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7/29/2019 9502523 Growth and Development of Child
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Growth and Development
in Children
Presentation by:
Basant Kumar KarnAsst. Professor, College of Nursing
B. P. Koirala Institute of health Sciences, Dharan, Nepal
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Objectives of the session
1. Define growth and development.
2. Discuss principles of growth and
development.
3. Describe need for monitoring growthand development.
4. Discuss pattern of normal growth and
development.
5. Provide tips of promoting growth and
development.
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IntroductionImportant characteristics of Human being
A process by which the fertilized ovum develops in to a
mature adult
Maturation occurs through successive changes in the
both physical structure and functional ability
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The most dramatic events in growth and development
occur before birth.
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GrowthIncrease in physical size and
weight of the body (Height and Weight)
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Development
Increase in Mental, Physical,
Social and Emotional abilitiesof the child. It meansfunctional and physiologicalmaturation.
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Developmental MilestonesAverage level of development of a child which is decided
through the scientific study of physical, mental and
nervous system of children.
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Prenatal: Conception to the BirthInfancy: Birth to 12 months
Neonatal period: Birth to 28 days
Early neonatal period: Birth to 7 days
Late neonatal period: 7 days to 28 days
Infancy Period: 29 days to 12 monthsEarly Childhood: 1 year to 6 years
Toddler Period: 1-3 years
Preschool Period: 3- 6 years
Middle childhood: 6- 12 yearsLate Childhood or Adolescent: 12-18 years
Puberty Period: Male: 12-14 years
Female: 11-13 years
Stages
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Principles of growth andDevelopment.There are definite and predictable pattern
of growth and development that are
continuous, orderly and progressive.
Crawl Creep Walk
Babbles Words Sentences Scribble Writing
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1.Directional Pattern:
Cephalocaudal Pattern ( Head to Tail)
Proximal to Distal (Midline to peripheral)
Mass to specific (Differentiation)
2. Sequential Pattern: Involves a predictablesequence of Growth and Development stages
through which a child normally proceeds.
For motor skills such as locomotion i.e. childstarts crawling before walking and for
behaviors such as language and social skills
(e.g. First child plays alone, then with others).
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Need for monitoring growthand development.
To find the deviation as soon as possible
To bring possible remedies.
Done through Anticipatory guidelines
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Factors influencing Growthand DevelopmentHeredity
Nutrition
Illness and DiseasePhysical, emotional and social environment
Age and gender
Others- Birth order, Birth interval,
dependence and independence.
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Assessment of GrowthGrowth can be measured in term of:1. Nutritional Anthropometry (Wt., Ht., Hc., Cc.)
2. Assessment of Tissue growth (Muscle mass, Skin fold
thickness)3. Bone age (Radiological assessment of epiphysis)
4. Dental age
5. Biochemical and histological means
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Formulas for Approximate Average Height and
Weight of Normal Infants and Children
Weight Kilograms (Pounds)
At birth 3.25 (7)
312 mo (age [mo] + 11)
16 yr age (yr) 2 + 8 (age [yr] 5 + 17)
712 yr age (yr) 7 + 5
Height Centimeters (Inches)At birth 50 (20)
At 1 year 75 (30)
112yr age (yr) 6 +77 (age [yr] 21/2 + 30)
2
9monthsinAge
2
57)yearsin(Age
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Assessment of Weight Newborn looses weight of
10% of Birth weight tillearly 7 days and regain by
10th Day.
Birth weight doubles by 4
month and triples by a year& 4 times by 2 years.
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Assessment of HeightAt Birth- 50cm
6 months- +12 cm
1 year- 75 cm
2 years- 85 cm
2-5 years- +6 to
8cm/year
5 years - 5cm/year
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At birth-------------------
3 4 years-----------------------
9 Years---------------------------------------
18 Years----------------------------------------------
Upper / Lower segment Ratio
SegmentLower
segmentUpper
1
1.8
1
1.3
Age
1
1
1
9.0
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Head CircumferencesAge HC velocity
Till 3 months---------2 cm / months
3 months to 1 year-2 cm/3months
(1/3 of initial velocity)
1 3 years----------- 1cm/6 months
(1/12 cm of initial velocity)
3 5 years----------- 1 cm/ year(1/24 cm of initial Velocity)
2
2.59.5)cmin(LengthHC
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Chest Circumferences
Measured at the level
of Nipple
2.5 cm lesser them HC
Equal to HC by 1 year
Lesser then HC by 1.5
year
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OthersMid arm circumference:
Applicable for 1-4 yearsbeing >13.5 is normal
At mid point- Acromion
and Olecranon.
Arm spam:
Distance between tips of the
middle fingers with botharm held wide open(Spread apart)
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Dental Growth Most infants have their first teeth erupt at
age 68 months of Age.
Two types of Tooth are
Primary or Deciduous
Secondary or Permanent Teeth
http://i/Pediatrics%20Text/Growth%20and%20Development/Pedia/Dental%20age.dochttp://i/Pediatrics%20Text/Growth%20and%20Development/Pedia/Dental%20age.dochttp://i/Pediatrics%20Text/Growth%20and%20Development/Pedia/Dental%20age.dochttp://i/Pediatrics%20Text/Growth%20and%20Development/Pedia/Dental%20age.dochttp://i/Pediatrics%20Text/Growth%20and%20Development/Pedia/Dental%20age.dochttp://i/Pediatrics%20Text/Growth%20and%20Development/Pedia/Dental%20age.dochttp://i/Pediatrics%20Text/Growth%20and%20Development/Pedia/Dental%20age.dochttp://i/Pediatrics%20Text/Growth%20and%20Development/Pedia/Dental%20age.doc7/29/2019 9502523 Growth and Development of Child
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Primary or DeciduousCalcification Age at Eruption Age at Shedding
Begins at Complete at Maxillary Mandibular Maxillary Mandibular
Centralincisors
5th fetal mo 18
24 mo 6
8mo
5
7 mo 7
8 yr 6
7 yr
Lateral
incisors
5th fetal mo 1824 mo 811
mo
710 mo 89 yr 78 yr
Cuspids
(canines)
6th fetal mo 3036 mo 1620
mo
1620 mo 1112 yr 911 yr
First molars 5th fetal mo 2430 mo 1016
mo
1016 mo 1011 yr 1012
yr
Second
molars
6th fetal mo 36 mo 2030
mo
2030 mo 1012 yr 1113
yr
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Secondary or Permanent Teeth
Central incisors 34 mo 910 yr 78 yr 67 yr
Lateral incisors Max, 1012 mo 1011 yr 89 yr 78 yr
Mand, 34 mo
Cuspids (canines) 45 mo 1215 yr 1112 yr 911 yr
First premolars
(bicuspids)
1821 mo 1213 yr 1011 yr 1012 yr
Second premolars(bicuspids)
24
30 mo 12
14 yr 10
12 yr 11
13 yr
First molars Birth 910 yr 67 yr 67 yr
Second molars 3036 mo 1416 yr 1213 yr 1213 yr
Third molars Max, 79 yr 1825 yr 1722 yr 1722 yr
Mand, 8
10 yr
Calcification Age at Eruption
Begins at Complete at Maxillary Mandibular
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Development
Dimensions of Development
Gross Motor
Fine Motor (Adaptive)
Communication and Language
Cognitive(Personal Social)
http://i/Pediatrics%20Text/Growth%20and%20Development/Pedia/Devlopment.dochttp://i/Pediatrics%20Text/Growth%20and%20Development/Pedia/Devlopment.doc7/29/2019 9502523 Growth and Development of Child
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Gross Motor
Milestone Average Age (mo) Implications
Head steady in sitting 2.0 Allows more visual interaction
Pull to sit, no head lag 3.0 Muscle tone
Hands together in midline 3.0 Self-discovery Tonic neck reflex gone 4.0 Child can inspect hands in midline
Sits without support 6.0 Increasing exploration
Rolls back to stomach 6.5 Truncal flexion, risk of falls
Walks alone 12.0 Exploration, control of proximity
Runs 16.0 Supervision more difficult
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Fine Motor (Adaptive)
Milestone Average Age (mo) Implications
Grasps rattle 3.5 Object use
Reaches for objects 4.0 Visuomotor coordination
Palmer grasp gone 4.0 Voluntary release
Transfers object hand to hand 5.5 Comparison of objects
Thumb-finger grasp 8.0 Able to explore small objects
Turns pages of book 12.0 Increasing autonomy during book
time
Scribbles 13.0 Visuomotor coordination Builds tower of two cubes 15.0 Uses objects in combination
Builds tower of six cubes 22.0 Requires visual, gross, and fine
motor coordination
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Communication and LanguageMilestone Average Age (mo) Implications
Smiles in response 1.5 Child more active socialparticipant
Monosyllabic babble 6.0 Experimentation with sound,tactile sense
Inhibits to no 7.0 Response to tone (nonverbal)
Follows one-step 7.0 Nonverbal communicationcommand with gesture
Follows one-step 10.0 Verbal receptive language
command without gesture (e.g., Give it to me)
Speaks first real word 12.0 Beginning of labeling
Speaks 46 words 15.0 Acquisition of object andpersonal names
Speaks 1015 words 18.0 Acquisition of object andpersonal names
Speaks two-word sentences 19.0 Beginning grammaticization,(e.g., Mommy shoe) corresponds with 50+ word
vocabulary
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Cognitive(Personal Social)
Milestone Average Age (mo) Implications
Stares momentarily 2.0 Lack of object permanence (out of
at spot where object sight, out of mind)_ (e.g., yarn ball
disappeared dropped)
Stares at own hand 4.0 Self-discovery, cause and effect
Bangs two cubes 8.0 Active comparison of objects Uncovers toy (after 8.0 Object permanence
seeing it hidden)
Egocentric pretend play 12.0 Beginning symbolic thought
(pretends to drink from cup)
Uses stick to reach toy 17.0 Able to link actions to solve
problems
Pretend play with doll 17.0 Symbolic thought
(gives doll bottle)
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Other areas
Cognitive Development
Psychosexual Development
Psychosocial Development
Spiritual/moralDevelopment
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Cognitive Development (Piaget)
Sensorimotor & Preconceptual Phase-Toddler (12 to 36 months) Appearmature but are really primitive;- Differentiation of self from objects
increased tolerance of separation from parents- Object permanence has
advancedincreasingly aware of existence of objects of objects behind
doors, in drawers, etc.- Domestic mimicry- Embryonic concept of timea
vagus concept- Why? and How? predominate language.
Preoperational Phase- Preschool (4 to 7 years) A shift from totallyegocentric thought to social awareness occursability to consider
anothers viewpoint begins. Egocentricity is still evident.- Play is this
childs way of understanding, adjusting to, and working out lifesexperiences- Magical thinkingthoughts are powerfulguilt may result
from bad thoughts or wishes- Words are accepted literallyyou are bad
means that I am a bad person, not merely that my actions were bad.
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Cognitive Development Cont..
Conceptual thinking. (concrete operations)-
School age (6-12 years)
These children are able to use thought processes to experience events and
actionsto understand relationships between things and ideas
(reasoning); their mental processes allow them to see things from
anothers point of view. Learn to master skills such as: conservation,
classification, reasoning, comprehension, and reading .
Abstract thinking (The period of formal operations)-
Adolescence (12 to 18 or 20)
These people now think in the realm of what is possiblebeyond the
present and concrete. They are concerned with future events such asmarriage, college, and vocations. Their thoughts are influenced by
logical principles rather than their own perceptions and experiences.
They are able to understand that few concepts are absolute orindependent of other influencing factors.
Ps chose al De elopment (S Fre d )
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Psychosexual Development (S. Freud)
1. Freud advanced a theory of personality development that centered
on the effects of the sexual pleasure drive on the individualpsyche. At particular points in the developmental process, heclaimed, a single body part is particularly sensitive to sexual,erotic stimulation. These erogenous zones are the mouth, the
anus, and the genital region.2. Both frustration and overindulgence lock some amount of the
child's libido permanently into the stage in which they occur; both
result in a fixation.
Oral Stage: (Infant)The oral stage begins at birth, when the oral cavityis the primary focus of libidal energy. The child, of course,preoccupies himself with nursing, with the pleasure of suckingand accepting things into the mouth.
Anal Stage: (Toddler) At one and one-half years, the advent of toilettraining comes the child's obsession with the erogenous zone of
the anus and with the retention or expulsion of the feces.
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Phallic Stage ( Preschool 4 to 7 years): In this stage, the child's erogenouszone is the genital region. As the child becomes more interested in his
genitals, and in the genitals of others, conflict arises. The conflict, labeled
the Oedipus complex (The Electra complex in women), involves the
child's unconscious desire to possess the opposite-sexed parent and to
eliminate the same-sexedone.
Latency Period ( School age 6-12 years):The period in which the sexual drivelies dormant. Freud saw latency as a period of unparalleled repression of
sexual desires and erogenous impulses. During the latency period,children pour this repressed libidal energy into asexual pursuits such as
school, athletics, and same-sex friendships. Freud implies that girl
always remains slightly fixated at the phallic stage.
Genital Stage ( Adolescence 12 to 18 or 20): But soon puberty strikes, and the
genitals once again become a central focus of libidal energy, interestturns to heterosexual relationships. The less energy the child has left
invested in unresolved psychosexual developments, the greater his
capacity will be to develop normal relationships with the opposite sex.
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Psychosocial Development (Erickson)
Autonomy vs. sense of Shame & doubt:
Toddler (12 to 36 months)
Newfound sense of independence as a result of havinglearned some basic self-care skillswalking, feeding, and
toileting.
Initiative vs. Guilt:
Preschool (4 to 7 years)
Child develops the ability to initiate and direct own activities.Because they are developing a super ego (conscience),conflicts arise from their desire to explore and the limitsplaced upon them by caregiversleads to feeling offrustration and guilt
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Psychosocial Development Cont.
Industry vs. Inferiority:
School age (6-12 years)
Learning to achieve, compete, perform and developing a sense of self
confidence because of successes. Thrive on accomplishments and
praise. May develop a sense of inferiority when tasks are too difficult,
thus producing failureneed support.
Identity vs. Role confusion:
Adolescence (12 to 18 or 20)
Stage is marked by dramatic physiological changes associated with
sexual maturation that leads to marked preoccupation with appearance
and body image. Identity development takes place in this stage as the
youth seeks autonomy, group identity, and to answer the question, Who
am I? Failure to develop a sense of self identity can lead to isolation
and inability to develop lasting attachments in future.
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Spiritual/moral (Kohlberg)
Toddler (12 to 36 months) Kohlberg said nothing.- Associate
God with something special- Assimilate behaviors (foldinghands in prayer) associated with God- Comforted by spiritualroutines (bedtime prayers- Near end of toddler- hood,religious teachings such as reward and fear of punishmentmay influence their behavior.
Preschool (4 to 7 years) Preconventional/Premoral - Moraljudgment is at its most basic levellittle concern for whysomething is wrong.- Actions are directed toward fulfillingtheir needs and less frequently the need of others.- Thesechildren have a very concrete sense of justice- fairness
involves the philosophy of you scratch my back and Illscratch yours, with no thought of loyalty or gratitude.-Development of conscious is strongly linked to spiritual;development. Behave correctly to avoid punishment, guilt.
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Spiritual/moral Cont
School age (6-12 years) -Reward and punishment guide their
judgmentthey adopt and internalize the moral values oftheir parents; they learn standards for acceptable behavior,act accordingly & feel guilty when they violate them.However, they do not understand the reasons behind therules.- These children view God as a human; they arefascinated with the concepts of heaven and hell and mayfear hell as punishment.
Adolescence (12 to 18 or 20) Adolescents, to gain autonomyfrom adults, often substitute their own set of morals andvalues. They seek to establish and internalize a set ofmorals and values that they have tested and found to be
worthy of living bythis often means questioning andsometimes abandoning existing morals and values. Oftenwhen adults merely ascribe to a code of morals and valuesverbally, without actually adhering to the codes, adolescentswill be inclined to abandon such codes.
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Play Infant ( Up to one year): Solitary Play--- Infant Play alone, exhibits
emotions with various visual and auditory stimulus.
Toddler (12 to 36 months) Parallel PlayThe toddler playsalongside, not with other children- Inspects toys; talks to toys; tests itsstrength and durability- Invents uses for toys- Imitation is a distinguishingcharacteristic of playengages in fantasy.
Preschool (4 to 7 years) Associative PlayGroup play in similar oridentical activities, but without rigid organization or rules. Providesphysical, social, and mental development, with refinement of motor skills.Includes: jumping, running, and climbing, as well as the use of tricycles,sports equipment, constructive and creative toys, etc.
Imitative, Imaginative and Dramatic Play Probably the mostcharacteristic & persuasive preschool activity. For self expression;involves the reproduction of adult behavior. Toward the end of thepreschool period children want to do adult activities not just pretend.
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Play Cont. School age (6-12 years): Play takes on a group or clique form
(team play) it involves increased physical skill, intellectual ability, andfantasy. A sense of belonging to a team is important.- Games have
fixed, rigid rules; Conformity and ritual permeate their play; - School-
aged children gain a sense of power from playing games where they
can use fantasy and imagination to gain mastery over others who
otherwise dominate them.
Adolescence (12 to 18 or 20):While the parents of adolescentsremain their primary influence, they are ever moving away from parental
dependency and toward autonomy. Their peers play an ever increasing
role in terms of significance. To belong is of utmost importance. Theirplay is group (peer) oriented and is more about relationships than play.
Sexual activity and romance preoccupy many adolescents. The leisure-
time activities amongst adolescents assist in the development of their
social, physical, and cognitive skills.
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Parents should know
Tips to the parents for safe growth and
development of the child.
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