Chil Growth and Dev

8/8/2019 Chil Growth and Dev

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PHYSICAL GROWTH AND

DEVELOPMENTDifferent aspects and

Assessment

Presented by

Dr Dipti Rami


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Definition of Terms

Growth: The process by which a livingbeing or any of his parts increase in sizeand mass either by multiplication or

enlargement of component parts(quantitative)

Development: Enhancement offunction, skills and maturation.

(qualitative)


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Biological influences Genetics

Role of Teratogens

Birth order, Birth interval

Postpartum illness

Exposure to hazardous substance

Maturation

Gender

Nutrition


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Psychological Influences

Attachment: tendency of ayoung child to seek proximityto the parents during thetimes of stress

Contingency: when adultcaregivers pay attention to the

verbal and non verbal cues ofchildren and respond to themaccordingly.


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Social Factors

Family systems: role ofparents; parent child dyad

Ecologic model: parent childdyad at the centre with thelarger society at theperiphery


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Stages Prenatal: Conception to the Birth

Infancy: Birth to 12 months

Neonatal period: Birth to 28 days

Early neonatal period: Birth to 7 days

Late neonatal period: 7 days to 28 days

Infancy Period: 29 days to 12 months


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Principles of growth and Development

There are definite and predictable patternof growth and development that arecontinuous, orderly and progressive.

Crawl Creep Walk Babbles Words Sentences

Scribble Writing


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1. Directional Pattern:

Cephalocaudal Pattern ( Head to Tail)

Proximal to Distal (Midline to peripheral)

Mass to specific (Differentiation)

2. Sequential Pattern: Involves a predictablesequence of Growth and Development stages

through which a child normally proceeds.

For motor skills such as locomotion i.e. child startscrawling before walking and for behaviours suchas language and social skills

(e.g. First child plays alone, then with others).


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Assessment of growth

Growth can be measured in term of: Nutritional Anthropometry (Wt., Ht., Hc., Cc.)

Assessment of Tissue growth (Muscle mass,

Skin fold thickness)

Bone age (Radiological assessment ofepiphysis)

Dental age

Biochemical and histological means


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Formulas for Approximate Average Height

and Weight of Normal Infants and Children

WEIGHT IN kg IN Lb

At birth 3 6

3-12 months Age (in mo)=9

2

Age (mo)+11

1-6 years age (yr) X 2+8 Age (yr) X 5+7

7-12 years (Age (in yr) x 7)+52

Age (yr) X 7+5

HEIGHT In cm In At birth 50 20

At 1 year 75 30

1-12 year Age (yr) x 6+77Age (yr) X 21/2+3


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Assessment of Weight

Best index of growth andnutrition

Newborn looses weight of 10%

ofBirth weight till early 7 daysand regain by 10th Day.

Birth weight doubles by 4

month and triples by a year &4 times by 2 years.


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Usual changes in weight at different ages

4-5 months-------------- BW X 2

1 Year ------------------- BW X 3

2 Year ------------------- BW X 4

3 Year ------------------- BW X 5

5 Year ------------------- BW X 6

7 Year ------------------- BW X 7

10 year------------------- BW X 10


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Assessment of Height

Reliable criterion of growth

Not affected by excess fat or fluid

Reflects growth failure and chronicmalnutrition


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AtBirth : 50cm 6 months : +12 cm

1 year : 75 cm, increased by 50%

2 years- 85 cm 2-5 years : +6 to 8cm/year

2-12 year: age in yr x 6 + 7

4 year : doubled

5 years - 5cm/year

13 year : tripled


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Acceleration of Growth :

Girls: 10-12 years

Boys: 12-14 years

Cessation of Growth :

Girls: 17-19 years

Boys: > 20 years


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Upper/Lower segment Ratio

Age upp seg/ lower seg

At birth 1.8/1

3-4 year 1.3/1

9 yrs 1/1

18yrs 0.9/1


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Head circumference

Taken up to 3 years of age

Landmarks: supraorbital ridge

(anteriorly) and most prominent part ofocciput (posteriorly).

Related to intracranial volume and braingrowth.


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Head Circumferences AGE HC VELOC

HC= Length in Cm+9.5)+2.5

2

Till 3 months 2 cm / months

3 months to 1 year- 2 cm/3months

(1/3 of initial velocity)

1 3 years 1cm/6 months

(1/12 cm of initial velocity)

3 5 years 1 cm/ year

(1/24 cm of initial Velocity)


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Chest Circumferences

Measured at the level of Nipple

2.5 cm lesser them HC

Equal to HC by 1 year

Lesser then HC by 1.5 year


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Others

Mid arm circumference:

Applicable for 1-4 years

being >13.5 is normal

At mid point- Acromion and Olecranon.

Arm spam:

Distance between tips of the middlefingers with both arm held wide open

(Spread apart)


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Dental Growth

Most infants have their first teeth eruptat age 68 months of Age.

First year of life:No. of teeth= age in month 6

Two types of Tooth are Primary or Deciduous

Secondary or Permanent Teeth


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Primary or Deciduous

Tooth Age at eruption Age at shedding

Maxillary Mandibular Maxillary Mandibular

Central

incisors

6-8 mo 5-7 mo 7-8 yr 6-7yr

Lateralincisors

8-11 mo 7-10 mo 8-9yr 7-8yr

Cuspid

(cannine)

16-20 mo 16-20 mo 11-12yr 9-11yr

First molars 10-16 mo 10-16 mo 10-11yr 10-12yr

Secondmolars

20-30 mo 20-30 mo 10-12yr 11-13yr


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Secondary or Permanent Teeth

Tooth Age at EruptionMaxillary Mandibular

Central incisors 7-8 yr 6-7nyr

Lateral incisors 8-9 yr 7-8yr

canines 11-12 yr 9-11yr

First premolars 10-11 yr 10-12 yr

Second premolars 10-12 yr 11-13yr

First molars 6-7 yr 6-7 yr

Second molars 12-13yr 12-13yr

Third molars 17-22 yr 17-22 yr


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Adolescence

10-20 years

Accelerated growth in height andweight

Appearance of secondary sexualcharacteristics


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Adolescence Growth spurt

Rapid increase of size of body and otherorgans

Height and weight spurt

First sign of puberty:

girls : breast bud

boys: testicular enlargement


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Height spurt

Height velocity increase and peaks atadolescent growth spurt

Acounts for 20-25%of final adult height

Average growth spurt last for 20-36months

Highly variable


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Difference in growth spurt b/w male andfemale

PHV occurs 18-24 mo earlier in femalesthen in males

Average PHV in female is 2 cm/yr lessthen in males

PWV coincide with PHV in male butPWV occurs 6-9 month after PHV infemales


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Secondary sex characteristics

Male

Genital changes

Appearance of

pubic, axillary andfacial hair

Voice changes

Female

breast changes

Growth of pubic hair

and axillary hair Onset of menarche


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Development

Dimensions of Development

Gross Motor

Fine Motor (Adaptive)

Communication and Language

Cognitive (Personal Social)


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PHYSICAL GROWTH:Reflexes

Reflexes - Involuntary movements elicited byenvironmental stimuli

Purposes vary nourishment, exercise,

protection

Three classes: primitive, postural, locomotor

Lack of reflexive response or delay inbeginning or end of a response can signal aproblem with neurological development


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Primitive

Help find nourishment

Rooting baby turns head toward touch

Sucking baby sucks when lips touched

Protective

Startle (Moro) particular posture whenstartled

Grasping hand closes around your finger

Babinsky toes fan outward when heel stroked

Begin to disappear around 4 months


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PHSYICAL GROWTH:Reflexes

Postural reflexes Help keep head upright

Maintain postural balance

Roll head in the direction of body lean Example parachute reflex

Start 2-4 months, disappear by 12months


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Locomotor reflexes Crawling motions when on stomach

Stepping motions when held upright on a

surface Swimming motions when supported in

water

Begin around first month, disappear by4 months


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PHYSICAL GROWTH:Motor Milestones

Gross motor development in first yearfollows cephalocaudal trend Head control; 1 month

Trunk; roll over 3 months

Sitting upright; 6 months

Crawl and stand; 7 months

First step; 12 months (on average)

Much individual variability caused bygenetics, brain development, practice


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PHYSICAL GROWTHMotor Milestones

Proximodistal trend Upper arm; 4-5 months

Palmar grasp; 4-5 months Pincer grasp;10 months

Tripod grasp; 2-3 years

By 5; print is smaller, usually write first

name

Trends mirror brain development


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Gross motor development

Milestones Age(mo)

Implication

Head steady in sitting 2.0 Allows more visual interaction

Pull to sit, no head lag 3.0 Muscle tone

Hands together in midline 3.0 Self discovery

Tonic neck reflex gone 4.0 Child can inspect hands inmidline

Sits without support 6.0 Increasing exploration

Rolls back to stomach 6.5 Truncle flexion, risk of fall

Walks alone 12.5 Exploration, control of proximity

Runs 16.0 Supervision more difficult


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Fine motor developmentmilestone Age

(mo)

Implication

Grasp rattle 3.5 Object use

Reaches for object 4.0 Visual coordination

Palmer grasp gone 4.0 Voluntary release

Transfer object hand to hand 5.5 Comparison of object

Thumb finger grasp 8.0 Able to explore small object

Turns pages of book 12.0 Increasing autonomy duringbook time

scribbles 13.0 Visuomotor coordination

Builds tower of two cubes 15.0 Uses object in combination

builds tower of 6 cubes 22.0 Visual, gross and fine motorcoordination


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Communication and LanguageMilestone Age(mo) Implication

Smiles in response 1.5 Child more active, social participant

Monosyllabic babble 6.0 Experimentation with sound, tactilesense

Inhibits to no 7.0 Response to tone

Follows one step, commandwith gesture

7.0 Non verbal communication

Follows one step, commandwithout gesture

10.0 Verbal receptive language

Speak first real word 12.0 Beginning of labeling

Speaks 4-6 words 15.0 Acquisition of object & names

Speak 10-15 words 18.0 Acquisition of object & names

Speaks 2 word sentence 19.0 Beginning grammaticization,corresponds with 50+ vocabulary


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PERCEPTUAL DEVELOPMENT:Basic Vision Acuity, Color, Depth

Acuity poor in first months but sufficient forinfants tasksAcuity ability to see in detail

Reaches 20/20 in second half of 1styear

Color vision relatively mature by 6 months

Infants as young as two months can perceivedepth on visual cliff, better developed by ageof crawling


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PERCEPTUAL DEVELOPMENT:Auditory Perception

Auditory system functional before birth

By six months, infants can respond to broadrange of sounds

Child-directed speech of adults inducesinfant to be more attentive

May be more sensitive than adults to higherfrequencies

Infants able to locate sounds in environment


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PERCEPTUAL DEVELOPMENT:Early Perception of Smell and Taste

Babies can react to certain odors in mannersimilar to adults Like bananas, butter, vanilla

Disgust at rotten eggs

Breast-fed newborns can recognize smell ofmother

Can also show taste preferences immediatelyafter birth Prefer sweet taste


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Few dos and

don'ts


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THANK YOU

Documents

Chil Growth and Dev