GROWTH AND GROWTH AND DEVELOPMENTDEVELOPMENT

Dr. Tee/Yu

GrowthThe act or process or a manner of growing Merriam

Webster

Indicator of overall well being, status of chronic disease and interpersonal and psychologic stress

Models of Development Biopsychosocial Model

Freud (psychosexual)

Erickson (psychosocial)

Piaget (cognitive)

Kohlberg (Moral)

Infancy(0-1yr)

Oral Basic trust vs mistrust

Sensorimotor --------

Toddler(1-3yr)

Anal Autonomy vs shame and doubt

Sensorimotor Preconventional: avoid punishment/obtain rewards

Preschool(3-6yr)

Phallic/ oedipal

Initiative and guilt

Preoperational

Conventional: conformity

School Age (6-12yr)

Latency Industry and inferiority

Concrete operations

Conventional: law and order

Adolescent (12-20yr)

Genital Identity vs role diffusion

Formal operations

Postconventional: moral principles

The Newborn Begins at birth and includes 1st month of life Physical Examination

Ave wt ~3.4kg Ave lt 50cm Ave HC 35cm assess vigor, alertness, tone

Infants

0 - 2 months

Physical Cognitive Emotional

• weight decreases 10% in the 1st wk

• regains or exceeds BW by 2 wks

• wt gain – 30 gm/day in 1st mo

• recognize human faces and smiles

• increased attention when stimulus changes

• Basic trust vs mistrust

• Crying peaks at 6 wks then decreases by 3 mos

2 - 6 months

Physical Cognitive Emotional• By 3-4 mos -

rate of growth = 20 gm/day

• Early reflexes disappear

• Voluntary movements appear

• Regular sleep wake cycle

• 4 mos – interested in a wider world

• Explore their own bodies, vocalizing, blowing bubbles

• Starts to have emotions of fear, anger, joy

6 - 12 months

Physical Cognitive Emotional Communication

• 1st yr – BW doubled, Lt increased by 50 %, HC increased by 10cm

• Motor improvement

• Tooth eruption

• Complex play

• Object permanence – 9 mos

• Stranger and separation anxiety

• Demand for autonomy

• Syllables or language development

Second Year

12 - 18 months

Physical Cognitive Emotional Communication

• Short legs and long torso

• Exaggerated lumbar lordosis and protruding abdomen

• Genu varus

• Exploration of environment

• Symbolic play

• Temperament depends on comfort given by parents

• Speak 1st words – 12mos

• Receptive language

• Polysyllabic jargoning

18 - 24 months

Physical Cognitive Emotional Communication

• Ht and wt increase at a steady state

• Improvement in balance and agility

• Object permanence firmly established

• Flexibility in problem solving

• rapproachment

• Understand 2 step commands

• Vocab 50-100

Preschool Years

2 – 5 years

Physical Cognitive• Increases of ~2kg in wt;

7-8 cm in Ht/ yr• Somatic and brain

growth slows• Knock- knee and flatfoot• VA 20/30 – 3yrs; 20/20 –

4yrs• All 20 primary teeth

erupted• Handedness• Bowel and bladder

control

• Magical thinking • Egocentricism• perception• cooperative play

2 – 5 years

Emotional Language• Tantrums peak between

2-4 yrs• Vocabulary increases to

2000• can count• Use future tense

Developmental Milestones

Newborn: lies in flex attitude turns head from side to side head lags on pull can fixate face or light in line with vision Moro , grasp , stepping reflexes Visual preference to a human face

At 1 month: Holds head up momentarily Tonic neck posture predominates head lags when pulled to sitting Follows moving object Reflex smile Body movements in cadence with voice of

others in social contact

At 2 months: Head sustained on ventral suspension Tonic neck posture predominates Follows moving objects past midline- 180 degrees Smiles on social contact (social smile) Listens to voice and coos

At 4 months:Symmetric posture No head lag When held erect, pushes with feetReaches & grasps objects and brings them to

mouthLaughs out aloudShows displeasure when social contact is

broken

At 7 months:

Rolls over; crawls or creepsSits briefly with support Rolls overTransfers objects from hand to handPolysyllabic vowel soundsPrefers mother babbles

At 10 months:Sits alone; pulls to stand Cruises; walks holding on to furniturePincer grasp; looks for hidden toyRepetitive consonant sounds( mama, dada)Responds to sound of nameWaves bye-bye; plays peek-a-boo

At 12 months

Walks with 1 hand held Obeys simple commands on request or gesture Speaks few words besides mama, dada Makes postural adjustment to dressing Plays simple ball game

At 15 months:

Walks alone crawls up stairs Makes a line Makes tower of 3 cubes Jargon follows simple commands May name a familiar object (ball) Indicates needs by pointing

At 18 months: Runs stiffly walks up stairs with 1 hand held Imitates scribbling and vertical stroke Makes tower of 4 cubes Names pictures; identifies 1 or more body

parts Average of 10 words Feeds self Seeks help when in trouble

At 24 months (2 yrs): Runs well walks up & down stairs one step at a time Jumps Makes tower of 7 cubes Circular scribbling, imitate horizontal line Puts 3 words together ( subject-verb-object) Handles spoon well; listens to stories with pictures Helps to undress

At 30 months:

Goes upstairs with alternating feet Imitates circular stroke

Makes tower of 9 cubes Knows full name; refers to self as “I” Helps put things away; pretends in play

At 36 months (3 yrs):

Rides tricycle Stands momentarily on one month Copies a circle; imitates a cross Knows age and sex counts 3 objects correctly Plays simple games with other children helps in dressing

At 48 months (4yrs):

Hops on one foot Throws ball overhand Copies cross and square draws a man with 2 to 4 parts besides the

head Tells a story Role playing Goes to toilet alone

At 60 months:

Skips Copies a triangle Names 4 colors Dresses and undresses Asks questions about meaning of words Domestic role-playing

MIDDLE CHILDHOOD 6-11 yr of age previously referred to as latency period during which children increasingly

separate from parents and seek acceptance from teachers, other adults, and peers

self-esteem becomes a central issue develop the cognitive ability to consider their own

self-evaluations and their perception of how others see them

judged according to their ability to produce socially valued outputs

MIDDLE CHILDHOOD Physical Development

growth averages 3-3.5 kg (7 lb) and 6-7 cm (2.5 in) per year

growth occurs discontinuously, in 3-6 irregularly timed spurts each year,

head grows only 2-3 cm, reflecting a slowing of brain growth.

myelinization is complete by 7 yr of age. body habitus is more erect than previously,

with long legs compared with the torso growth of the midface, lower face occurs

gradually

MIDDLE CHILDHOOD Physical Development

loss of deciduous (baby) teeth is a more dramatic sign of maturation, beginning around 6 yr of age replacement with adult teeth occurs at 4 per year by age 9 yr, children will have 8 permanent incisors & 4

permanent molars premolars erupt by 11-12 yr of age

lymphoid tissues hypertrophy, often giving rise to impressive tonsils and adenoids

muscular strength, coordination, and stamina increase progressively,

sedentary habits at this age are associated with increased lifetime risk of obesity and cardiovascular disease

MIDDLE CHILDHOOD Cognitive Development

increasingly apply rules based on observable phenomena, factor in multiple dimensions and points of view, and interpret their perceptions using physical laws Piaget documented this shift from “preoperational” to

“concrete logical operations.” the concept of “school readiness” is controversial

there is no consensus on whether there is a defined set of skills needed for success on school entry

by age 5 yr, most children have the ability to learn in a school setting, as long as the setting is sufficiently flexible to support children with a variety of developmental achievements

MIDDLE CHILDHOOD Social, Emotional and Moral Development

energy is directed toward creativity and productivity central Ericksonian psychosocial issue, the crisis between

industry and inferiority, guides social and emotional development

changes occur in three spheres: the home, the school, and the neighborhood

increasing independence is marked by the 1st sleepover at a friend's house and the 1st time at overnight camp

the beginning of school coincides with a child's further separation from the family and the increasing importance of teacher and peer relationships

social groups tend to be same-sex popularity, a central ingredient of self-esteem, may be

won through possessions as well as through personal attractiveness, accomplishments, and actual social skills.

MIDDLE CHILDHOOD Social, Emotional and Moral Development

by age of 5 or 6 yr, the child has developed a conscience has internalized the rules of the society. can distinguish right from wrong will adopt family and community values, seeking

approval of peers, parents, and other adult role models

ADOLESCENCE consists of 3 distinct periods—early, middle, and late—each

marked by a characteristic set of biologic, psychological, and social issues

in girls, the 1st visible sign of puberty and the hallmark of SMR2 is the appearance of breast buds, between 8 and 12 yr of age. menses typically begins 2 to 2 ½ yr later, during SMR3-4 (median

age, 12 yr; normal range, 9-16 yr) less obvious changes include enlargement of the ovaries, uterus,

labia, and clitoris, and thickening of the endometrium and vaginal mucosa.

in boys, the 1st visible sign of puberty and the hallmark of SMR2 is testicular enlargement, beginning as early as 9 ½ yr followed by penile growth during SMR3 peak growth occurs when testis volumes reach approximately 9-

10 cm3 during SMR4\ under the influence of LH and testosterone, the seminiferous

tubules, epididymis, seminal vesicles, and prostate enlarge

ADOLESCENCE Growth acceleration begins in early adolescence for

both sexes, but peak growth velocities are not reached until SMR3-4 Boys typically peak 2-3 yr later than girls, begin this growth

at a later SMR stage and continue their linear growth for approximately 2-3 yr after girls have stopped.

asymmetric growth spurt begins distally, with enlargement of the hands and feet, followed by the arms and legs, and finally, the trunk and chest

rapid enlargement of the larynx, pharynx, and lungs elongation of the optic globe often results in

nearsightedness dental changes include jaw growth, loss of the final

deciduous teeth, and eruption of the permanent cuspids, premolars, and finally, molars

ASSESSMENT OF GROWTH critical component of pediatric health

surveillance is the assessment of a child's growth

growth results from the interaction of genetics, health, and nutrition

many biophysiologic and psychosocial problems can adversely affect growth, and aberrant growth may be the first sign of an underlying problem

most powerful tool in growth assessment is the growth chart

ASSESSMENT OF GROWTH accurate measurement is a critical component of

growth assessment for infants and toddlers, weight, length, and head

circumference are obtained performed with the infant naked

head circumference is determined using a flexible tape measure run from the supraorbital ridge to the occiput in the path that leads to the largest possible measurement.

length is most accurately measured by two examiners (one to position the child) with the child supine on a measuring board for older children, the measure is stature or height,

taken without shoes, using a stadiometer

ASSESSMENT OF GROWTH body mass index for age complements the

standard growth charts for children over 2 yr of age BMI can be calculated as weight in kilograms/(height in

meters)2 or weight in pounds/(height in inches) BMI percentile varies with age over childhood: a 6 yr

old girl with a BMI of 21 is overweight, whereas a 16 yr old girl with the same BMI is just above the 50th percentile.

height velocity charts, which evaluate the rate of growth per yr, are considered by many to give a more sensitive and specific indicator of abnormal growth. used primarily by pediatric endocrinologists.

ASSESSMENT OF GROWTH between 6 and 18 mo of age, infants may shift

percentiles upward or downward toward their genetic potential.

thereafter, most children will track along a growth percentile tracking often represents the mid-parental height and

a corresponding weight, where mid-parental height is calculated in inches as follows:   

•    Boys: [(maternal height + 5) + paternal height]/2   •    Girls: [maternal height + (paternal height − 5)]/2   •    13 cm (instead of ? 5 in) if using metric units

ASSESSMENT OF GROWTH diagnosis of failure to thrive usually a

diagnosis of children under 3 yr of age, is considered if a child's weight is below the 5th percentile, if it drops down more than 2 major percentile lines, or if weight for height is less than the 5th percentile

weight for height below the 5th percentile remains the single best growth chart indicator of acute undernutrition.

BMI less than the 5th percentile also indicates that a child is underweight

low weight for age or height or weight loss may be referred to as wasting

ASSESSMENT OF GROWTH another way to evaluate weight is to

determine the ideal body weight for height and compare the current weight to the ideal body weight for length or height

ASSESSMENT OF GROWTH Linear growth deficiency (stunting) is more likely to be

due to congenital, constitutional, familial, or endocrine causes than to nutritional deficiency in endocrine disorders, length or height declines first or at the

same time as weight; weight for height is normal or elevated in nutritional insufficiency, weight declines before length, and

weight for height is low (unless there has been chronic stunting)

in congenital pathologic short stature, an infant is born small and growth gradually tapers off throughout infancy

in constitutional growth delay, weight and height decrease near the end of infancy, parallel the norm through middle childhood, and accelerate toward the end of adolescence. Adult size is normal

in familial short stature, both the infant and the parents are small; growth runs parallel to and just below the normal curves.

ASSESSMENT OF GROWTH Obesity

weight for height exceeds 120% of the standard (median) weight for height

BMI over the 95th percentile indicates obesity and a BMI between the 85th and 95th percentiles indicates overweight BMI may not provide an accurate index of adiposity,

because it does not differentiate lean tissue and bone from fat

Measurement of the triceps, subscapular, and suprailiac skinfold thickness can be used to estimate adiposity;

OTHER INDICES OF GROWTH Body proportions

lower body segment is defined as the length from the symphysis pubis to the floor,

upper body segment is the height minus the lower body segment

ratio of upper body segment divided by lower body segment (U/L ratio) equals approximately 1.7 at birth 1.3 at 3 yr of age\ 1.0 after 7 yr of age Higher U/L ratios are characteristic of short-limb

dwarfism or bone disorders, such as rickets.

OTHER INDICES OF GROWTH Bone Maturation

bone age correlates well with stage of pubertal development and can be helpful in predicting adult height in early- or late-maturing adolescents

in familial short stature, the bone age is normal (comparable to chronological age)

in constitutional delay, endocrinologic short stature, and undernutrition, the bone age is low and comparable to the height age

skeletal maturation is linked more closely to sexual maturity rating than to chronological age

it is more rapid and less variable in girls than in boys

OTHER INDICES OF GROWTH dental development includes mineralization, eruption, and

exfoliation initial mineralization begins as early as the 2nd trimester

(mean age for central incisors, 14 wk) and continues through 3 yr of age for the primary (deciduous) teeth and 25 yr of age for the permanent teeth

eruption begins with the central incisors and progresses laterally begins at about 6 yr of age and continues through 12 yr of age eruption of the permanent teeth may follow exfoliation

immediately or may lag by 4-5 mo delayed eruption is usually considered when there are no teeth by

approximately 13 mo of age common causes include hypothyroid, hypoparathyroid, familial, and (the

most common) idiopathic causes of early exfoliation include histiocytosis X, cyclic

neutropenia, leukemia, trauma, and idiopathic factors nutritional and metabolic disturbances, prolonged illness, and

certain medications (tetracycline) commonly result in discoloration or malformations of the dental enamel.

End