HUMAN GROWTH AND By: MAC PAUL V.

ALARIAO, RN,

DEVELOPMENT MSN
 INTRODUCTION
Growth is defined as an irreversible constant increase in size, and
development is defined as growth in psychomotor capacity. Both
processes are highly dependent on genetic, nutritional, and
environmental factors.  Evaluation of growth and development is a
crucial element in the physical examination of a patient. A piece of
good working knowledge and the skills to evaluate growth and
development are necessary for any patient's diagnostic workup. The
early recognition of growth or developmental failure helps for
effective intervention in managing a patient's problem.
 STAGES IN HUMAN GROWTH
AND DEVELOPMENT 
1. Fetal stage: Fetal health issues can have
detrimental effects on postnatal growth. One-
third of neonates with intrauterine growth
retardation might have curtailed postnatal
growth. Good perinatal care is an essential
factor in promoting fetal health and indirectly
postnatal growth.
 STAGES IN HUMAN GROWTH
AND DEVELOPMENT 
2. Postnatal stage: The process of postnatal
growth and development happens together but
at different rates. The growth occurs by
discontinuous saltatory spurts with a stagnant
background. There are five significant phases
in human growth and development, Infancy
(neonate and up to one year age)
 STAGES IN HUMAN GROWTH
AND DEVELOPMENT 
Toddler ( one to five years of age)
Childhood (three to eleven years old) - early childhood is
from three to eight years old, and middle childhood is
from nine to eleven years old. 
Adolescence or teenage (from 12 to 18 years old)
Adulthood
 FACTORS AFFECTING
GROWTH AND
DEVELOPMENT 
The growth and development are positively
influenced by factors, like parental health and
genetic composition, even before conception
 FACTORS AFFECTING
GROWTH AND
DEVELOPMENT 
1. Genetic factors play a primary role in growth and
development. The genetic factors influencing
height is substantial in the adolescence phase. A
large longitudinal cohort study of 7755 Dutch twin
pairs has suggested that the additive genetic factors
predominantly explained the phenotypic
correlations across the ages for height and body
mass index.
 FACTORS AFFECTING
GROWTH AND
DEVELOPMENT 
2. Fetal health has a highly influential role in
achieving growth and development. Any stimulus
or insult during fetal development causes
developmental adaptations that produce permanent
changes in the latter part of life.
 FACTORS AFFECTING
GROWTH AND
DEVELOPMENT 
3. After birth, the environmental
factors may exert either a
beneficial or detrimental effect
on growth
 FACTORS AFFECTING
GROWTH AND
DEVELOPMENT 
4. Socioeconomic factors: Children of higher socio-
economical classes are taller than the children of the
same age and sex in the lower socioeconomic groups.
Urbanization has positively influenced growth. The
secular trend is observed in growth where the kids grow
taller and mature more rapidly than the previous
generation. This secular trend is observed significantly in
developed countries like North America.
 FACTORS AFFECTING
GROWTH AND
DEVELOPMENT 
5. The family characteristics: Higher family education
levels have a positive impact on growth. The inadequate
emotional support and inadequate developmental
stimulus, including language training, might cause
growth and development deterioration. 
 FACTORS AFFECTING
GROWTH AND
DEVELOPMENT 
6. The human-made environment influences human growth
and development significantly. Certain ongoing studies
have proven the relationship of pollutants in sexual
maturation, obesity, and thyroid function. The excess lead
exposure antenatally significantly associates with low
birth weight. Noise pollution due to transportation
sources also has an association with reduced prenatal
growth. 
 FACTORS AFFECTING
GROWTH AND
DEVELOPMENT 
7. Nutrition 
 Malnutrition plays a detrimental role in the process of growth and development. 
 Deficiencies of trace minerals can affect growth and development. Iron deficiency
usually affects psychomotor development and does not affect growth. Zinc deficiency
might cause growth retardation and developmental delay. Selenium, iodine, manganese,
and copper also play a significant role. 
 Growth faltering or rapid weight gain in early childhood influences health in the later
part of life. The diet in early childhood has a strong association with the likelihood of
obesity later in life. 'Early Protein Hypothesis' shows that lowering the protein supply
during infancy helps achieve normal growth and reduce obesity in early childhood. This
concept of the early protein hypothesis helps in improving the food products for
children. 
 FACTORS AFFECTING
GROWTH AND
DEVELOPMENT 
8. Genetic and environmental factors influence the growth
and development in a perplexing interrelated pathway.
Genetic and environmental risk factors are not mutually
exclusive. Plasticity is the potential of a specific
genotype to bring out diversified phenotypes in response
to diverse environmental factors. The developmental
plasticity can happen from the embryonic stage to
adolescence and can be passed onto the next generation. 
 FACTORS AFFECTING
GROWTH AND
9.
DEVELOPMENT 
Role of experience during early childhood: Exposure to
adverse experiences in early childhood might hinder
development. Profound neglect during early childhood can
impair development. Children adopted before six months of
age have similar development when compared to their non-
adoptive siblings. If children adopted after six months have a
high risk of cognition deficits, behavioral issues, autism, and
hyperactivity. Early intervention for children with adverse
experiences is the pillar in healthy development.
 ISSUES OF CONCERN
Measurement of Growth
Anthropometry is the gold standard by which clinicians can
assess nutritional status. The major anthropometric
measurements for age up to 2 years are weight, length,
weight for length, and head circumference. The major
measurements used for children above two years are weight,
height, body mass index (BMI), and head circumference for
the 2-3 years age group. 
 ISSUES OF CONCERN
Length or height: For children less than two years or children with severe cerebral palsy,
the length is the ideal way of measuring stature. Length is measured by placing the child
supine on an infant measuring board. For children aged more than two years, standing
height is measured in the stadiometer after removing shoes. The supine length is usually 1
cm higher than standing height. Length and height can be documented to the closest 0.1
cm. For children with severe cerebral palsy or spinal deformities, upper arm length, tibial
length, and knee height can be useful to assess stature.

•Weight: The kids below one year are weighed on a scale after removing the clothes,
shoes, diaper, and documented to the closest 0.01 kg. The kids outside the infancy phase
should be measured without shoes, with little or no outer clothing, and documented to the
closest 0.1 kg. 
 ISSUES OF CONCERN
Head circumference or occipitofrontal circumference: Head circumference is
assessed by measuring the largest area from the prominent site at the back
(occiput) to the frontal prominence above the supraorbital ridge. Brain growth is
maximum in the first three years of life, so head circumference is used in
children less than three years.  It is measured as the maximum diameter through
the supraorbital ridge to the occiput and documented to the closest 0.01 cm.
Microcephaly is more than two standard deviations below the mean.
Macrocephaly is more than two standard deviations above the mean. 
 ISSUES OF CONCERN
Measure of adiposity:
Body mass index (BMI) is a useful predictor of adiposity. BMI is calculated with formula,
weight (kg) / height (m) squared. BMI is the single best indicator for detecting overweight
or obesity
< 5th percentile - underweight 
5th to 84th percentile - normal 
85th to 95th percentile - overweight 
95th to 98th percentile - obesity 
More than 99th percentile - severe obesity
The weight to length ratio is an alternative for body mass index in predicting adiposity in less
than two years. 
Self-assessment of the hip to waist ratio can help to guide the measure of central adiposity,
Triceps and subscapular skinfolds can also be a useful measure of adiposity.
 ISSUES OF CONCERN
Body proportions
 The upper segment to lower segment (U/L) ratio is 1.7 at birth, 1.3 at three years, and
reaches 1.0 at greater than seven years. A higher U/L ratio is a feature in short-limb
dwarfism.
 Arm span to height ratio is a fixed ratio across all ages. The ratio of more than 1.05:1 is
suggestive of Marfan syndrome.
Sexual maturity: Tanner's stage can be used to assess sexual maturity.
Skeletal maturity: Bone age can be determined by doing Hand & Wrist
radiographs from 3 to 18 years of age. 
Dental assessment: Primary tooth eruption begins with the central incisors at
six months. No single tooth by 13 months of age is of concern. Permanent tooth
eruption starts at six years of age and continues up to 18 years of age. 
 ISSUES OF CONCERN
Growth Velocity 
The growth velocity is different at different stages of life. Also, different tissues
grow at different rates at the same stage of life. The lymphoid tissues can
exceed adult size at six years of age. Girls are taller than boys at 12 to 14 years,
but later they will not grow taller than their boy's counterpart. Growth velocity
is maximum during infancy and adolescence. The head circumference reaches
closer to adult size by six years of age. The prepubertal height velocity of less
than 4 cm per year is of concern. During puberty, the height velocity is 10 to 12
cm per year in boys and 8 to 10 cm per year in girls. The prepubertal weight
velocity of less than 1 kg per year is of concern. Weight velocity is highest
during puberty, up to 8 kg per year.
 STAGES OF
DEVELOPMENT
Development is a continuous process from neonatal to adulthood. Though the
growth ceases after adolescence, adolescence is not the end for development.
Each developmental stage has a new set of challenges and opportunities.
Infancy: Development progress in cephalo-caudal direction and also from the
midline to the lateral direction.  A three to four-month variation can be there in
achieving the developmental milestone. Social development is a cortical
function that develops earlier than motor skills. Lack of social smile by four
weeks is of concern. At birth, the infant is equipped with primitive reflexes.
Certain primitive reflexes help in the normal physiology of infants. Sucking
and rooting reflex helps inefficient feeding. Most of the primitive reflex
disappears to facilitate the mature development process. For example, the grasp
reflex disappears by six months, and the child develops mature grasp
development from 6-12 months. 
 STAGES OF
DEVELOPMENT
Early and late childhood: Between ages 1 and 3 years, locomotion and
language are crucial. The best predictor of cognitive function is language. Fine
motor skills are related to self-help skills. The most common development in
early childhood is to establish self-identity. A child may have independent
existence by three years of age. The kids learn independent existence skills like
feeding behavior, toilet training, and self dressing during this stage of early and
late childhood. Questioning skills develop during early childhood
development.   
 STAGES OF
DEVELOPMENT
Adolescence: Adolescence is hallmarked by
puberty changes, which occur two years earlier in
females than in males. Puberty changes are
assessed using the Tanner staging. Acceptance of
a new body and separation from home, and
establishing oneself as an independent adult in
society are the significant challenges in puberty.
 RED FLAGS IN GROWTH AND
DEVELOPMENT 
Red flag signs in motor development are persistent fisting for more
than three months, the persistence of primitive reflexes and rolling
before two months, and hand dominance before 18 months. 
No babbling by twelve months, no single words by sixteen months,
no two-word sentences by two years, and loss of language skills are
red flags.
Children whose height or weight readings below the 5th percentile,
above the 95th percentile, or cross two major centile lines need
further evaluation.