Pediatric Health Nursing

Unit 2:
Growth and Development

Prepared by: Miss Rabia Hanif

Nursing Lecturer
Sharif College of Nursing
Topics will be discussed in this lecture

1. Growth and development

2. Direction or patterns of Growth and
Development.
3. FACTORS THAT INFLUENCE GROWTH AND
DEVELOPMENT

4. Height, weight, chest circumference, head

circumference at birth
5. Milestones of growth and development
 Child growth and development
• Child growth and development is a complex
process, which includes not only physical growth,
but also the maturity of systems and
development of functioning.

• The process of growth and development is

influenced by a variety of internal and external
factors. ‡Therefore it is one of the most important
goals of pediatric to monitor and improve child
growth and development, personality, and
behaviors.
 Growth
It is the process of physical maturation resulting an increase in size of the body
and various organs. It occurs by multiplication of cells and an increase in
intracellular substance. It is quantitative changes of the body.

Development
It is the process of functional and physiological maturation of the
individual. It is progressive increase in skill and capacity to function. It is
related to maturation and myelination of the nervous system. It
includes psychological, emotional and social changes. It is qualitative
aspects.
Development a gradual change and expansion; advancement from a
lower to a more advanced stage of complexity the emerging and
expanding of the individual's, capacities through growth, maturation,
and learning.
Growth indicates a quantifiable change in size, whereas
Development indicates a transformation of structure.
Growth Development
Child growth andQualitative
Quantitative development
Objectively observed and measured It cannot be measured
It does not continue throughout life span. It is continue in all areas of mental
Growth: Quantitative change ‡
Stops after maturation. activity.

Development: QualitativeIt ischange

It is one aspect of development.
‡
complex and has many sided.
It is not directional It is progressive and sequential.
It is not affected by learning. Learning and experience affects.

Maturation: An increase in competence and

adaptability; a change in the complexity of a
structure that makes it possible for that
structure to begin functioning to function at a
higher level.
 Direction or patterns of Growth and
Development
1. Cephalocaudal (Head-to-tail )‡
2. Proximo-distal or near-to far
(Midline to periphery).

3. Differentiation (General to specific),

describes development from simple
operations to more complex activities and
functions.
FACTORS THAT INFLUENCE GROWTH AND
DEVELOPMENT
• Genetic factors • Physical and Psychological
• Gender environment
Prenatal factors
• Maternal malnutrition • Cultural influence
• Maternal infection • Socio economic status
• Maternal substance abuse
• Maternal illness • Climate and season
• Hormones • Play and exercise
• Miscellaneous
• Birth order of the child
Postnatal factors • Hormonal influence
• Growth potential
• Nutrition
• Childhood illness
 Weight
• It is an easily obtainable measurement and a sensitive index reflecting the
child's overall growth and nutrition.
• Growth is very rapid during the first year of age, especially during the
initial 6 months.
• The younger the infant, the more the weight gain. Age Weight
• A steady annual increase of approximately New born 3 kg
2 to 2.75 kg per year until the adolescent
growth spurt. 6m 7.5 kg
12 m 9 kg
• By 5month of age weight has double, triple a 1 year
and fourth time by 2 years, five times by 3 year, 2 years 12 kg
six times by 5 year, seven times by seven year and 5 years 18 kg
ten times by ten year.
10 years 28 kg

Formula:
• For Infants < 12 months: Weight (kg) = (age in months + 9)/2
• For Children aged 1-5 years: Weight (kg) = 2 x (age in years + 5)
 Height
• Height is the vertical distance of two points
between the top of the head and heel of the feet.

The measuring varies with age:

(a) Children younger than age 3 years are measures
lying down in no shoes, socks and cap;
measurement.
(b) Children older than age 3 years are measured by
standing straight.
Conti….
Age Head
New born 50 cm
• At approximately 2 years of age
the child begins a relatively stable 6m 66 cm
and steady growth rate of 5 to 6 cm 12 m 75 cm
per year; this rage continues for the 2 years 85 cm
next 10 years. 5 years 105 cm
10 years 140 cm

• The Height of child (2 yrs-12 yrs) can be estimated With

Height(cm) = age × 7 ＋70

• Individual Differences in height is within ± 30 %.

 Head Circumference
• H
‡ ead circumference is an important
determinant of brain growth and potential
neurologic function. ‡It is usually measured in
children up to 2 years of age.

• The measurement is made by placing a tape

measure around the head just above the
eyebrows and around the most prominent
portion of the back of the skill.
Conti…. Age Head
New born 34cm

• Head growth is also rapid. ‡ 6m 42cm

• The average head circumference 12 m 46cm

is 33-34cm at birth. 2 years 48cm

5years 50cm

• ‡During the first 6 months head

circumference increases approximately
1.5 cm per month but decreases to only 0.5
cm per month during the second 6 months.
• After 2 years of age the growth is slowly.
 Chest Circumference
• The measurement of chest
Age Head Chest
circumference is made at the New 34cm 32cm
nippier line. born

6m 42cm 41cm

• The chest circumference 12 m 46cm 46cm

2 years 48cm 50cm
at birth is about 32 cm, less than
5years 50cm 55cm
the head circumference.
• The chest circumference approximately equals
head circumference by the end of the first year.
• They can be estimated after 1 years With (chest
one - head one ) = age (years)
 Fontanel
• The space between the bones of an infant's skull where the
sutures intersect) that are covered by tough membranes.

 At birth, anterior and posterior fontanelle are usually present.

Posterior fontanelle closes early few weeks(6-8week) of age.
 The anterior fontanels normally closes by 12- 18 months of age.

 Over-bulge of anterior fontanel indicates increased intracranial

pressure.
 Sunken fontanel indicates dehydration. ‡
 Delayed close of anterior fontanel is evidenced as children with
rickets. ‡

• Expanding head size reflects the growth and differentiation of the

nervous system.
 Teething
• There are totally 20 deciduous (primary) teeth. The
first deciduous tooth usually erupts at around 4 to 10
months (average 6 months), followed by a new one
monthly.

• A
‡ ll 20 deciduous teeth are generally present by 2 to 2.5
years of age.
• The first permanent (secondary) teeth erupt at about 6
years of age.

• The others appear in approximately the same order as

eruption of the primary teeth occur and follow
shedding of the deciduous teeth.
 Points to remember
 There are significant differences between children and adults.
 ‡The stage of growth and development include fetal period, neonatal
period, infancy, toddler's age, preschool age, school age, and
adolescence. ‡

 Growth and development of children are strongly influenced by

genetic and environmental factors.

 Growth and development are affected by a variety of conditions

and circumstances, including heredity, physiologic function, gender,
disease, physical environment, nutrition, and interpersonal
relationships.

• Growth and development follow predictable patterns in direction,

sequence, and pace.
• Biologic growth is determined by height, weight, bone age, and
dentition.
Age Milestones of development of Vision
1 month Can focus only about 20cm to 30cm away
4-5 month Looks at hand while sitting or lying on back
6-7 month Develop hand-eye coordination
11-12 month Can follow rapidly moving objects

Age Milestones of development of hearing

1 month Turns head to side when sound is make at the level of ear
4-5 month Locates sound by turning to side and then looking up or down
6-7 month Responds to own name
11-12 month Knows several words and their meaning
`