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.

By understanding what to expect during each stage of development, parents can easily capture the teachable moments in everyday life to enhance their child's language development, intellectual growth, social development and motor skills.

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.

Principles of Growth & Development
G & D proceed in regular related directions :
- Cephalo-caudal(head down to toes)
- Proximodistal (center of the body to the peripheral)
- General to specific

Growth Pattern

Growth Patterns
The child’s pattern of growth is in a head-to-toe direction, or cephalocaudal, and in an inward to outward pattern called proximodistal.

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
- Infection with German measles
- 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 development
- Social development

Stages of Growth and Development
Prenatal
- Embryonic (conception- 8 w)
- Fetal stage (8-40 or 42 w)
Infancy
Neonate
Birth to end of 1 month
Infancy
1 month to end of 1 year
Early Childhood
Toddler
1-3 years
Preschool
3-6 years
Middle Childhood
School age
6 to 12 years
Late Childhood
Adolescent
13 years to approximately 18 years

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
Boys average Ht = 50 cm
Girls average Ht = 49 cm
Normal range for both (47.5- 53.75 cm)
Head circumference
33-35 cm
Skull has 2 fontanels (anterior & posterior)

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

Chest circumference
It is 30.5 to 33cm (usually 2–3cm less than head circumference).

Physiological growth
Vital signs
- Temperature (36.3 to37.2°C ).
- Pulse ( 120 to 160 b/min ).
- Respiration ( 35 to 50C/min) .

Simulation for vital signs

APGAR scoring chart

Newborn Senses

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 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.

Normal Newborn Infant

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

Reflexes
Swallowing
Gagging
Sucking
Grasp
Tonic-neck

One month-Reflexes

Emotional development
The newborn infant expresses his emotion just through cry for hunger, pain or discomfort sensation

Infancy

Sitting Up
Age 2 months
Age 8 months

Ambulation
13 month old
Nine to 12-months

Fine Motor Development
in infancy
6-month-old
12-month-old

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 4-5 months and triple it by 10-12 months of age

Calculating infant’s weight
Infants from 3 to 12 months
Weight = Age in months + 9
2
Wt of 7 months old infant = 7+9 = 8 kg
2

Height
Length increases about 3 cm /month during the 1st 3 months of age,
then it increases 2 cm /month at age of 4-6 months,
Then, at 7 – 12 months, it increases 1 ½ cm per month

Head circumference
It increases about 2 cm /month during the 1st 3 months,
Then, 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
By the end of the 1st year, it will be equal to head circumference.
Physiological growth of infants:-
Pulse 110-150 b/min
Resp 35 ± 10 c/min
Breath through nose.
Blood pressure 80/50 ± 20/10 mmHg

Dentition:
Eruption of teeth starts by 5–6 months of age. It is called "Milky teeth" or "Deciduous teeth" or "Temporary teeth".

Average age for teeth eruption:
Lower central incisors
Upper central incisors
Upper lateral incisors
Lower lateral incisors
Lower first molars
Upper first molars
Lower cuspids
Upper cuspids
Lower 2nd molars
Upper 2nd molars
Erupt at 6 months
Erupt at 7.5 months
Erupt at 9 months
Erupt at 11 months
Erupt at 12 months
Erupt at 14 months
Erupt at 16 months
Erupt at 18 months
Erupt at 20months
Erupt at 24 months.

Motor Development
At 2 months
Hold head erects in mid-position.
Turn from side back.
At 3 months, the infant can
Hold head erects and steady.
Open or close hand loosely.
Hold object put in hand

Head Control
Newborn
Age 6 months

At 4 months, the infant can:
Sit with adequate support.
Roll over from front to back.
Hold head erect and steady while in sitting position.
Bring hands together in midline and plays with fingers.
Grasp objects with both hands.

At 5 months, the infant can:
Balance head well when sitting.
Site with slight support.
Pull feet up to mouth when supine.
Grasp objects with whole hand (Rt. or Lt.).
Hold one object while looking at another

At 6 months, the infant can:
Sit alone briefly.
Turn completely over ( abdomen to abdomen ).
Lift chest and upper abdomen when prone.
Hold own bottle.

At 7 months, the infant can:
Sit alone.
Hold cup.
Imitate simple acts of others.

At 8 months, the infant can:
Site alone steadily.
Drink from cup with assistance.
Eat finger food that can be held in one hand.

At 9 months, the infant can:
Rise to sitting position alone.
Crawl (i.e., pull body while in prone position).
Hold one bottle with good hand-mouth coordination

At 10 months, the infant can:
Creep well (use hands and legs).
Walk but with help.
Bring the hands together.
At 11 months , the infant can:
Walk holding on furniture.
Stand erect with minimal support

At 12 months , the infant can:
Stand-alone for variable length of time.
Site down from standing position alone.
Walk in few steps with help or alone (hands held at shoulder height for balance).
Pick up small bits of food and transfers them to his mouth

Ambulation(motor growth)
9 month old: crawl
10 month old: creep
1 year: stand independently from a crawl & creep position
13 month old: walk and toddle quickly
15 month old: can run

Emotional development:
His emotions are instable, where it is rapidly changes from crying to laughter.
His affection for or love family members appears.
By 10 months, he expresses several beginning recognizable emotions, such as anger, sadness, pleasure, jealousy, anxiety and affection.
By 12 months of age, these emotions are clearly distinguishable.

Social development
He learns that crying brings attention.
The infant smiles in response to smile of others.
The infant shows fear of stranger (stranger anxiety).
He responds socially to his name.
According to Erikson, the infant develops sense of trust. Through the infant's interaction with caregiver (mainly the mother), especially during feeding, he learns to trust others through the relief of basic needs.

As an infant's vision develops, he or she may seem preoccupied with watching surrounding objects and people

Speech Milestones
1-2 months: coos
2-6 months: laughs and squeals
8-9 months babbles: mama/dada as sounds
10-12 months: “mama/dada specific
18-20 months: 20 to 30 words – 50% understood by strangers
22-24 months: two word sentences, >50 words, 75% understood by strangers
30-36 months: almost all speech understood by strangers

Hearing
BAER hearing test done at birth
Ability to hear correlates with ability enunciate words properly
Always ask about history of otitis media – ear aiding devices.
Early referral to MD to assess for possible fluid in ears (effusion)
Repeat hearing screening test
Speech therapist as needed

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.

Vision in toddler age

Toddlers

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.
Formula to calculate normal weight of children over 1 year of age is
Age in years X 2+8 = ….. kg.
e.g., The weight of a child aging 4 years
= 4 X 2 + 8 = 16 kg

Height:
During 1–2 years, the child's height increases by 1cm/month.
The toddler's height increases about 10 to 12.5cm/year.

Formula to calculate normal height
Age in years X 5 + 80 = cm.
e.g., the length of 2 years old child
= 2 X 5 + 80 = 90cm

Head and chest circumference:
The head increases 10 cm only 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 (2.5 years), 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.

Fine Motor - 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

Gross - Motor of toddler
At 15 months, the toddler can:
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: the toddler can:
Jump with both feet.
Jump from chair or step.
Walk up and downstairs, one foot on a step.
Drink without assistance.

Social development:
The toddler is very social being but still egocentric.
He imitates parents.
Notice sex differences and know own sex.

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: He 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 – Older Toddler
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 and cognitive abilities
pre-school
Buttoning clothing
Holding a pencil
Building with small blocks
Using scissors
Have child draw picture of himself

Emotional Development of Preschooler
Fears the dark
Tends to be impatient and selfish
Expresses agression through physical and verbal behaviours.
Shows signs of jealousy of siblings.

Social development
According to Erikson theory:
The preschooler is in the stage where he develops a sense of initiative, Where he wants to learn what to do for himself, learn about the world And other people.

Red flags: preschool
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

Pool Safety

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.
Weight Formula for 7 - 12 yrs
= (age in yrs x 7 )– 5
2

Height:
The child gains about 5cm/year.
Body proportion during this period: Both boys and girls are long-legged.
Dentition:
Permanent teeth erupt during school-age period, starting from 6 years, usually in the same order in which primary teeth are lost.
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.

School Years: fine motor
Writing skills improve
Fine motor with more focus
Building: models – logos
Sewing
Musical instrument
Painting
Typing skills
Technology: computers

Motor development
At 6–8 years, the school–age child:
Rides a bicycle.
Runs Jumps, climbs and hops.
Has improved eye-hand coordination.
Prints word and learn cursive writing.
Can brush and comb hair.

At 8–10 years, the school–age child:
Throws balls skillfully.
Uses to participate in organized sports.
Uses both hands independently.
Handles eating utensils (spoon, fork, knife) skillfully.
At 10–12 years, the school–age child:
Enjoy all physical activities.
Continues to improve his motor coordination.

School Age: gross motor
8 to 10 years: team sports
Age ten: match sport to the physical and emotional development

School Age

Red flags: school age
School failure
Lack of friends
Social isolation
Aggressive behavior: fights, fire setting, animal abuse

13 to 18 Year Old

Adolescent age
Physical growth
Physiological growth
Secondary sex characteristics
Cognitive development
Emotional development
Social development

Definition of adolescent:
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 and the individual is psychological mature.

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 adult value 60–80 beats/min.
Respiration: 16–20C/minute.
NB: The sebaceous glands of face, neck and chest become more active. When their secretion accumulates under the skin in face, acne will appear.

Appearance of secondary sex characteristics
1- Secondary sex characteristics in girls:
Increase in transverse diameter of the pelvis.
Development of the breasts.
Change in the vaginal secretions.
Growth of pubic and axillary hair.
Menstruation (first menstruation is called menarche, which occurs between 12 to 13 years).

Body image

2- 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 (which is sign of puberty).

Adolescent behavioral problems
Anorexia
Attention deficit
Anger issues
Suicide