Educative powerpoint presentation for students in MD. Pediatrics/ DNB Paediatrics, DCh Pediatrics, Trainees , Interns , Fellow in Paediatrics, Fellowship in Endocrinology, FNB Endocrinology, DM Endocrinology

1. Dr Isha Deshmukh
Assistant Professor,
Pediatrics,
BJGMC & Sassoon General Hospital,
Pune

2.  Growth- a net increase in the size or mass of tissues,
largely attributed to multiplication of cells and
increase in the intracellular substance.
 Hypertrophy contributes to a lesser extent to the
process of growth.
 Development- specifies maturation of function and
myelination of the nervous system.
 It indicates acquisition of a variety of skills for optimal
functioning of the individual.

3. Growth

4. Development

5.  GROWTH & DEVELOPMENT TOGETHER
CAN BE DEFINED AS A PROCESS OF
TRANSFORMATION OF A SINGLE CELL
INTO AN INFANT, AND THEN INTO AN
ADULT

6. Introduction
 Process of growth starts from the time of conception
and continues until the child grows into a fully mature
adult.
 Number of the cells increases from about 0.2 x 1012 at
60 days of fetal life to 2 x 1012 at birth, 60 x 1012 in a fully
grown adult.
 Fetal cells differentiate to form tissues and organs.
 The body cells remain in a state of dynamic
equilibrium.

7. Factors affecting growth and
development
 Genetic factors-
a. Phenotype
b. Characteristics of parents- parents of high IQ are
more likely to have children with higher IQ
c. Race
d. Sex
e. Biorhythm and maturation
f. Genetic disorders- chromosomal abnormalities, gene
mutation

8. Cont….
 Environmental factors-
a. Prenatal period- obstetric disorders, maternal
infection, drugs
b. Hormonal influence on growth- fetal
hypothyroidism, maternal diabetes, growth hormone
c. Postnatal period- nutrition, infections and
infestations, drugs, trauma, socioeconomic level,
emotional factors, cultural factors

9. Laws of growth
 Growth and development is a continuous and orderly
process
 Growth pattern of every individual is unique- order of
growth is cephalocaudal and distal to proximal.
 Different tissues of the body grow at different rates.
a. General body growth- two peaks, early and during
puberty
b. The brain growth- early in life
c. The growth of gonads- during puberty
d. Lymphoid growth- 4-8 yrs hypertrophied

10. Somatotypes (physical patterns)
 Ectomorph: has light bone structure and
small body mass relative to length
 Endomorphs: stocky build with large
amounts of soft tissue
 Mesomorphs: exhibit mixed features. Their
build is more muscular.

11. Assessment of physical growth
 Growth is assessed by ANTHROPOMETRY
 Anthropometry-
 Weight
 Length/ height
 Head circumference
 Mid-arm circumference
 Many other measurements & ratios

12. Assessment of development
 Proper history for milestones of development
 Direct observation & evaluation of child
 Charts-
 Denver development screening test
 Phatak’s Baroda screening test
 Trivendrum development chart etc…

13. Fetal growth
 1st wk: Fertilization, implantation starts on the 6th day
 2nd wk: Two layers (bilaminar)- ectoderm & endoderm,
implantation completed
 3rd wk: Three layers (trilaminar)- endoderm,
mesoderm & ectoderm
 4th wk: 4mm size
 6th wk: 21-23 mm size

14. Cont…
 9th wk: 9gm & 5 cm
 10-12 wk: External genitalia distinguishable
 20th wk: 20 cm & 450 gm
 24th wk: surfactant production begins
 25th wk: 25 cm & 900 gm
 28th wk: 1300 gm
 39th wk: 50 cm & 2800 gm

15. DURING THE THIRD TRIMESTER
THE LENGTH DOUBLES AND
WEIGHT TRIPLES.

17. Growth ( after birth)
 Weight:
At birth : 2.9 to 3.2 kg
At 5 mths: 2 x birth weight
At 2 yrs : 4 x birth weight
At 3 yrs : 5 x birth weight
At 5 yrs : 6 x birth weight
At 7 yrs : 7 x birth weight
At 8 yrs : 8 x birth weight
At 9 yrs : 9 x birth weight
At 10 yrs : 10 x birth weight

18. Weight gain
 Age weight gain
0 – 3 months:30 g/day 900 g/mth
3 – 6 months:20 g/day 600 g/mth
6 – 9 months: 15 g/day 450 g/mth
9 – 12 months: 12 g/day 360 g/mth
1 – 3 years: 8 g/day 240 g/mth(2.8 Kg/yr)
4 – 6 years: 6 g/day 180 g/mth(2 Kg/yr)

19. Formula for weight
 During infancy:
wt (kg) = [ Age in months + 9] / 2
 During 2-6 yrs:
wt (kg) = Age (yrs) x 2 + 8
 7-12 yrs:
wt (kg) = [ Age ( yrs) x 7 – 5] / 2

20. Length / height
Supine length is measured for children
of less than two years of age
After two years of age, standing height
is taken as a measure of stature

21. Length
At birth:
Full term male= 50.4 ± 2 cm
Full term female: 49.7 ± 2 cm
At one year : 75 cm
At two years : 87.5 cm
At four years : 100 cm

22. Length gain
 1st year = 25 cm
 2nd year = 12 cm
 3rd year = 10 cm
 4th year to puberty = 3 cm/ year
 At puberty :
 Girls = 6- 11 cm
 Boys = 7- 12 cm

23. Height velocity curve

24. Gain in length / height
The child doubles her/ his height at
four years of age.
At two years of age, the child is approx.
half of his expected adult height

25. Formula for calculating height
 From 1-6 years:
height (cm)= Age (yrs) x 6 + 77
 Sitting height:
70% at birth
57% at 3 years of age
52% at puberty

26. Body proportions

27. Head circumference
 Age Gain
0-3 mths 2 cm/ mth
3-6 mths 1 cm /mth
6-12 mths 0.5 cm/ mth
1-3 years 0.25 cm/ mth
3-6 years 1 cm/ year

28. Head circumference
At birth: 35 cm
At 1 year : 47 cm
At 2 years: 49 cm
At 3 years: 50.5 cm
At 14 years : 53 cm

30. Fields of development
 Gross motor activity
 Fine motor activity
 Vision
 Hearing
 Speech
 Social behavior & play
 Sphincter control

31. Motor development
 Involves control of the child over his body.
 Development of the child is observed in the
following positions:
Ventral suspension
Supine position
Prone position
Sitting

32. Development milestones: gross motor
 3 mths- Neck holding
 5 mths- Roll over
 8 mths- Sitting without support
 9 mths- Standing with support
 10 mths- walking with support
 11 mths- Creeping
 12 mths- Standing without support
 13 mths- Walking without support
 18 mths- Running
 24 mths- walking upstairs
 36 mths- Riding tricycle

33. Fine motor & adaptive development
This includes coordination of eyes,
hand-eye coordination, hand-mouth
coordination, and skills for
manipulation with hands.

34. Fine motor: key milestones
 4 mths: Grasps a rattle or rings when placed in
hand
 5 mths: Reaches out to an object and holds it
with both hands
 7 mths: Holding objects with crude grasp from
palm
 9 mths: Holding small object, like a pallet,
between index finger & thumb ( pincer grasp)
 15 mths: builds tower of 2 cubes.
 22 mths: builds tower of 6 cubes.

35. Language milestones
 1 mths: Turns head to sound
 3 mths: Cooing
 6 mths: Monosyllables
 9 mths: Bisyllables
 10 mths: Understands spoken speech
 12 mths: 2 words with meaning
 18 mths: 10 words with meaning
 24 mths: Simple sentence
 36 mths: Telling a story

36. Social/ personal development
2 mths: Social smile
3 mths: Recognizing mother
6 mths: Smiles at mirror image
9 mths: Waves ‘bye-bye’
12 mths: Plays a simple ball game
36 mths: Knows gender

37. Toilet training
15-18 mths: Ready for starting toilet
training
2 years: Child is trainable
3 years: Can withhold & postpone
bowel movement

38. Dentition
 Deciduous teeth
Lower Upper
Central incisors 5-7 mth 6-8 mth
Lower incisors 7-10 mth 8-11 mth
Canine 16-20 mths
1st molar 10-16 mths
2nd molar 20-30 mths

39. Cont…
Permanent dentition:
1st molar: 6 years
Incisors: 7-8 years
Premolar: 10-12 years
Canines: 9-12 years
2nd molars: 10-13 years
3rd molar: 12-25 years

40. Cont…
AGE IN MONTHS – 6 = EXPECTED NUMBER
OF TEETH
(UP TO A TOTAL OF 20 ONLY)

42. Radiological Evaluation of Bone Age at various ages
Age X ray Finding
Newborn Knee, ankle and foot Five ossification centres
1. Epiphysis of distal end of femur
2. Proximal epiphysis of the tibia
3. Cuboid
4. Talus
5. Calcaneum
6 months Wrist of the left hand Ossification centres for the carpal
bones i.e , capitate and hamate
3 to 9 months Shoulder Humerus upper end
1 year knee Lower end of femur and upper end
of tibia
3 years wrist Metacarpals and phalangeal centres
1 to 12 years Wrist of left hand Upto 8 years : number of carpal
bones
8 to 12 years – distal ulnar epiphysis
8 to 9 years –girls
10 to 12 years – boys
12 to 16 years Elbow
Hip
Distal end of humerus- lateral
epicondyle
12 years – lesser trochanter
16 years – iliac crest

43. Number of ossification Centres in the wrist
Age (years) Number of ossification centres in the wrist
1 2 (capitate and ghamate)
2 3
3 4
4 5
5 6
6 7
7 8

44. Age of appearance of Ossification Centres
Age (years) Part of the Bone Ossified
5 Head of radius , trapezoid , scaphoid
6 Lower end of ulna , trapezium
6 to 7 Medial condyle of humerus
9 Olecranon
9 to 11 Trochea of humerus
10 to 11 Pisiform
11 Lateral condyle of humerus
13 Separate centres in tri-radiate cartilage of acetabulam
14 Crest of ileum
Head and tubercles of ribs
15 Acromion
16 Ischial tuberosity
18 to 19 Inner end of clavicle

45. Interpretation of relationship between
Chronological age and Bone age
Relation between CA &
BA
Normal Abnormal
CA>BA (Delayed bone
age)
Constitutional delay
Constitutional dwarfism
Chronic systemic diseases
Endocrine related
hypopitutarism
Hypothyroidism
Male hypo-gonadism
Malnutrition
CA<BA (Advanced bone
age )
Obesity Precocius puberty
Congenital Adrenal
hyperplasia
Hyperthyroidism
Chondrodystrophy

46. Growth velocity for Height in Children
Age Normal Growth
velocity
Abnormal Growth
velocity
0 to 6 months 16 cm in first 6 months <15 cm in first 6 months
6 to 12 months 9 cm in next 6 months <7 cm in next 6 months
1 to 2 years 12 cm/yr <10 cm/ yr
2 to 5 years 6 cm/yr <5 cm/yr
5 to 10 years 5 to 6 cm/yr <4 cm/yr

47. Growth velocity for Weight in Children
Age Growth velocity
First year 6 kg
2 to 6 years 2 kg/year
6 years to puberty 3 kg/year

48. Recommendations for Growth Monitoring
Age Parameters Interval
Birth to 1.5 years Ht, weight and HC At birth , 6, 10, 14
weeks, 6 months, 9
months and 15 to 18
months
1.5 to 3 years Ht, wt, HC 6 monthly
4 to 8 years Height , wt 6 monthly
9 to 18 years Height weight BMI,
Sleeping Metabolic
rate
Yearly

49. `
 That’s all for Today ...!