Child Growth and Development

Almaz Tarekegn
MD, pediatrician
December 2024
Introduction
• GROWTH: increase in the size of the organism due to
increase in the number of cells of tissues or increase in
the size of each individual cell.
Change in QUANTITY

• DEVELOPMENT: indicates acquisition of function by

the tissues or the organism as a whole. An increase in
skill and complexity of function
Change in QUALITY
• G & D in physical, intellectual, emotional and social
terms are the essential Biological characteristics of
childhood
General principles of childhood development

I. The sequence of each pathway of development does

not vary, although the rate of development is
variable.
• A child must sit before standing and walking, even
though the age at which the child walks varies from
8 to 18 months in the normal population.
II. The rate of development along different pathways is
variable.
• A child may be precocious in motor development
but delayed in language development

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III. Infant development is dependent upon neurological
maturation.
• A skill cannot be achieved until there is maturation of
all the neuromuscular components involved.
IV. Generalized mass activity is replaced by individual
responses.
• The general agitation of the neonate presented with a
toy is replaced by the fine index finger approach at the
end of the first year.

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V. Motor development proceeds in a cephalo-caudal
direction.
• Head control develops before truncal control which
precedes upright posture.
VI. Some primitive reflexes must be lost before voluntary
movement occurs
e.g. the primitive grasp reflex must disappear before a
voluntary grasp can develop.
Types of growth and development

Growth type

- Physical growth (Ht, Wt, head chest circumference)

- Physiological growth (vital signs )

Development type

- Motor development

- Cognitive development

- Emotional development

- Social development
Four main types of growth and development

• Physical – Body growth that includes height and weight changes.

• Mental – Intellectual development, problem solving

• Emotional – Refers to feelings and includes dealing with love, hate, joy, fear,
excitement, and other similar feelings.

• Social – refers to interactions and relationships with other people.

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.
GROWTH assessment

 Weight
 Length
 BMI (Body Mass Index)
 Circumference:
Head Circumference
Chest Circumference
Mid-upper arm Circumference
 Dentition/eruption of teeth
 Osseous growth
 Weight

• average term newborn weighs approximately 3.4 kg (7.5 lb)

• boys are slightly heavier than girls.

 10% loss of weight in the first week of life

 regain or exceed birthweight by 2 weeks of age

 20-30gm/day increases till 3 months.

 Doubled their birth weight by 4 months age.

 Tripled by one year of age.

 Four times in 2 yrs

 Five times in 3 yrs, Six times in 5 yrs


 Length
• Height improvement indicates skeletal growth.

• At birth, the average length is about 50cm.

• Increases to 60cm at 3 months, 70cm at 9 months.75cm-1 yr

• 12cm increases in 2nd yr

• 9cm increases in 3rd yr

• 7cm increases in 4th yr
• 6cm increases at 5th yr
• Doubles in height at 4-5yrs
• For those 2-12 yrs age
• Ht =( age in yr x6)+77cm
 Formulas to approximate wt and ht when the
age is known
weight kilogram
At birth 3.25
3–12 mo Age(mo)+9/2
1–6 yr Age (yr) × 2 + 8
7–12 yr Age(yr)X7-5/2

height centimeter
At birth 50
At 1 yr 75
2–12 yr age (yr) × 6 + 77

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 Head circumference

• Average head circumference ( 34-35 cm at birth) increases to ~44 cm by 6 mo &

to 47 cm by one year.

• At 2 Years it is about 48cm

• At 7 Year it is about 50cm

• At 12 Years it is about 52cm

The anterior fontanel is closed between 9 and 18 months, and the posterior is
closed by 6-8 weeks
• head grows at a rate of 0.5 cm/ week first 3mo
• Between 3-6 months →1 cm/ month.
• Between the age of 6-12 months → 0.5cm/ month.
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Body proportions

• Body ratios(proportions) of upper to lower extremity as measured from the

pubis is
• 1.7:1 at birth

• 1.3 :1 at 3 yrs b/c of rapid growth of the legs than the trunk
• After 7 yrs, mostly at 10-12 yrs it becomes 1:1
• Higher U/L ratios are characteristic of short-limb dwarfism, as occurs with Turner
syndrome or bone disorders
• Lower ratios suggest hypogonadism or Marfan syndrome

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Head to chest circumference

• At birth head circumference is greater than the chest circumference by about 2.5
cm

• By 6 months, both are equal

• At first yr chest circumference becomes 2.5 cm greater

• By 5 yrs chest circumference is 5 cm greater than the head circumference

• For measuring the chest circumference measure it at the level of the nipples

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 Dentition
birth Nill
6-7 months Central incisors

10months Lateral incisors

12-18 months First molars

15-21 months cuspids

2-3 yrs Second molars

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Assessment of growth

• Many biophysiologic and psychosocial problems can adversely affect growth,

• aberrant growth may be the first sign of an underlying problem.

• The most powerful tool in growth assessment is the growth chart used in
combination with accurate measurements of height, weight, and head
circumference.

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interpretation of growth charts

• The data are presented in 5 standard gender-specific charts:

(1) weight for age;

(2) height (length and stature) for age;

(3) head circumference for age;

(4) weight for height (length and stature) for infants; and

(5) BMI for children over 2 yr of age

• Charts contain lines b/n 3rd and 97th percentiles.

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Development

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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
 Gross Motor
Development

 Newborn: hardly 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

Nine to 12-months 13 month old

 fine motor or adaptive milestones

includes
• eye coordination
• hand eye coordination
• hand mouth coordination and
• manipulation with hands

Eye coordination:
• 4 wks –fixate face on light in line of vision; doll's eye movement (oculocephalic reflex)
of eyes on
turning of the body
• 6 wks – follows object from side to side –unsteadily
• 2-3 mths – follows with steady movements of eyes
Fine Motor Development

12-month-old
6-month-old
 FINE MOTOR (Cont’d)

Hand skills: Book:

• 13 mths – turn 2-3 pages at a time
• 24 mths – turns 1 page at a time

Scribbling
• 12-24 mths – scribbles
• 2 yrs – copies vertical line
• 2 ½ yrs –copies horizontal line
• 3 yrs – circle
• 4 yrs – cross, rectangle
 SOCIAL DEVELOPMENT
• 1 mth - regards face of mother/caretaker

• 2 mth - social smile

• 3 mths - recognizes mother/caretaker

• 6 mths - enjoys mirror

• 7-8 mths - separation anxiety

• 9 mths - waves bye-bye

 LANGUAGE DEVELOPMENT

• 1 mth - turns head towards sound

• 3-5 mths - vowel sounds, gurgles

• 6 mths - monosyllabes

• 9 mths - bisyllables

• 10 mths - understands spoken speech

• 12 mths - speaks 2 words with meaning

• 18 mths - 20 words

• 24 mths - joins 2-3 words in a short sentence

• 3 yrs - 250 words

 Adolescence…
Variable Early Adolescence Middle Adolescence Late Adolescence
Age/yrs 10-13 14-16 17-20& beyond
Somatic 20 sexual charac., Ht peak, acne & odor, Slower growth
beginning of rapid menarche,
G spermarche
Sexual Sexual interest Sex drive urges Consolidation of
experimentation sexual identity
Cognitive concrete Abstract thought, self- Idealism,
& Moral operation, centered absolution
conventional
morality
Family Bids for Continued struggle for Practical,
independence greater autonomy independent,
family remains
secure base
Peers Same sex groups, Dating, peer groups Intimacy, possibly
conformity, cliques less important 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…

A B
2 3 1

2
4 5
3
2 3 4
4 5 5

Fig. A – Sex maturity ratings of pubic hair changes in adolescent boys and girls
Fig. B – Sex maturity ratings of breast changes in adolescent girls
 Sexual maturity rating for adolescence
assessment, males
SMR STAGE PUBIC HAIR PENIS TESTES

1 None Preadolescent Preadolescent

2 Scanty, long, slightly Minimal Enlarged scrotum, pink,
pigmented change/enlargement texture altered

3 Darker, starting to curl, Lengthens Larger

small amount

4 Resembles adult type, Larger;glans and breadth Larger, scrotum dark

but less quantity; coarse, increase in size
curly

5 Adult distribution, spread Adult size Adult size

to medial surface of
thighs

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 Sexual maturity rating for adolescence
assessment,females
SMR STAGE PUBIC HAIR BREASTS
1 Preadolescent Preadolescent
2 Sparse, lightly pigmented, straight, Breast and papilla elevated as small
medial border of labia mound;
diameter of areola increased

3 Darker, beginning to curl, increased Breast and areola enlarged,

amount no contour separation

4 Coarse, curly, abundant, but less than Areola and papilla form secondary
in adult mound

5 Adult feminine triangle, spread to Mature, nipple projects, areola part

medial surface of thighs of general breast contour

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Factors affecting growth and
development
• Genetic/biologic factors
• Neuro hormonal factors
• Nutritional factors
• Psychologic factors
• Social factors

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Genetics
• Growth is the interaction b/n genetics and environment
• Some are taller others are short
• Pigmies are short b/c they lack somatomedin.

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Neurohormonal factors
• Brain controls the growth of children genetically
• Accelerated growth after illness or malnutrition
• Endocrine glands affect growth by promoting protein synthesis ,regulating
substrate supply or enhancing the effect of other hormones on specific organs
• E.g. GH,insulin,TH,sex hormones , somatomedin

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Nutritional factors

• Deficiency of macro nutrients,vitamins,minrals retards both growth and

development

• Illnesses which interfere with nutritional intake or compete for it delays growth
and dev’t.

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Thank you!!