Growth and Development

Consultant pediatrician
Dr. Alaa M. Alrubae
Assisst. Prof. of pediatrics
College of medicine
University of Wasit
 Developmental pediatrics is concerned with the processes of
children’s learning and competent adaptation to the environment
from birth to adulthood.
The goal of pediatrics care is to optimize the growth and
development of each child.
Objectives:-
-Understand normal growth, development, and behavior.
-Normal physical and mental growth and development.
-Normal motor cognitive and emotional development.
-Observe the interrelationships between physical
growth cognitive, motor, and emotional development.
-How to assess growth and development.
-Know abnormal growth and development in children.
-Pediatricians need to understand normal growth, development,
and behavior in order to monitor
*children's progress,
*identify delays or abnormalities
in development.
*obtain needed services, and
*counsel parents.
-The context for observing a child’s development is the family,
school and community. Family, educational, social, cultural,
spiritual, economic, environmental and political forces act
favorably or unfavorably, but always significantly, on the
health and functioning of children.
*Childhood marks the change from the entirely dependent baby
into the mature independent adult.
*During this period the child:-
•Builds up a store of knowledge about the environment.
•Learns motor skills to survive.
•Learns a language with which to communicate and think.
•Develops a sense of self, self-regulation of emotions and
behavior and successful interpersonal relationships.
Growth:- increase in the size or dimensions; as weight, height, skull
circumference…. is the increase in size and number of cells in certain
tissues ( increase in the size of the body as a whole).

*The most dramatic events in growth and development occur before birth and
involve the transformation of a fertilized egg into an embryo and a fetus, the
elaboration of the nervous system, and the emergence of behavior in utero.
Development:- (Functional maturation of organs)… progressive
acquisition of skills and abilities in the multiple spheres of functioning:
motor (both gross and fine motor); communication; language;
cognitive; and social-adaptive.
 Stages Growth and Development

Intrauterine:-
*Embryonic period:-
1st trimester (organogenesis)
*Fetal period:-
2ndtrimester (more in length)
3rdtrimester (more in weight)
Extratrauterine:-
*Infancy:-
-Early Neonate: Birth to 1 week
-Neonate: Birth to 1 month
-Infancy : Birth to 1 year

*Early Childhood:-
-Toddler : 1-3 years
-Preschool: 4-5 years

*Middle Childhood:-
-School age (6 to 12 years)
Factors affecting Stages of Growth and Development:-
1.Genetic factors: racial & genetic.
2.Nutritional factors: adequate nutrition:
3.Socio-economic factors: poverty & ignorance.
4.Environmental factors: general hygiene.
5.Endocrinal factors.
6.Sex differences.
7.Chronic diseases.
8.Emotional factors
Growth Patterns:-
 Growth Patterns:-
*The child’s pattern of growth is in a head-to-toe direction,
or cephalocaudal, and
*In an inward to outward pattern called proximodistal.
Method of studying growth :-
1.Cross -sectional: -
2.Longitudinal

Measurements used in normal growth :-

1.Linear :-
a.height b.length c.sitting height d.span

2.Weight.

3.Circumference:-
a.head circumference b.chest circumference c.lower limbs

4.Skin & subcutaneous fat.

Growth Curves( Charts )
Early detection of deviation in child’s pattern of development:-

•To promote optimal physical and mental health and

development for all children.
•applying principles of prevention of impairment, wherever
possible, and to reduce disability and handicap.
•to discover the means of preventing such impairments.
•to ensure early diagnosis and effective treatment of impairments
of body, mind and personality.
It is useful to subdivide growth and development in to four
functional Skill areas:-
1.Gross motor
2.Fine motor and vision
3.Speech, language and hearing
4.Social, emotional and behavioral
FETAL GROWTH AND DEVELOPMENT :-
*The most dramatic events in growth And development occur
before birth. The transformation of a single cell into an infant.
*The uterus is permeable to social, psychological, and
environmental influences such as maternal drug use .
*Examination of the newborn should include an evaluation of growth
and an observation of behavior. The average term newborn weighs
approximately 3.4 kg; boys are slightly heavier than girls are. The
average length was about 50 cm and head circumference was 35 cm in
term infants.

*The weight may drop 10% below birth weight in the 1st week as a
result of excretion of the excess extravascular fluid and possibly poor
intake. Infant should regain the birth weight by 2 weeks of age and
should grow at average of 30 gm per day.
a.Primary Primitive neonatal reflexes:-
Reflexes are unique in the newborn period and can further elucidate or eliminate concerns
over asymmetric function. The most important reflexes to assess during the newborn period
are as follows:
The Moro reflex: resulting in a startle, then abduction and upward movement of the arms
followed by adduction and flexion. The legs respond with flexion.

The rooting reflex: touching the corner of the infant’s mouth…….lowering

of the lower lip on the same side with tongue movement toward the stimulus. The face also
turns toward the stimulus.
The sucking reflex: The sucking reflex is replaced later by voluntary sucking.

The grasp reflex: palm (palmar grasp) or sole (plantar grasp)…. The infant responds by
flexing fingers or curling the toes.

The asymmetric tonic neck reflex: is elicited by placing the infant supine and turning the head
to the side. This placement results in ipsilateral extension of the arm and the leg into a
“fencing” position. The contralateral side flexes as well.

The stepping reflex:

Most of these primitive reflexes disappear by age 3 – 4 months and a delay in the expected
disappearance of the reflexes may also warrant an evaluation of the central nervous system.
b.Secondary primitive reflexes:-
become apparent after the newborn period indicating proper
maturation of appropriate brain structure and these include:-
*Parachute:-
with the infant sitting, tilting to either side results in extension of the
ipsilateral arm in a protective fashion(it appear at age of 6—8 months
and never disappear).
*Landau:-
with the infant held about the waist and suspended, extension of the
neck produces extension of the arm and legs(it appear at the age of
6—8 months and disappears at the age of 15 mo.—2yr.).
NEONATAL PERIOD (1ST 4 WK):-
Prone: Lies in flexed attitude; turns head from side to side; head
sags on ventral suspension.

Supine: Generally flexed and a little stiff.

Visual: May fixate face on light in line of vision; “doll’s-

eye” movement of eyes on turning of the body.

Reflex: Moro response active; stepping and placing reflexes;

grasp reflex active.
Social: Visual preference for human face.
AT 1 MONTH:-
Prone: Legs more extended; holds chin up; turns head; head
lifted momentarily to plane of body on ventral suspension.
Supine: Tonic neck posture predominates; supple and relaxed;
head lags when pulled to sitting position.
Visual: Watches person; follows moving object.
Social: Body movements in cadence with voice of other in
social contact; beginning to smile.
AT 2 MONTH:-
Prone: Raises head slightly farther; head sustained in plane of body
on ventral suspension .
Supine: Tonic neck posture predominates; head lags whenpulled
to sitting position .
Visual: Follows moving object 180 degrees.
Social: Smiles on social contact; listens to voice and coos.
AT 3 MONTHS:-
Prone:
Lifts head and chest with arms extended; head above plane of body on
ventral suspension.
Supine:
Tonic neck posture predominates; reaches toward and misses objects;
waves at toy.
Sitting:
Head lag partially compensated when pulled to sitting position; early
head control with bobbing motion; back rounded.
Reflex:
Typical Moro response has not persisted; makes defensive movements
or selective withdrawal reactions.
Social:
Sustained social contact; listens to music; says “aah, ngah”
AT 4 MONTHS:-
Prone:
Lifts head and chest, with head in approximately vertical axis; legs
extended.
Supine:
Symmetric posture predominates, hands in midline; reaches and
grasps objects and brings them to mouth.
Sitting:
No head lag when pulled to sitting position; head steady, tipped
forward; enjoys sitting with full truncal support.
Standing:
When held erect, pushes with feet.
Adaptive:
Sees pellet, but makes no move to reach for it.
Social:
Laughs out loud; may show displeasure if social contact is broken;
excited at sight of food.
AT 7 MONTHS:-
Prone:
Rolls over; pivots; crawls or creep-crawls (Knobloch).
Supine:
Lifts head; rolls over; squirms.
Sitting:
Sits briefly, with support of pelvis; leans forward on hands; back rounded.
Standing:
May support most of weight; bounces actively.
Adaptive:
Reaches out for and grasps large object; transfers objects from hand to hand;
grasp uses radial palm; rakes at pellet.
Language:
Forms polysyllabic vowel sounds.
Social:
Prefers mother; babbles; enjoys mirror; responds to changes in emotional
content of social contact.
AT 9 MONTHS :-
Sitting:
Sits up alone and indefinitely without support, with back straight.
Standing:
Pulls to standing position; “cruises” or walks holding on to furniture,
Creeps or crawls.
Adaptive:
Grasps objects with thumb and forefinger; pokes at things with
forefinger; picks up pellet with assisted pincer movement; uncovers
hidden toy; attempts to retrieve dropped object; releases object
grasped by other person.
Language:
Repetitive consonant sounds (“mama,” “dada”).
Social:
Responds to sound of name; plays peek-a-boo or pat-a-cake; waves
bye-bye.
AT 1 YEAR:-
Motor:
Walks with one hand held (48 wk);
rises independently, takes several steps (Knobloch).
Adaptive:
Picks up pellet with unassisted pincer movement of forefinger and
thumb; releases object to other person on request or gesture.
Language:
Says a few words besides “mama,” “dada”
Social:
Plays simple ball game; makes postural adjustment to dressing.
15 MONTHS:-
Motor:
Walks alone; crawls up stairs.
Adaptive:
Makes tower of 3 cubes; makes a line with crayon; inserts raisin in
bottle.
Language:
Jargon; follows simple commands; may name a familiar object(e.g.,
ball); responds to his/her name.
Social:
Indicates some desires or needs by pointing; hugs parents.
18 MONTHS:-
Motor:
Runs stiffly; sits on small chair; walks up stairs with one hand held;
explores drawers and wastebaskets.
Adaptive:
Makes tower of 4 cubes; imitates scribbling; imitates vertical stroke;
dumps raisin from bottle.
Language:
10 words (average); names pictures; identifies one or more parts of
body.
Social:
Feeds self; seeks help when in trouble; may complain when wet or
soiled; kisses parent with pucker.
2 nd YEARS:-
Motor:
Runs well, walks up and down stairs, one step at a time; opens doors;
climbs on furniture; jumps.
Adaptive:
Makes tower of 7 cubes (6 at 21 mo); scribbles in circular pattern;
imitates horizontal stroke; folds paper once imitatively.
Language:
Puts 3 words together (subject, verb, object).
Social:
Handles spoon well; often tells about immediate experiences; helps to
undress; listens to stories when shown pictures.
30 MONTHS:-
Motor:
Goes up stairs alternating feet.
Adaptive:
Makes tower of 9 cubes; makes vertical and horizontal strokes, but
generally will not join them to make cross; imitates circular stroke,
forming closed figure.
Language:
Refers to self by pronoun “I”; knows full name.
Social:
Helps put things away; pretends in play.
3 rd YEARS:-
Motor:
Rides tricycle; stands momentarily on one foot.
Adaptive:
Makes tower of 10 cubes; imitates construction of “bridge” of 3 cubes;
copies circle; imitates cross.
Language:
Knows age and sex; counts 3 objects correctly; repeats 3 numbers or a
sentence of 6 syllables; most of speech intelligible to strangers.
Social:
Plays simple games (in “parallel” with other children); helps in dressing
(unbuttons clothing and puts on shoes); washes hands.
4 th YEARS:-
Motor:
Hops on one foot; throws ball overhand; uses scissors to cut out
pictures; climbs well.
Adaptive:
Copies bridge from model; imitates construction of “gate” of 5 cubes;
copies cross and square; draws man with 2 to 4 parts besides head.
Language:
Counts 4 pennies accurately; tells story.
Social:
Plays with several children, with beginning of social interaction and
role-playing; goes to toilet alone.
5 th YEARS:-
Motor:
Skips.
Adaptive:
Draws triangle from copy; names heavier of 2 weights.
Language:
Names 4 colors; repeats sentence of 10 syllables; counts 10 pennies
correctly.
Social:
Dresses and undresses; asks questions about meaning of words;
engages in domestic role-playing.
Dental development:-
* it includes mineralization, eruption and exfoliation.
* initial mineralization begin as early as the second trimester and
continuous through 3 yr. of age for the primary(deciduous teeth) and
25 yr. of age for the( permanent teeth).
* mineralization begins at the crown and progresses toward the root.
* eruption begins with the central incisors and progresses laterally.
* exfoliation begins at about 6 yr. of age and continues through 12 yr.
of age.
* eruption of permanent teeth may follow exfoliation immediately
or may lag by 4-5 mo.
* the timing of dental development is poorly correlated with other
processes of growth and maturation.
* delayed eruption is usually considered when there are no teeth by
approximately 13 mo. of age.
*Common causes of delay eruption include:-
hypothyroid, hypoparathyroid, familial, and (the most common)
idiopathic. Individual teeth may fail to erupt because of
mechanical blockage (crowding, gum fibrosis).
*Causes of early exfoliation include:-
histiocytosis X, cyclic neutropenia, leukemia,trauma, and idiopathic
factors. Nutritional and metabolic disturbances, prolong illness, and
certain medications (tetracycline) commonly result in discoloration or
malformations of the dental enamel. A discrete line of pitting on the
enamel suggests a time-limited insult.
 Weight Height Head circumference
)WT) )HT) (HC)

*Average at birth:- 3.5 kg

*Loss 5-10% of birth wt. in *At birth about 50 cm. *At birth HC around 35 cm.
the first few days.
*Return to birth wt.at 10-14
day of age.

* Double birth wt. at 4-5 mo. *At 1 year around 75 cm. *It increase by 2cm/mo.for
the first 3 mo.of life.

*Triple birth wt. at 1year *At 3 years about 85 cm. *Increase by 1 cm.up to 6
(become around 10 kg.) mo. of life.
*Quadruple birth wt.at the
age of 2 years. *At 4 years will double birth height( *Increase by 0.5 cm/mo.for
100 cm.). the rest of the first year.

*20 kg. at 5 years. *So at the end of the first yr.

the HC will be 47 cm.

* 30 kg. at 10 years.
THANK YOU