Growth Growth & &

DevelopmentDevelopment

By By

Dr Muhammad Saleem LaghariDr Muhammad Saleem LaghariMBBS(KEMU), MCPS,FCPS (paeds) MBBS(KEMU), MCPS,FCPS (paeds)

Gold Medalist FCPS-IGold Medalist FCPS-I

Assistant ProfessorAssistant ProfessorSZMC,RYKSZMC,RYK

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GROWTHGROWTH Change in size resulting

from increase in number or size of cells of the body.

Quantitative increase in size of body.

Can be measured in terms of cm & kg etc.

DEVELOPMENTDEVELOPMENT

Qualitative and functional maturation of organ system.

Assessed in terms of acquisition of skills and ability to adopt to new situation.

GROWTH & DEVELOPMENTGROWTH & DEVELOPMENT

Growth and development are assessed Growth and development are assessed simultaneously as they are very simultaneously as they are very closely closely relatedrelated to each other to each other..They provide the best and most practical They provide the best and most practical means of means of evaluation of healthevaluation of health of an of an individual.individual.Diseases tend to have Diseases tend to have more impairmentmore impairment when they occur during period of when they occur during period of rapid growth & development.growth & development.

GROWTH: WeightWeight, Length/HeightLength/Height, OFCOFC , MUACMUAC & DentitionDentition.

DEVELOPMENTDEVELOPMENT 1. Gross motor

2. Fine motor and vision.

3. Hearing and speech.

4. Social behavior.

ASSESMENT OF GROWTH & ASSESMENT OF GROWTH & DEVELOPMENTDEVELOPMENT

GROWTHGROWTH• Rate of growth

is more important than actual size.

• Serial measurements of growth plotted on standard growth chart are best indicator of health.

WEIGHTWEIGHT

• The best index of nutrition & growth.

• Changes in weight occur before changes in other aspects of growth.

• Average weight at birth is 3.2 kg. (7lb)

• The increase in weight is 30 gm/ day or 200 gm/week during first three months.

• Birth weight is doubled at 6-months, tripled at 1-year and four times at 2-years age.

• Then annual increase of 5-lb/year.

• At 7-years it becomes 7-time of birth weight.

• During puberty, there is growth spurt.

HEIGHT (LENGTH)HEIGHT (LENGTH)

• Average length at birth is 50 cm.• It increases by 25 cm in first year.• It is 85 cm at 2-years, 95 cm at 3 years, 100 cm

at 4 years.• Then it increases by 5-cm/year until puberty.• The pubertal growth spurt leads to increase 10-

cm/year for 2 -- 3 years.• Adult height is twice the height at 2 years age.• Only Chronic illness affects length.

HEAD CIRCUMFERENCEHEAD CIRCUMFERENCEAge

Birth

3 months

6 months

9 months

1 year

2 years

3 years

5 years

Head Circumference (cm)

35

41

44

46

47

49

50

51

DENTITIONDENTITION

• First MILK tooth erupts at 6-months age

• Eruption of milk teeth completes by 2.5 years (20-teeth)

• Shedding of milk teeth at 6-years and is complete by 12-years of age.

• PERMANENT Teething is complete by 12-years of age except wisdom teeth which appear at 22-years (32 - teeth).

DEVELOPMENTDEVELOPMENT• It takes place in cephalocaudal

direction.

• It is influenced by,

child’s maturity, illness, hunger or thirst and alertness or drowsiness.

Development is assessed under

four headings:1. Gross motor

2. Fine motor and vision.

3. Hearing and speech.

4. Social behavior.

NEONATENEONATEGross Motor• In prone position turns head

to one side, limbs flexed under the body.

• In supine position tonic neck reflex is present.

• Pulled to sit Marked head lag • Ventral suspension Head &

limbs are flexed, limbs hang downward

NEONATENEONATE• Fine motor and vision• Pupils react to light.• Optical closure from sudden bright light.• Doll’s eye reflex present.

Hearing & Speech• Startle response to sudden loud noise.• Cries vigorously.

Social Behaviour• Sleeps most of the time.• Moro, rooting & sucking reflexes

present.• Social smile comes at 4-6 weeks.

3 MONTHS AGE3 MONTHS AGEGross Motor• Pulled to sit Neck holding present.• Prone position Lifts head and

chest above couch using forearm as support.

• Held sitting Straight back• Held Standing Sags at knees

• Ventral suspension Head held well above the body, Hips extended

3 MONTHS AGE3 MONTHS AGEFine Motor & Vision• Grasps rattle for few

moments ( Palmer Grasp ).• Regards mother’s face.• Follows dangling ball/ light

through an arc of 180 degree

3 MONTHS AGE3 MONTHS AGEHearing and speech.• Quietens to sound of rattle

and spoon in cup • Vocalizes & Delighted when

spoken to• Turns to nearby voice.

• Social Behaviour• Happy response to mother’s

face.• Laughs at pleasurable social

contact.• Active Grasp present.

6 MONTHS AGE6 MONTHS AGEGross Motor• Supine Lifts head from pillow,

Lifts legs to vertical, Grasps feet & takes to mouth.

• Prone Lifts head and chest well up supporting weight on extended arms while in prone position.

• Sitting with support present• Held standing

Bears weight on legs

6 MONTHS AGE6 MONTHS AGEFine Motor & Vision• Transfers objects

from one hand to others.

• Both eyes move in union.

• Follows dangling ball in all directions.

6 MONTHS AGE6 MONTHS AGE• HEARING AND SPEACH• Responds to hearing tests

at 1 foot on ear level.• Vocalizes in single or double e.g..

Goo, ah-ah etc.• Shouts to attract attention.

Social Behaviour• Mouthing present• Imitates bye-bye.• Fear of strangers present from 7-months age onwards

12 MONTH AGE12 MONTH AGE

Gross Motor• Crawling (10-m) • Walks like a bear.• Can build a tower of

three tubes

12 MONTH AGE12 MONTH AGEFine Motor & Vision• Pincer grasp present (10 months)• Imitates hand clapping. • Drinks from a cup• Looks for hidden and fallen toys.

Hearing & Speech• Knows and turns to own name.• Speaks 2-3 words (papa, mama)

12 MONTHS AGE12 MONTHS AGE

Social Behaviour • Drinks from cup• Waves bye-bye.• Points to desired

objects.• Gives toys on

request.

2 YEARS AGE2 YEARS AGE

Gross Motor• Runs well, stops and

starts safely.• Climbs on furniture.• Walks up and downstairs

one hand held, two feet per step.

2 YEARS AGE2 YEARS AGE

Fine Motor & Vision

• Picks up pins, thread.• Turns pages singly.• Builds tower of six cubes.• Holds pencil and scribbles

2 YEARS AGE2 YEARS AGEHEARING & SPEACH• Joins 2-3 words to form

sentences.• Refers to self by name • Constantly asking names

of objects and people.

2 YEARS AGE2 YEARS AGESocial Behavior• Verbalizes toilet needs• Usually dry by day.• Enjoy picture books and stories.• Lifts and replaces cup safely. • Handle spoon well.

3 YEARS AGE3 YEARS AGE

GROSS MOTOR• Rides tricycle using

pedals. • Can walk on tiptoe• Walks upstairs with

alternating feet.• Can stand momentarily

on one foot.

3 YEARS AGE3 YEARS AGE

FINE MOTOR AND VISION

• Copies a circle• Builds tower of 9-10

cubes.

3 YEARS AGE3 YEARS AGEHEARING AND SPEECH• Gives full name and knows

age and sex.• Counts up to 10 or more.• Knows several nursery

rhythms.

SOCIAL• Dry by night (toilet trained)• Washes and dries hand

under supervision.• Can pull pants down and up

but unable to button.

4 YEARS AGE4 YEARS AGEGROSS MOTOR • Stands on one foot 3-5 seconds.• Runs on tiptoe.• Climbs well.

FINE MOTOR AND VISION• Can copy a cross.• Draws a man with head, leg, and trunk.• Builds three steps with six cubes.

4 YEARS AGE4 YEARS AGEHEARING AND SPEECH• Gives full name and address• Speaks grammatically correct and

intelligibleSOCIAL• Washes and dries hand • Brushes the teeth.• Can dress and undress except shoe laces.• Tells a story.• Understands taking turns as well as

sharing.

5 YEARS AGE5 YEARS AGEGROSS MOTOR• Walks on a straight line.• Hops and skips on one foot.• Runs up and downstairs.• Stands on one foot with folded

arms.

FINE MOTOR & VISION• Can catch a ball.• Copies square and triangle• Thread large needle and sew

stitches.

5 YEARS AGE5 YEARS AGEHEARING & SPEECH• Gives full name, age

and birthday.• Name four colors.

SOCIAL• Washes and dries hands

and face.• Dress and undress alone.• Affectionate and helpful to

younger sibs.• Knows right and left.• Goes to school unattended.

THANKS