1. growth and development
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Transcript of 1. growth and development
Growth and Development
Goitom Gebreyesus, MD
Introduction
• Growth • The increase in size and development of a living
organism from a simple to a more complex form
• Development • An increase in skill and complexity of function
• Growth and development in • physical, intellectual, emotional and social terms are
the essential Biological characteristics of childhood
Intro…
• A child is not a small adult, but is• A developing human being who changes from a new
born through infancy, toddlerhood and early school years in to and adolescent and finally, a mature adult
• One needs to understand Growth and Development in 3 ways:
Intro…
• Understanding – The normative pattern allows one to monitor
children's progress– Of how biological and environment forces interact
to shape development allows one to target factors that increase risks
– Of how parents conceptualize development facilitates guidance and intervention
Developmental Theories
Theory/Stage Infancy (0–1 yr)
Toddlerhood (2-3)
Preschool (3-6)
School age (6-12)
Adolescence (12-20))
Freud: psycho-sexual
Oral Anal oedipal latency Genital
Erikson: psycho-social
Basic trust Autonomy vs. shame & doubt
Initiative vs. guilt
Industry vs. inferiority
Identity vs. ID diffusion
Piaget: cognitive Sensori -motor Sensori -motor Preoperational
Concrete operation
Formal operation
Classic Developmental Stage Theories
General Principles
– The sequence of each pathway of development doesn’t vary, although the rate is variable
– The rate of development along different pathways is variable
– Motor development proceeds in a cephalo-caudal direction
– Some primitive reflexes must be lost before voluntary movement occur
Developmental Assessment
• Gross motor development• Gross muscular activity and neuro-development including posture,
independent mobilities and progress from head control to running
• Fine motor development (Manipulation)• The ability to reach for, grasp and manipulate objects
• Cognition and Social skill• Social smile, watching a mirror, waving goodbye, general alertness and
curiosity about the surrounding
• Language
Milestones at different ages
• Infancy (0-12 months) – Physical:
• Weigh an average of 10 Kg at 12 months, length increases by 25 cm, and head circumference by 12 cm
– GM: • at 3 M support head, at 6 M sit without support, at 8 M
crawl and at 12 M stand without support
– FM: • 3-4 M grasp objects, 5-6 M transfer objects from hand
to hand, at 9 M thumb-finger grasp and at 12 M scribble
Infancy…
– C & S: • at 2M social smile, at 4 M laugh, 6-8 M stranger anxiety
and at 9-12 M object permanence
– L:• first 6 M vowels, at 7 M start with consonants, at 8-9
M papa & mama, at 12 M few words
Toddlerhood (12-24 months)
– Physical: • Gain average Wt of 2 Kg, Ht 12 cm & HC 3cm
– GM: • Walk at 12-15 M, at 18 M run stiffly, walk upstairs with
one hand held, at 24 run well and walk up and down stairs one at a time
– FM: • at 15 M make a line, insert pellet in a bottle, at 18 M
imitate vertical stroke and at 24 M imitate horizontal stroke
Toddlerhood…
– C & S: • at 15 M indicate desire by pointing, at 18 M feeds self,
complain when wet or soiled, at 24 M helps undress and listens to stories with picture
– L: • at 15 M start to speak in jargons, at 18 M 10-15 words
and at 24 M two word sentence
Preschool (2-5 years)
– Physical: • Gain 2 Kg/yr and Ht 7 cm/yr; by end of 3 yr all primary
teeth have erupted
– GM & FM: • at 2 & half yr walk upstairs alternating feet, at 3 yr ride
tricycles & copy circle, at 4 hop on one foot, throw ball over head & copy cross; at 4 & half yr copy square; at 5 yr skip & copy triangle
2078
1630
Preschool…
– C & S: • at 2 & half yr Know full name and pretend plays; at 3 yr
know age and sex, count 3 objects, wash hands & put shoe; at 4 yr tell a story; at 5 yr name 4 colors, count 10 objects correctly and dress &undress; think in prelogical operations
– L: • language develop most rapidly between 2-5 yr,
vocabulary increases from 50-100 to about 2000 words; number of words in a sentence equals age in yrs
School age (6-12 yrs)
– Physical:• Average weight and height gain per year is 3-3.5 kg and
6 cm respectively, HC increase by 2-3
– Motor:• coordination and stamina increase progressively, and
are able to perform complex movements such as dancing
– C&L:• start thinking in concrete logical operations
Adolescence (10-20)
• Rapid change in – body size, shape, physiology, psychologic and
social functioning
• Three distinct periods– Early, middle and late
• Common changes that occur during the three periods are:
Adolescence…
Variable Early Adolescence
Middle Adolescence Late Adolescence
Age/yrs 10-13 14-16 17-20& beyond
Somatic 20 sexual charac., beginning of rapid G
Ht peak, acne & odor, menarche, spermarche
Slower growth
Sexual Sexual interest Sex drive urges experimentation
Consolidation of sexual identity
Cognitive & Moral
concrete operation, conventional morality
Abstract thought, self-centered
Idealism, absolution
Family Bids for independence
Continued struggle for greater autonomy
Practical, independent, family remains secure base
Peers Same sex groups, conformity, cliques
Dating, peer groups less important
Intimacy, possibly commitment
Adolescence…
– The sequence of somatic and physiologic changes that occur can be used to assess developmental maturity according to Tanners’ staging: • Sexual Maturity Rating (SMR)
Adolescence…
Fig. A – Sex maturity ratings of pubic hair changes in adolescent boys and girlsFig. B – Sex maturity ratings of breast changes in adolescent girls
A B2 3
4 5
2 3
4 5
1
2
3
4
5
Adolescence…
SMR Stage
PUBIC HAIR BREASTS
11 Preadolescent Preadolescent
22 Sparse, lightly pigmented, straight, medial border of labia
Breast and papilla elevated as small mound; areola diameter increased
33 Darker, beginning to curl, increased amount
Breast and areola enlarged, no contour separation
44 Coarse, curly, abundant, but amount less than in adult
Areola and papilla form secondary mound
55 Adult feminine triangle spread to medial surface of thighs
Mature, nipple projects, areola part of general breast contour
Classification of sex maturity stages in girls
Adolescence…
SMR Stages
PUBIC HAIR PENIS TESTES
11 None Preadolescent preadolescent
22 Scanty, long and slightly pigmented
Slight enlargement
Enlarged scrotum, pink, texture altered
33 Darker, beginning to curl, small amount
Longer larger
44 Resembles adult type but less in quantity, coarse, curly
larger; glans and breadth increase in size
Larger, scrotum dark
55 Adult distribution, spread to medial surface of thigh
Adult size Adult size
Classification of sex maturity stages in boys