lb)/year
• HEIGHT: increase by 7-8cm (2-3in)/year
• HEAD CIRCUMFERENCE: additional 5-6cm
between ages 3 and 18 years

An average 4 year old weighs 40lb and is 40in tall

 Physical Development
• (+) genu valgum
(knock-knees) and
mild pes planus (flat-
foot)
• Torso slims as legs
strengthen
• VISUAL ACUITY
– 3 years old: 20/30
– 4 years old: 20/20
• PRIMARY TEETH
erupted by 3 years old
 Physical Development
• HANDEDNESS
– Established by 3 years
old
• BOWEL AND BLADDER
CONTROL
– Readiness have large
individual and cultural
variation
– Girls tend to train faster
and earlier than boys
– BED-WETTING is normal
up to age 4 years in girls
and age 5 years in boys
Developmental milestones:
GROSS MOTOR
Age Skills
3 years Ride a tricycle
4 years Hop
5 years Skip
 Developmental milestones:
FINE MOTOR
Age Skills
3 years Draw a circle or a person
with 2 body parts
3.5-4 Draw a cross
years
4-4.5 Draw a square
years
5 years Draw a triangle
Improving eye-hand coordination
 Developmental milestones:
LANGUAGE
Age Skills
3 years 3-4 worded telegraphic
sentences
Understand prepositions
4 years Complete sentences
Understand concept of size
5 years Understand concept of time
Follow 3-step commands
Linguistic development is an important
determinant of future cognitive and
academic competence
 Developmental Milestones:
PERSONAL-SOCIAL
Age Skills
3 years Dress under supervision
4 years Dress
independently/correctly
5 years Do simple errands
Help in household chores
 Language
• Speech: production of intelligible sounds
• Language: refers to the underlying mental
act (receptive and expressive)
• Language development occurs most
rapidly between 2 and 5 years of age
• Vocabulary increases from 50-100 words to
2,000
• Number of words in a typical sentence
equals the child’s age from 2 to 5 years old
 Language
• Linked to cognitive and emotional
development
• Plays a critical part in the regulation
of behavior
• Allows the child to express feelings
 Cognition
• Piaget’s preoperational stage
– Magical thinking: confusing coincidence
with causality, animism
– Egocentrism: inability to take another’s
point of view; does not connote
selfishness
– Dominance of perception over logic
• Gender identification by age 3
– Progression from rigidity to more flexible
realistic understanding
 Play
• Learning, physical activity,
socialization with peers, practicing
adult roles
– Simple imitation of common experiences
(2-3 years old)
– Extended scenarios involving singular
events (3-4 years)
– Creation of imagined scenarios (4-5
years)
 Emotional and Moral
Development
• 2 years old: behavioral limits are
predominantly external
• 5 years old: behavioral controls are
internalized
• Tantrums peak between 2-4 years old
– >15min or >3x/day may reflect
problems
• Modesty appears between 4-6 years
old
 Nelson textbook of Pediatrics 20th ed, Chapter 13
Fundamentals of Pediatrics Vol 1, Chapter 8

MIDDLE CHILDHOOD
 Physical Development
• Growth occurs DISCONTINUOUSLY
• WEIGHT: 3-3.5kg (6.6-7.7lb)/year
• HEIGHT: 6-7cm (2.4-2.8in)/year
• HEAD CIRCUMFERENCE: 2cm
throughout the entire period (slowing
of brain growth)
• Body habitus is more erect than
previously, with long legs compared
with the torso
 Physical Development
• Growth of the midface and lower face
occurs gradually
• Loss of deciduous teeth beginning at 6
years old
• Replacement of adult teeth ~4/year
– By 9 years old, 8 permanent incisors and 4
permanent molars
• Premolars erupt by 11-12 years old
• Lymphoid tissues hypertrophy
 Physical Development
• Muscular strength, coordination, and
stamina increases
• Perceptions of body image
 Developmental
Milestones
Domain Age Skills
Gross 7 Climb
Motor years Run
Fine 6 Copy letters
Motor years Reverse some letters
Draw a person with 12
parts
7 Know right and left sides
years
Languag 6 Verbalizes emotions
e years Follows 3-serial command
 Cognitive Development
• Piaget’s CONCRETE LOGICAL
OPERATIONS
– Apply rules based on observable
phenomena
– Factor in multiple dimensions and point
of view
– Interpret their perception using physical
laws
 Social and Emotional
Development
• Increasing independence
• Increasing importance of teacher and
peer relationship
• Social groups tend to be same-sex
 Moral Development
• CONSCIENCE (by 6 years old) – internalized
rules of society
• Younger children
– Rules are established and enforced by an authority
figure (parent/teacher)
– Decision-making is guided by self-interest
– Needs of others are NOT strongly considered
• Older children
– Recognize the needs of others
– Understanding of reciprocity (“golden rule”) by 10-
11years old
THANK YOU