Dr: Omer. M.

Baashen
Infancy
Early Childhood
Middle Childhood
Adolescent
 Definition of growth

Growth is a physical maturation

resulting an increase in size or numbers of
the body tissues and its various organs.
 Development

It is the process of functional,

physiological maturation of the body. It is
the progressive increase in skills and
capacity to function.
 Stages of Growth and Development

• Infancy
• Neonate: Birth to 1 month
• Infancy: 1 month to 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
 Principles of Growth and
Development
• Growth is an orderly process, occurring
continuously and unique to each child everywhere
in the world.
• G& D is proceed by stages and its sequence is
predictable.
• G& D depends on many factors especially
heriditary and environment.
• Society has strong influence on G& D of a children.
• Development proceeds from the simple to the
complex and from the general to the specific.

• Development occurs in a cephalocaudal and a

proximodistal progression.

• There are critical periods for growth and

development.

• There is a positive correlation between physical,

mental and emotional development of a child.
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.
 Why developmental assessment?

• Early detection of deviation in child’s

pattern of development

• Simple and time efficient mechanism to

ensure developmental progress

• Domains assessed: cognitive, motor,

language, social / behavioral and adaptive
 Anthropometric assessment
• Weight
• Length
• BMI (Body mass Index)
• Circumference:
Head Circumference
Chest Circumference
Mid upper arm Circumference
• Dentition/eruption of teeth
• Osseous growth
1. Weight
• Weight of full term infant: 2.5-3.8 kg
• 20% loss of weight in first week of life

• 25-30gm/day increases till 3 months.

• 40gm/month increases till 1 yr

• Doubled their birth weight in 5 months old.

• Tripled by one year of age.

• Four times in 2 yrs

• Five times in 3 yrs, Six times in 5 yrs

• 7 times in7yrs, 10 times n 10 yrs
 2.Length

• Height improvement indicates skeletal

growth.
• At birth average length is about 50cm.
• Increases to 60cm at 3 months, 70cm at 9
months.
• 75cm-1 yr
• 12cm increases in 2nd yr
• 9cm increases in 3rd yr
• 7cm increases in 4th yr
• 6cm increases in 5th yr
• Doubles in height 4-5yrs
• Height increases in every year after the 5
years of age.
 3.Body mass index (BMI)

• BMI= weight in Kg
Height in M2
• BMI remains constant up to 5 yrs of age.
• BMI >30kg/ M2 indicates obesity
• BMI <10kg/ M2 indicates malnutrition
 4. Head circumference

• Average Head circumference at birth is

about 35 cm
• At 3 months it is about 40cm
• At 6 months it is about 43cm
• At 1 Year it is about 45cm
• At 2 Years it is about 48cm
• At 7 Year it is about 50cm
• At 12 Year it is about 52cm
 Fontannelle closure

• Anterior Fontannelle & posterior

Fontannelle present at birth.
• Posterior Fontannelle closes early within
6-8 weeks of life
• Anterior Fontannelle closes at 12-18
months of life.
• Delayed closure results from malnutrition.
Hydrocephalus, con. Heart disease.
Fontannelle

Anterior Fontannelle Posterior Fontannelle

 Chest circumference
• Also known as thoracic diameter
• At birth 2-8cm less than the head circumference.
• 6-12 months head circumference becomes equal.
• After 1 yr head circumference more than chest
circumference.
• During birth chest circumference round in shape,
later becomes transverse diameter increases.
 Mid upper arm circumference
• It helps to find out the nutritional condition of children.

• At birth average MURC is about 12cm in a normal newborn.

• At 1 yr of age about 12-16cm

• 1-5 yrs about 16-17cm

• At 12 yrs 17-18cm
• At 15 yrs 20-21 cm

• Measurement is taken from acromian process to oleocranon

process of ulna. The simple tape measures are used.
5. Dentition /eruption of teeth
 Types of teeth

• Temporary for small face in small size

• Permanent teeth Bigger in size for growing
face.
Temporary teeth
Also called as Milk teeth/Deciduous teeth,
which erupt at the rate of one tooth every
month.
By the age of 2.5-3yrs all (20)temporary
teeth erupts.
 Permanent teeth
• all temporary teeth replaced by permanent teeth.
• It starts from 6yrs and 12yrs.
• Third molar appears at 18 yrs or later in some
children.

Some babies born with teeth, it is called as natal teeth.

Malocclusion of teeth due to thumb sucking
 6. Osseous growth

• Bony growth is essential for the proper height

of the child.
• Full term neonate have five ossification center.
• They are;
Distal end of femur
Proximal end of tibia
Talus
Calcaneous
Cuboid
Ossification centers
 Factors affecting growth and
development
• Genetic
1. Sex
2. Race and nationality
• Environmental
1. Prenatal
Maternal
nutrition/Infections
2. Postnatal
 Genetic factors
• Characteristics such as
height, body structure, color
of skin, eyes and hair
depends upon inherited
genes from parents.

• Some familial diseases also

affected the growth of
children
 Environmental factors
1. Prenatal factors
Intrauterine environment is an important
predominant factor of growth and development.
• Maternal malnutrition
• Maternal infections
• Maternal substance abuse
• Maternal illness
• Hormones- Thyroxine es the skeleton growth
• Uterine malformations
 2. Postnatal environmental factors
• Growth pattern
• Nutrition
• Childhood illness
• Acute illness
• Physical environment
• Psychological environment
• Cultural influences
• Socio economic status
• Climate and season
• Play and exercises
Growth and development of Infant
(0-1yr)
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 = 16 = 8 kg
2 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
Physiological growth of
infants:-

Pulse 110-150 b/min

Resp 35 ± 10 c/min
Breath through nose.
Blood pressure 80/50 ± 20/10 mmHg
 Gross Motor Skills

• The acquisition of gross motor skill precedes

the development of fine motor skills.

• Both processes occur in a cephalocaudal

fashion
• Head control preceding arm and hand control
• Followed by leg and foot control.
 Gross Motor Development

• Newborn: hardly able

to lift head
• 6 months: easily lifts
head, chest and upper
abdomen and can
bear weight on arms
Head Control

Newborn Age 6 months

 Sitting up

• 2months old: needs assistance

• 6 months old: can sit alone in the tripod

position

• 8 months old: can sit without support and

engage in play
Sitting Up

Age 2 months Age 8 months

 Ambulation

• 9 month old: crawl

• 1 year: stand independently from a crawl
position
• 13 month old: walk and toddle quickly
• 15 month old: can run
Ambulation

13 month old

Nine to 12-months
 Fine Motor - Infant

• Newborn has very little control. Objects will

be involuntarily grasped and dropped
without notice.
• 6 month old: palmer grasp – uses entire hand
to pick up an object
• 9 month old: pincer grasp – can grasp small
objects using thumb and forefinger
Fine Motor Development

12-month-old
6-month-old
 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
• Hearing test done at birth
• Ability to hear correlates with ability enunciate
words properly
• Always ask about history of otitis media – ear
infection, placement of PET – tubes in ear
• Early referral to pediatrician to assess for possible
fluid in ears (effusion)
• Repeat hearing screening test
• Speech therapist as needed
 Personal and social development

• 2 months……..social smile
• 3 months …….. Recognizing the mother
• 6months………. He responds socially to his name
• 9 months……….waves bye bye
• 12 months…….. The infant shows fear of stranger
(stranger anxiety).

He learns that crying brings attention.

The infant smiles in response to smile of others.
 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.
 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.
Growth and development of
Toddler (1-3 yrs)
 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
 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.

 Gross motor development

15 month- stands and walk without support.

• Creeps upstairs
• Throw small objects and pick them up
repeatedly.
18 months- walk sideways and backward
• Runs and often falls
• Climbs on furniture
 24 months- runs more quikly
• Walk backward
• Kicks large balls with out falling.
30 months- stands on one feet alone
• Jumps with both legs
• Ride a walker or pedal car.
 Fine Motor - toddler

15 month- build a tower of 2-3 cubes.

• Open boxes
• Makes a line with crayon.
• Pokes finger in holes
18 months- build a tower of 3-4 cubes
• Scripple vigorously
• Turns a page in book two to three at a time
• Transfers object hand to hand
 Fine Motor – Older Toddler

24 months- build a tower of 6-7 cubes

• Scrippled in more controlled way
• Imitates a circle stroke.
• Able to fold the paper
30 months- build a tower of 8 cubes
• Hold crayons with finger instead of entire
hand.
• Make vertical and horizontal stroke.
 Feeding skills- toddler

15 month- hold a cup with all fingers.

• Cause spilling
• Enjoys finger feeding than spoon feeding.
• Cannot fill the spoon it goes up and down
18 months- Eat with spoon
• Play with food
• Drop the food in the floor
• Spills while eating
 Feeding skills – Older Toddler

24 months- drink well from a single glass

• Plays with food
• Can use straw to drink.
• Imitate eating habit of others
30 months- self feeding with occasional
spilling
• Uses fork and spoon.
• Distinguishes from finger and spoon feed.
Toddler
Toddler

Safety becomes a problem as the toddler becomes more

mobile.
 Issues in parenting - toddlers

• Stranger anxiety – avoid strangers 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
G & D of Pre-School
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 and cognitive abilities

• Buttoning clothing
• Holding a crayon / pencil
• Building with small blocks
• Using scissors
• Playing a board game
• Have child draw picture of himself .
 Emotional Development of
Preschooler
• Fears the dark
• Tends to be impatient and selfish
• Expresses aggression through physical
and verbal behaviors.
• Shows signs of jealousy of siblings.
 Social development in
preschoolers
• Egocentric (Selfish)

• Tolerates short separation

• Less dependant on parents

• May have dreams & night-mares

• Attachment to opposite sex parent

• More cooperative in play

 Red flags: preschool

• Inability to perform self-care tasks, hand washing

simple dressing, daytime toileting

• Lack of socialization

• Unable to play with other children

• Able to follow directions during exam

• Performance evaluation of pre-school teacher for

kindergarten readiness
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.

 Fine motor development
• Writing skills improve

• Fine motor is refined

• Fine motor with more focus

• Building blocks

• Sewing

• Musical instrument

• Painting

• Typing skills

• Technology: computers
 Motor development

At 6–8 years :

• 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:

• Throws balls skillfully.

• Uses to participate in organized sports.

• Uses both hands independently.

• Handles eating utensils (spoon, fork, knife) skillfully.

At 10–12 years:

• Enjoy all physical activities.

• Continues to improve his motor coordination.

 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
 Emotional development

The school–age child:

• 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
The school–age child is :
• 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 (formal and informal).

• Engage in tasks in the real world.

 Cognitive development

• Greater ability to concentrate and

participate in self-initiating quiet activities
that challenge cognitive skills, such as
reading, playing computer and board
games.
 Red flags: school age

• School failure
• Lack of friends
• Social isolation
• Aggressive behavior: fights, fire setting,
animal abuse
Adolescent (13 to 18 Year Old)
 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.
 Adolescent

• As teenagers gain independence they

begin to challenge values

• Critical of adult authority

• Relies on peer relationship

• Mood swings especially in early

adolescents
 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/pimples 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).
 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).
Emotional development:

This period is accompanied usually by

changes in emotional control. Adolescent
exhibits alternating and recurrent episodes of
disturbed behavior with periods of quite one.
He may become hostile or ready to fight,
complain or resist every thing.
Social development:

He needs to know "who he is" in relation to family

and society, i.e., he develops a sense of identity.

Adolescent shows interest in other sex.

He looks for close friendships.

 Adolescent behavioral problems

• Anorexia
• Attention deficit
• Anger issues
• Suicide
Adolescents
 Adolescent Teaching

• Relationships
• Sexuality – STD’s / AIDS
• Substance use and abuse
• Gang activity
• Driving
• Access to weapons
Adolescents