Growth and

Development of
Children
By
Dr. Asma
Growth and Development of
Children
Specific
Objectives:
By the end of this lecture, the student will be able
to:
• Identify the importance of growth and
development.
• Define growth and development.

• Mention the principles of growth and

development.
• List factors affecting growth and development.

• Mention types of growth and development.

• Identify the stages of development.

 Growth

 Growth refers to an increase in physical size of the

whole body or any of its parts.
 It is simply a quantitative change in the child’s
body.
 It can be measured in Kg, pounds, meters, inches
etc
Child Growth (Image: WHO)
Changes in bodily proportions with
age.
 Development

• Development refers to a progressive increase in

skill and capacity of function.
• It is a qualitative change in the child’s functioning.
• It can be measured through observation.
By understanding what to expect during each stage of development,
parents can easily capture the teachable moments in everyday life to
enhance their child's language development, intellectual growth, social

development and motor skills.

 Maturation

• Increase in child’s competence and adaptability.

• It is describing the qualitative change in a
structure.
• The level of maturation depends on child’s
heredity.
 Principles of Growth &
Development

• Continuous process
• Predictable Sequence
• Don’t progress at the same rate (↑ periods of GR in early
childhood and adolescents & ↓ periods of GR in middle
childhood)
• Not all body parts grow in the same rate at the same time.
• Each child grows in his/her own unique way.
• Each stage of G&D is affected by the preceding types of
development.
 Principles of Growth &
Development

 G & D proceed in regular related directions:

 Cephalo-caudal (head down to toes)
 Proximodistal (center of the body to the
peripheral)
 General to specific
Growth Pattern
 Growth Patterns

 The child’s pattern of growth is in a head-to-toe

direction, or cephalocaudal, and in an inward to
outward pattern called proximodistal.
 Factors affecting growth and development:

• Hereditary
• Environmental factors

Pre-natal environment
1. Factors related to mothers during pregnancy :
- Nutritional deficiencies
- Diabetic mother
- Exposure to radiation
- Infection with German measles
- Smoking
- Use of drugs
 2-Factors related to fetus

• Mal-position in uterus
• Faulty placental implantation

Post-Natal Environment
I - External environment:
- socio-economic status of the family
- child’s nutrition
- climate and season
- child’s ordinal position in the family
- Number of siblings in the family
- Family structure (single parent or extended family)
 Internal environment

• Child’s intelligence
• Hormonal influences
• Emotions
 Types of growth and
development

Types of growth:
- Physical growth (Ht, Wt, head & chest circumference)
- Physiological growth (vital signs)

Types of development:
- Motor development
- Cognitive development
- Emotional development
- Social development
 Stages of Growth and Development

• Prenatal
- Embryonic (conception- 8 w)
• Middle Childhood
- Fetal stage (8w-40 or 42 w) - School age
- 6 to 12 years
• Infancy
- Neonate
- Birth to end of 1 month
• Late Childhood
- Infancy - Adolescent
- 1 month to end of 1 year - 13 years to approximately
18 years
• Early Childhood
- Toddler
- 1-3 years
- Preschool
- 3-6 years
1- Newborn stage

Newborn stage is the first 4

weeks or first month of life. It
is a transitional period from
intrauterine life to extra
uterine environment.
Normal Newborn Infant

Physical growth

- Weight = 2.700 – 4 kg
- Wt loss 5% -10% by 3-4 days after
birth
- Wt gain by 10th days of life
- Gain ¾ kg by the end of the 1st month
 Weight:

They loose 5% to 10% of weight by 3-4 days

after birth as result of :
 Withdrawal of hormones from mother.
 Loss of excessive extra cellular fluid.
 Passage of meconium (feces) and
urine.
 Limited food intake.
Height
 Boys average Ht = 50 cm
 Girls average Ht = 49 cm
 Normal range for both (47.5- 53.75 cm)

Head circumference
 33-35 cm
 Head is ¼ total body length
 Skull has 2 fontanelles (anterior &
posterior)
 Anterior fontanelle
• Diamond in shape
• The junction of the sagittal, coronal and
frontal sutures forms it
• Between 2 frontal & 2 parietal bones
• 3-4 cm in length and 2-3 cm width
• It closes at 12-18 months of age
 Posterior fontanelle
• Triangular
• Also called lambdoid fontanelle
• Located between occipital & 2 parietal bones
• Closes by the end of the 1st month of age
Chest circumference

It is 30.5 to 33cm (usually 2–3cm

less than head circumference).
 Physiological growth

• Vital signs
- Temperature (36.3 to 37.2C/97.5 F)
- Pulse (120 to 160 beats/min)
- Respiration (35 to 50 breaths/min) .
Simulation for vital signs
 Calculate the APGAR score

 A female baby is born showing cyanosis in her

upper and lower limbs. Her heart rate is recorded
to be 120 beats/min. She is showing irregular
breathing. The baby is lying down with lower
extremity in flexion. She cries in a feeble manner
when stimulated.
 What is her APGAR score?
APGAR scoring chart
 Interpretation of APGAR scores

• Scores 7 and above are generally normal

• 4 to 6 fairly low
• 3 and below are generally regarded as critically low.
Newborn Senses
• Senses
- Touch
- Vision
- Hearing
- Taste
- Smell
 Touch

• It is the most highly developed sense.

• It is mostly at lips, tongue, ears, and forehead.

• The newborn is usually comfortable with touch.

 Vision
• Pupils react to light

• Bright lights appear to be unpleasant to

newborn infant.

• Follow objects in line of vision

 Hearing

• The newborn infant usually makes some

response to sound from birth.
• Ordinary sounds are heard well before 10 days of
life.
• The newborn infant responds to sounds with
either cry or eye movement.
Taste

Well developed as bitter and sour fluids

are resisted while sweet fluids are
accepted.

Smell
Only evidence in newborn infant’s search
for the nipple, as he smell breast milk.
Normal Newborn Infant
 Gross Motor Development

Motor development:
The newborn's movement are random,
diffuse and uncoordinated. Reflexes
carry out bodily functions and
responses to external stimuli.
 Fine motor development

• Holds hand in fist

• Grips everything that comes in contact of hand
• When crying, he draws arms and legs to body
Reflexes

 Root reflex
 Suck reflex

 Moro reflex

 ATNR

 STNR

 Grasp reflex

 Galant reflex
 Reflexes
 Root reflex - This reflex begins when the corner of
the baby's mouth is stroked or touched. The baby
will turn his/her head and open his/her mouth to
follow and "root" in the direction of the stroking.
 Suck reflex –
 Rooting helps the baby become ready to suck.
When the roof of the baby's mouth is touched, the
baby will begin to suck. This reflex does not begin
until about the 32nd week of pregnancy and is not
fully developed until about 36 weeks. Premature
babies may have a weak or immature sucking ability
because of this. Babies also have a hand-to-mouth
reflex that goes with rooting and sucking and may
suck on fingers or hands.
 Moro reflex -
 The Moro reflex is often called a startle reflex
because it usually occurs when a baby is startled by
a loud sound or movement. In response to the
sound, the baby throws back his/her head, extends
out the arms and legs, cries, then pulls the arms and
legs back in. A baby's own cry can startle him/her
and begin this reflex. This reflex lasts about five to
six months.
 Asymmetric Tonic neck reflex -

 When a baby's head is turned to one side, the

arm on that side stretches out and the
opposite arm bends up at the elbow. This is
often called the "fencing" position. The tonic
neck reflex lasts about six to seven months.
 Symmetrical tonic neck
reflex
 forward head flexion produces flexion of upper
extremities and extension of the lower
extremities while extension of the head
produces extension of upper extremities and
flexion of the lower extremities.
 Grasp reflex - Stroking the palm of a baby's hand
causes the baby to close his/her fingers in a grasp.
The grasp reflex lasts only a couple of months and
is stronger in premature babies.
 Babinski reflex - When the sole of the foot
is firmly stroked, the big toe bends back
toward the top of the foot and the other
toes fan out. This is a normal reflex up to
about 2 years of age.
 Step reflex - This reflex is also called
the walking or dance reflex because a
baby appears to take steps or dance
when held upright with his/her feet
touching a solid surface.
One month-Reflexes
Galant reflex

 It is elicited by holding the newborn in

ventral suspension (face down) and
stroking along the one side of the
spine. The normal reaction is for the
newborn to laterally flex toward the
stimulated side
Identify the reflexes
Identify the reflexes
Identify the reflexes
Identify the reflexes
Identify the reflexes
Identify the reflexes
Identify the reflexes
 Cognitive development

The cognitive development of newborn

infant is difficult to understand or
observe it.
 Emotional development

The newborn infant expresses his

emotion just through cry for hunger,
pain or discomfort sensation
Social development
Infancy
Sitting Up

Age 2 months
Age 8 months
 Ambulation

13 month old
Nine to 12-months
 Fine Motor Development
in infancy

6-month-old
12-month-old
Definition of normal infant:-

It is the period which starts at

the end of the first month up
to the end of the first year of
age. Infant's growth and
development during this
period are rapid.
 Physical growth of normal
infant
Weight : the infant gains :
- Birth to 4 months → ¾ kg/month
- 5 to 8 months → ½ kg / month
- 9 to 12 months → ¼ kg /month

The infant will double his birth wt by 4-5

months and triple it by 10-12 months of age
 Calculating infant’s weight

Infants from 3 to 12 months

Weight = Age in months + 9

2
Wt of 7 months old infant = 7+9 = 16 = 8 kg
2
 Height

• Length increases about 3cm/month during the

1st 3 months of age,

• Then it increases 2 cm/month at age of 4-6

months

• Then, at 7–12 months, it increases 1 ½ cm per

month
 Head circumference
• It increases about 2cm/month during the 1st 3
months,
• Then, ½ cm/month during the 2nd 9 months of
age.
• Posterior fontanel closes by 6-8 w of age.
• Anterior fontanel closes by 12-18 months of age.
Chest circumference

By the end of the 1st year, it will be equal

to head circumference.

Physiological growth of infants:-

Pulse 110-150 b/min
Resp 35 ± 10 c/min
Breath through nose.
Blood pressure 80/50 ± 20/10 mmHg
 Dentition:

Eruption of teeth starts by 5–6 months of

age. It is called "Milky teeth" or
"Temporary teeth".
 Average age for teeth eruption:

• Lower central incisors • Erupt at 6 months

• Upper central incisors • Erupt at 7.5 months
• Upper lateral incisors • Erupt at 9 months
• Lower lateral incisors • Erupt at 11 months
• Lower first molars • Erupt at 12 months
• Upper first molars • Erupt at 14 months
• Lower cuspids • Erupt at 16 months
• Upper cuspids • Erupt at 18 months
• Lower 2nd molars • Erupt at 20months
• Upper 2nd molars • Erupt at 24 months.
Motor Development

• At 2 months
• Hold head erects in mid-position.
• Turn from side back.

• At 3 months, the infant can

• Hold head erects and steady.
• Open or close hand loosely.
• Hold object put in hand
 Head Control

Newborn Age 6 months

At 4 months, the infant can:

• Sit with adequate support.

• Roll over from front to back.
• Hold head erect and steady while in
sitting position.
• Bring hands together in midline and
plays with fingers.
• Grasp objects with both hands.
At 5 months, the infant can:

• Balance head well when sitting.

• Sit with slight support.
• Pull feet up to mouth when supine.
• Grasp objects with whole hand (Rt. or
Lt.).
• Hold one object while looking at
another
At 6 months, the infant can:

• Sit alone briefly.

• Turn completely over ( abdomen to
abdomen ).
• Lift chest and upper abdomen when
prone.
• Hold own bottle.
At 7 months, the infant can:

• Sit alone.
• Hold cup.
• Imitate simple acts of others.
 At 8 months, the infant can:

• Sit alone steadily.

• Drink from cup with assistance.
• Eat finger food that can be held in one hand.
 At 9 months, the infant can:

• Rise to sitting position alone.

• Crawl (i.e., pull body while in prone position).
• Hold one bottle with good hand-mouth
coordination
 At 10 months, the infant can:
• Creep well (use hands and legs).
• Walk but with help.
• Bring the hands together.

At 11 months , the infant can:

• Walk holding on furniture.
• Stand erect with minimal support
At 12 months , the infant
can:
• Stand-alone for variable length of
time.
• Sit down from standing position alone.
• Walk in few steps with help or alone
(hands held at shoulder height for
balance).
• Pick up small bits of food and
transfers them to his mouth
 Ambulation(motor growth)

• 1 year: stand independently from a crawl &

creep position

• 13 month old: walk and toddle quickly

• 15 month old: can run

 Emotional development:
• His emotions are instable, where it rapidly
changes from crying to laughter.
• His affection or love for family members appears.
• By 10 months, he expresses several beginning
recognizable emotions, such as anger, sadness,
pleasure, jealousy, anxiety and affection.
• By 12 months of age, these emotions are
clearly distinguishable.
 Social development
• He learns that crying brings attention.
• The infant smiles in response to smile of others.
• The infant shows fear of stranger (stranger anxiety).
• He responds socially to his name.
• According to Erikson, the infant develops sense
of trust. Through the infant's interaction with
caregiver (mainly the mother), especially during
feeding, he learns to trust others through the relief
of basic needs.
As an infant's vision develops, he or she may
seem preoccupied with watching surrounding
objects and people
 Speech Milestones
• 1-2 months: coos
• 2-6 months: laughs
• 8-9 months babbles: mama/dada as sounds
• 10-12 months: “mama/dada specific
• 18-20 months: 20 to 30 words – 50% understood by
strangers
• 22-24 months: two word sentences, >50 words, 75%
understood by strangers
• 30-36 months: almost all speech understood by
strangers
 Red Flags in infant
development

• Unable to sit alone by age 9 months

• Unable to transfer objects from hand to hand
by age 1 year
• Abnormal grip by age 15 months
• Unable to walk alone by 18 months
• Failure to speak recognizable words by 2
years.
Vision in toddler age
 Toddler

Safety becomes a problem as

the toddler becomes more
mobile.
Toddlers
 Normal toddler:

Toddler stage is between 1 to 3

years of age. During this period,
growth slows considerably.
 Physical growth

Weight:
The toddler's average weight gain is 1.8 to 2.7
kg/year.
Formula to calculate normal weight of children over 1
year of age is
Age in years X 2+8 = ….. kg.
e.g., The weight of a child aging 3 years
= 3 X 2 + 8 = 14 kg
 Height:
• During 1–2 years, the child's
height increases by 1cm/month.

• The toddler's height increases

about 10 to 12.5cm/year.
Formula to calculate normal
height
Age in years X 5 + 80 =
cm.

e.g., the length of 2 years old

child
= 2 X 5 + 80 = 90cm
Head and chest
circumference:
• The head increases 10 cm only from
the age of 1 year to adult age.

• During toddler years, chest

circumference continues to increase
in size and exceeds head
circumference.
Teething:

• By 2 years of age, the toddler

has 16 temporary teeth.

• By the age of 30 months (2.5

years), the toddler has 20
teeth
 Physiological growth:
Pulse: 80–130 beats/min (average
110/min).
Respiration: 20–30C/min.
Bowel and bladder control:
Daytime control of bladder and
bowel control by 24–30 months.
Fine Motor - toddler

• 1 year old: transfer objects from hand

to hand
• 2 year old: can hold a crayon and
color vertical strokes
• Turn the page of a book
• Build a tower of six blocks
• 3 year old: copy a circle and a cross –
build using small blocks
 Gross - Motor of toddler

At 15 months, the toddler can:

• Walk alone.
• Creep upstairs.
• Assume standing position without falling.
• Hold a cup with all fingers grasped around it.

At 18 months:
• Hold cup with both hands.
• Transfer objects hand-to hand at will.
 Continuous

At 24 months:
• Go up and down stairs alone with
two feet on each step.
• Hold a cup with one hand.
• Remove most of own clothes.
• Drink well from a small glass held
in one hand.
 At 30 months: the toddler can:
• Jump with both feet.
• Jump from chair or step.
• Walk up and downstairs, one
foot on a step.
• Drink without assistance.
 Issues in parenting – toddler
(emotional development)
• Stranger anxiety – should dissipate by age 2
½ to 3 years
• Temper tantrums: occur weekly in 50 to 80%
of children – peak incidence 18 months –
most disappear by age 3
• Sibling rivalry: aggressive behavior towards
new infant: peak between 1 to 2 years but
may be prolonged indefinitely
• Thumb sucking
• Toilet Training
What signs do kids show
while in a temper tantrum?
 Cry
 Screams

 Kicking

 Breath holding

 Throw away things

 Hit anything and anyone

 Gets stubborn

 Refuses every thing

 When does a tantrum
occur?
 If they are tired
 Hungry

 Uncomfortable

 they can't get something (e.g. an object or

a parent)
 Cant do what they want to do

 Anything that makes them frustrated

 How to deal with a temper
tantrum?
 Never ever give in to a tantrum
 Distract the child when you see them getting frustrated

 Show empathy and try to resolve the tantrum

 Give them wise options to decide themselves

 Move on quickly after they settle down

 Discuss the matter calmly

 What to do if you are in public???

 Simply leave
 Cognitive development:

• Up to 2 years, the
toddler uses his
senses and motor development to
different self from objects.
• The toddler from 2 to 3 years will be in
the pre-conceptual phase of
cognitive development (2-4 years),
where he is still egocentric and can not
take the point of view of other people.
 Social development:
• The toddler is very social being but still
egocentric.
• He imitates parents.
• Notice gender differences and know own
gender.
• According to Erikson,
• The development of autonomy during this
period is centered around toddlers
increasing abilities to control their bodies,
themselves and their environment i.e., "I
can do it myself".
Pre-School
Preschool stage

Definition:-
It is the stage where child
is 3 to 6 years of age. The
growth during this period
is relatively slow.
 Physical growth:-

Weight: The preschooler gains

approximately 1.8kg/year.

Height: He doubles birth length

by 4–5 years of age.
 Physiological growth

• Pulse: 80–120 beat/min.

(average 100/min).
• Respiration: 20–30C/min.
• Blood Pressure:
100/67+24/25.
 Fine Motor – Older Toddler

• 3 year old: copy a circle and a cross – build

using small blocks
• 4 year old: use scissors, color within the
borders
• 5 year old: write some letters and draw a
person with body parts
 Fine motor and cognitive
abilities in pre-school age
• Buttoning clothing
• Holding a pencil
• Building with small blocks
• Using scissors
• Playing a board game
• Have child draw picture of himself
Cognitive development

Preschooler up to 4 years of age is in

the pre-conceptual phase. He
begins to be able to give reasons
for his belief and actions, but not
true cause-effect relationship.
 Emotional Development of
Preschooler
• Fears the dark
• Tends to be impatient and selfish
• Expresses aggression through
physical and verbal behaviors.
• Shows signs of jealousy of
siblings.
Social development in
preschoolers
• Egocentric
• Tolerates short separation
• Less dependant on parents
• May have dreams & night-mares
• Attachment to opposite gender parent
• More cooperative in play
 Social development

According to Erikson theory:

• The preschooler is in the stage
where he develops a sense of
initiative, where he wants to learn
what to do for himself, learn about
the world and other people.
 Red flags: preschool
• Inability to perform self-care tasks, hand
washing, simple dressing, daytime toileting

• Lack of socialization

• Unable to play with other children

• Unable to follow directions

Pool Safety
School-Age
 Normal school-age child:

School-age period is between

the age of 6 to 12 years. The
child's growth and development
is characterized by gradual
growth.
 Physical growth

Weight:
• School–age child gains about
3.8kg/year.
• Boys tend to gain slightly more weight
through 12 years.
• Weight Formula for 7 - 12 yrs
= (age in yrs x 7 )– 5
2
 Height:
• The child gains about 5cm/year.
• Body proportion during this period:
Both boys and girls are long-legged.
Dentition:
• Permanent teeth erupt during school-
age period, starting from 6 years,
usually in the same order in which
primary teeth are lost.
• The child acquires permanent molars,
medial and lateral incisors.
Physiological growth:

• Pulse: 90+15 beats/min

(75 to 105).
• Respiration: 21+3C/min
(18–24).
• Blood Pressure:
100/60+16/10.
School Years: fine motor
• Writing skills improve
• Fine motor is refined
• Fine motor with more focus
• Building: models – logos
• Sewing
• Musical instrument
• Painting
• Typing skills
• Technology: computers
 Motor development

At 6–8 years, the school–age child:

• Rides a bicycle.
• Runs Jumps, climbs and hops.
• Has improved eye-hand coordination.
• Prints word and learn cursive writing.
• Can brush and comb hair.
At 8–10 years, the school–age child:
• Throws balls skillfully.

• participate in organized sports.

• Uses both hands independently.

• Handles using different utensils (spoon, fork,

knife) skillfully.
At 10–12 years, the school–age child:
• Enjoy all physical activities.

• Continues to improve his motor coordination.

 School Age: gross motor

• 8 to 10 years: team sports

 School performance

• Ask about favorite subject

• How they are doing in school
• Do they like school
• By parent report: any learning difficulties,
attention problems, homework
• Parental expectations
School Age
 School Age: cognitive
development
At 7-11 years, the child now is in the
concrete operational stage of cognitive
development. He is able to function on a
higher level in his mental ability.
Greater ability to concentrate and
participate in self-initiating quiet activities that
challenge cognitive skills, such as reading,
playing computer and board games.
 Emotional development

The school–age child:

• Fears injury to body and fear of dark.

• Jealous of siblings (especially 6–8 years old

child).
• Curious about everything.

• Has short bursts of anger by age of 10 years

but able to control anger by 12 years.
 Social development
The school–age child is :
• Continues to be egocentric.
• Wants other children to play with him.
• Insists on being first in every thing
• Improves relationship with siblings.
• Has greater self–control, confident, sincere.
• Respects parents and their role.
• Joints group (formal and informal).
• Engage in tasks in the real world.
 Red flags: school age

• School failure
• Lack of friends
• Social isolation
• Aggressive behavior: fights, fire
setting, animal abuse
13 to 18 Year Old
 Adolescent age

• Physical growth
• Physiological growth
• Secondary sexual characteristics
• Cognitive development
• Emotional development
• Social development
 Definition of adolescent:

Adolescence is a transition period from

childhood to adulthood. It is based on
childhood experiences and accomplishments
 It begins with the appearance of secondary
sexual characteristics and ends when
somatic growth is completed and the
individual is psychological mature.
 Physical growth:

Weight:
• Growth spurt begins earlier in girls (10–14 years, while it
is 12–16 in boys).
• Males gains 7 to 30kg, while female gains 7 to 25kg.
Height:
• By the age of 13, the adolescent triples his birth length.
• Males gains 10 to 30cm in height.
• Females gains less height than males as they gain 5 to
20cm.
• Growth in height ceases at 16 or 17 years in females
and 18 to 20 in males
Physiological growth:

Pulse: Reaches adult value 60–80

beats/min.
Respiration: 16–20C/minute.
The sebaceous glands of face,
neck and chest become more
active. When their secretion
accumulates under the skin in face,
acne will appear.
 Adolescent
• As teenagers gain independence they begin
to challenge values
• Critical of adult authority
• Mood swings especially in early adolescents
 Cognitive development:
Through formal operational thinking, adolescent
can deal with a problem.

Emotional development:
This period is accompanied usually by changes in
emotional control. Adolescent exhibits alternating and
recurrent episodes of disturbed behavior with periods of
quite one. He may become hostile or ready to fight,
complain or resist every thing.

Social development:
He needs to know "who he is" in relation to family and
society, i.e., he develops a sense of identity. If the
adolescent is unable to formulate a satisfactory identity
from the multi-identifications, sense of self-confusion will
be developed according to Erikson:-
Adolescent shows interest in other gender.
He looks for close friendships.
Adolescent behavioral
problems
• Anorexia

• Attention deficit

• Anger issues

• Suicide
 Adolescent Teaching
• Relationships
• Sexuality – STD’s / AIDS
• Substance use and abuse
• Gang activity
• Driving
• Access to weapons
 Developmental theory

 Freud theory
(sexual development).
 Piaget theory
(cognitive development).
 Erikson theory
(psychosocial development).