Growth and Development

in Children

Presentation by:
Basant Kumar Karn
Asst. 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 and

development.

5. Provide tips of promoting growth and

development.
 Intr oduction
•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.
 Gr owt h

Increase in physical size and

weight of the body (Height and Weight)
De velopme nt

Increase in Mental, Physical,

Social and Emotional abilities
of the child. It means
functional and physiological
maturation.
 Devel opmental
Mi lestones
Average level of development of a child which is decided
through the scientific study of physical, mental and
nervous system of children.
 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
• Early Childhood: 1 year to 6 years
• Toddler Period: 1-3 years
• Preschool Period: 3- 6 years
• Middle childhood: 6- 12 years
• Late Childhood or Adolescent: 12-18 years
• Puberty Period: Male: 12-14 years
Female: 11-13 years
Pri nci ples of grow th and
Devel opment.
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 fo r moni tori ng
gro wth
and devel opment.

• To find the deviation as soon as possible

• To bring possible remedies.

Done through Anticipatory guidelines

 Factors inf lue nci ng
Gr ow th and Devel opm ent
Heredity
Nutrition
Illness and Disease
Physical, emotional and social environment
Age and gender
Others- Birth order, Birth interval,
dependence and independence.
 Assess ment 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 of epiphysis)
• Dental age
• Biochemical and histological means
Formulas for Approximate Average Height and
Weight of Normal Infants and Children
Weight Kilograms (Pounds)
At birth 3.25 (7)
Age in months + 9
3–12 mo 2 (age [mo] + 11)

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

(Age in years ×7) +5
7–12 yr 2 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)
As sessment of Wei ght

• 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.
 Ass essment of Hei ght
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
 Upper / Lower s egment
Ratio

Upper segment
Age Lower Segment
1.8
At birth------------------- 1
1.3
3 – 4 years----------------------- 1
1
9 Years--------------------------------------- 1
0 .9
18 Years----------------------------------------------
1
 Head C ircumferences
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)

(Length in cm + 9.5) + 2.5

HC =
2
 Ches t Cir cumf erences

• 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
 Ot hers
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 Grow th

• 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 D eciduous
Calcification Age at Eruption Age at Shedding
Begins at Complete at Maxillary Mandibular Maxillary Mandibular

Central 5th fetal mo 18–24 mo 6–8 5–7 mo 7–8 yr 6–7 yr

incisors mo
Lateral 5th fetal mo 18–24 mo 8–11 7–10 mo 8–9 yr 7–8 yr
incisors mo
Cuspids 6th fetal mo 30–36 mo 16–20 16–20 mo 11–12 yr 9–11 yr
(canines) mo
First molars 5th fetal mo 24–30 mo 10–16 10–16 mo 10–11 yr 10–12
mo yr
Second 6th fetal mo 36 mo 20–30 20–30 mo 10–12 yr 11–13
molars mo yr
 Secondary or Permanent
Teeth
Calcification Age at Eruption
Begins at Complete at Maxillary Mandibular

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 18–21 mo 12–13 yr 10–11 yr 10–12 yr
(bicuspids)
Second premolars 24–30 mo 12–14 yr 10–12 yr 11–13 yr
(bicuspids)
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
 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 Language
Milestone 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 language
command 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 )

• 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.
• 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)
• Kohlberg said nothing.- Associate
Toddler (12 to 36 months)
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…
• Reward and punishment guide their
School age (6-12 years) -
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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