Growth and development

At the end of this lesson, the students will able to:

Identify the factors affecting Growth
and development
List the principles of growth and
development
Describe the normal growth & developmental
stages from birth to adolescent
Discuss the theories of GD
Demonstrate the growth monitoring using
chart
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 Introduction to Growth and development

Brainstorming

What is growth ?
What is development?

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 Introduction.....
Growth,
• a measure of physical maturation,
• signifies an increase in size
• refers to the child getting bigger in size.
• It is quantitative change in the child’s body.

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 Development
• refers to how a child becomes able to do more
complex things as they get older.
• It is an increase in skill and complexity of function.
• development as an increase in function of
processes related to body and mind
• It is a qualitative change in the child’s
functioning.

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Types of growth
– Physical growth (Ht, Wt, head & chest
circumfera)
– Physiological growth (vital signs …….)
Types of development:
• Gross motor (running, jumping, skipping)
• Fine motor (writing, picture, key board)
• Cognitive (thinking, reasoning, creativity, calculations)
• Social (laughing, dressing, interaction, playing)
• Language (words, sentences, speech, listening etc)
Endashaw F(BSC, MSC ) 8
8
 Types of development
1. Large/Gross motor skills:
• Using large groups of muscles to sit, stand, walk,
run, and keep their balance, etc.
2. Small/Fine motor skills:
• Using hands to be able to eat, draw, dress, play,
write....
3. cognitive development :
• learning, reasoning , memory,
• problem solving , thinking

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 Types of development….
4. Language skills: Speaking,
• using body language and gestures,
• communicating, and
• understanding what others say.
5. Social/Emotional skills:
• having relationships with family, friends, and
teachers;
• Cooperating & responding to feelings of
others.
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Principles of Growth & Development
• Continuous process
• Predictable Sequence
• Don’t progress at the same rate
• Not all body parts grow in the same rate at the
same time.
• Each child grows in his/her own unique way.
• proceeds from simple to complex
• Proceeds from the general to the specific.

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 Principles….

 Growth & Development proceed in

regular related directions :
 Cephalo-caudal(head to toes)

 Proxi-modistal (center of the

body to the peripheral) inward to
outward

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12
2
 Principles of Growth & Development..
• Growth is an orderly process, occurring in
systematic fashion.
• Rates and patterns of growth are specific to
certain parts of the body.
• Wide individual differences exist in growth
rates.
• influenced by multiple factors.

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3
factors affecting growth and development
• Genetic Factors
• Race , sex
• Twinning
• Nutritional Factors
• Socioeconomic Factors
• Environmental and Seasonal Factors
• Chronic Diseases
• Prenatal and Intrauterine Factors
• Emotional Factors
• Hormonal Factors 141
4
 growth and development.....
There are many interrelated factors which
influence a child’s overall healthy development;
• Education,
• Health status
• Socioeconomic status, housing,
• access to quality health and social services,
• access to stimulating early learning environments,
• adequate nutrition,
• clean water, and
• a secure and nurturing parent-child relationship
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VARIOUS PERIODS OF GROWTH
– Ovum - 0 to 14 days after conception.
– Embryo –Up to 12th or 14th week.
– Fetus -Up to birth.
– Newborn - First 4 weeks of life( birth to 28 days).
– Infancy -First year of life ( less than one year age)
– Toddler -1 to 3 years.
– Preschool (early childhood) : 3 to 6 years.
– School children : 6 to 10 years for girls and 6
to 12 years for boys.
– Adolescent (Late Childhood) -13 - 20 years

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1
7
NORMAL GROWTH

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 Growth
parameters
Weight
• On average 3.25 kg (2.5 - 4 kg) at
birth
• lose 1 0 % of BW in the first week
• regain or exceed birth weight by 2 wk
of age
• birth weight is doubled: 4 -5 mo,
• birth weight has tripled: 10-12 mo
• Birth weight quadruples : 2.5 yr of
age.
• Increase by 2kg/year up to 6 years 19
Weighingaccur
acy

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 Growth
Height /length
parameters
• 50 cm at birth
• 75 cm at one year of life
• Double birth height at 4 years
• Triples by about 13 years of age
• Increase by 10cm/year from 1 to 4 years of age
• Increase by 5-7 cm/year from 4 to 12 years of
age
• Half of adult height by 2 years
• Height (cm) at 2 to 12 years =( agein yearsX 6 ) +77 cm

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Height velocity in children

2
2
Accurate Measurement of height

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 NORMAL GROWTH….
Newborn
• Weight = 2.5 – 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

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 Newborn....
• Boys average Ht = 50 cm , girls 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 fontanels (anterior & posterior)

• Chest circumference: 30.5 to 33cm

• Vital signs:Temperature (36.5 to37.5C ),

• Pulse ( 100 to 160 b/min ),RR ( 30 to 60bpm) 25

normal infant( under one years)
• Birth to 4 months → ¾ kg /month,
• 5 to 8 months → ½ kg / month
• 9 to 12 months → ¼ kg /month
• double his birth wt. by 4-5 months and
• triple it by 10-12 months of age
• Quadruple birth weight by 2 yr
• Average weight: 10 kg at 1 yr , 20 kg at 5 yr , 30 kg at 10 yr
 Infants from 3 to 12 months:-

Weight = Age in months + 9

2
 What is the average weight of the 5 months infants?
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 Infants
Length: incr 3 cm /month during 1st 3 months
• it incr 2 cm /month at 4-6 months,
• it incr 1 ½ cm per month at 7 – 12 months,

Head cercumferance
• incr 2 cm /month during the 1st 3 months,
• Then, ½ cm/month during the 2nd 9 months
• ~ 44 cm by 6 month &
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• ˜ 47 cm by 1 year.
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 Infants
• Posterior fontanel closes by 2-3 months
• Anterior fontanel closes by 12-18 months
• Chest circumference: By the end of the 1st year,
it will be equal to head circumference.
• Physiological growth of infants:-
• Pulse 100-150 b/min, Resp 35 ± 10 b/min
• Blood pressure 80/50 ± 20/10 mmHg

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 Average age for teeth eruption:
• Erupt at 6 months
• Lower central incisors
• Erupt at 7.5 months
• Upper central incisors
• Erupt at 9 months
• Upper lateral incisors
• Erupt at 11 months
• Lower lateral incisors
• Erupt at 12 months
• Lower first molars
• Erupt at 14 months
• Upper first molars
• Erupt at 16 months
• Lower cuspids
• Erupt at 18 months
• Upper cuspids
• Erupt at 20months
• Lower 2nd molars
• Erupt at 24 months.
• Upper 2nd molars 31
 Toddler (1-3 years)
• The head incr 10 cm only from 1 year to adult age.
• chest circumference continues to increase in size and
exceeds head circumference.
• Median Height 2 – 12 years;
= Age (yrs) x 6 + 77 (cm)
• Teething: By 2 years of age(16 temporary teeth) and
• by 2.5 years (20 teeth)
• Pulse: 80–130 beats/min (average 110/min),
Respiration: 20–30b/min.
• Daytime control of bladder and bowel:24–30
months.
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 Preschool stage(3-6 years)
 normal weight of children 1-6 years of age is:-
Age in years X 2+8 = ….. kg.
• gains approximately 1.8 -2.7 kg/year
 Height: doubles birth length by 4–5 years
• At age 3 yr, the child is 91.44 cm tall
• Average annual height increase:-
 5.08-7.62 cm between age 4 yr
and puberty
• Pulse: 80–120 beat/min, Respiration: 20–30b/min.
• Blood Pressure: 100/67 + 24/25.

 What is the average weight of the 4 years age

child ? 33
 School age ( 6-12 years)
• gains weight about 3.8kg/year,
• Boys tend to gain slightly more weight
through 12 years.
• Weight for 7 - 12= (age in yrs. x 7 )– 5 2
yrs
• Height: The child gains about 5cm/year.
• Permanent teeth starts from 6 years
• Pulse: (75 to 105), Respiration (18–24),
• Blood Pressure(100/60+16/10).
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 Adolescents ( 13-18 years)
• Growth speed up in girls (10–14 years)
• Growth speed up in boys (12–16 years).
• Males gains 7 to 30kg,
• while female gains 7 to 25kg.
• Males gains 10 to 30cm in height.
• Females gains 5 to 20cm in height.
• height in boys , 5 - 11 cm/year
• Height in girls, 6 -10 cm/year
• Growth height ceases in females 16 or 17 yrs and
• height ceases in males 18 to 20 yrs
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 GROWTH MONITORING
• It is the regular measurement of a child’s size
• Is the process of following the growth rate of a child.
• Growth monitoring and promotion is provided for all
children below five years of age (under-5 children).
• But currently, more emphasis is given on under-two
children.

What are the rationale for GM?

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 Growth monitoring
Rationale for GM :
 Growth monitoring can greatly
strengthen preventive health programs.
 Growth is the best general index of the health
of an individual child.
 For early identification and intervention for
children with growth disturbances (obesity / poor
growth)
Regular measurements of growth permit the
early detection of malnutrition.

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Growth Monitoring and Promotion (GMP)
• WHO defines GMP as a nutritional intervention
that measures and charts the weight of
children and uses this information to counsel
parents so that they can take actions to improve
child growth.
 Today, three growth charts are available
to monitor the nutritional state of children.
a) National Center for Health
Statistics (NCHS/1977) ( for 2- 18 years)
b) Centers for Disease Control and
Prevention (CDC/2000) (for 0- 20 years)
and
c) WHO/2006 ( for 0- 5 years) 38
1.CDC growth reference
the normal range is generally defined as;
• between the 5th and 95th percentiles
2. WHO growth reference
the normal range is generally defined as;
• between -2SD and +2SD (Head cercm for age)
• between -1 and 1 SD is normal(WFH)
• between the 3rd and 97th percentiles(WFA)
What are the Growth Chart Measures?

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 Growth Chart Measure:
• Length/height for age: -whether an infant is an
appropriate length for their age
• Weight for age: -whether an infant is
an appropriate weight for their age
• Weight for length/height :-whether the
weight and length of an infant are in proportion
• Head circumference for age: -information about
brain development
• MUAC:- growth of muscle & subcutaneous
fat
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Mid-upper arm circumference (MUAC)
• It measure the left upper arm, measured at mid
point between the tip of shoulder(olecranon)
and tip of the elbow(acromium).
• MUAC:<11cm/red plus edema =SAM
• 11-12.5cm yellow plus no edema=MAM
• > 12.5 cm = Normal(green)

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 Mid-upper arm circumference
(MUAC)
• The circumference
of upper arm is
taken at mid
point while the
arm is hanging by
the side.

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 Anthropometric assessment

NB. Now For 1-5 yrs Normal >12.5

cm SAM < 11.5 cm
MAM 11.5 - 12.5 cm 44
 MUAC....
Advantages:
 Indicates severe current malnutrition.
 quick to use.
 the measuring tape can be color coded

 Useful as method of screening large number of children, during nutritional

emergencies.
 doesn’t require exact age data.
 the equipment is portable and cheap.
Disadvantages:
 only identifies children with severe malnutrition
 less useful in long term growth monitoring.
 great variability in measurement.

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 Weight for age:

1 – 12 months
Median weight (kg) = Age (in months) + 9
2
1 – 6 years
Median weight (kg) = Age (yrs) x 2 + 8

7 – 12 years
Median weight (kg) = (Age (yrs) x 7) – 5
2
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 Weight for age (WFA)
 Gomez: WFA = Wt. of subject x 100
Wt. of normal child of same age
Wt. for age Degree of malnutrition
• 90-109% normal
• 75-89% mild (grade I) moderate
• 60-74% (grade II)
• < 60 severe (grade III)

 CalculateWFA of a 5 years old child and her

weight is 13 kg. Interperate your result .
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 WFA...
Advantages
 The only tools needed are weighing scales
and charts.
 weighing is a fairly easy task for
inexperienced health workers.
Disadvantages:
 should be done regularly
 child’s age to the nearest month.
 cultural unacceptability (some places).
 Falsely normal in edema or Ascites.

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 WFH
Advantages:
 Identifies the very thin or wasted child with
definite malnutrition who requires immediate
attention.
 Good indicator to distinguish children who
are well proportioned from those who are
wasted for their height.
 Doesn’t require age data.

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 WFH
Disadvantages:
 stunted children with reasonable body
proportion are classified as not malnourished.
 two pieces of equipments required.
 takes longer time.
 measuring length in infants may require
two persons.
 more difficult for unskilled health workers.

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WFA, CDC

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HFA, CDC

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 Measuring patient's body weight
 Weight is measured using;
• beam balance/spring balance for small children

• standing scale: >2 years by stadiometer

• Weigh infants directly with an infant scale;
• this is more accurate than an indirect
method based on weighing the parent.

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Measuring patient's body weight...
During weighting Should be ;
• undressed or wear light clothing .
• Infants should be clothed only in a diaper or
• Infants weighed naked.
• Hands and arms straight down by side
• Make the patient room warm.
• Wipe the scale with cotton with alcohol.
• Remove the clothing ( keep privacy)
• Put a scale paper on the scale.
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 Taking patient's height
• Height is measure in upright position for children
above two years of age
• The older children should stand straight against a
wall or the erect measuring scale and their
head,shoulder,buttock and heels should touch the
wall or measurement scale.
• Then they should take deep breath to relax the
shoulder and with object the upper level of the head
should be marked against the scale.
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Taking height

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 Taking patient's length
• for those <2 years, length should be taken.
• should be taken by two examiner.
• Length should be measured without footwear

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Taking patient's length …
1. Place the towel on the board.
2. Remove the infant clothing.
3. Place infant on center of board firmly in supine
position.
4. Hold the head against headboard firmly.
5. Grasp the knees together gently.
6. Push down in knees until the legs are fully
extended &hold the legs firmly.
7. Bring the headboard against soles of
heals firmly.
8. Read and record. 66
Head circumference
 Increases in size during the 1st year of life,
but little increment between 1 and 5 years of
age.
Average HC (cm) at birth = 35 (33 – 37)
At 6mo =44 At 1 yr = 47
At 2 yr = 49
 Microcephaly is HC < 2SD below the mean
 Macrocephaly is HC > 2SD above the
mean
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 measuring Head Circumference

• The head circumference should be

measured during the first 2 years of life, but ;
• measurement can be useful at any age to assess
growth of the head.
• The head circumference in infants reflects
the rate of growth of the cranium and the brain.

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 Head Circumference...
• Head circumference should be measured using a
narrow non- stretchable plastic or disposable
lasso tape.
• Clean tape with antiseptic wipes [or soapy water]
between child use
• Measurement should be taken at the maximum
occipito-frontal circumference taking the largest
of consecutive measurements

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Head Circumference...

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 Based on Body mass index

• Official Centers for Disease Control [CDC]

growth charts;
• 85th to 95th percentile is " risk for
overweight"
• >95th percentile is "overweight";

• <5th percentile is "underweight."

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74
 BMI weight in kg
= (height in meter) square

BMI (WHO - Classification)

 BMI < 18.5 = Under Weight
 BMI 18.5-24.5= Healthy weight range
 BMI 25-30 = Overweight (grade 1 obesity)
 BMI >30-40 = Obese (grade 2 obesity)
 BMI >40 =Very obese (morbid or grade 3
obesity)

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DEVELOPMENTAL STAGES
Normal developmental milestone

 Developmental milestones: Are a set

of functional skills or age-specific tasks
that most children can do at a certain
age.

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 Developmental mile
stones
PARAMETERS OF DEVELOPMENT
ASSESSMENT
• Gross motor (running, jumping, skipping)
• Fine motor/Adaptive (writing, picture, key
board)
• Cognitive (thinking, reasoning,
creativity, calculations)
• Social (laughing, dressing,
interaction)
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DEVELOPMENTAL MILESTONE....
• Developmental quotient (DQ)
DQ = the developmental age x
100 chronologic age
• A quotient above 85 : normal limits;
• A quotient below 70 is considered
abnormal.
• A quotient between 70 and 85; gray
area( need advise, supervision)
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 Class activity
• A 12-month-old boy is seen for health
supervision. He is not walking alone but now
he is achieving his milestone of the age
10 months.

Is this child is in normal DQ/M?

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Developmental milestone

80
Cont.
..

81
Cont.
..

82
Cont.
..

83
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85
• 1-2 months: social smile

86
 Head Control

Newborn Age 4
months
87
• 6-7 months :
- stranger anxiety
• 9 months :
- ‘bye- bye’, baba
mama

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9 MONTHS-
• begins to stand holding on
the furniture ,
• crawling
10 – 11 months –
• start cruising around the
furniture

89
 At 10 months, the infant
• Creep well (use hands and legs).
can:
• Walk but with help.
• Bring the hands together.
At 11 months , the infant can:
• Walk holding on furniture.
• Stand erect with minimal support

90
 At 12 months , the infant can:

• Stand-alone for variable length of time.

• Site 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 91
First Steps
~ 12 Months

92
 Ambulation

13 month
old
Nine to 12-
months 93
12- 13 months
• stands alone.

13- 15 months
start walking alone

• 18 months _
runs

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 Moral development
• 0-2 years- preconventional morality(unable to
understand good or bad)
• 2-3 years- child if punished for doing is
wrong or

- if not punished ,it is

right
• 3-6 years-follow rules strictly for the purpose of
self interest
96
 To develop good behaviour (child)
• Always about good/positive things ( playing,
talking, working....)
• Not do bad things in front of the child
To develop good behaviour ;teach child:
• Begin with simple, broad rules.
– Be safe, responsible, respectful, kind, ethical.
– Describe what each of those means.
• Provide examples of appropriate behavior.
• Provide examples of inappropriate behavior.
• Clearly state the expectation (incentives/reward or the
results of doing good/ bad )
97
PLAY ACITIVITES:

• 0-1 year-solitary play(infant play alone for

longer period)

• 1-3 year-parallel play(playing beside and

watch each other

• 3-6 year-co-operative play(children begin to

exchange their ideas with other children

• 6-12 year-competitive play

98
 Continue……….
Language development:

• 1-2 months: coos

• 2 month- turn head towards sound

• 2-6 months: laughs and squeals

• 6 month-response to own name by smiling

• 8-9 months babbles: ma/da as sounds

• 9 month-understand ‘ no’ , can say ma

da
• 10-12 months: mama/dada specific 99
 Speech
• Milestones…
18-20 months: 20 to 30 words – 50%
understood by strangers
• 22-24 months: two word sentences, > 5 0
words, 7 5 % understood by strangers
• 30-36 months: almost all speech
understood by strangers
• 1-6 year- more than 2100 words

100
 Developmental mile
stones…..
Neonatal life
• Gross motor- flexed posture, turn to
one side on prone position
• Fine motor/adaptive- Listen to loud
noise
• Cognition-Identify mother from
strangers
• Social- look at the mother’s face on
feeding 101
 Developmental mile
Youngstones…
infants ( < 6months)
• Gross motor: hand movement at 3-4
months
– Lift head at 2 months on prone position
– Lift head and chest at 3-4 months
• Fine motor: palmar grasp, hand mid
line at 4 months, grasp and mouth
objects at 6months
• Social: smile at 1-2 months, laugh at 3-
• Cognitive:
4 months Watch object until 1041
0
2
 Developmental mile
Late infancy
stones(6-12 months)
• Gross motor: sit at 6-7 months,
- roll over 7-8 months
– Crawl/creep at 9-10 months
– Stand supported at 11-12 months
• Fine motor: Pincer grasp at 9-10
months
• Social: stranger anxiety at 7-8
months
• Language: few clear words at 10-12
months 103
 Developmental mile
Toddler stones
(preschool)
Stand alone by 12-13
months
Walk alone by 13-15
months,
 Started to run 16-18 months
Climb up stairs by 18-24
months
Jump by 2 years of age,
skip-5years
Fine motor: scribble at
2years,
copy circle-3years, 104
 Toddler
(preschool)…..
Cognitive: Reach object by stick,
- symbolic play
Language: vocabulary increases,
• combine two words by two years,
• three words by three years and so
forth
Social: feed self from a cup-18
months,
• Feed self by forks by 24 months,
• control urine at night by 2-3
years, 105
 Development
m…..
School age (6-12years)
• Gross motor: Run, jump, skip
• Fine motor: complex tasks
(keyboards, drawing)
• Social: dress self, wear shoe
• Language: several word
combination
• Cognitive: addition, subtraction,
reasoning
• Dentition: shedding of primary 106
 ADOLESCEN
AdolescenceCE
(10-20 years)
Early: (10-13), Middle: (14-16), Late:
(17-20)
• Cognition: reasoning, abstract thinking
(logical thinking )
• Gross motor: Routine activity
• Fine motor: Extreme agility in fine work
• Social: Abide with social laws, cultures
etc
1091
• Language: complex statements 0
7
 ADOLESCENC
E….concerned with
• Self concept:
attractiveness
• Family: struggle for autonomy
• Social: limited relation and dating
(early) to intimacy and future planning
(late)
• Sexual: anatomy, anxiety and questions
about sexual organs (early) to
consolidated identity (late)
• Neurology: maturity of frontal and
superior temporal cortex; to control 108
 Red Flags in child
• development
Poor head control by 5 months
• Unable to sit alone by age 9 months

• Unable to transfer objects from hand to hand

by age 1 year
• Abnormal pincer grip or grasp by age 15
months
• Unable to walk alone by 18 months

• Failure to speak recognizable words by 2

years. 109
 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 during

110
 Red flags: school
age
• School failure

• Lack of friends

• Social isolation

• Aggressive behavior: fights, fire setting, animal

abuse

111
 What age is each infant?

A- sits without support

B- just started walking

D- can lift chest off the table

C- crawling
112
What age is the age of this infant?
A. Infants starts to say baba mama ,
crawling, hold bottle , throw object.
B. stands independently.
C. Walks alone
D. Run

113
What age is each infant?

114
THEORIES OF DEVELOPMENT
• The concept of a developmental line implies that
a child passes though successive stages.

The psychoanalytic theories of Sigmund Freud &

Erik Erikson
 cognitive theory of Jean Piaget
behavioral theory of Skinner
Biological-maturational Theory
Sociocultural Theory
Attachment theory
Bioecological Systems Theory
115
 Freudian theory
• it is the idea of body-centered or "sexual"drives.

• The focus of the drives shifts with maturation from;

1. oral satisfactions (sucking in the 1st yr of life);

2.anal sensations (i.e., holding on and letting

go during the toddler years);

3.oedipal drives (possessiveness toward a parent in

the preschool years), and

4. genital drives (in puberty and beyond) 116

117
118
Erikson stages...

119
 J. Piaget theory
• study of cognitive development.
• It says that cognition changes in quality, not just
quantity
• Children actively contribute to their own
cognitive development by constructing their
own understanding of the world.

120
 J. Piaget theory stages
1. Sensorimotor: (birth to about age 2)
• have the following basic senses: vision, hearing,
and motor skills.
• knowledge of the world is limited
• At 7–9 months :begin to develop - object permanence,
this means ;
• the child has ability to understand that
objects keep existing even when they cannot
be seen.

121
2. Preoperational: ( 3 to7 years)
• analyzing environment using mental symbols.
• apply these various symbols in their everyday lives
• use different props to make play more real.
• 3–4 years, egocentrism, which means the child
is not able to see someone else’s point of view,
• at 7 years, no longer egocentric, more
intuitive( now think about the way something
looks instead of rational thinking).

122
3. Concrete: (7 -11 years )
• use appropriate logic to develop cognitive
operations and
• begin applying this new thinking to
different events they may encounter.
• inductive reasoning( drawing conclusions
from other observations).
4. Formal operations ( early to late adolescence)
• ability to think more rationally and
systematically about abstract concepts.

123
BEHAVIORAL THEORY( skinner)
• behavior and learning can be shaped by providing
rewards and punishment.
• No stages are implied: Children, adults, and indeed
animals all respond the same.
• behaviors that are positively reinforced occur
more frequently.
• It is simple, wide applicability, and conduciveness
to scientific verification.

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 Biological-maturational Theory
• genetic and physiological changes (i.e.,
nature) contribute to developing structures of
the body.
• Brain development and motor capabilities occur
almost automatically without learning or instruction.

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 Sociocultural Theory
• Proposed by Vygotsky
• social interactions as important in development
• knowledge is actively and socially constructed
through interactions with others.
• This theory focuses on how culture is transmitted to the
next generation through tools such as language and
social interaction.
• Working with adults and more skilled peers is essential
for children to acquire the ways of thinking, knowing,
and behaving that make up a community’s culture .

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Attachment theory
• By John Bowlby and Mary Ainsworth,
• believe that close emotional bonds or “attachments”
between an infant and their primary caregiver is an
important requirement that is necessary to form “normal
social and emotional development”.
Bioecological Systems Theory
• focuses on the interactions and influences of the
outside environment on the child's development.

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 Bioecological Systems Theory
 It influence on the child's development.
1. microsystem :
• family, school, child care providers, peers
2. Mesosystem: interactions and linkages of the
interconnections of the microsystem.
3. exosystem : legal services, social services,
neighbors, extended family, and work place.
4. Macrosystem: laws, customs, and values of a
particular society or cultural system. .

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Promoting growth and development
 Play is essential to development because it
contributes to the ;
• cognitive, physical, social, and
• emotional well-being of children and youth.
 healthy eating habits
 Physical activity is essential to promote
children's health and well-being.
 Good sleeping habits,
 talk about stories, words, and ideas
 Recreation and rest

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 ANTICIPATORY GUIDANCE
• Anticipatory guidance is information conveyed to
parents verbally or by written materials to assist
them in facilitating optimal growth and development
for their children.
• educating parents and caregivers about what to
expect in the next phase of development.
• Age-appropriate discussions should occur at each visit.
• Health promotion & prevention of disease/injuiry
• supports the healthy development of the child.
• It should focus on issue in depth

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 Anticipatory guidance...
Anticipatory guidance : discussions on this area:
 Importance of playing
 Healthy habits
 Nutrition and healthy eating counselling
 injury prevention
 Safety and prevention of injury
 Violence prevention,
 sleep position counselling (back until 6 months old),
 fostering optimal development and behavior.
 Discipline( means to teach, not merely to punish)
 Developmental milestone
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Anticipatory guidance : discussions on this area....
• Emotional and mental health
• Oral health
• Prevention or recognition of illness
• Prevention of risky behaviors
• School and vocation
• Peer relationships
• Community interactions
• Sexual development and sexuality
• Self-responsibility and efficacy
• Family relationships (interactions, strengths,
supports)
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 Play in children
• Play is critical to the healthy growth and
development of children
Importance of playing for children :
 Language and communication skills,
 Cognitive(thinking...) development,
 Creative development.
 motor skills, and
 Social awareness,

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10 Needs of the children

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 Play methods
• My Book about Me, Cups and Spoons,
• Dolls, Washing Dishes, Hidden Toys
• Touching Songs, Big Pictures
• Talking Walk, Signs, Nursery Rhymes and Chants(
sound),
• Puppets(movable model), Mimic
• Take-Apart Toys, Moving Like the Animals,
• Doing it Songs
• Dump and Fill, Crush sound, Keys,
• Variations on Push and Pull
• Scrunches(biting sound),
• Painting with Water
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 Play methods….
• Infants & children are exposed to family
members, relatives for interaction purposes.
• Infants are given different types of toys for
playing ( doll, children book, car ,animal,.......)
• Children are provided with manipulative or
creative toys and games/puzzle as needed.

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Play methods….
• Complex construction sets and accessories
• Board games teach children to follow
simple rules and enhance concepts such as
math and reading in a fun way
• Different types of music invite baby to
experience different rhythms and sounds.

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 Play methods….
• Children are given exercise activities to construct
house ,car, animal, funnel, furniture....)
• Fitness and fun materials such as balls, bean
bags, and jump ropes
• Holding a bottle, cup, a crayon or paint brush,
buttoning, zipping, cutting, scissor.
• Dance , Drama, hidden toys, Give pen/pencil to
draw something
• Give activities that need moral judgement

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