Growth and Development of

Children

Dr Hodan Ahmed, Mbbs, Mmed,

Dep of Pediatrics, Amoud Medical School, AU
 Objectives

• Define growth and development.

• Mention the principles of growth and
development.
• List factors affecting growth and development.
• Mention types of growth and development.
• Identify the stages of development.
• Discuss growth and development of children.
 Growth
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.

It can be measured in Kg, pounds, meters,

inches, ….. etc
Child Growth (Image: WHO)
Changes in bodily proportions with age.
 Development
• Development refers to a progressive increase
in skill and capacity of function.

• It is a qualitative change in the child’s

functioning.

• It can be measured through observation.

 Maturation
• Increase in child’s competence and
adaptability.

• It is describing the qualitative change in a

structure.

• The level of maturation depends on child’s

heredity.
 Principles of Growth & Development
• Continuous process

• Predictable Sequence

• Don’t progress at the same rate (↑ periods of GR in early childhood and

adolescents & ↓ periods of GR in middle childhood)

• Not all body parts grow in the same rate at the same time.

• Each child grows in his/her own unique way.

• Each stage of G&D is affected by the preceding types of development .

 Factors affecting growth and development:
• Hereditary

• Environmental factors

Pre-natal environment
1-Factors related to mothers during pregnancy:

- Nutritional deficiencies
- Diabetic mother
- Exposure to radiation
- Infections
- Smoking, Use of drugs
2-factors Related To Fetus
• Mal-position in uterus
• Faulty placental implantation
Post-Natal Environment

I - External environment:
- socio-economic status of the family
- child’s nutrition
- climate and season
- child’s ordinal position in the family
- Number of siblings in the family
- Family structure (single parent or extended family … )
Internal environment
• Child’s intelligence
• Hormonal influences
• Emotions
 Types of growth and development
Types of growth:
- Physical growth (Ht, Wt, head & chest circumference)
- Physiological growth (vital signs …)

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

• Prenatal • Middle Childhood

- Embryonic (conception- 8 w)
- School age
- Fetal stage (9-40 w) - 6 to 12 years

• Infancy
- Neonate • Late Childhood
- Birth to end of 1 month
- Infancy
- Adolescent
- 1 month to end of 1 year
- 13 years to 17 years

• Early Childhood
- Toddler
- 1-3 years
- Preschool
- 3-6 years
PRENATAL GROWTH AND
DEVELOPMENT
 Definition
Refers to the process of transformation of a
fertilized egg into an embryo and foetus until
birth.
Divided into two stages:-
• Embryonic Period
From fertilisation to 8th week
• Foetal Period
From the 9th week to Birth
 Embryonic Period

Folding of the embryo into human.

Most critical stage of development as highly

susceptible to teratogenesis due to organogenesis

Differentiation of cells into tissues and organs

capable of performing specialized functions occurs
at this stage
 Foetal period
• Precursors of all major organs have formed
• There is an increase in cell number and size
with structural remodelling of the major organ
systems.
 Factors influencing foetal growth
• Maternal factors
Poor nutrition, Hypertension, Diabetes, Renal
Disease, Severe Anaemia, Infections - rubella,
cytomegalovirus, toxoplasmosis or syphilis
Drugs –narcotics, alcohol, cigarettes
NEWBORN
 1- Newborn 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 days of life
- Gain ¾ kg by the end of the 1st month
Weight:

They loose 5 % to 10 % of weight by 3-4 days

after birth as result of
 Withdrawal of hormones from mother.
 Loss of excessive extra cellular fluid.
 Passage of meconium (feces) and urine.
 Limited food intake.
 Height
• Average Ht = 50 cm
• Normal range (47.5- 53.75 cm)

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

• Diamond in shape
• The junction of the sagittal, corneal and
frontal sutures.
• Between 2 frontal & 2 parietal bones
• 3-4 cm in length and 2-3 cm width
• It closes at 12-18 months of age
 Posterior fontanel

• Triangular
• Located between occipital & 2 parietal bones
• Closes by the end of the 1st few months of age
 Physiological growth
• Vital signs
- Temperature (36.3 to37.2C )
- Pulse ( 120 to 160 b/min )
- Respiration ( 35 to 60/min)
• Senses
- Touch
- Vision
- Hearing
- Taste
- Smell
 Touch

• It is the most highly developed sense.

• It is mostly at lips, tongue, ears, and forehead.

• The newborn is comfortable with touch.

 Vision
• Pupils react to light

• Follow objects in line of vision

 Hearing
• The newborn infant usually makes some
response to sound from birth.
• The newborn infant responds to sounds with
either cry or eye movement, cessation of
activity.
 Taste
Well developed as bitter and sour fluids are resisted
while sweet fluids are accepted.

Smell

Only evidence in newborn infant’s search for the

nipple.
 Gross Motor Development

Motor development:
The newborn's movement 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

 Primitive Reflexes
• Palmar Grasp
• Sucking
• Rooting
• Moro
• Symmetric Tonic Neck
 Primitive Reflexes ~ Palmar
Stimulus / S: Palm stimulated
Grasp
Response R: 4 fingers (not thumb) close
Duration 5 months gestation - 4 months
postpartum
Concerns No palmer grasp may indicate
neurological problems
Other One of the most noticeable reflexes
May lead to voluntary
reaching / grasping
May predict handedness in adulthood
 Primitive Reflexes ~ Sucking
Stimulus / S: touch of lips
Response R: sucking action
Duration In utero - 3 months postpartum
Concerns No reflex: problematic for nutrition
Other Often in conjunction with searching
reflex
 Primitive Reflexes ~ rooting
Stimulus / S: touch cheek
Response R: head moves toward stimuli
Duration Birth - 3 months postpartum
Concerns No reflex may be sign of CNS
dysfunction.

Other Often in conjunction with sucking reflex.

Contributes to head/body-righting
reflexes.
 Primitive Reflexes ~ Moro
Stimulus / S: Suddenly but gently lower baby’s
Response head S: Hit surface beside baby
R: Arms and legs
extend
Duration Birth– 3-6 months postpartum
Concerns May signify CNS dysfunction if lacking
Birth trauma
Injury to one side of brain if
asymmetical
Primitive Reflexes ~ Moro
 Primitive Reflexes ~ Asymmetric Tonic Neck
Stimulus / S: Prone/supine position, turn head to one
Response side
R: Limbs flex on one side, extend on other
side
Duration After birth – 3 months
Concerns Facilitates bilateral body awareness
Facilitates hand-eye coordination
UMN
 Primitive Reflexes ~ Symmetric Tonic Neck
Stimulus / S: Baby sitting up and tip forward
Response R: Neck and arms flex, legs extend
S: Baby sitting
up and tip backward R: Neck and
arms extend, legs flex
Duration After birth – 3 months
Concerns Persistence may impede many motor skills
and cause spinal flexion deformities
 Cognitive development

The cognitive development of

newborn infant is difficult to
understand or observe it.
 Emotional development
The newborn infant expresses his
emotion just through cry for hunger,
pain or discomfort sensation
INFANCY
 Definition of normal infant:-
It is the period which starts at the end
of the first month up to the end of
the first year of age. Infant's growth
and development during this period
are rapid.
 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 wt by 4-6 months

and triple it by 10-12 months of age
 Height
• Length increases about 3 cm /month during
the 1st 3 months of age,

• It increases 2 cm /month at age of 4-6 months,

• At 7 – 12 months, it increases 1 ½ cm per

month
 Head circumference
• It increases about 2 cm /month during the 1st
3 months,
• ½ cm/month during the 2nd 9 months of age.
• Posterior fontanel closes by 6-8 w of age.
• Anterior fontanel closes by 12-18 months of
age.
 Chest circumference
Head circumference is 1 to 2 cm larger than chest
circumference in most newborns and in children 12
to 18 months old.
Physiological growth of infants:-
Pulse 140 - 128 b/min
Resp 41 - 37 b/min
Breath through nose.
Blood pressure 85/50 ± 20/10 mmHg
 2-6 months
• Emerging of voluntary (social) smile and increased eye-to-eye
contact.
Physical development
• 3-4 months weight gain slows down to 20g/day.
• Early reflexes that limit movement recede.
• Waning of grasp reflexes.
• Loss of asymmetrical tonic neck reflex, can roll over, begins to
examine objects in the mid-line and manipulates them with
both hands.

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• Increased control of truncal flexion makes intentional rolling
possible
• Head control allows the baby to gaze across things.
• The baby also learns to take food from a spoon
• Maturation of visual system allows much greater depth.
• Sleep requirements are
– 14-16 hours with 9-10 hours concentrated in the night.

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Cognitive development
• Baby no longer focused on the mother only but
becomes distracted in her arms.
• Infants explore their bodies, staring intently at their
fingers, toes, vocalizing, touching the different body
parts.
• Infant build a sense of self – when he wiggles the
toes, he can see and feel the sensation and do it
deliberately.
• Learns what is self and that he has control\over it
and what is non self which he has no control eg smell
and touch by mother.

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• Emotional development
• Primary emotions of anger, joy, interest, fear, disgust, and
surprise appear
• Face to face with a trusted adult, expression infant and adult
matche affective expressions eg smiling to each other
• Infants of depressed mothers behave differently –
– spend less time on co-ordinated behaviour,
– little effort to connect and co-ordinate with the parent,
– baby shows sadness and loss of energy a parent continues to be
unavailable.
• Babies are able to share the emotional state of their parents –
first step in development of communication.

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 6-12 months
Key themes are
• Increased mobility and exploration
• Advances in cognitive understanding and
competences
• New tensions around themes of separation
• Infant develops will and intention

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Physical development
– Growth slows down
– Able to sit unsupported (7mos)
– Ability to pivot while sitting (9-10mos)
– Pincer grasp 9 months
– Crawling and pulling to a stand - 8 mos
– Walking 1 year
• Motor achievements correspond to increasing myelination
and cerebellar growth.
• Increased ambulation
– increases child’s exploratory range
– create new physical dangers
– Provides new learning experiences.
• Tooth development starts

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Cognitive development
• Everything goes to the mouth.
• Novel things are inspected, Passed from hand to hand,
dropped, and then mouthed
• Object constancy – a major cognitive milestone achieved at
around 9 months. ie. An object exists even when it cannot be
seen. Once this is achieved an infant will persist in finding
objects hidden under a cloth or behind the examiner.

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Emotional development
• Object constancy corresponds to social and communication
changes
• Babies begin to differentiate familiar and strange faces and
may cling and cry.
• Separation becomes more difficult
• Babies may wake up more often to check parents are still
there.
• Emerging autonomy
• Self-feeding with finger foods – practice newly acquired fine
motor skill (pincer skills)

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Communication
• 7-month olds adept at non-verbal communication
showing a range of emotions.
• 9 months babies realize that emotions can be shared
between two people
• 8-9 months – babbling increasing in complexity with
multiple syllables (ba-da-ma) and inflection - mimic
the native language.
• Emergence of true words – sound used consistently
to refer to a specific subject.

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 Implication for the clinician and parents
• Feeding and sleeping problems re-emerge.
• Poor weight gain may reflect the struggle between the infant
and the parent over control of the infant’s feeding.
• Discussions with parents may help to pre-empt these
difficulties.
• 9-month examination of the child is difficult because of the
babies wariness of strangers.

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 Red Flags in infant development

• Unable to sit alone by age 9 months

• Unable to transfer objects from hand to hand
by age 1 year
• Abnormal pincer grip or grasp by age 15
months
• Unable to walk alone by 18 months
• Failure to speak recognizable words by 2
years.
EARLY CHILDHOOD
 Normal toddler:

Toddler stage is between 1 to

3 years of age. During this
period, growth slows
considerably.
 Physical growth
Weight:
The toddler's average weight gain is 1.8 to 2.7
kg/year.
 Height:
• During 1–2 years, the child's height
increases by 1cm/month.

• The toddler's height increases about

10 to 12 cm/year.
 Head and chest circumference:
• The head increases 10 cm from the age of 1
year to adult age.

• During toddler years, chest circumference

continues to increase in size and exceeds head
circumference.
 Teething:
• By 2 years of age, the toddler has 16
temporary teeth.

• By the age of 30 months, the toddler

has 20 teeth
 Physiological growth:
Pulse: 80–130 beats/min (average
110/min).
Respiration: 20–30C/min.
Bowel and bladder control:
Daytime control of bladder and bowel
control by 24–30 months.
 Motor Fine/Gross - toddler
• 1 year old: transfer objects from hand to hand
• 2 year old: can hold a crayon and color vertical
strokes
• Turn the page of a book
• Build a tower of six blocks
• 3 year old: copy a circle and a cross – build
using small blocks
 Motor Fine/Gross - toddler
At 15 months:
• Walk alone.
• Creep upstairs.
• Assume standing position without falling.
• Hold a cup with all fingers grasped around it.

At 18 months:
• Hold cup with both hands.
• Transfer objects hand-to hand at will.
 Continuous
At 24 months:
• Go up and down stairs alone with
two feet on each step.
• Hold a cup with one hand.
• Remove most of own clothes.
• Drink well from a small glass held in
one hand.
At 30 months:
• Jump with both feet.
• Walk up and downstairs, one foot
on a step.
• Drink without assistance.
 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:
• 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.
• Notice sex differences and know own sex.
• The development of autonomy during this
period is centered around toddlers increasing
abilities to control their bodies, themselves
and their environment.
PRE-SCHOOL
 Preschool Stage

Definition:-
It is the stage where child is 3 to 6
years of age. The growth during
this period is relatively slow.
Physical Growth:-
Weight: The preschooler gains
approximately 1.8kg/year.

Height: Doubles birth length by 4–

5 years of age.
Physiological Growth
• Pulse: 80–120 beat/min.
(average 100/min).
• Respiration: 20–30C/min.
• Blood Pressure:
100/67+24/25.
 Fine Motor

• 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

• Buttoning clothing
• Holding a pencil
• Building with small blocks
• Using scissors
• Playing a board game
• Have child draw picture of himself
 Cognitive Development

Preschooler up to 4 years of age is

in the pre-conceptual phase. He
begins to give reasons for his
belief and actions.
 Emotional Development

• Fears the dark

• Impatient and selfish
• Aggression through physical and
verbal behaviours.
• Jealousy of siblings.
 Social Development
• Egocentric
• Tolerates short separation
• Less dependant on parents
• May have dreams & night-mares
• Attachment to opposite sex parent
• More cooperative in play
 Red Flags

• Inability to perform self-care tasks, hand

washing simple dressing, daytime toileting

• Lack of socialization

• Unable to play with other children

• Unable to follow directions during exam

SCHOOL AGE
 Normal School-age Child:
 School-age period is between
the age of 6 to 12 years. The
child's growth and development
is characterized by gradual
growth.
 Physical Growth

Weight:
• School–age child gains about 3.8kg/year.
• Boys tend to gain slightly more weight
through 12 years.
Height:
• The child gains about 5cm/year.
Dentition:
• Permanent teeth erupt during school-
age period, starting from 6 years.
• The child acquires permanent molars,
medial and lateral incisors.
 Physiological Growth:
• Pulse: 90+15 beats/min
(75 to 105).
• Respiration: 21+3C/min
(18–24).
• Blood Pressure: 100/60+16/10.
 Fine Motor
• Writing skills improve
• Fine motor with more focus
• Building: models
• Sewing
• Musical instrument
• Painting
• Typing skills
• Technology: computers
 Gross Motor

match sport to the physical and

emotional development
 School Performance
• Ask about favorite subject
• How they are doing in school
• Do they like school
• By parent report: any learning difficulties,
attention problems, homework
• Parental expectations
 Cognitive Development
The child is in the concrete operational
stage of cognitive development.
He is able to function on a higher level in
his mental ability.
Greater ability to concentrate and
participate in self-initiating quiet activities
that challenge cognitive skills
 Emotional Development
• Fears injury to body and fear of dark.
• Jealous of siblings (especially 6–8 years old
child).
• Curious about everything.
• Has short bursts of anger by age of 10 years
but able to control anger by 12 years.
 Social Development

• Continues to be egocentric.
• Wants other children to play with him.
• Insists on being first in every thing
• Becomes peer oriented.
• Improves relationship with siblings.
• Has greater self–control, confident, sincere.
• Respects parents and their role.
• Joints group.
• Engage in tasks in the real world.
 Red Flags

• School failure
• Lack of friends
• Social isolation
• Aggressive behavior: fights, fire setting,
animal abuse
ADOLESCENCE
 Definition

Adolescence is a transition period from

childhood to adulthood.
Its is based on childhood experiences and
accomplishments.
It begins with the appearance of secondary sex
characteristics and ends when somatic growth
is completed.
Physical growth:
Weight:
• Growth spurt begins earlier in girls (10–14 years,
while it is 12–16 in boys).
• Males gains 7 to 30kg, while female gains 7 to 25kg.
Height:
• By the age of 13, the adolescent triples his birth
length.
• Males gains 10 to 30cm in height.
• Females gains less height than males as they gain 5
to 20cm.
• Growth in height ceases at 16 or 17 years in females
and 18 to 20in males
 Physiological Growth:

Pulse: Reaches 60–80 beats/min.

Respiration: 16–20C/minute.
 Appearance Of Secondary Sex
Characteristics
Secondary sex characteristics in girls:
• Increase in transverse diameter of the pelvis.
• Development of the breasts.
• Vaginal secretions.
• Growth of pubic and axillary hair.
• Menstruation (which occurs between 12 to 13
years).
Secondary sex characteristics in boys:
• Increase in size of genitalia.
• Swelling of the breast.
• Growth of pubic, axillary, facial and chest hair.
• Change in voice.
• Rapid growth of shoulder breadth.
• Production of spermatozoa.
 Adolescent
• As teenagers gain independence they begin to
challenge values
• Criticize adult authority
• Rely on peer relationship
• Mood swings especially in early adolescents
Cognitive Development:
• Through thinking, adolescent can deal with a
problem.

Emotional Development:
• Accompany by changes in emotional control.
• Adolescent exhibits alternating and recurrent
episodes of disturbed behavior with periods of
quite one. He/she may become hostile or ready to
fight, complain or resist every thing.

Social Development:
• Need to family and society, i.e., developing a sense
of identity
• Adolescent shows interest in other sex.
Questions