GROWTH & MOTOR DEVELOPMENT

Jie Shao M.DDepartment of Pediatrics

Zhejiang University

1. Definition2. Principles of Growth and Development3. Normal Growth3. Normal Motor Development

GROWTH & MOTOR DEVELOPMENT

Growth Implies change in size of the body as whole or its

separate parts.

Development Embraces changes of function （ differentiation and

maturation), including those largely shaped by interaction with the structural, emotional or social environment.

DEFINITION

Consecutive with variant velocityImbalance between different systemsGeneral sequence of developmentInterpersonal difference

PRINCIPLES OF GROWTH & DEVELOPMENT

General sequence of development

Upper LowerProximal DistalClumsy FineLower grade Higher gradeSimple ComplexUncoordinated Coordinated

Interpersonal difference

Normal and abnormal are relative Dynamic observation is more important A complex interaction between

genes( nature) and environment (nurture)

Contributing Factors

Inherence( Gene)NutritionDiseaseMaternal statusEnvironment

Deviations in growth patterns may be nonspecific but may be important indicators of serious and chronic disorders

Accurate physical measurements should be obtained at every health supervision visit

Growth is assessed by plotting accurate measurements on growth charts Growth level Growth velocity Proportion of body ( eg. BMI)

NORMAL PHYSICAL GROWTH

Common parameters & methods

Body weightBody lengthSitting heightHead circumferenceChest circumferenceUpper arm circumference

Rules of Thumb for Growth

Body weightBirth weight3.2~3.3kg (2.5~4kg)Related factors: Gravidity and Parity, gestational age, gender, intrauterine nutrition status

Physiological loss of body weight: Body weight deceased by 3-5% ( <9% of birth weight) over the first 5 to 6 days after birth as initial loss of ECF, and recovered to birth weight by the 7-10 days.

Double birth weight: 3~4mo Triple birth weight: 1 yrQuadruple birth weight: 2 yr

Rules of Thumb for Growth

Body weightAverage Weights:Birth weight3.5 kg (3.2~3.3kg) 1 Yr 10kg5 Yr 20kg10Yr 30kgDaily weight gain: 20-30 g for first 3-4mo

15-20g for rest of the first yr

Rules of Thumb for Growth

Body weight Contributing factors: Nutrition Diseases The 1st Year the most rapid growth stage

1st 6 Mo Wt.(kg)=BW+Age(Mo)×0.7(kg)

7~12 Mo Wt.(kg)=BW+6×0.7+ (Age -6) ×0.25

2~12 Yr Wt.(kg)=Age(Yr) )×2 + 7(or 8) Adolescent: increase more rapidly

Rules of Thumb for Growth

Body length (standing height or recumbent length) :

the length of head, spine and lower limbs Contributing factors: Gene, endocrine, intrauterine

development At birth averages 50 cm in full term 1 Yr 75 cm (increase 25 cm) 2 Yr 85 cm (increase 10 cm) 2~12 Yr Age×7 + 70 (cm) (5-7cm/yr.)

<3Yr should be measured by recumbent length

Rules of Thumb for Growth

Sitting height (from crown to buttock) Present the development of head and spine

Trunk-leg ratio:Newborn 67 % of the BL4 Yr 60 % of the BLMenarche (girls)14 Yr (boys) 53% of the BL

Disorders: Hypothyroidism, AchondroplasiaSpan

Rules of Thumb for Growth

Head circumference

- related to development of brain and skull

- measurement is the most valuable in the first 2yrs

Head circumference

At birth 32-34 cm3 months 40 cm (increase 6 cm)1 Yr 46 cm (increase 6 cm)2 Yr 48 cm5 Yr 50 cm15 Yr 54 ~ 58 cm

HC< X-2SD ? MicrocephalyHC ? Hydrocephalus

Rules of Thumb for Growth

Chest circumference (CC)At birth 32 cm

1 Yr equals to head circumference

> 1 Yr larger than that of head,

the difference value equals to the

years of age minus 1

(HC+ Age – 1cm)

Rules of Thumb for Growth

Upper arm circumference (< 5 yr)Screen malnutrition:

>13.5 cm Good

12.5~13.5 Medium

<12.5cm Malnutrition

Osseous development

Cranial bone development closures of sutures & fontanels main sutures 3th or 4th Mo anterior fontanel 1 ~ 1.5 Yr posterior fontanels 6th ~ 8th Wk. lateral fontanels 6th ~ 8th Wk.

Clinical significance

Osseous development

Development of Spine( Vertebral Column)At birth: almost straight

3rd Mo: forward curvature at neck column

6th Mo: backward curvature at thoracic column

12thMo: forward curvature at lumbar column

6~7Yr fixed by ligament

Osseous development

Ossification centers appearance & union of epiphyseal ossification The ossification centers occur in an orderly

sequence with age; they cover the entire period from birth to early

adulthood; The changes associated with progressive

maturity are readily visible in the X-ray film;

Osseous development

Bone Age The numbers and progressive changes of

ossification centers are measured by X-ray , and standardized by corresponding chronological age and sex. Bone age retardation

hypothyroidism, dwarfism, malnutrition

Bone age advancedprecocious puberty, adrenal hyperactivity

Dental development

Deciduous teeth 20begin to erupt 7~8 Mo (4 ~ 10 Mo)

complete 2 ~ 2.5 Yr

Permanent teeth 32begin to erupt 6 Yr

Individual difference Gene, endocrine, food texture

Abnormal Hypothyroidism

运动行为是许多亚系统包括生长，神经系统的成熟、感知和认知发育相互作用的结果

目标 : 从有目的的运动到熟练灵巧的运动运动发育包括 : 姿势 , 移动 和操作

Motor Development

运动发育的决定因素

身体的生长和成熟（包括大脑神经、骨骼、肌肉）

Neurological Development: Tone, deep tendon reflexes, primitive reflexes clearly elicitable in the

newborn through ages 3-4mo

环境的约束 ( 重力、支持表面、养育人态度）任务 ( 活动目标、用具 )

运动发育原则

发育方向头－尾发育 “从头部向尾部”近端 - 远端 发育 “从中心向周围”

敏感时期 – 关键时期 粗大运动和精细运动

Gross Motor Milestones

年龄

运动发育里程碑

里程碑是运动发育过程中的一个新获得的技能，是技能操作的基础， 是个体运动发育的标志。

姿势改变够取和抓握 ( 操作性运动 )

身体活动 、灵活性

年龄 俯卧 坐 站立 手－眼1 月 四肢屈曲，抬头一会 . 拉坐时，头后

坠 反射性踏步 . 眼追踪至中线

手握拳 .

2 月 头中位线 . 抬头 . 头开始跟随矫正

  眼睛跟随超过中线 . 伸展手臂开始看自己的手 .

3 月 持续抬头 .肘部支撑膝部屈曲

头向前使劲 . 体重支持不稳定 眼睛跟随 1800

快速注视物体 .两手松开 .

4 月 头和胸部持续抬起 拉坐时，很少头后坠

站立 初时以足趾站立 .

可将手聚到胸前－手指张开看手中的物体 .

6 月 手臂伸展，从仰卧位翻到俯卧位头竖直，够取玩具

靠坐 可支持大部分体重 .跳跃

用手够取和抓取物体

8 月 用手和膝动作从俯卧位转为坐位，俯卧爬行 .

拉坐时能主动用力

能支撑整个身体体重，扶栏杆

伸手抓 – 手张开 .摇动 , 敲打 , 换手 .

10 月 爬行 . 扶着以双足站起 .站立 , 两手自由 .

坐直 : 1 minute 站立 , 拉着手 .扶物移步

指点 手指捏取 . 

12 月 爬行协调 拉手行走 穿衣合作

婴儿期的自主运动

1. 姿势控制 头部控制躯干控制

2. 移 动踏步反应踢腿匐爬 & 爬行扶物移步直立行走

3. 操作控制够取物体和抓握关联够取和坐预料和物体控制 双手控制

视觉作用 & 其他感觉特征

3 条目

Gross Motor Development Timetable

Prone (lift head)Head up 1moChest up 2moUp on elbows 3moUp on hands 4mo

Gross Motor Development Timetable

RollingLateral to back 1- 2mo

Front to back 3-5mo

Back to front 4-5mo

6-8 mo

Gross Motor Development Timetable

SittingSit with support (tripod)

5-6moSit without support

7-8mo Get up to sit 8mo

Gross Motor Development Timetable

Creeping• Crawling by dragging rest of

body/pelvis on floor

8 mo• Creeps( hands and knees on

floor with feet and trunk raised)４ point reciprocal

10 -12mo• Creeps up stairs 18 mo

Gross Motor Development Timetable

Stand WalkingStepping reflexPositive support reflexBounce 5-6moPull to stand 8-9moCruise 9-10moStand 11moWalk alone 12-15moJump in place 24mo

Fine Motor Development

1st month fist

3rd~4th month grasp object

6th~7th month transfers object

9th~10th month thumb-finger grasp

(pincer)

12th 15th month scribbles

18~24th month play

Fine Motor Development