Growth and development of the Child

Definition of terms
 Growth: Can be described as an increase in physical size (weight, height &
length) or a quantitative change which facilitates a more effective
functioning. It is a structural increase.
 Growth in weight is measured in pounds or kilograms; growth in
height/length is measured in inches or centimeters.

 Development: indicates an increase in skill or the ability to function (a

qualitative change).
 Development can be measured by observing a child’s ability to perform
specific tasks such as how well a child picks up small objects.
 Development can be achieved through three main processes Maturation,
Adaptation and learning. 1
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Definition of terms cont.

 Maturation: This is a qualitative change that is not induced by

learning or experience but comes about as a result of mere passage of
time. It is simply a process of ripening.

 Adaptation: This is the result of body‘s accommodation or adjustment

to meet its environmental needs.

 Learning: Acquiring of knowledge through experience. A relative

permanent change in behaviour resulting from experience,
experimentation and training.

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Importance of study of growth and development of the child

 It helps nurses to know what to expect of a particular child at any given age
and at what age certain kinds of behaviour are likely to emerge in more
mature and natural forms.
 This knowledge is used to observe and judge each child in term of the norms
for level of specific development. In order for the Nurse to formulate plan
for total care for each child she must understand the stages of growth and
development.
 It also helps the Nurse to understand the reason for particular conditions
and illnesses which occur in various age groups. She can then teach the
mothers how to observe and use the knowledge to help the child achieve
optimal growth and development.
 She can recognize abnormal behaviors, mental & physical handicaps and
refer on time. 05/15/2024 3
Growth and development cont.

 N.B: All children go through a normal sequence of growth, but not at the same rate but there is
coronation between physical growth, mental, emotional and sexual development. It is dangerous
to force a child into a standard pattern of growth or task.

 Growth is not due to one factor but combination of many factors, all interdependent i.e. heredity,
Racial, national, characteristics, sex and environmental.

Child Development includes:

 Physical Development: This deals with physical and physiological characteristics of an
individual.
 Social Development: Deals with the development of the awareness of one in relation to others and
interactional style of the child at home, in the school and among his peer.
 Emotional Development: This deals with the development of affection and cognition of the child.

 The individual is an entity, a whole: any malfunction in one area may therefore affect the other
areas e.g. a physical defect may cause social or emotional problems.
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General Principles of Growth and Development
 Growth and development are continuous processes from conception until death:
Although there are variations in the rate at which growth and development
proceed, at all times a child is growing new cells and learning new skills. An
example of how the rate of growth varies with stages of development can be
seen in a comparison between the first year and later in life. An infant triples
birth weight and increases height by 50% during the first year of life; this is
lesser in later years.
 Growth and development proceed in an orderly sequence: Growth in height
occurs in only one sequence that is from smaller to larger. Development also
proceeds in a predictable order. For example, the majority of children sit
before they creep, creep before they stand, stand before they walk, and walk
before they run. Occasionally, a child may skip a stage or pass through it so
quickly. Occasionally, a child may progress in a different order, but most
children follow a predictable sequence of growth and development. 05/15/2024
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General Principles cont.

 Different children pass through the predictable stages at different rates:

All stages of development have a range of time rather than a certain
point at which they are usually accomplished. Two children may pass
through the motor sequence at different rates, for example, one may
begin walking at 9 months, another at 14 months; both are
developing normally. They are both following the predictable
sequence; they are merely developing at different rates.
 All body systems do not develop at the same rate: Certain body tissues
mature more rapidly than others. For example, neurologic tissue
experiences its peak growth during the first year of life, whereas
genital tissue grows little until puberty.
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General Principles cont.

 Development is cephalocaudal: i.e. development proceeds from head to tail. Newborns

can lift only their head off the bed when they lie in a prone position. By age 2 months,
infants can lift both the head and chest off the bed; by 4 months, the head, chest, and
part of the abdomen; by 5 months, infants have enough control to turn over; by 9
months, they can control legs enough to crawl; and by 1 year, children can stand upright
and perhaps walk.

 Development proceeds from proximal to distal body parts: This principle is closely related
to cephalocaudal development. It can best be illustrated by tracing the progress of upper
extremity development. A newborn makes little use of the arms or hands. Any
movement, except to put a thumb in the mouth, is a flailing motion. By age 3 or 4
months, the infant has enough arm control to support the upper body weight on the
forearms, and the infant can coordinate the hand to scoop up objects. By 10 months, the
infant can coordinate the arm and thumb and index fingers sufficiently well to be able
to pick up an object as fine as a piece of breakfast cereal on a highchair tray.
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General Principles cont.

 Development proceeds from gross to refined skills: This principle parallels the preceding
one. Once children are able to control distal body parts such as fingers, they are able to
perform fine motor skills (a 3-year old colors best with a large crayon; a 12-year-old
can write with a fine pen).

 There is an optimum time for initiation of experiences or learning: Children cannot

learn tasks until their nervous system is mature enough to allow that particular
learning. A child cannot learn to sit, for example, no matter how much the child’s
parents have him or her practice, until the nervous system has matured enough to
allow back control. Children who are not given the opportunity to learn developmental
tasks at the appropriate or “target” times for that task may have more difficulty than
the usual child learning the task later on. A child who is confined to a body cast at 12
months, the time the child would normally learn to walk, may take a long time to learn
this skill once free of the cast. The child has passed the time of optimal learning for
that particular skill. 8
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General Principles cont.

 Neonatal reflexes must be lost before development can proceed: An

infant cannot grasp with skill until the grasp reflex has faded nor
stand steadily until the walking reflex has faded. Neonatal reflexes
are replaced by purposeful movements.

 A great deal of skill and behavior is learned by practice: Infants

practice over and over taking a first step before they accomplish this
securely. If children fall behind in growth and development because
of illness, they are capable of “catch-up” growth to bring them equal
again with their age group.

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Factors influencing growth and development

 Genetic inheritance and environmental factors are two primary factors that
determine a child’s pattern of growth and development. A unique combination of
these factors determines how each child grows and matures.

 Genetics: each child is unique; inheritance determines physical characteristics such

as eye color and height potential and characteristics such as learning style and
temperament. An infant may inherit a genetic abnormality, which could result in
disability or illness at birth or later in life.

 Gender: On average, girls are born lighter (by an ounce or two) and shorter (by an
inch or two) than boys. Boys tend to keep this height and weight advantage until
prepuberty, at which time girls surge ahead because they begin their puberty
growth spurt 6 months to 1 year earlier than boys. By the end of puberty (14 to 16
years), boys again tend to be taller and heavier than girls.
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Factors cont.

 Intelligence: children with high intelligence do not generally grow faster

physically than other children, but they advance faster in skills. Children of
high intelligence may even fall behind in physical skills because they spend
their time with books or mental games rather than with games that develop
motor skills and so do not receive practice in these areas.

 Socioeconomic Level: children born into families with low socioeconomic

means may not receive adequate health supervision or good nutrition. Poor
health supervision can leave them without immunization against measles or
other childhood illnesses and therefore vulnerable to diseases that could
cause permanent neurologic damage if complications occur. Poor nutrition
can also leave them vulnerable to disease as antibody formation depends on a
good protein intake.
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Factors cont.
 Parent–Child Relationship: children who are loved thrive better than those who are not. Either
parent or a nonparent caregiver may serve as the primary caregiver or form a primary parent–
child love relationship. It is the quality of time spent with children, not the amount of time that is
important. Loss of love from a primary caregiver, as might occur with the death of a parent, or
interruption of parental contact through hospitalization, imprisonment, divorce, or inadequate
parental love, can interfere with a child’s desire to eat, improve, and advance.

 Ordinal Position in the Family: the position of a child in the family (first-born child, middle child,
youngest child, only child) and the size of the family have some bearing on a child’s growth and
development. An only child or the oldest child in a family, for example, generally excels in
language development because conversations are mainly with adults. is likely to develop more
rapidly along intellectual line because he is constantly with adult. He is mentally stimulated by
their companionship. Last born he may be slow in motor development because he has so much
done for him. Youngest children may develop language more slowly, especially if older children
talk “baby talk” with them. Children learn by watching other children, however, so a youngest
child who has many examples to watch may excel in other skills, such as toilet training at an
early age.
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Factors cont.

 Health: diseases that come from environmental sources can have as strong an influence
on growth and development as genetically inherited diseases. Infants cared for in
neonatal intensive care units, for example, may develop some decrease in hearing
because of the overstimulation of sound. Also children who have residual heart
impairment as a result of contracting rheumatic fever might be limited in their ability to
play an active sport. Fortunately, if an illness does not last long, most children achieve
“catch-up” growth afterward.

 Nutrition: poor maternal nutrition may limit the growth and intelligence potential of a
child from the moment of birth. Children whose diets lack essential nutrients show
inadequate physical growth. A lack of energy and stamina prevents children from
learning at their best intellectual level. Nutrition also plays a vital role in the body’s
susceptibility to disease because poor nutrition limits the body’s ability to resist infection.
Lack of calcium could leave a child prone to rickets, lack of vitamins can lead to visual
impairments, poor healing, and poor bone growth.
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Stages of growth and development

Stage Age Period

 Neonate First 28 days of life
 Infant 1 month – 1 year
 Toddler 1–3 years
 Preschooler 3–5 years
 School-age child 6–12 years
 Adolescent 13–19 years
 Early adulthood 20-40 years
 Middle adulthood 40-65 years
 Late adulthood 65 years and older

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 Difference between growth and development

Growth Development
It is used in purely physical sense, refers to increase in height, weight, size and length Implies overall change in shape, form or structure resulting in improved cognitive, social,
emotional working or functioning

Changes are mainly quantitative Changes are qualitative or character

Growth is for limited period, does not continue throughout life; it stops when maturity has It continues throughout life and is progressive
been attained

It occurs due to cell division It happens due to motor and adjust mental processes and their interplay.

Growth can be measured. It can be observed by matured behavior

Growth tells about one aspect of personality but in limited scope. Development deals with all the aspect of personality and has a vast scope

Growth is structural Development is considered as functional

Growth focuses on only one aspect i.e. increase in child’s size Development focuses on various aspects like interpersonal skills, intelligence, emotion etc

Growth is a physical/external process Development is an internal process

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Development of the Child

 Development of the child can be divided into two:

 Pre and Post natal periods.
 The first 8 weeks (prenatal) is the most critical period in life because
most organs, nervous system, blood and heart are formed.
 At this stage any chemical changes in the mother‘s blood stream
caused by virus or drugs can lead to mal-development and can affect
any organ in the process of being formed.
 From here the fetus starts to grow and develop in the woman at
various stages until viable (24 weeks).

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Growth & Development of Infant from Birth – 1-year

1month
 Weight gain – steady weight gain.
 Height – Increase of 2.5cm is expected in the first 6 month.
 May lift head up intermittently, cannot hold head up; can turn head
side to side.
 Posture at birth is face down and can lie on its stomach.
 Stare indefinitely at his surrounding notices face and bright objects.
Smiles indefinitely and cries when hungry or uncomfortable.

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Growth & Development of Infant cont.

2 months
 Posterior fontanelle closes, raises his chest up with arms, can hold head erect in mid-
position.
 Can follow a moving light or object with his eyes.
 Begins social behavior – smile in response to another‘s smile. Learnt that he gets
something from cry, sound of cry varies with the reason for crying.e.g. sleep, pain,
hunger etc.

3 months
 Hold hands up in front of him and plays with fingers and hands.
 Hold head erect and steady.
 Lies on his back.
 Shows awareness of presence of people.
 Laugh aloud and shows pleasure in making sounds.
 Cries less, smiles in response to mother‘s face. 05/15/2024 18
Growth & Development of Infant cont.

4-5 months
 Increasing aware of his surroundings, Gasps object with the whole hand and carries it to
mouth (Proximodistal principle) can hold head steadily.
 Can sit without support. Drools with saliva running down his mouth.
 Becomes more talkative and respond to name, recognizing strange look and places.

6 – 7 months
 Teeth starts to appear (lower 2 incisor) grasp with flexion of fingers.
 Hold leg and put in the mouth. Balances well by leaning forward slightly on one or both
hands.
 Moves backwards in a sitting position by using his hands to push.
 Begins to make sound like Ba, Da, Ma, Ta
 Bounces actively when held in upright position.
 There is emotional instability by changing from laughing to crying and visa versa.
 Doubles birth weight.
 There is indiscriminate social attachment. Not attached to any particular person.
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Growth & Development of Infant cont.

8-9 months
 Sit alone steadily. Stand with help at 8 months holding furniture by 9 months.
 There is perfect co-ordination of hand and eyes.
 Shows first fear reaction to strangers.
 Greets strangers by turning away and crying and may not stop crying until he sees familiar
face.
 Affection or love of family group appears, increase interest in activities.
 Can put nipple in and out of the mouth at will, crawl with the trunks above the floor stand
supported.
 May triple the birth weight.

10-12 months
 Stands by holding on to something, as support. Stand alone unsupported.
 Walk with help, can hold crayon or pencil, to make strokes and marks on a piece of paper.
 Participates in dressing/ can say two words – Mama, Dada, Baba, and Tata, knows his own
name. Recognizes meaning of NO, egocentric, concern only with himself, can climb stairs
steps by 13 months. 05/15/2024 20
Growth & Development of Infant cont.

13-15 Months
 Can walk alone.

 This is however not strictly by all children Nigerian children have been
found to be faster in locomotion – sit unsupported by 5-6 months and
walk by 10 months.
 Generally African children are trained by siblings and parents. After 1
year of age the weight and height do not give accurate information about
growth because of several factors.
 Boys are heavier and taller than girls, but girls mature at more rapid
rate. Genetic factors have much to do with body build e.g. effect of
nutrition on weight and height.
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Growth & Development of Infant cont.

 Intelligence: Can be defined as the ability to adjust to new situations, to

think abstractly or to profit from experience.
 Intelligence quotient (IQ) – Ratio between the child‘s chronologic age and
his mental age as gained from an intelligence test.

 Mental Age X 100 = I.Q

Chronologic age

 Mental maturity is usually reached between 16-21 years. An I.Q. between

90-109 is considered normal or average.
 I.Q may range below or above this point. Children with I.Q of 140 or over
are called gifted children while those below the average represent
retardation of varying degrees. 22
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Development of teeth

 Infant is usually born without teeth. Already he has 20 deciduous

(primary) teeth in his mandible and maxilla which begins to calcify in-
utero.
 Eruption of primary teeth begins at about 6-7 months. For some it
brings no discomfort but for some it is a painful experience.
 The claim that teething causes high fever, diarrhea or other serious
upset is not justified. Baby with these symptoms should be investigated
and treated.

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Development of Teeth

Eruption Shedding

Central incisor 6-7months 6-7½years 10½ years

First permanent molar 6-7years Second

11years.
baby molar (Lower)20month

Lateral 9-13months

Canines 16-20months

First Molars 13-19months nd Molars 25-33months 2

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Child growth curve

 The growth curve tells us if the child is growing or not. A child who is
growing is usually healthy. So, in the process of monitoring health we
monitor growth and vice versa. Healthy children should always visit
clinics for growth monitoring. The child should be seen every month
for the first 6 months, then six monthly. Weight and height are
assessed periodically. The weight of the child increases each month. A
chart should be used, the weight, indicated by a dot and all the dots
are joined together to form a growth curve. If the growth curve is
rising the child is growing and he is healthy but if it remains flat it
means the child is not gaining weight well. If falling it means is losing
weight.
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Child growth curve cont.

 The upper line shows the weight of a child that is well fed and healthy child.
The lower line shows a malnourished child and under-weight. The line
between these is called the road to heath.

 Children should be on the road to health. The best way to assess the child‘s
health is by measuring the arm circumference. During the first year the arm
circumference grows rapidly but from 1-5 years it remains stable. But if arm
circumference is less than 14cm during this time the child is malnourished.
Arm circumference is used because the age does not have to be known. A
tape measure is used to measure the child‘s upper left arm. A colored string
can be used as well, then the length is measured on a ruler
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