1) Growth and development is a continuous process from fetal life through adulthood that follows general patterns and principles. 2) Key periods of growth include fetal development, infancy, childhood, puberty and adolescence, with the greatest growth rates during fetal life and the first years after birth. 3) Different tissues grow at different rates, and growth is influenced by genetic, nutritional, hormonal and environmental factors.

1. GROWTH
&
DEVELOPMENT
JUBAIR P A
SNMC BAGALKOT

2.  GROWTH:-
• Net increase in size or mass of tissues.
• Multiplication of cells and increase in the
intracellular substances.
• Hypertrophy or expansion of cell size.

3. LAWS OF GROWTH
1) Growth and development of children is a
continuous and orderly process
 The general body growth is rapid during
fetal life ,first one to two years of postnatal
life and also during puberty.
 Growth decelerates for sometime after
puberty and then ceases.

4. Periods of growth
Prenatal period
Ovum 0 to 14 days of gestation
Embryo 14 days to 9 wks
Fetus 9wks to birth
Perinatal period 22wks to 7 days after birth
Postnatal period
Newborn First 4 wks after birth
Infancy First year
Toddler 1-3 yr
Preschool child 3-6 yr
School age child 6-12 yr
Adolescence
Early 10-13 yr
Middle 14-16 yr
Late 17-20 yr

5. 2) Growth pattern of every individual is
unique
Order of growth is cephalocaudal and distal to
proximal.
In fetal life growth of head occurs before neck.
Distal part of body such as hands increase in size
before upper arms.
In postnatal life ,growth of head slows down but
limbs continue to grow rapidly.

6. 3) Different tissues grow at different rates
BRAIN GROWTH:-
 The fetal period and first two years of life are very
crucial for brain development.
 Late periods of life are important for acquiring
neuromotor function and cognitive ability.
GROWTH OF GONADS:-
 Dormant during childhood.
 Conspicuous during puberty.

7.  LYMPHOID GROWTH:-
 Growth of lymphoid tissue is more during
mid-childhood.
 GROWTH OF BODY FAT & MUSCLE MASS:-
 Taller children have greater lean body mass
than shorter children of same age.
 After pubertal growth spurt boys have
greater lean body mass compared to girls.
 Girls have more subcutaneous adipose
tissue than boys.

9. • CATCH-UP GROWTH
- Children weigh below expected, start gain
weight rapidly with adequate diet.
- The rate of growth is more in such children
as compared to other children of the same
age.
-Depends on duration of illness and cessation
of growth.

10. ASSESSMENT OF GROWTH
1- Anthropometry
Measuring the human body.
2- Dental age
3- Bone age

11. Eruption of Deciduous Teeth
AGE ERUPTION
Birth Nil
6-8 months Central incisors
By 10 months Lateral incisors
12-15 months First molars
15-21 months Canine
21-24 months Second molars

12. Eruption of Permanent Teeth
Age(years) Eruption
6 First molars
7-8 Central and lateral incisors
9 First premolar
10-11 Second premolar
11-12 Canines
12-13 Second molars
17-22 Third molars

13. • Interpretation:-
Eruption of deciduous teeth delayed in infants
with hypothyroidism, hypopituitarism and
vitamin A and vitamin D deficiencies.
Early eruption of primary teeth is seen in
hyperthyroidism.
Prolonged retention of deciduous teeth seen
in pycnodysostosis and cleidocranial
dysostosis.

14. BONE AGE
• Time of appearance of epiphyses
• Progress of maturity
• Time when all epiphyses are present

15. Radiological evaluation of Bone at various ages
Age X-ray Ossification centres
Newborn Knee , ankle and foot Epiphysis of the distal end of
femur, proximal epiphysis of
the tibia , cuboid , talus ,
calcaneum
6 months Wrist of the left hand Capitate and hamate
3-9 months Shoulder Humerus upper end
1 year Knee Lower end of the femur and
upper end of tibia
3 years Wrist Metacarpals and phalangeal
centres
1-12 years Wrist of the left hand Up to 8 years – number of
carpal bones
8-12 years – distal ulnar
epiphysis
12-16 years Elbow
Hip
Distal end of humerus-lateral
epicondyle
12 years – lesser trochanter
16 years – iliac crest

16. Interpretation of the relationship between
Chronological Age (CA) and Bone Age(BA)
Relation between CA and BA Abnormal
CA>BA (delayed bone age) Chronic systemic diseases
Endocrine – related
hypopituitarism
Hypothyroidism
Male hypogonadism
Malnutrition
CA<BA (advanced bone age) Precocious puberty
Congenital adrenal hyperplasia
Hyperthyroidism
Chondrodystrophy

17. Growth monitoring
Age Parameters Interval
Birth to 1.5 years Height, weight and
head circunference
At birth, 6,10,14wks, 6
months , 9 months
and 15-18 months
1.5 – 3 years Height, weight and
head circunference
6 - monthly
4 – 8 years Height and weight 6 - monthly
9 – 18 years Height , weight , BMI
and sleeping
metabolic rate( SMR)
yearly

18. Growth chart
-used to assess growth by plotting changes in height ,
weight, etc. over a period of time.

19. FACTORS AFFECTING GROWTH
A) FETAL PERIOD
B) POSTNATAL PERIOD
C) SOCIAL FACTORS

20. A) FETAL PERIOD
• Genetic potential
• Sex
• Fetal hormones
• Fetal growth factors
• Placental factors
• Maternal factors

21. B) POSTNATAL PERIOD
1. Genetic factors
2. Intrauterine growth restriction
3. Hormonal influence
4. Sex
5. Nutrition
6. Infections
7. Chemical agents
8. Trauma

22. C) SOCIAL FACTORS
1. Socioeconomic level
2. Poverty
3. Natural resources
4. Climate
5. Emotional factors
6. Cultural factors
7. Parental education

23.  DEVELOPMENT:-
• Functional or physiological maturation.
• Maturation and myelination of nervous
system.
• Acquisition of a variety of skills .

24. PRINCIPLES OF DEVELOPMENT
1) Development is a continuous process,
starting in utero and progressing in an
orderly manner until maturity.

25. 2) Development depends on
functional maturation of nervous
system.
–Maturation of CNS is essential for a
child to learn particular milestone or
skill.

26. 3) The sequence of attainment of
milestones is the same in all
children.
-All infants babble before they speak in
words.
-Sit before they stand.

27. 4) The process of development
progresses in a cephalocaudal
direction.
-Head control precedes trunk control
which precedes ability to use lower
limbs.
-The control of limbs proceeds in a
proximal to distal manner.

28. 5) Certain primitive reflexes have to
be lost before relevant milestones
are attained.
-Palmar grasp is lost before voluantary
grasp is attained.
-Asymmetric tonic neck reflex has to
disappear to allow the child to
turnover.

29. 6) The initial disorganized mass
activity is gradually replaced by
specific and wilful actions.

30. FACTORS AFFECTING
DEVELOPMENT
A) PRENATAL FACTORS:-
1) Genetic factors
2) Maternal factors
a- maternal nutrition
b- exposure to drugs and toxins
c- maternal diseases and infections

31. B) NEONATAL RISK FACTORS :-
1) Intrauterine growth restriction
2) Prematurity
3) Perinatal asphyxia

32. C) POSTNEONATAL FACTORS:-
1) Infant and child nutrition
2) Iron deficiency
3) Iodine deficiency
4) Infectious diseases
5) Environmental toxins
6) Acquired insults to brain

33. D) PSYCHOSOCIAL FACTORS:-
1) Parenting
2) Poverty
3) Lack of stimulation
4) Violence and abuse
5) Maternal depression
6) Institutionalization

34. E) PROTECTIVE FACTORS :-
1) Breastfeeding
2) Maternal education