9502523 Growth and Development of Child

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
http://scripts.affiliatefuture.com/AFClick.asp?affiliateID=24466&merchantID=2678&programmeID=7004&mediaID=0&tracking=&url=http://www.childrensalon.co.uk/product_info.php?products_id=7644


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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.doc


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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)


mo

1620 mo 1112 yr 911 yr

First molars 5th fetal mo 2430 mo 1016

mo

1016 mo 1011 yr 1012

yr

Second

molars


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.doc


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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)


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)


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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9502523 Growth and Development of Child

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