Growth and Development
Maria Consuelo Maramag-Manuel M D
DEPARTMENT OF PEDIATRICS
OVERVIEW AND ASSESSMENT OF
VARIABILITY
• MONITOR CHILDRENS PROGRESS
• IDENTIFY DELAYS OR ABNORMALITY
• COUNSEL PARENTS
• PRESCRIBE TREATMENTS
• Growth
Increase in size
Development
Increase in function of processes
related to body and mind.
BIOPSYCHOSOCIAL MODELS OF
DEVELOPMENT
• Involves Extrinsic And Intrinsic Forces
• INTERRELATIONSHIP INVOLVING
1. BIOLOGIC
2. PSYCHOLOGIC
3. SOCIAL
BIOLOGIC INFLUENCES
• Genetics
• In utero exposure to teratogens
• Postpartum illnesses
• Exposure to hazardous substances
• maturation
TEMPERAMENT
• Refers to child’s characteristic style of
responding
• Concept is useful to help parents understand
and accept the characteristics of their children
• Behavior and emotional problems often
develop once it is not address accordingly.
PSYCHOLOGIC INFLUENCES
ATTACHMENT AND CONTINGENCY
CHILD REARING ENVIRONMENT
SOCIAL FACTORS
• Family factors
• Influences outside of mother-child dyad.
FETAL GROWTH AND DEVELOPMENT
• Deals with transformation of fertilized egg into
embryo
• Elaboration of the NS
• Emergence of behavior in utero
FETAL GROWTH AND DEVELOPMENT
WEEK milestone
1 • Embryonic period – fertilization and implantation
2
• Endoderm and ectoderm appear
3
4 • Mesoderm appear. Somite formation
5 • Fusion of neural folds,folding of embryo to human like shape
6 • Lens placode; primitive mouth
7 • Primitive nose; philtrum;CR length:21-23 mm
8
• Eyelids begin
8
9 • Ovaries and testes distinguishable
10 • Fetal period begins;CR length 5 cm, wt 8 gms
20 • External genitalia distinguishable
25 • Lower limit of viability; length 19 cms;wt 460 gms
• Third trimester begins; length 25 cms ; wt 900 gms
28
38 • Eye opens; fetus turns head down; wt 1300 gms
• term
The newborn period
• From birth up to 1st month of life.
• Marked physiologic transitions in all organ
systems
• Infant learns to respond to many forms of
external simuli.
• Parenting of newborn requires dedication and
many factors influence parents ability to
assume the role.
• Physical examination include evaluation of
growth and observation of behavior.
• 3.4 kg (71/2 lb) – ave weigh of term
newborn
• 50 cm (20 1n) – ave length
• 35 cm(14 in) – ave head circumference
• Newborn parameters shld be plotted on
growth curves
Periods of growth
prenatal 0-280 days
postnatal
infancy birth to 2 years
neonate First 4 wks after birth
infant nursling First year
toddler, transition 2 years
childhood 2-10 girls 2-12 boys
early childhood-preschool 2-6 yrs
late childhood-school age 6-10 girls; 6-12 boys
adolescent 10-18 girls;12-20 boys
prepubescent Girls 10-12 boys 12-14
pubescent 12-14 14-16
puberty 13 15
postpubescent 13-18
The first year
• Marked by physical growth, maturation,
acquisition of competence and psychologic
reorganization.
• Children acquire new competencies in all
developmental domains.
• Concept of developmental trajectories highlights
complex skills build on simpler ones.
• Age 0-2 months
Tremendous growth occur.
Establishment of effective feeding routine and a
predictable sleep-wake cycle.
PHYSICAL DEVELOPMENT
- NB weight dec 10% below bw in the 1st week.
- Nutrition improves as infants learn to latch on and
suck efficiently.
- BW regains/exceeds at 2 wks
dentition
• Hard tissue formation: 4 months
• No. of teeth= age in months-6
• Teeth eruption and shedding: GIRLS> boys
• Primary teeth: central incisors
• Permanent teeth: erupts at 6-7 ½ years
first molars and incisors
measurements
• At birth
weight: 3000 grms
height: 50 cms
HC: 35+/-2 cms
• Newborn
weight may drop 10% during first wk
regains or exceed BW by 2nd wk
gain 30 gms /day during 1st month
• 8-12 years girls surpass boys
• 14 years boys take the lead
• Females enters growth spurt 2 yrs earlier
than boys
Weight
Formula for average approximate weight
age kilograms
Infants<6 mos age(mos) x 6oo+BW
6-12 mos age(mos)x 500+BW
1-6 yrs age(yrs)x 2+8
6-12 age(yrs)x 7-5/2
Usual changes in weight at different ages
4 mos 2xBW
2 yrs 4xBW
3yrs 5xBW
5yrs 6xBW
7 yrs 7xBW
10yrs 10xBW
height
height(cm)= age (yrs)x5+80
height(in) = age (yrs)x2+32
Total ave. gain during the first year = 25 cms
birth-3 mos 9 cm
3-6 mos 8 cm
6-9mos 5cm
9-12mos 3 cm
Head circumference
1st year of life 10 cm
1-4 mos ½ in/mo
5-12mos ¼ in/mo
2nd year of life 1 in/year
3rd- 4th yr of life ½ in/yr
6th-12th yr of life ½ in 5 yrs
Organ growth and development
muscles
• Growth in muscle mass follows maximal growth in ht.
• Largest increment: 4th month AOG
• Relation to body size:
mid pregnancy – 1/6
birth - 1/5 to ¼
adolescence - 1/3
adulthood - 2/5
• Strength doubles: 12-16 yrs
Cutaneous structures
• 3rd fetal month:hair matrix, sebaceous,apocrine
• 5th fetal month: eccrine swat glands
• Birth: lanugo
• 1 month: sweat glands for temp. regulation
• 2 yrs old: scalp hair lost and replaced by
permnent hair
• Pubescence and adolescence: pupic and axillary
Subcutaneous fat
appears : last 3 months AOG
doubles: first yr of life
increases in amount during adolescence
Nervous system
• 4 wks – brain starts to develop
• 5 wks AOG: 3 main brain divisions
• 7 yrs : complete myelinization
• 10 yrs: calcification of pineal gland
• rapid brain growth during infancy and
childhood
Sensory
vision-not well developed at birth
birth – 20/400
1 mo – regards
3 mos – fixation/tracking
3-7 mos- binocular
3 yrs- 20/30
4 yrs- 20/20 (3-5 yrs old)
Auditory – functional at birth
6 mos – localizes sound
Tactile
no tactile sensation during the first week of life
more localized response to pain during the next mos.
• Taste
newborn – un able to distinguish flavors
3 mos: acute taste discrimination
olfactory
present at birth
more acute in later stage
• Digestive system
birth – 30-90 ml
1 mo – 90-150 ml
1 yr – 210-360
2 yrs – 500-750 ml
late childhood - 750-900 ml
• Urinary system
newborn – may not normally void in first 12-24 hrs
5-6 yrs- mature function is observe
• Lymphatic system
peak increases: 6-7 yrs
spleen – largest ymphoid organ
formal closure of fontanelles and sutures
3 months Post fontanelle
6 mos Fibrous union of suture lines
occurs
20 mos Anterior fontanelle closed
8 yrs Ossification of craniobasal bones
complete
12 yrs Sutures cannot be separated by
ICP
20 yrs Sutures still visible on xray
8th Solid body union of all sutures
complete
Developmental reflexes
reflex appears disappears
Moro birth 4-5 mos
rooting birth 3 months
Palmar grasp birth 4-5 months
Tonic neck birth 6-7 months
Plantar grasp birth 9-10 months
parachute 4-9 months persist
landau 10 months 24 months
adolescence
• Rapid change in body size, shape, physiology,
psychological and social functioning.
• Hormones play an important role
• Gender and culture has profound effect.
• First sign of puberty:
girls : breast budding – 8 yrs
boys: testicular enlargement – 9.5 yrs
• development
Principles of development
1. continuous process :birth to maturity
2. sequence : same for all children but
rate varies from child to child
3. Intimately related to maturation of the NS
4. Generalized mass activity replaced by
specific
individual responses.
5. Primitive reflexes have to be lost before
voluntary movement is acquired.
Core concept on development
• Interaction between biology and experience.
• Influenced by culture and reflected in child
rearing beliefs and practices.
• Children are active participants in their own
development.
• Human relationships and its effects are the
building blocks of health development.
• There is interplay bet. Vulnerability and resilience
• It can be altered by interventions
Reqirements for satisfactory development
Nervous System
Well-formed functioning
Environmental
Appropraite and
Oppurtunties
adequate nutrition
To learn and act
at all stages
Challenges and
Rewards
A good primary care physician…
• Has a thorough knowledge of normal child
development
• Understand factors that might interfere
with it
• Actively monitors symptoms that should
elicit concerns
Developmental monitoring in primary care
• Developmental monitoring integral part of
a child health supervision
• Goal: Early detection of children with
developmental disabilities and those at
high risk for adverse developmental and
behavioral outcomes
Developmental surveillance
• Flexible, longitudinal, continous and cumulative
process
• Knowledgeable health care professionals identify
children who may have developmental problems
• Components:
1. Eliciting and attending to parents’ concern
2. Maintaining and developmental history
3. Making accurate and informed observations
4. Identifying presence of risk and protective factors
5. Documenting the process and findings
Developmental domains
• Gross and Fine Motor
• Language
• Daily Living
• Social
Motor development
• Dependent on brain maturity
• Sequece: Gross: cephalocaudal
• Weakest correlate to IQ
Cephalocaudal pattern of development
Gross motor
Mean age Milestones Mean Milestones
(mos) age (mos)
3 Good head control 15 Walk alone
5 Roll over 24 Runs well, walk up
stairs 1 step at a time
6 Sit with support 36 Rides a trike
Stand on 1 foot
8 Sit without support 48 Hop on 1 foot
Climbs well
9 Pulls to stand holding 60 Skips
on
Fine motor skills
• Eye-hand coordination
• Sequence : Proximal Distal
• Coordination of small muscles
• Related to self-help skills
• Upper extremity and manipulative hand
abilities dress and play
Fine motor
Mean age Milestones Mean age Milestones
(mos) (yrs)
3 Hands open grasp 2 Make strokes
Towers of 7 cubes
4 Reaches for objects 3 Copy circle
Tower of 10 cubes
5 Transfer objects 3½ Copy cross
6 Holds bottle 4 Copy square; draws man
with 2-4 body parts
9 Pincer grasp 5 Copy triangle
12 Turn pages of book 6 Copy diamond
13 Scribble spontaneously 9 Copy cylinder
language
• Sequence: simple complex
• Correlates with IQ
• Language delay:
– Most common reason for referral
– Part of most neurodev disabilities
Receptive language
Age Milestone Age Milestone
(mos) (mos)
1 Startles, alert to sound
4 Turns to noise and voice 18 Identifies 1 or more body
parts
7 Respond to name 24 Follow 2-step commands
9 Respond to word “no” 36 Identifies action in
pictures
11 Follows 1-step commands 48 Knows 4 colors
with gesture
12 Follows 1-step commands 60 Follows 3-step commands
without gesture
Expressive language
Age Milestone Age (yrs) Milestone
(mos)
3 Vocalizes and coos 2 2-word phrases
6 Monosyllabic babbles 3 3-word sentences
Give full name, age, sex
8 Says dada, mama non- 4 Tells a story
specifically Speech 100% intelligible
10 First words other than 5 Uses past tense of eat, run,
mama, dada go
12 Speaks first real word 6 Repeats sentence of 10
syllables
Names 4 colors
15 jargons
Cognitive development
• Learn, undertand and solve problems
• Verbal and non-verbal reasoning
• Meeting daily living demands
Infants & toddlers : Motor & Language Milestone
Pre-school child : Reasoning abilities
School age child : Neuropsychological assessment
cognitive
Age (Months) Milestones
NB Identify mother’s voice and smell
3 Reach for dangling ring
6 Respond playfully to mirror
10 Object permanence
12 Understand spatial relationships
18 Understand cause-and-effect
24 Categorize similarities (eg. Vehicles, animals)
36 Knows full name
48 Knows color or any letters
Daily living/personal
• Performance of activities of daily living
• Can be affected by culture and
chidrearing practices
personal
Age (mos) Milestones Age (yrs) Milestones
3 Opens mouth expectantly 2 Express need to go to
bathroom
Cooperates in dressing
6 Holds bottle 3 Puts on shirt and shorts
Finger – feeds Dry night
Feeds self cracker Use fork to pierce
12 Drinks well from cup 4 Dresses without
Begins to hold spoon supervision, brush teeth
with assistance
18 Feeds self with spoon 5 Ties shoelaces
social
How child interacts, forms and maintains
relationships
Concerns would manifest as behavioral
problems
social
Age Milestones Age (yrs) Milestones
(mos)
3 Smiles responsively 2 Parallel play
6 Imitates action 3 Likes to play make
believe
9 Plays patty 4 Respond to
cake,peek-a-boo instructions,imitates
task
12 Comes when called 5 Plays games with
by name simple rule(tag)
18 Follows directions 6 Plays board
related to routine games,domestic role
playing
Detection of concerns
• History and PE
• Checklist/questionnaires:
Pediatric Symptom checklist
Pediatric Evaluation of Developmental status (PEDS)
• Formal Screening tools
Barley Infant Neurodev Screener
Denver II
Early Language Milestones
Early Childhood Care and Development Tool
Developmental red flags
• Limit ages
• Age at which you expect almost every
child to have mastered a pacticular skill.
• Warning signs or signals that something
may not be right.
• It should not incite panic.
• If absent or doubtful, do further
evaluation
Classic theories
ageoddler psychosexual psychosocial cognitive
Infancy(o-1 yr) oral Basic trust Sensorimotor I-
IV
Toodler 2-3 anal Autonomy vs Sensorimotor V-
shame and doubt VI
Preschool 3-5 phallic Initiative vs guilt Pre-operational
School age 6-12 latency Industry vs Concrete
inferiority operational
adolescence 12- adolescence iIdentity vs Formal
20 identity diffusion operational
Psychosexual theory
stage issues
infancy oral Food, love, care,
nurturance, dependency
toodler anal Control power limits
preschool oedipal Boyness, girliness,
masculinity, femininity
School age latency storm of adolescence
adolescence genital True genitality
Psychosocial theory
stage issues Virtues or qualityof
strength
infancy Trust vs mistrust hope
toddler Autonomy vs shame and will
doubt
preschool Initiative vs guilt purpose
School age Industry vs inferiority competence
adolescence Identity vs role confusion fidelity
Cognitive theory
age stage issues
infancy Sensorimotor I-IV Object permanence
toddler sensorimotorV-VI Spatial relations
preschool Pre-operational Ego-centrism
School age Concrete operational Concrete thinking
adolescence Formal operational Scientist or
philosopher
