Growth ad development for first 5 years

1. Dr. Amit Vatkar
MBBS, DCH, DNB Pediatrics
Fellow in Pediatric Neurology, Mumbai
Trained in Neurophysiology & Epilepsy, USA
Contact No. : +91-8767844488
Email: vatkaramit@yahoo.com
Growth and
Developmental

2. Growth & Development
Definitions
• Growth: the natural increase in body size as well as
sizes of different organs. This is achieved by cell
multiplication and by increase in the intracellular
substances
• Development: maturation of organs and systems,
gaining of skills and ability of adaptation & assuming
responsibilities

3. Stages of Growth & Development:
• Embryonic stage
1st 12 weeks of pregnancy during which the fertilized
ovum differentiates into an organism
• Fetal stage
12-40 weeks of pregnancy characterized by rapid
growth & development
• Perinatal stage
Start of labor to end of 1st 24 hours after birth

4. • Postnatal stage
Neonatal period:
1st month of life
Infancy
1-12 months.
Preschool child (toddler)
1-4 years
School child
5-12 yr
Adolescence
12-20 yr

5. Factors Affecting Growth & Dev.
• 1. genetic factors e.g. achondroplasia
• 2. endocrinal: growth, thyroid, sex hormones are essential for normal
growth. e.g. cong. hypothyroidism
• 3. environmental e.g health of mom during preg. & socioeconomic status
of family
• 4. nutritional
• 5. cong. anomalies e.g. cong. heart ds.
• 6. chronic Dis. e.g. TB
• 7 activity: bedridden child will not grow normally

6. ASSESMENT OF GROWTH
Nutritional anthropometry
Assessment of tissue growth
Bone age
Dental age
Biochemical and histological means

7. NUTRITIONAL ANTHROPOMETRY
• Length/Height
• Weight
• Sitting height
• Body proportions
• Head circumference
• Midarm circumference

8. • A) Weight
• Table 1 … Dr. Chishti
Age Weight
@ birth 3 k.g. (2.5-3.5)
5 mth X 2 birth wt
1 year X 3 birth
2 year X 4 birth
2 yrs – puberty 2-2½ k.g./yr

9. • Table 2 … Nelson
Age Weight (k.g.)
@ birth 3.25
3-12 mth [Age(mth)+9] / 2
1-6 yr Age(yr) X 2 + 8
7-12 yr [Age (yr) X 7 – 5 ] /2
• There is an initial period of weight loss in the first 3-4 days d/t
redistribution of body fluids with loss of extra-fluid in the ECF. It is
estimated as 10% in full term & 15 % in preterm

10. • B) Height
Table 1 … Dr.Chishti
Age Height
@ birth 50 cm (45-55)
1 yr Birth + 50 % of birth ht
2 yr Birth + 75 % of birth ht
2- puberty + 5 cm/ year
Table 2… Nelson
Age Height
@ birth 50 cm
1 yr 75 cm
2-12 yr Age(yr) X 6 +77

11. BODY PROPORTIONS
• U/L segment ratio
• At birth 1.7:1
• By 6 to 7 yrs 1:1

12. Head circumference … Nelson
Age Growth in hd circ (cm/mth)
0-3 mth 2.0
3-6 mth 1.0
6-9 mth 0.5
9-12 mth 0.5
1-3 yr 0.25
4-6 yr 1 cm/yr

13. MIDARM CIRCUMFERENCE
• >13.5-normal
• 12.5 to 13.5-moderate PEM
• <12.5- severe PEM

14. AGE INDEPENDENT ANTHROPOMETRY
• Weight for height
• Quackstick
• Midarm/Head circumference
• Body mass index
• Ponderal index

15. WEIGHT FOR HEIGHT
• Degree of wasting

16. TISSUE GROWTH
• Triceps skinfold thickness
• Subscapular skinfold thickness

17. BONE AGE
• Appearance and fusion of epiphyseal centers

18. DENTAL DEVELOPMENT
Dentition … Nelson
Teeth Age of Eruption
Lower central incisor 5 mth
Upper central incisor 6 mth
Lower lateral incisor 7 mth
Upper lateral incisor 8 mth
1st molars 10 mth
Canines 16 mth
2nd molars 20 mth

19. DEVELOPMENT
• Qualitative and quantitative changes and acquisition
of variety of competencies for functioning optimally
in a social milieu
• Maturity and myelination of brain

20. PRINCIPLES OF DEVELOPMENT
• Continous process from conception to maturity
• Sequence of development is the same in all children rate of
development varies from child tochild
• DISSOCIATION-lack of parallelism
• Related to maturation of nervous system
• Generalized mass activity is replaced by specific individual
responses
• Cephalocaudal direction
• Primitive reflexes are to be lost before corresponding
voluntary movement is acquired

21. SEQUENCE OF DEVELOPMENT
• LOCOMOTION
• MANIPULATION
• USE OF EYES AND EARS
• GENERAL UNDERSTANDING
• PLEASURE AND DISPLEASURE
• FEEDING AND DRESSING
• SPEECH
• SPHINCTER CONTROL
• HANDEDNESS

22. THENEWBORNBABY
• The state of sleep and wakefulness
• The first few days of a baby’s life are usually composed of long periods of sleep
interspersed with short periods when the baby is awake.
• The duration of wakefulness lengthens gradually and includes periods of
fretfulness, crying and calmness.

23. Posture and large Movements
• At birth, the arms and legs are characteristically stiff (hypertonia) and the trunk and
neck floppy (hypotonia).
• Pulled to sitting, marked head lag is present.
• Held in a sitting position, the back is curved, and the head falls forward.
• Held in ventral suspension, the head drops below the plane of the body, and the
arms and legs are kept partly flexed.

24. The primary Reflexes
• Represent neurological maturation of the newborn
• Most develop before birth.
• Some reflexes- establishing symmetry of movement
• The Moro reflex is the best-known of all the neonatal reflexes.
• Infants show nutritive sucking for feeding and non-nutritive sucking patterns (self-
calming on fingers or dummies).
• Rooting fades by 6 months and involuntary suckling by 12 months.
• Protective gag and cough reflexes are also present, and these persist throughout
life.
• Strong and symmetrical palmar grasp reflex is present but fades rapidly over the
next 4 to 5 months.

25. Hearing and vision
• birth onwards- few days, turn their eyes towards a large and
diffuse source of light and close their eyes to sudden bright
light.
• An object or face- distance of 30 centimetres to obtain interest
and fixation.
• The startle reaction to sudden loud sounds is present.
• Eyes may be turned towards a nearby source of continued
sound, such as a voiced ‘ah-ah’ or a bell.

26. Social interaction and formation of attachments
• few days of birth - interaction with their carers through eye
contact, spontaneous or imitative facial gestures and
modulation of their sleep–wakefulness state.

27. AGE 1 MONTH
GROSS MOTOR

28. HANDS
• Hands predominantly closed
• Grasp reflex

29. GENERAL UNDERSTANDING
• Watches mothers face when she talks to him
• Opens and closes mouth
• Bobs head up and down

30. Visual perceptual and fine motor

31. Hearing behaviour
Hearing behaviour quiets when the
bell is rung

32. SOCIAL BEHAVIOUR AND PLAY
• SUCKS WELL
• SLEEPS MOST OF THE TIME
• SOCIAL SMILE AT 5TO6 WEEKS

33. Self-care and independence

34. AGE 3 MONTHS
• GROSS MOTOR

35. Visual perceptual and fine motor

36. Hearing
• Hearing TURNS HEAD TO THE SOUND

37. Contd….
• Speech, language and communication squeals of pleasure
• Talks a great deal when spoken to

38. Contd….
• Social behaviour and play

39. AGE 6 MONTHS
• Posture and large movements

41. Contd….
• Visual perceptual and fine motor

42. Contd….
• Hearing behaviour
• Turns immediately to a familiar voice
• Turns to source when hears sound at ear level

43. Contd….
• Speech, language and communication
• Vocalises using single or double syllables
• Laughs chuckles squels aloud in play

44. Contd….
• Social behaviour and play

45. Contd….
• Self-care and independence
• Attempt to grasp cup if used
• Takes smmoth semisolids
• Lears to suck food from spoon

46. AGE 9 MONTHS
• Posture and large movements

47. Contd….
• Visual perceptual and fine motor

48. Contd….
• Hearing behaviour
• Localises sounds made above and below ear level

49. Contd….
• Speech, language and communication

50. Contd….
• Social behaviour and play

51. Contd….
• Self-care and independence
• Holds bites chews smal piece of food
• Tries to grasp spoon when being fed

52. AGE 12 MONTHS
• Posture and large movements

53. Contd….
• Visual perceptual and fine motor

54. Contd….
• Hearing behaviour

55. Contd….
• Speech, language and communication
• 2 or 3 words with a meaning
• Knows meaning of more words

56. Contd….
• Social behaviour and play

57. Contd….
• Self-care and independence
• Drincks well from cup
• Helps with dreesing

58. AGE 15 MONTHS
• Posture and large movements

59. Contd….
• Visual perceptual and fine motor

60. Contd….
• Speech, language and communication
• Several intelligeble words
• Jorgoring
• Usdarstands and obeys simple instructions

61. Contd….
• Social behaviour and play

62. Contd….
• Self-care and independence
• Holds and drinks from a cup
• Manages spoon but rotates it
• Feeds self fully no help

63. AGE 18 MONTHS
• Posture and large movements

64. Contd….
• Visual perceptual and fine motor

65. Contd….
• Speech, language and communication

66. Contd….
• Social behaviour and play

67. Contd….
• Self-care and independence
• Manages spoon well without any rotation
• Assists with dressing and undressing
• Bowel control is attained

68. AGE 2 YEARS
• Posture and large movements

69. Contd….
• Visual perceptual and fine motor

70. Contd….
• Speech, language and communication

71. Contd….
• Social behaviour and play

72. Contd….
• Self-care and independence

73. AGE 2 1/2 YEARS
• Posture and large movements

74. Contd….
• Visual perceptual and fine motor

75. Contd….
• Speech, language and communication

76. Contd….
• Social behaviour and play

77. Contd….
• Self-care and independence
• Eats skillfully with spoon may use a fork
• Pulls down the pants when using the toilet
• Dry through the night

78. AGE 3 YEARS
• Posture and large movements

79. Contd….
• Visual perceptual and fine motor

80. Contd….
• Speech, language and communication

81. Contd….
• Social behaviour and play

82. Contd….
• Self-care and independence

83. AGE 4 YEARS
• Posture and large movements

84. Contd….
• Visual perceptual and fine motor

85. Contd….
• Speech language and communication

86. Contd….
• Social behaviour and play

87. Contd….
• Self-care and independence

88. AGE 5 YEARS
• Posture and large movements

89. Contd….
• Visual perceptual and fine motor

90. Contd….
• Speech, laguage and communication
• Speech fluent grammatically conventionall phonatically correct
• Loves to be read or told stories
• Gives full name age and birthday
• Delights in reciting or singing rhymes
• Enjoys jokes and riddles

91. Contd….
• Social behaviour and play

92. Contd….
• Self-care and independence
• Uses knife and fork competently
• Washes and dries face and hands but needs help
• Undresses and dresses alone

93. Dr. Amit Vatkar
Pediatric Neurologist, Navi Mumbai
MBBS, DNB
Email: vatkaramit@yahoo.com
Contact No.: +91-8767844488
Visit us at: http://pediatricneurology.in/
THANK YOU !