2. Growth
• It is the process of physical maturation
resulting an increase in size of the body and
various organs. It occurs by multiplication of
cells and an increase in in intracellular substance.
It is quantitative changes of the body.
3. Development
• It is the process of functional and
physiological maturation of the individual. It
is progressive increase in skill and capacity
to function. It is related to maturation and
myelination of the nervous system. It
includes psychological, emotional and social
changes. It is qualitative aspects.
6. Cephalocaudal
direction
• The process of
b r i d a l direction
from bond down to
tail.
improvement in
structure aad function
come first in the head
region, then in the
8. General Specific
• Childi'en use their cognitive and language skills to
reasOn and solve problems.
• Children at first are able hold the big things by using both
arms, In the next part able to hold things iii a single
hand, then only able to pick small objects like pcas,
cereals etc.
• Childi•en when able to hold pencil, first stans di•aw circles
then squares then only letters after that the words.
11. • Growth and development depend upon
multiple factors or determinates.
• They influence directly or indirectly by
promoting or hindering the process.
13. Genetic factors
• Genetic predisposition is the
importance factors which influence the
growth and development of children.
• Sex
• Race and Nationality
14. Prenatal factors
• Intrauterine environment is an
important predominant factor of growth
and development. Various conditions
influence the fetal growth in utero.
16. Postnatal factors
• Growth potential
• Nutrition
• Childhood illness
• Physical
environment
• Psychologic
al
environmen
t
• Socio
economic
status
• Climate and
season
• Play and
exercise
• Bi h order
of the
17. GROWTH AND &DEVELOPMEN A
AGE PERIODS
• Infancy
Neonate
•Birth to
Infancy
month
• month to
year
21. Assessment of
growth
• Assessment of physical growth can be done
by antliropometric measurement and the study
of velocity of physical growth.
• Measurement of different growth parameters
is the importance nursing responsibility in
child care.
22. Weight
• weight is one of the best criteria for assessment of
growth and a good indicator of health and nutritional
status of child.
• Among Indian children, weight of the full terms
nconate at birth is approximately 2.5 kg to 3.Skg.
• there is about 10*Z» loss of weight first week of
life, which regains by 10 days of age.
24. COPit ...
• Then, weight gain is about 25- 30 gis per day
for 1°' 3 month
and 400gm/ month till one year of age.
• The infants double weight gain their birth
weight by Smontli of age, trebled by one
year, four th time by two years, fit e times
by thi ee year, six times by fire year, set en
times by set en year and ten times by ten
year.
• Then weight inci•eases rapidly during
pubeny followed by weight increase to
adult size.
25. Length and height
• Increase in height indicates skeletal growth.
Yearly increments in height gradually diminished
from birth to maturity.
• At birth average length of a healthy
Indian newborn baby is 50 cm.
• it increases to 60 cm at 3 months, 70 cm of
9 month and 7 cm at one year of age.
26. • In second year, there is 12 cm increase, third
year it is 9 cm, fourth year it is 7 cm and in
fifth year it is 6 cm.
• so the child double the birth by 4 to 4.5
years of age afterwards there is about 5 cm
increase in every year till onset of puberty.
29. Body Mass index (BMI)
• It is an important criteria which helps to assess
the normal growth 0£ Its deviatiOns i.e.
malnutrition or obesity.
Weight in Kg
BMI =
(Height iii meter)
• BMI remains content up to the age of 5 years. If the
BMI is lnore than 30 kg/ni*, it indicates obesity and if
it is less then 1SKg/m* , it indicates malnutrition.
31. Head circumference
• It is related to brain growth and development
of intracranial volume. Average head
circumference measured about 35 cm at birth.
• At 3 months it is about 40 cm, at 6 month 43 cm,
at one year 45cm, at 2 years 48 cm, at 7 year 50
cm and at 12 years of age it is about 52 cm, almost
same a adult.
32. • If head circumference increase whore than 1
cm in two weeks during the first 3 month of age
then hydrocephalus should be suspected.
• Head circumference is measured by ordinal
tap, placing it over the occipital protuberance at
the back, above the ear on the side and just over
the supraorbital ridges in
front measuring the point of height circumference.
34. Fontanelle Closure
• At birth, antenor and posterior fontanelle are
usually present. Posterior fontanelle closes
early few weeks(6-8week) of age.
• The anterior fontanelle normally closes by
12- 18 months of age. Early closure of
fontanelle indicates craniostenosis due to
premature closure of skull sutures.
36. Chest circumference
• chest circumference or thoracic diameters is an
importance parameter of assessment of growth
and nutrition status.
• At binh it is 2-3cm less than head circumference.
At
6 to 12 months of age both become equal.
• After first year of age, chest circumference is
greater than head circumference by 2.5
cm and by the age of 5 year, it is about 5 cm larger
37. • Chest circumference is measured by placing
the tape measure around the chest at level by
placing the tape measure around the chest at the
level of the nipple, in between inspiration and
expiration.
39. did Upper Arm Circuml’erence(M
AC)
• This measurement helps to asses the
nutritional
status of younger children.
• There is growth due to inadequate
nutritional, which can be this simple paoicle
and useful measurement.
41. Cont....
• The average MUAC at birth is 11 to 12 cm, at
one year of age it is 12 to 16 cm, at 1 to 5 years
it is 16 to 17 cv, at 12 years it is 17 to 18 cm
and at 15 years it is 20 to 2lcm.
42. Eruption of teeth
• There is a variation for the time of eruption of
teeth. First teeth coinlnonly the lower central
incision may appear in
6 to 7 months of age.
• It can be delayed even up to 15 months, which
also can be considered within the normal range of
tilne for teething.
• So dentition is not dependable parameters for
assessment of growth.
• There are ‘two sets of teeth, temporary teeth bigger
in size for two
43. Age T'ype Totel number of teeth
Temporary teething
6 — I y months Incisors(csntza1 and lateral)
12 — 15 months First moral 8- t2
Canines( cuspids)
24 - 30 months Secondary moral t6 - 20
Pera›aneot teething
6-7yoars First permanent molars
7 10 years Rep$cemenofiempoi
10 -12 years Replacement of temporary
molar by prcmo1ars
12 — 15 years Secondary permanent molars 28
16 years Third permanent molars
44. Osseous growth
• Bony growth follows a definite pattern and
time schedule from birth to maturation.
• It is calculated by the appearance of
ossification center by X — ray study.
• Skeletal maturation or bone growth is an
indicator of physiological development and
continue up to 25 years of age.
45. Growth monitoring
• Assessmentof growth way be done by
longitudinal & cross sectional studies. The
common parameters used for growth
monitoring include, head circumference, chest
circumference, UL/LS ratio. The following
are the 3 members used for comparisons:-
46. COnt..
.
• Use of idea inedian values.
• Use of percentile
• Use of indices as weight for
height
weight for age.
• Common reference values-
—WHO reference value
—Indian standards-
47. Indian standards-
• NCCR undei took a national wide cross
sectional study during the year 1956-
1965. this tool is widely used in India as
the reference value to assess growth.
49. Assessment of Development
• NOnnal development is a complex
process & has a multitude of facets.
However, it is convenient to
understand & assess development under
the following domains.
51. Gross motor development
• Motor development progress in an
orderly sequence to ultimate attainment
of locomotion & more complex
motor tasks thereafter. In an infant it is
assessed & observed as follOWS:-
52. Age hfilcstonc
3m Neck holding
5m Rolls tivcr
SitS 'ltli own support
Sitting without support
Standing holding on (with support)
l2m Creep well, stand without support
I 5m Walks alone creeps upstairs
l8m Runs
2 yr Walks up and down stairs
or Rides tricycle,
4yr Hops on one fool, alternatc feel going downstairs.
Key gross motor development
milestones
53. Fine motor skill development
• Fine motor development upon neural tract
maturation. Fine motor development promotes
adaptive actives with fine sensorimotor
adjustments and include etc coordination,
hand eye coordination, hand to mouth
coordination, hand skill as linger thumb
apposition, grasping, dressing ect.
54. Age Milestone
4m reaching out for the objects with both hands
6ir Reaching out for the objects with one hand
9in Immatui'e pincer graps
l2m Pincer graps mature
l5in Imitates sci•ibbling, tower of 2 blocks
18m Scribbles, tower of 3 blocks
2yr Tower of 6 blocks, vertical and cii cular
stroke
3 yr Tower of 9 blocks, copies circle
4yr Copies cross, bridge with blocks
5yr COpies triangle, gate With blocks
Key fine motor development
milestone
55. Personal social
development
• Personal and social development includes
personal reactions to his own social and cultural
situations with neuroinotor maturity and
environment stimulation. It is related to
interpersonal and social
skill as social smile, recognition of mother, use of
toys.
56. Age Milestone
2m Social smile
3m Recognizes mother
6m Recognizes strangers, sir anger anxiety
9m Waves “bye bye”
l2m Comics when called, plays simple ball gauze
15ni Jargon
l8m Copies parents in tasks
2yr Asks for food, drink, toilet
Shares toys, knows ilill name and gender
4yr Plays cooperatively in a group, docs to toilet alone.
Syr Helps in household tasks, dressing and undressing
Key social and adaptive milestones
57. Age
fiyr
I.anguage development
Milestone
Alerts to sound
Coos ( iiiusical vowel sounds)
3m
4m Laugh
load
6m Monosyllablcs (ba, da, pa) sound
9m Bisy llablcs ( mama, baba, dada) sound
I 2m I-2 words with meaning
18 m 8 -10 woi'ds vocabulary
2yr 2-3 word sentences, uses pronouns “I”, “Me”,
“you”
3 yr Ask question
Asks iiieaning of
58. Assessment of Development
• Healthy development, in all forms, particularly
social7emotional, communication, and behavior,
should be monitored by parents andR*•ysicians
through screenings at each well visit.
59. • The Denver Developmental screening test
• Denver articulation screening examination
(DASE)
• Baroda screening test
• Trivandrum development screening test
• Other test
— Woodside DST
Cognitive adaptive test
Early language milestone
etc.
60. The Denver Developmental
screening test
• Developmental oi'iginally by Franker — burg
and dodds(1967), this simple, economic and useful
test screens for developmental delays during
infancy and the preschool period.
• On the test, the age division are monthly unit 2
years
of age , and half yearly from 2 to 6 years of age.
61. Baroda Screening test
• It was developed by Dr. Proniila phatak with
25 test items primarily for psychological aspects.
The test is relevant for age 0 to 30 months. Gross
motor, fine motor and cognitive aspects are
evaluated in 10 mints mainly by the psycholOgisi
62. Trivandrum development screening test
• It is simplified version of Baroda DST that can
be used by the health worker, nurses and
pediatricians/ physicians. It has17 test items
relevant for 0 to 2 years of age. The children are
evaluated in three domains( gross motor, fine
motor and cognitive for 5 minutes only.
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