PAEDIATRIC NURSING
1. CARING OF THE HOSPITALISED CHILD
1.2 Normal growth and
development of children
LEARNING OUTCOMES
• At the end of lecture the students should be able to:-
• Define growth and development
• State the purpose for developmental assessment
• State the principles of growth and development
• Discuss the factors that influence growth and development
• State the normal development of a child of 3, 6,9 months
• Identify the red flags in the development according to the
age.
• State the adolescent behavioral problems.
GROWTH AND DEVELOPMENT
OF CHILDREN 0-12 YEARS
Growth and Development
• Infancy
• Early Childhood
• Middle Childhood
• Adolescent
Stages of Growth and Development
• Infancy • Middle Childhood
– Neonate – School age
• Birth to 1 month
– 6 to 12 years
– Infancy
• 1 month to 1 year
• Early Childhood • Late Childhood
– Toddler – Adolescent
• 1-3 years – 13 years to approximately
– Preschool 18 years
• 3-6 years
DEFINITION
• Growth
- Is the process of physical maturation resulting an
increase in size of the body and various organ
• Development
- Is the process of functional and physiological
maturation
Why developmental assessment?
• To assess the normal growth and
development
• Early detection of deviation in child’s pattern
of development
• To ascertain the needs of the child according
to the level of the growth and development
Principles of Growth and Development
• Growth is an orderly process, occurring in systematic
fashion.
• Rates and patterns of growth are specific to certain
parts of the body.
• Wide individual differences exist in growth rates.
• Growth and development are influences by a multiple
factors.
Principles of Growth and Development
• Development proceeds from the simple to the
complex and from the general to the specific.
• Development occurs in a cephalocaudal and a
proximodistal progression.
• There are critical periods for growth and development.
• Rates in development vary.
• Development continues throughout the individual's life
span.
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.
Factors Influencing Growth and
Development
1. Genetics
5. 4. physical
2. Maternal illness /
environment
infection / substance
abuse 6. Psychological
environment
3. Nutritional
7. cultural influence
- Breast feeding
8. Socio-economic status
- Bottle feeding
4. Diseases/Injuries
ASSESSMENT OF GROWTH
ASSESSMENT OF PHYSICAL GROWTH
• Weight
• Length and Height
• Head circumference
• Chest circumference
• Fontanelle closure
Weight
• Best criteria for assessment of growth and good
indicator of health and nutritional status
- Infants (6 months) = 2 x Bw
(1yr) = 3x BW
- Toddlers: (2yr) = 4 x BW
- Preschoolers: = +2.5 Kg/year
- School-age children: = +1.5- 3Kg/yr
- Adolescents: rapid growth
Length and Height
• Indicates skeletal growth
• Average length of healthy newborn - 50cm
• 3 month – increase to 60cm
• 9 month - increase to 70cm
• 1 year of age – 75cm
• 4 to 5 years – doubles the birth length
• 5cm increase every year till the onset of puberty the
gradual slow increase
Head circumference
• Related to brain growth and development of
intracranial volume
• Average head circumference at birth - 35cm
• 3 month – increase to 40cm
• 6 month – increase to 43cm
• 2 years of age – 48cm
• 7 years – 50cm
• 12 years – about 52cm almost same as adult
Chest circumference
• Important assessment of growth and nutritional
status
• at birth it is 2-3cm less than head circumference
• At 6-12 months both become
• At 1 years – chest circumference is greater than head
circumference by 2.5cm
• At 5 years - is about 5cm larger than head
circumference
Fontanelle closure
• Posterior fontanel – closes early within 6-8
weeks of age
• Anterior fontanel – closes by 12-18 month of
age
Primitive Reflexes
Seen in normal newborns; abnormal if persist after 3-5 months
• MORO REFLEX •semi-upright, head supported
•sudden withdrawal
•immediate re-support elicits reflex
•abduction extension of the
arms, opening of the hands
flexion and adduction of arms
• absence suggests CNS injury
• asymmetry suggests focal motor
lesions(e.g. brachial plexus
injury)
• disappears by 3-4 months
Galant reflex
• Infant is held in ventral suspension and one side of
the back is stroked along para-vertebral line
• Reflex consists of lateral curvature of the trunk
toward the stimulated side
• Disappears by 2-3 months
Walking and stepping reflex
• Placing and stepping reflex (“primitive
❏
walking”): disappears by 2-5 months
• Crossing the feet and scissoring: may indicate
spastic paraplegia or diplegia.
Rooting and sucking reflex
• Rooting/sucking: disappears by 3-4 months
Grasp reflex
• Grasp reflex: disappears by 1-4 months
Barbinski reflex
• Occurs when the big toe moves toward the top
surface of the foot and the other toes fan out after
the sole of the foot has been firmly stroked.
• This reflex, or sign, is normal in very young children.
• It is not normal after age 2 - damage to the nerve
paths connecting the spinal cord and the brain (the
corticospinal tract).
DEVELOPMENTAL MILESTONES
Table for Developmental Milestones
• Age, Gross Motor, Fine Motor (Adaptive), Speech
(Language) and Social Skills
==========================================
6 weeks
• prone-lifts chin
• social smile intermittently
2 months
• prone-arms pulls at clothes
• coos
DEVELOPMENTAL MILESTONES
4 months
• prone-raises head + chest
• rolls over
• no head lag
• reach and grasp objects to mouth
• responds to voice
6 months
• prone-weight on ulnar
• grasp hands
• begins to babble, stranger anxiety
• tripod sit
• responds to name
9 months
• pulls to stand
• finger-thumb grasp
• mama, dada - plays games
• separation/stranger
• imitates 1 word
• anxiety
12 months
• walks with support, pincer grasp, throws 2 words with plays
peek-a-boo
• drinks with cup
• mama, dada
15 months
• walks without support
• draws a line
18 months
• up steps with help
• tower of 3 cubes, 10 words, follows uses spoon
• scribbling
• simple commands
• points to body parts
24 months
• up 2 feet/step, tower of 6 cubes, 2-3 words phrases
• parallel play,
• runs, kicks ball
• undresses, helps to dress
• uses “I”, “me”, “you”
• 25% intelligible
3 years
• tricycle, up 1 foot/step, copies a circle and prepositions, plurals,
dress/undress
• down 2 feet/step,
• puts on shoes
• counts to 10
• stands on one foot, 75% intelligible, buttons
• knows sex, age
4 years
• hops on 1 foot
• copies a square, tells story
• knows cooperative play
• down 1 foot/step
• uses scissors,colours,
• normal toilet trained,
• buttons clothes
• intelligible
5 years
• skips, copies a triangle, fluent speech,
• rides bicycle
• future tense,
• ties shoelaces
Gross Motor Skills
• The acquisition of gross motor skill precedes
the development of fine motor skills.
• Both processes occur in a cephalocaudal
fashion
– Head control preceding arm and hand control
– Followed by leg and foot control.
Gross Motor Development
• Newborn: barely able to lift head
• 6 months: easily lifts head, chest and upper
abdomen and can bear weight on arms
Head Control
Newborn Age 6 months
Sitting up
• 2months old: needs assistance
• 6 months old: can sit alone in the tripod
position
• 8 months old: can sit without support and
engage in play
Sitting Up
Age 2 months Age 8 months
Ambulation
• 9 month old: crawl
• 1 year: stand independently from a crawl
position
• 13 month old: walk and toddle quickly
• 15 month old: can run
Ambulation
13 month old
Nine to 12-months
Fine Motor - Infant
• Newborn has very little control. Objects will
be involuntarily grasped and dropped without
notice.
• 6 month old: palmar grasp – uses entire hand
to pick up an object
• 9 month old: pincer grasp – can grasp small
objects using thumb and forefinger
Speech Milestones
• 1-2 months: coos
• 2-6 months: laughs and squeals
• 8-9 months babbles: mama/dada as sounds
• 10-12 months: “mama/dada specific
• 18-20 months: 20 to 30 words – 50% understood by
strangers
• 22-24 months: two word sentences, >50 words, 75%
understood by strangers
• 30-36 months: almost all speech understood by
strangers
Hearing
• BAER (brain stem auditory evoked response) hearing
test done at birth
• Ability to hear correlates with ability enunciate words
properly
• Always ask about history of otitis media – ear infection,
placement of PET – tubes in ear
• Early referral to MD to assess for possible fluid in ears
(effusion)
• Repeat hearing screening test
• Speech therapist as needed
Fine Motor Development
6-month-old
12-month-old
Red Flags in infant development
• Unable to sit alone by age 9 months
• Unable to transfer objects from hand to hand
by age 1 year
• Abnormal pincer grip or grasp by age 15
months
• Unable to walk alone by 18 months
• Failure to speak recognizable words by 2
years.
Fine Motor - toddler
• 1 year old: transfer objects from hand to hand
• 2 year old: can hold a crayon and color vertical
strokes
– Turn the page of a book
– Build a tower of six blocks
Fine Motor – Older Toddler
• 3 year old: copy a circle and a cross – build
using small blocks
• 4 year old: use scissors, color within the
borders
• 5 year old: write some letters and draw a
person with body parts
Toddler
Adele Piliterri, Child Health Nursing, Lippincott
Toddler
Safety becomes a problem as
the toddler becomes more
mobile.
Pilliterri, Lippincott
Toddlers
Issues in parenting - toddlers
• Stranger anxiety – should dissipate by age 2 ½ to 3
years
• Temper tantrums: occur weekly in 50 to 80% of
children – peak incidence 18 months – most disappear
by age 3
• Sibling rivalry: aggressive behavior towards new infant:
peak between 1 to 2 years but may be prolonged
indefinitely
• Thumb sucking
• Toilet Training
Pre-School
Fine motor and cognitive abilities
• Buttoning clothing
• Holding a crayon / pencil
• Building with small blocks
• Using scissors
• Playing a board game
• Have child draw picture of himself
– Pre-school tasks
Red flags: preschool
• Inability to perform self-care tasks, hand
washing simple dressing, daytime toileting
• Lack of socialization
• Unable to play with other children
• Able to follow directions during exam
• Performance evaluation of pre-school teacher
for kindergarten readiness
Pool Safety
School-Age
School Years: fine motor
• Writing skills improve
• Fine motor is refined
• Fine motor with more focus
– Building: models – legos
– Sewing
– Musical instrument
– Painting
– Typing skills
– Technology: computers
School performance
• Ask about favorite subject
• How they are doing in school
• Do they like school
• By parent report: any learning difficulties,
attention problems, homework
• Parental expectations
Red flags: school age
• School failure
• Lack of friends
• Social isolation
• Aggressive behavior: fights, fire setting, animal
abuse
School Age: gross motor
• 8 to 10 years: team sports
• Age ten: match sport to the physical and
emotional development
School Age
School Age: cognitive
• Greater ability to concentrate and participate
in self-initiating quiet activities that challenge
cognitive skills, such as reading, playing
computer and board games.
13 to 18 Year Old
Adolescent
• As teenagers gain independence they begin to
challenge values
• Critical of adult authority
• Relies on peer relationship
• Mood swings especially in early adolescents
Adolescent behavioral problems
• Anorexia
• Attention deficit
• Anger issues
• Suicide
Adolescents
Adolescent Teaching
• Relationships
• Sexuality – STD’s / AIDS
• Substance use and abuse
• Gang activity
• Driving
• Access to weapons
Adolescents
THE END
