Growth and Development

in Children

Presentation by:

Basant Kumar KarnAsst. Professor, College of Nursing

B. P. Koirala Institute of health Sciences, Dharan, Nepal

Objectives of the session

1. Define growth and development.

2. Discuss principles of growth and development.

3. Describe need for monitoring growth and development.

4. Discuss pattern of normal growth anddevelopment.

5. Provide tips of promoting growth and development.

Introduction

•Important characteristics of Human being

•A process by which the fertilized ovum develops in to a mature adult

•Maturation occurs through successive changes in the both physical structure and functional ability

The most dramatic events in growth and development occur before birth.

Growth

Increase in physical size and weight of the body (Height and Weight)

Development

Increase in Mental, Physical, Social and Emotional abilities of the child. It means functional and physiological maturation.

Developmental Milestones

Average level of development of a child which is decided through the scientific study of physical, mental and nervous system of children.

Prenatal: Conception to the BirthInfancy: Birth to 12 monthsNeonatal period: Birth to 28 days

Early neonatal period: Birth to 7 daysLate neonatal period: 7 days to 28 days

Infancy Period: 29 days to 12 monthsEarly Childhood: 1 year to 6 yearsToddler Period: 1-3 yearsPreschool Period: 3- 6 yearsMiddle childhood: 6- 12 yearsLate Childhood or Adolescent: 12-18 yearsPuberty Period: Male: 12-14 years

Female: 11-13 years

Stages

Principles of growth and Development.

There are definite and predictable pattern of growth and development that are continuous, orderly and progressive.

• Crawl Creep Walk

• Babbles Words Sentences

• Scribble Writing

1. Directional Pattern:– Cephalocaudal Pattern ( Head to Tail)– Proximal to Distal (Midline to peripheral)– Mass to specific (Differentiation)

2. Sequential Pattern: Involves a predictable sequence of Growth and Development stages through which a child normally proceeds.

– For motor skills such as locomotion i.e. child starts crawling before walking and for behaviors such as language and social skills (e.g. First child plays alone, then with others).

Need for monitoring growth

and development.

• To find the deviation as soon as possible

• To bring possible remedies.

Done through Anticipatory guidelines

Factors influencing Growth and Development

Heredity

Nutrition

Illness and Disease

Physical, emotional and social environment

Age and gender

Others- Birth order, Birth interval, dependence and independence.

Assessment of Growth

Growth can be measured in term of:1. Nutritional Anthropometry (Wt., Ht., Hc., Cc.)

2. Assessment of Tissue growth (Muscle mass, Skin fold thickness)

3. Bone age (Radiological assessment of epiphysis)

4. Dental age

5. Biochemical and histological means

Formulas for Approximate Average Height and Weight of Normal Infants and Children

Weight Kilograms (Pounds)

At birth 3.25 (7)

3–12 mo (age [mo] + 11)

1–6 yr age (yr) × 2 + 8 (age [yr] × 5 + 17)

7–12 yr age (yr) × 7 + 5

Height Centimeters (Inches)

At birth 50 (20)

At 1 year 75 (30)

1–12yr age (yr) × 6 +77 (age [yr] × 21/2 + 30)

2

9 monthsin Age

257) yearsin (Age

Assessment of Weight

• Newborn looses weight of 10% of Birth weight till early 7 days and regain by 10th Day.

• Birth weight doubles by 4 month and triples by a year & 4 times by 2 years.

Assessment of Height

At Birth- 50cm

6 months- +12 cm

1 year- 75 cm

2 years- 85 cm

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

5 years - 5cm/year

At birth-------------------

3 – 4 years-----------------------

9 Years---------------------------------------

18 Years----------------------------------------------

Upper / Lower segment Ratio

SegmentLower

segmentUpper

1

1.8

1

1.3

Age

1

1

1

9.0

Head Circumferences

Age HC velocity

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)

2

2.5 9.5) cmin (Length HC

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

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

middle fingers with both arm held wide open (Spread apart)

Dental Growth

• Most infants have their first teeth erupt at age 6–8 months of Age.

• Two types of Tooth are

Primary or Deciduous

Secondary or Permanent Teeth

Primary or Deciduous

  Calcification Age at Eruption Age at Shedding

  Begins at Complete at Maxillary Mandibular Maxillary Mandibular

Central incisors

5th fetal mo 18–24 mo 6–8 mo

5–7 mo 7–8 yr 6–7 yr

Lateral incisors

5th fetal mo 18–24 mo 8–11 mo

7–10 mo 8–9 yr 7–8 yr

Cuspids (canines)

6th fetal mo 30–36 mo 16–20 mo

16–20 mo 11–12 yr 9–11 yr

First molars 5th fetal mo 24–30 mo 10–16 mo

10–16 mo 10–11 yr 10–12 yr

Second molars

6th fetal mo 36 mo 20–30 mo

20–30 mo 10–12 yr 11–13 yr

Secondary or Permanent Teeth

Central incisors 3–4 mo 9–10 yr 7–8 yr 6–7 yr

Lateral incisors Max, 10–12 mo 10–11 yr 8–9 yr 7–8 yr

  Mand, 3–4 mo      

Cuspids (canines) 4–5 mo 12–15 yr 11–12 yr 9–11 yr

First premolars (bicuspids)

18–21 mo 12–13 yr 10–11 yr 10–12 yr

Second premolars (bicuspids)

24–30 mo 12–14 yr 10–12 yr 11–13 yr

First molars Birth 9–10 yr 6–7 yr 6–7 yr

Second molars 30–36 mo 14–16 yr 12–13 yr 12–13 yr

Third molars Max, 7–9 yr 18–25 yr 17–22 yr 17–22 yr

  Mand, 8–10 yr      

Calcification Age at Eruption

Begins at Complete at Maxillary Mandibular

Development

Dimensions of Development

Gross Motor

Fine Motor (Adaptive)

Communication and Language

Cognitive (Personal Social)

Gross Motor

Milestone Average Age (mo) Implications

• 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 in midline

• Sits without support 6.0 Increasing exploration

• Rolls back to stomach 6.5 Truncal flexion, risk of falls

• Walks alone 12.0 Exploration, control of proximity

• Runs 16.0 Supervision more difficult

Fine Motor (Adaptive)

Milestone Average Age (mo) Implications

• Grasps rattle 3.5 Object use

• Reaches for objects 4.0 Visuomotor coordination

• Palmer grasp gone 4.0 Voluntary release

• Transfers object hand to hand 5.5 Comparison of objects

• Thumb-finger grasp 8.0 Able to explore small objects

• Turns pages of book 12.0 Increasing autonomy during book time

• Scribbles 13.0 Visuomotor coordination

• Builds tower of two cubes 15.0 Uses objects in combination

• Builds tower of six cubes 22.0 Requires visual, gross, and fine motor coordination

Communication and LanguageMilestone Average Age (mo) Implications

• Smiles in response 1.5 Child more active social participant

• Monosyllabic babble 6.0 Experimentation with sound, tactile sense

• Inhibits to “no” 7.0 Response to tone (nonverbal)

• Follows one-step 7.0 Nonverbal communication command with gesture

• Follows one-step 10.0 Verbal receptive languagecommand without gesture (e.g., “Give it to me”)

• Speaks first real word 12.0 Beginning of labeling• Speaks 4–6 words 15.0 Acquisition of object and

personal names• Speaks 10–15 words 18.0 Acquisition of object and

personal names• Speaks two-word sentences 19.0 Beginning grammaticization,

(e.g., “Mommy shoe”) corresponds with 50+ word vocabulary

Cognitive (Personal Social)

Milestone Average Age (mo) Implications• Stares momentarily 2.0 Lack of object permanence (out of at

spot where object sight, out of mind)_ (e.g., yarn ball disappeared dropped)

• Stares at own hand 4.0 Self-discovery, cause and effect• Bangs two cubes 8.0 Active comparison of objects• Uncovers toy (after 8.0 Object permanence

seeing it hidden) • Egocentric pretend play 12.0 Beginning symbolic thought

(pretends to drink from cup) • Uses stick to reach toy 17.0 Able to link actions to solve

problems• Pretend play with doll 17.0 Symbolic thought

(gives doll bottle)

Other areas

Cognitive Development

Psychosexual Development

Psychosocial Development

Spiritual/moral Development

Cognitive Development (Piaget)

Sensorimotor & Preconceptual Phase- Toddler (12 to 36 months) Appear mature but are really primitive;- Differentiation of self from objects—increased tolerance of separation from parents- Object permanence has advanced—increasingly aware of existence of objects of objects behind doors, in drawers, etc.- Domestic mimicry- Embryonic concept of time—a vagus concept- “Why?” and “How?’ predominate language.

Preoperational Phase- Preschool (4 to 7 years) A shift from totally egocentric thought to social awareness occurs—ability to consider another’s viewpoint begins. Egocentricity is still evident.- Play is this child’s way of understanding, adjusting to, and working out life’s experiences- Magical thinking—thoughts are powerful—guilt may result from bad thoughts or wishes- Words are accepted literally—“you are bad” means that “I am a bad person,” not merely that my actions were bad.

Cognitive Development Cont…..

Conceptual thinking. (concrete operations)-

School age (6-12 years)

These children are able to use thought processes to experience events and actions—to understand relationships between things and ideas (reasoning); their mental processes allow them to see things from another’s point of view. Learn to master skills such as: conservation, classification, reasoning, comprehension, and reading .

Abstract thinking (The period of formal operations)-

Adolescence (12 to 18 or 20)

These people now think in the realm of what is possible—beyond the present and concrete. They are concerned with future events such as marriage, college, and vocations. Their thoughts are influenced by logical principles rather than their own perceptions and experiences.

They are able to understand that few concepts are absolute or independent of other influencing factors.

Psychosexual Development (S. Freud )

1. Freud advanced a theory of personality development that centered on the effects of the sexual pleasure drive on the individual psyche. At particular points in the developmental process, he claimed, a single body part is particularly sensitive to sexual, erotic stimulation. These erogenous zones are the mouth,

the anus, and the genital region. 2. Both frustration and overindulgence lock some amount of the

child's libido permanently into the stage in which they occur; both

result in a fixation. Oral Stage: (Infant) The oral stage begins at birth, when the oral cavity

is the primary focus of libidal energy. The child, of course, preoccupies himself with nursing, with the pleasure of sucking and accepting things into the mouth.

Anal Stage: (Toddler) At one and one-half years, the advent of toilet training comes the child's obsession with the erogenous zone of

the anus and with the retention or expulsion of the feces.

Phallic Stage ( Preschool 4 to 7 years): In this stage, the child's erogenous zone is the genital region. As the child becomes more interested in his genitals, and in the genitals of others, conflict arises. The conflict, labeled the Oedipus complex (The Electra complex in women), involves the child's unconscious desire to possess the opposite-sexed parent and to

eliminate the same-sexed one. Latency Period ( School age 6-12 years): The period in which the sexual drive

lies dormant. Freud saw latency as a period of unparalleled repression of sexual desires and erogenous impulses. During the latency period, children pour this repressed libidal energy into asexual pursuits such as school, athletics, and same-sex friendships. Freud implies that girl

always remains slightly fixated at the phallic stage. Genital Stage ( Adolescence 12 to 18 or 20): But soon puberty strikes, and the

genitals once again become a central focus of libidal energy, interest turns to heterosexual relationships. The less energy the child has left invested in unresolved psychosexual developments, the greater his

capacity will be to develop normal relationships with the opposite sex.

Psychosocial Development (Erickson)

Autonomy vs. sense of Shame & doubt: Toddler (12 to 36 months)

Newfound sense of independence as a result of having learned some basic self-care skills—walking, feeding, and toileting.

Initiative vs. Guilt: Preschool (4 to 7 years)

Child develops the ability to initiate and direct own activities. Because they are developing a super ego (conscience), conflicts arise from their desire to explore and the limits placed upon them by caregivers—leads to feeling of frustration and guilt

Psychosocial Development Cont….

Industry vs. Inferiority:

School age (6-12 years)Learning to achieve, compete, perform and developing a sense of self confidence because of successes. Thrive on accomplishments and praise. May develop a sense of inferiority when tasks are too difficult, thus producing failure—need support.

Identity vs. Role confusion:

Adolescence (12 to 18 or 20)Stage is marked by dramatic physiological changes associated with sexual maturation that leads to marked preoccupation with appearance and body image. Identity development takes place in this stage as the youth seeks autonomy, group identity, and to answer the question, “Who am I?” Failure to develop a sense of self identity can lead to isolation and inability to develop lasting attachments in future.

Spiritual/moral (Kohlberg)

• Toddler (12 to 36 months) Kohlberg said nothing.- Associate God with something special- Assimilate behaviors (folding hands in prayer) associated with God- Comforted by spiritual routines (bedtime prayers- Near end of toddler- hood, religious teachings such as reward and fear of punishment may influence their behavior.

• Preschool (4 to 7 years) Preconventional/Premoral - Moral judgment is at its most basic level—little concern for why something is wrong.- Actions are directed toward fulfilling their needs and less frequently the need of others.- These children have a very concrete sense of justice- fairness involves the philosophy of “you scratch my back and I’ll scratch yours, “ with no thought of loyalty or gratitude.-Development of conscious is strongly linked to spiritual; development. Behave correctly to avoid punishment, guilt.

Spiritual/moral Cont…• School age (6-12 years) - Reward and punishment guide their

judgment—they adopt and internalize the moral values of their parents; they learn standards for acceptable behavior, act accordingly & feel guilty when they violate them. However, they do not understand the reasons behind the rules.- These children view God as a human; they are fascinated with the concepts of heaven and hell and may fear hell as punishment.

• Adolescence (12 to 18 or 20) Adolescents, to gain autonomy from adults, often substitute their own set of morals and values. They seek to establish and internalize a set of morals and values that they have tested and found to be worthy of living by—this often means questioning and sometimes abandoning existing morals and values. Often when adults merely ascribe to a code of morals and values verbally, without actually adhering to the codes, adolescents will be inclined to abandon such codes.

Play• Infant ( Up to one year): Solitary Play--- Infant Play alone, exhibits

emotions with various visual and auditory stimulus.

• Toddler (12 to 36 months) Parallel Play—The toddler plays alongside, not with other children- Inspects toys; talks to toys; tests its strength and durability- Invents uses for toys- Imitation is a distinguishing characteristic of play—engages in fantasy.

• Preschool (4 to 7 years) Associative Play—Group play in similar or identical activities, but without rigid organization or rules. Provides physical, social, and mental development, with refinement of motor skills. Includes: jumping, running, and climbing, as well as the use of tricycles, sports equipment, constructive and creative toys, etc.

• Imitative, Imaginative and Dramatic Play – Probably the most characteristic & persuasive preschool activity. For self expression; involves the reproduction of adult behavior. Toward the end of the preschool period children want to do adult activities not just pretend.

Play Cont….• School age (6-12 years): Play takes on a group or clique form

(team play) —it involves increased physical skill, intellectual ability, and fantasy. A sense of belonging to a team is important.- Games have fixed, rigid rules; Conformity and ritual permeate their play; - School-aged children gain a sense of power from playing games where they can use fantasy and imagination to gain mastery over others who otherwise dominate them.

• Adolescence (12 to 18 or 20): While the parents of adolescents remain their primary influence, they are ever moving away from parental dependency and toward autonomy. Their peers play an ever increasing role in terms of significance. To belong is of utmost importance. Their play is group (peer) oriented and is more about relationships than play. Sexual activity and romance preoccupy many adolescents. The leisure-time activities amongst adolescents assist in the development of their social, physical, and cognitive skills.

Parents should know

• Tips to the parents for safe growth and development of the child.

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