Growth and Development • Genetic factors

• It is the process of physical maturation • Prenatal factors

resulting an increase in size of the body and
• Postnatal factors
various organs. It occurs by multiplication of
cells and an increase in in intracellular substance. Genetic factors
3 • Genetic predisposition is an important factor
which influence the growth and development of
Develompent
children.
• It is the process of functional and physiological
• Sex
maturation of the individual. It is a progressive
increase in skill and capacity to function. It is • Race and Nationality
related to maturation and myelination of the
nervous system. It includes psychological, Prenatal factors
emotional and social changes. It is qualitative • Intrauterine environment is an important
aspects. predominant factor of growth and development.
Principle of Growth and Development Various conditions influence the fetal growth in
utero.
• Cephalocaudal direction
• Maternal malnutrition
• Proximodistal direction
• Maternal infection
• General to Specific
• Maternal substance abuse
Cephalocaudal direction
• Maternal illness
• The process of cephalocaudal direction
• Hormones
from head down to tail. This means that

improvement in structure and function come

first in the head region, then in the trunk, and Postnatal factors
last in the leg region. • Growth potential
Proximodistal direction • Nutrition
The process in proximodistal from center or • Childhood illness
midline to periphery direction. development
proceeds from near to far - outward from central • Physical environment

axis of the body toward the extremities • Psychological environment

General to Specific • Cultural influence

• Children use their cognitive and language skills • Socio economic status
to reason and solve problems. • Climate and season
• Children at first are able hold the big things by • Play and exercise
using both arms, In the next part able to hold
things in a single hand, then only able to pick • Birth order of the child
small objects like peas, cereals etc.
• Intelligence
• Children when able to hold pencil, first starts
• Hormonal influence
draw circles then squares then only letters after
that the words. GROWTH AND &DEVELOPMENTAL AGE
PERIODS
• Development proceeds from general to
• Infancy
specific responses
–Neonate
Factor influencing Growth and Development
•Birth to 1 month
• Growth and development depend upon
multiple factors or determinates. –Infancy

• They influence directly or indirectly by •1 month to 1 year

promoting or hindering the process.
• Early Childhood Length and height

–Toddler • Increase in height indicates skeletal growth.

Yearly increments in height gradually diminished
•1-3 years
from birth to maturity.
–Preschool
• At birth average length of a healthy newborn
•3-6 years baby is 50 cm.( 47-53 cm)

• Middle Childhood • it increases to 60 cm at 3 months, 70 cm of 9

– School age month and 75 cm at one year of age.

– 6 to 12 years • In second year, there is 12 cm increase, third

• Late Childhood year it is 9 cm, fourth year it is 7 cm and in fifth

•Adulthood year it is 6 cm.

-13 to approximately 18 years • so the child double the birth by 4 to 4.5 years
of age afterwards there is about 5 cm increase in

every year till onset of puberty.

Growth and Development Monitoring
Body Mass index (BMI)
Assessment of Growth
• It is an important criteria which helps to assess
• Assessment of physical growth can be done by the normal growth or its deviations i.e.
anthropometric measurement and the study of malnutrition or obesity.

velocity of physical growth. Weight in Kg

• Measurement of different growth parameters BMI = (Height in meter) 2

is an nursing responsibility in child care. Rate of • BMI remains content up to the age of 5 years.
change in height (height velocity) is a more If the BMI is more than 30 kg/m2 , it indicates
sensitive measure of growth than time-specific obesity and if it is less then 15Kg/m2 , it indicates
height measurements. In general, healthy term malnutrition.
Assessment infants and children grow about 2.5 BMI Categories:-
cm/month between birth and 6 months, 1.3
cm/month from 7 to 12 months, and about 7.6 –Underweight = <18.5
cm/year between 12 months and 10 years
–Normal weight = 18.5–24.9
Weight
–Overweight = 25–29.9
• weight is one of the best criteria for
–Obesity = BMI of 30 or greater
assessment of growth and a good indicator of
health and nutritional status of child. Head circumference

• Among children, weight of the full terms • It is related to brain growth and development
neonate at birth is approximately 2.5 kg to of intracranial volume. Average head
3.5kg. circumference measured about 35 cm at birth.

• there is about 10% loss of weight first week of • At 3 months it is about 40 cm, at 6 month 43
life, which regains by 10 days of age. cm, at one year 45cm, at 2 years 48 cm, at 7 year
50 cm and at 12 years of age it is about 52 cm,
• Then, weight gain is about 25- 30 gm per day
almost same a adult.
for 1st 3 month and 400gm/ month till one year
of age. • If head circumference increase more than 1 cm
in two weeks during the first 3 month of age
• The infants double weight gain their birth
then hydrocephalus should be suspected.
weight by 6 month of age, trippled by one year,
fourth time by two years, five times by three • Head circumference is measured by ordinal
year, six times by five year, seven times by seven tap, placing it over the occipital protuberance at
year and ten times by ten year. the back, above the ear on the side and just over
the supraorbital ridges in front measuring the
• Then weight increases rapidly during puberty
point of height circumference.
followed by weight increase to adult size.
Fontanelle Closure • There are ‘two sets of teeth, temporary teeth
and a bigger in size for the 2nd sets of teeth.
• At birth, anterior and posterior fontanelle are
Age Type Total number of teeth
usually present. Posterior fontanelle closes early
-phone
few weeks(6-8week) of age.

• The anterior fontanelle normally closes by 12-

Assessment of Development
18 months of age. Early closure of fontanelle
• Normal development is a complex process &
indicates craniostenosis due to premature
has a multitude of facets. However, it is
closure of skull sutures.
convenient to understand & assess development
Chest circumference under the following domains.

• chest circumference or thoracic diameters is an –Gross motor development

importance parameter of assessment of growth –Fine motor skill development

and nutrition status.
–Personal & social development
• At birth it is 2-3cm less than head
–Language
circumference. At 6 to 12 months of age both
become equal. –Vision & hearing.

• After first year of age, chest circumference is Gross motor development

greater than head circumference by 2.5 cm and
• Motor development progress in an orderly
by the age of 5 year, it is about 5 cm larger than
sequence to ultimate attainment of locomotion
head circumference.
& more complex motor tasks thereafter. In an
• Chest circumference is measured by placing infant it is assessed & observed as follows:-
the tape measure around the chest at level by
Key gross motor development milestones
placing the tape measure around the chest at the
level of the nipple, in between inspiration and -Nasa phone
expiration.
Fine motor skill development
Mid Upper Arm Circumference(MUAC)
• Fine motor development upon neural tract
• is a measurement that allows health workers maturation.
to quickly determine if a patient is acutely • Fine motor skills are the tiny movements we
make with our hands, fingers, feet and toes. We
malnourished.
develop these skills from birth to adulthood.
• Measured from the circumference of a
• Fine motor development promotes adaptive
patient's arm at the midpoint between his or activities with fine sensorimotor adjustments
and include eye coordination, hand eye
her shoulder and elbow.
coordination, hand to mouth coordination, hand
MUAC skill as finger thumb apposition, grasping,
dressing, ect.
• The average MUAC at birth is 11 to 12 cm, at
one year of age it is 12 to 16 cm, at 1 to 5 years Personal & social development
it is 16 to 17 cm, at 12 years it is 17 to 18 cm and
• Personal and social development includes
at 15 years it is 20 to 21cm.
personal reactions to his own social and cultural
Eruption of teeth situations with neuromotor maturity and
environment stimulation. It is related to
• There is a variation for the time of eruption of interpersonal and social skill as social smile,
teeth. First teeth commonly the lower central recognition of mother, use of toys.
incision may appear in 6 to 7 months of age.
Assessment of Development
• It can be delayed even up to 15 months, which
also can be considered within the normal range • Healthy development, in all forms, particularly
of time for teething.
social/emotional, communication, and behavior,
• So dentition is not a dependable parameter
should be monitored by parents and physicians
for assessment of growth.
through screenings at each well visit.

• The Denver Developmental screening test

• Denver articulation screening examination

(DASE)

• Baroda screening test

• Trivandrum development screening test

• Other test

– Woodside DST

– Cognitive adaptive test

– Early language milestone etc.

The Denver Developmental screening test

• Developmental originally by Franken – burg

and dodds(1967), this simple, economic and
useful test screens for developmental delays
during infancy and the preschool period.

• a standardized screening for children from

birth to age 6, is designed to test the child's
abilities in the following four sectors: personal-
social, fine motor, gross motor, and language
(including expressive-receptive vocabulary).

Baroda Screening test

• It was developed by Dr. Promila phatak with

25 test items primarily for psychological aspects.
The test is relevant for age 0 to 30 months. Gross
motor, fine motor and cognitive aspects are
evaluated in 10 minutes mainly by the
psychologist

Trivandrum Development Screening Chart

(TDSC)

• is a 51-item assessment of cognitive and motor

milestones for children 0-6 years old. The test-
giver first assesses the actual age of the child by
drawing a vertical line through the chart through

their age.