GROWTH AND

DEVELOPMENT
KABITA MITRA (SEN)
SENIOR LECTURER
DEFINITION

GROWTH------------ The term growth

denotes a net increase in the size, or
mass of the tissue. It is largely attributed
to multiplication of cells and increase in
the intracellular substance
ACCORDING TO HURLOCK

GROWTH is change in size, in proportion,

disappearance of old features and acquisition
of new ones
According to Crow and Crow (1962)

Growth refers to structural and physiological

changes
DEVELOPMENT

Development specify maturation of

functions. It is related to the maturation and
myelination of the nervous system and
indicates acquisition of a variety of skills
for optimal functioning of the individual
According to Hurlock(1959)

Development means a progressive series of

changes that occur in an orderly predictable
pattern as a result of maturation and
experience.
According to J.E. Anderson(1950)

 Development is concerned with growth as

well as those changes in behavior which
results from environmental situations
According to Liebert, Poulos and Marmor
(1979)
Development refers to a process of change
in growth and capability over time, as
function of both maturation and interaction
with the environment
DIFFERENCE BETWEEN GROWTH AND
DEVELOPMENT
GROWTH DEVELOPMENT

The term is used in purely Development implies overall

physical sense. It generally refers change in shape, form or
to increase in size, length structure resulting in improved
working or functioning

Changes in the quantitative Changes in the quantitative

aspects come into the domain of aspects come into the domain of
Growth Growth
 Contd…..
GROWTH
It is a part of developmental
process. Development in its
quantitative aspect is termed as
growth.
Growth does not continue
throughout life. It stops when
maturity has been attained
DEVELOPMENT
It is a comprehensive and wider
term and refers to overall changes
in the individual
Development is a wider and
comprehensive term and refers to
overall changes in the individual. It
continues throughout life and is
progressive
Contd…..
GROWTH DEVELOPMENT

Growth involves body changes Development involves changes of

an orderly, coherent type tending
towards the goal of maturity

The changes produced by growth Development implies improvement

are the subject of measurement. in functioning and behavior and
They may be quantified. hence bring qualitative changes
which are difficult to be measured
directly
Contd…..
GROWTH DEVELOPMENT

Growth is cellular . It takes place Development is organizational. It

due to the multiplication of cells. is organization of all the parts
which growth and differentiation
have produced

Growth may or may not bring Development is also possible

development. without growth.
Principles/Characteristics of Growth and
Development*****
 Growth and development is continuous and orderly process with
individual difference and unique to each child
 It proceeds by stages and it’s sequence is predictable and same in
all children but there may be difference in time of achievement.
 There is coordination between increase in size and maturation.
 They proceed in cephalocaudal (from head down to tail)and
Proximodistal (from the center or midline to periphery).
Contd….

 Initial mass activities and movements are replaced by specific

response or actions by the complex process of individualized
changes
 Rate of growth and development is interrelated and rapid in
infancy and in puberty but slow in preschool and school age.
 Growth and development depends on combination of many
interdependent factors especially by heredity and environment.
Cephalocaudal and proximodistal direction
Importance of Growth and Development for
Nurses:
• Knowing what to expect of a particular child at any given age.

• Gaining better understanding of the reasons behind illnesses.

• Helping in formulating the plan of care.

• Helping in parents’ education in order to achieve optimal growth

& development at each stage.
Factors affecting growth and development:
• Genetic factors ( Sex, Race )
• Environmental factors

Prenatal Factors -------

1-Factors related to mothers during pregnancy:
- Nutritional deficiencies
- Illness like Diabetes, Heart disease, Hypothyroidism,
Hypertension etc
- Exposure to radiation
- Infection like HIV,HBV,STORCH
- Substance abuse
- Miscellaneous like uterine malformation, mental status
Contd……
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 …
)
Contd….
• Child’s intelligence
• Hormonal influences
• Emotions of the child
• Cultural influence
• Play and exercise
Stages of Growth and Development
• Prenatal
- Ovum (0-14 days after conception)
- Embryo (14 days - 8 w)
- Fetal stage (8-40 or 42 w)
• Infancy
- Neonate (Birth to 4 weeks of life)
- Early neonate (0-7 days of life)
- Late Neonate (7-28 days of life)
- Infancy (First year of life)
• Early Childhood
- Toddler (1-3 years)
- Preschool (3-6 years)
Contd……
• Middle Childhood
- School age (6 to 12 years)
• Late Childhood
Adolescent (from puberty to Adulthood)
 Early adolescent (10-12 years in Girls and 12-14 yrs in Boys)
 Middle adolescent (12-14 yrs in Girls and 14-16 yrs in Boys)
 Late adolescent (14-18 yrs in Girls and 16-20 yrs in Boys
Post natal growth pattern (Scammon’s
Growth Curve)
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 development
- Social development
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 mon

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.
Contd…….
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 4-5 months and triple it by 10-12 months of
age
 Weight calculation
Infants from 3 to 12 months
Weight = (Age in months + 9) / 2

Wt of 7 months old infant = (7+9)/2 = 16/2 = 8 kg

Weight according to age
 Birth ---- 3 kg
 5 months ----- 6 kg (2 x Birth weight)
 1 year ---- 9 kg (3 x Birth weight)
 2 years ---- 12 kg (4 x Birth weight)
 3 years ------15 kg ( 5 x Birth weight)
 5 years ------ 18 kg ( 6 x Birth weight)
 7 years ------ 21 Kg ( 7 x Birth weight)
 10 years ----- 30 Kg ( 10 x Birth weight)
Height
• Boys average Ht = 50 cm
• Girls average Ht = 49 cm
• Normal range for both (47.5- 53.75 cm)

Head circumference
33-35 cm
Head is ¼ total body length
Skull has 2 fontanels (anterior & posterior)
Chest circumference
It is 30.5 to 33cm (usually 2–3cm less than head circumference
LENGTH ACCORDING TO AGE

 Birth ------ 50 cm
 1 Year ----- 75 cm
4 and ½ years ---- 100 cm
Mid Arm Circumference ( MAC)
 Measured between acromian and olecranon in the middle of
upper arm
 Measured by Sakir’s tape ( can be measured by normal tape)
 >13.5 cm is NORMAL
 12.5 cm – 13.5 cm --- BORDERLINE MALNUTRITION
 <12.5 cm ----- SEVERE MALNUTRITION
WHO Growth Chart/Road to Health chart----
Weight for age chart
Height for Age chart (Chronic or long
duration malnutrition)
Weight for Height ( Measures Stunting)
Anterior fontanel
• Diamond in shape
• The junction of the sagittal, corneal and frontal sutures forms it
• 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 month of age
Location of fontanels
Physiological growth
• Vital signs
- Temperature (36.3 to37.2C ).
- Pulse ( 120 to 160 b/min ).
- Respiration ( 35 to 50/min) .
- Blood pressure 80/50 ± 20/10 mmHg
APGAR scoring chart
Downe’s scoring chart
Newborn Senses/ Sensory Development

-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 usually comfortable with touch.

Vision

• Pupils react to light

• Bright lights appear to be unpleasant to newborn infant.

• Follow objects in line of vision

Hearing

• The newborn infant usually makes some response to sound from

birth.

• Ordinary sounds are heard well before 10 days of life

• The newborn infant responds to sounds with either cry or eye

movement, cessation of activity and / or startle reaction.
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, as he smell

breast milk.
MOTOR DEVELOPMENT
Gross Motor Development
 Involves control of the child over his/her body by increasing mobility
 It promotes independent locomotion and proceeds fine motor activities
Key gross motor developmental milestones include------
 Neck holding ------------------------- 3 months
 Rolls over -----------------------------5 months
 Sitting with support (Tripod fashion) --- 6 months
 Sitting without support ------------------- 8 months
 Crawling on abdomen ---------------------8-9 months
 Creeping on hands and knees ----------- 9-10 months
Cont…….
 Standing with support -------------------- 9 months
 Standing without support ---------------- 10-12 months
 Walk holding furniture ------ 11-12 months
 Walks alone, creeps upstairs ---- 15 months
 Running/ Explore drawers -------- 18 months
 Climbing up and downstairs (2 feet /step) ------ 2 years
 Jumps ------ 2 years
 Riding tricycle ------ 3 years
 Going upstairs ( alternate feet) --------- 3 years
 Hop on one foot, alternate feet going downstairs ----- 4 years
 Skip ----- 5 years
Fine motor development
 Depends upon neural tract maturation
 Initial neurological reflexes are replaced by purposeful activities
 Fine motor development promotes adaptive activities with fine sensorimotor
adjustment
 Key fine motor developmental milestones include------
1. Hand Eye coordination
 Hand regard ------ 3-4 months
 Bidextrous reach (reaching out for objects with both hands) ---- 4 months
 Unidextrous reach (reaching out for objects with one hand) ----- 6 months
 Immature grasp/Palmar grasp/ Transfer objects ------ 6 months
 Intermediate grasp ( Beginning to use radial aspect of the hand)----- 8 months
Cont ------
 Immature pincer grasp( Probes with index finger) ----- 9 months
 Mature pincer grasp (thump and index finger approach) ---- 12 months

2. Hand to Mouth coordination

 Tends to mouth all objects offered to child ---- 6 months
 Feed self from a cup but spills ------------- 1 year
 Can pick up a cup and drink from it without much spilling ------ 15 months
 Can feed himself well using a spoon ------- 18 months
Cont ………..
3. Advance hand skills
 Imitates scribbling/ Make tower of 2 blocks/ Turn 2-3 pages together of a book
-----15 months
 Scribbles/Tower of 3 blocks -------- 18 months
 Vertical and circular strokes/ Tower of 6 blocks/ Unscrew lids/ Turns door
knobs/Turn pages of a book, one at a time ------ 2 years
 Copies circle/ Tower of 9 blocks ------- 3 years
 Copies cross/ make figures with blocks ------ 4 years
 Copies triangles and other figures ------ 5 years
Cont …………….
4.Dressing
 Starts to pull off mittens, caps and socks -------- 1 year
 Can unzip but fumble with buttons ------ 18 months
 Can put on shoes and socks and undress completely ------ 2 years
 Can dress and undress fully ( need help with buttons) ----- 3 years
 Can tie shoelaces as well ------ 5 years
Personal and Social Development/ General
understanding
 The child intently watches his mother when she talks to him -----1 month
 Starts smiling back (Social smile) when any one talks to him or smiles to him
------ 6-8 weeks of age
 Enjoys looking around and recognizes mother ---- 3 months
 Vocalizes and smiles at his mirror image and imitates act such as tongue
protrusion ----- 6 months

 Recognizes strangers/ Stranger anxiety ------ 6-7 months

 Waves “bye-bye” / Repeat any performance that evokes an appropriate response

from the observer-------- 9 months
Cont --------------
 Comes when called/ Can understand simple question ------- 1 year
 He points to objects in which he is interested ------ 15 months
 He follows simple order/ Indulges in domestic mimicry ------ 18 months
 Asks for food, drink, toilet/ pulls people to show toys/ When asked he can point
to 5-6 familiar objects/ name at least 2-3 objects/ point to 3-4 body parts
------------ 2 years

 He begins to count/ identify 1-2 colours/ sing simple rhymes/ shares toys/ Knows
full name and gender ------- 3 years

 Left and right discrimination/ Plays cooperatively in a group/ goes to toilet alone
---------- 4 years
 Follow 3 step command/ Identify 4-6 colours/ repeat 4 digits/helps in household
tasks --------- 5 years
 Sensory Development
AT BIRTH ----
Vision
 The eye is structurally incomplete, can not focus on an object,
pupils react to light, blink reflex is present, corneal reflex is
present, tear glands do not begin to function until 2-4 weeks
of age
 Focus momentarily on a bright and moving object that is
within 20 cm or 8 inches and in the midline of the visual field
 Infants also demonstrate visual preferences: medium colours
(yellow, green, pink) over bright( Red, Orange, Blue) or dim
colours
 Also prefer black and white contrasting patterns
Hearing
 Newborn probably have auditory acuity similar to that of
adult
 Response to low frequency and high frequency sound
differently
 Early sensitivity to the sound of human voice
 Infants younger than 3 days can discriminate the
mother’s voice than that of other women.
Smell
 React to strong odors like alcohol or vinegar
 Able to smell breast milk
 Can differentiate the breast milk of their mother from
other women
 Can identify maternal odor.
Taste
 Can distinguish among tastes and various types of solution
elicit differing facial reflexes

Touch
 Newborn are able to perceive tactile sensation in any part
of the body
 Has a strong sense of pain
 Sensory development
1 month old
 Able to fixate on moving object in range of 45 degree at a
distance of 20-25 cm
 Follow light to midline Quiets when hears a voice
 Low visual acuity
2 months
 Binocular fixation and convergence to near objects
beginning when supine
 Follow dangling toys from side to point beyond midline
 Visually searches to locate sound
 Turns head to side when sound is made at level of ear
3 months
 Follow objects to periphery(180 degree)
 Locate sound by turning head to side and looking in same
direction
 Begin to have ability to coordinate stimuli from various
sense organ
4 months
 Able to accommodate to near objects
 Binocular vision fairly well established
 Can focus on a 1.25 cm (0.5 inch) block
 Beginning eye – hand coordination
5 months
 Visually pursues a dropped object
 Is able to sustain visual inspection of an object
 Can localize sounds made below ear

6 months
 Adjust posture to see an object
 Prefers more complex visual stimuli
 Can localize sounds made above ear
 Will turn head to the side and then look up or down
7-8 months
 Can fixate on very small object
 Responds to own name
 Localizes sound by turning head in a curving arch
 Beginning awareness of depth and space
 Has taste preferences
9-11 months
 Localizes sounds by turning head diagonally and
directly towards sound
 Depth perception increasing
12 months
 Discriminate simple geometric forms
 Amblyopia may develop with lack of binocularity
 Can follow rapidly moving object
 Controls and adjust response to sound
 Listens for sound to recur
15- 24 months
 Able to identify geometric forms
 Places round objects into appropriate hole
 Binocular vision well developed
 Displays an intense and prolonged interest in pictures

24-30 MONTHS
 Accommodation well developed in geometric
discrimination
 Able to insert square block into oblong space
Language Development
 1 Months --- Alert to sound
 3 Months ---- Coos ( Musical vowel sounds)
 4 Months ---- Lough loud
 6 Months ---- Monosyllables( ba, da, pa)
 9 Months ---- Bisyllables ( mama, baba, dada)
 12 Months ---- 1-2 words with meaning
 18 Months ---- 8-10 words vocabulary
 2 Years ---- 2-3 word sentences, Uses “I”, “Me”, “ You”
 3 Years --- Ask questions, knows full name and gender
 4 Years ----- Says song or poem, tells stories
 5 Years ----- Asks meaning of words
Dentition
 Red Flag Signs in child development
 No Visual fixation or following by ------ 2 months
 No vocalization by ------- 6 months
 Not sitting without support by ------ 9-10 months
 Not standing alone by ------- 16 months
 Not walking alone by ------ 18 months
 No single words by ------ 18 months
 Lack of imaginative play at ------ 3 years
 Loss of comprehension, single ward or phrases at any age