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Pediatrics Growth and Development Month 4 Week 1 T3
Pediatrics Growth and Development Month 4 Week 1 T3
76
Medical
Graduate
11/24/2018

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Term
Growth
Definition
refers to
an increase in
physical size of
the whole body or
any of its parts.
• It is simply a
quantitative
change in the
child’s body
Term
Development
Definition
• Development refers to a
progressive increase in
skill and capacity of
function.
• It is a qualitative change
in the child’s functioning.
• It can be measured
through observation.
Term
Maturation
Definition
• It is an increase in child’s
competence and
adaptability.
• It is describing the
qualitative change in a
structure.
• The level of maturation
depends on the child’s
heredity
Term
Principles of Growth and Development
Definition
• Continuous process
• Predictable sequence
• Don’t progress at the same rate (↑ periods of
growth rates in early childhood and adolescents
and ↓ periods of growth rate in middle childhood)
• Not all body parts grow at the same rate at the
same time
• Each child grows in his/her own unique way
• Each stage of growth and development is
affected by the preceding types of development
proceed in regular related
directions:
• Cephalo-caudal (head
down to toes)
• Proximodistal (center of
the body to the periphery)
Term
Types of growth
Definition
• Physical growth (height, weight, head and
chest circumference)
• Physiological growth (vital signs…)
Term
• Types of development
Definition
• Motor development
• Cognitive development
• Emotional development
• Social development
Term
Stages of Growth and Development
Definition
- Prenatal
• Embryonic (conception–8 w)
• Fetal stage (8–40 or 42 w)
- Infancy
• Neonate
• Birth to end of 1 month
• Infancy
• 1 month to end of 1 year
- Early childhood
• Toddler
• 1–3 years
• Preschool
• 3–6 years
- Middle childhood
• School age
• 6 to 12 years
- Late childhood
• Adolescent
• 13 years to approximately
18 years
Term
Newborn Stage
Definition
first 4 weeks or first
month of life. It is a
transitional period from
intrauterine life to extrauterine
environment

Physical growth
• Weight = 2.700 – 4 kg
• Weight loss 5–10%
by 3–4 days after
birth
• Weight gain by 10th
day of life
• Gain ¾ kg by the end
of the 1st month
Term
Newborn
Weight
Definition
They lose 5–10% of weight by 3–4
days after birth as result of:
• Withdrawal of hormones from
mother
• Loss of excessive extra cellular
fluid
• Passage of meconium (feces) and
urine
• Limited food intake
Term
newborn chest circumference
Definition
• It is 30.5 to 33cm (usually
2–3cm less than head
circumference)
Term
newborn height
Definition
• Boys average height is 50 cm
• Girls average height is 49 cm
• Normal range for both
(47.5–53.75 cm)
Term
newborn head circumference
Definition
• 33–35 cm
• Head is ¼ total body length
• Skull has two fontanels (anterior
and posterior)
Term
Anterior Fontanel
Definition
• Diamond in shape
• The junction of the
sagittal, coronal, and
frontal sutures forms it
• Between two frontal and
two parietal bones
• 3–4 cm in length and 2–3
cm width
• It closes at 12–18 months
of age
Term
Posterior Fontanel
Definition
• Triangular
• Located between occipital
and two parietal bones
• Closes by the end of the
1st month of age
Term
Physiological Growth
newborn Vital signs
Definition
• Temperature (36.3 to 37.2°C)
• Pulse (120 to 160/min)
• Respiration (35 to 50/min)
Term
APGAR
Definition
[image]
Term
newborn Touch
Definition
• It is the most highly
developed sense.
• It is mostly at lips, tongue,
ears, and forehead.
• The newborn is usually
comfortable with touch
Term
newborn vision
Definition
• Pupils react to light.
• Bright lights appear to be
unpleasant to newborn
infant.
• Newborns follow objects
in line of vision.
Term
newborn hearing
Definition
• The newborn infant usually
makes some response to
sound from birth.
• Ordinary sounds are heard
well before 10 days of life.
• The newborn infant
responds to sounds with
either cry or eye movement,
cessation of activity, and/or
a startle reaction
Term
newborn taste
Definition
• Well developed since bitter
and sour fluids are resisted,
while sweet fluids are
accepted.
Term
newborn smell
Definition
• Only evidence in newborn
infant’s search for the
nipple, since they smell
breast milk
Term
newborn Gross Motor
Definition
movements are
random, diffuse, and
uncoordinated.
Reflexes carry out
bodily functions and
responses to external
stimuli.
Term
newborn fine motor
Definition
• Newborn holds hand
in fist.
• When crying,
newborn draws arms
and legs to body
Term
newborn reflexes
Definition
[image]
Term
newborn cognitive development
Definition
difficult to understand
or observe
Term
emotional cognitive development
Definition
expresses emotion
just through crying for
hunger, pain, or
discomfort sensation
Term
sitting up
Definition
age 2 months- start w help, age 8 months- comfortable
Term
ambulation
Definition
9-12 months while holding onto support, 13 months on own
Term
fine motor development
Definition
large blocks- 6 month old. small blocks- 12 month old
Term
Physical Growth of Normal Infant
Definition
- Weight—the infant gains:
• Birth to 4 months → ¾ kg/month
• 5 to 8 months → ½ kg/month
• 9 to 12 months → ¼ kg/month
- The infant will double the birth weight by
4–5 months and triple it by 10–12 months
of age
Term
WEECH's formula
Definition
calculating weight

3-12 mo, expected weight (kg) = age (months) + 9/2

1-6 years, expected weight (kg) = age (years) x 2 +8

7-12 years, expected weight (kg) = age (years) x 7 - 5 / 2
Term
Height in infancy
Definition
• Length increases about 3 cm/month during
the 1st 3 months of age.
• Then it increases 2 cm/month 4–6 months
of age.
• Then, at 7–12 months, it increases 1½ cm
per month.
Term
Head Circumference in infancy
Definition
• It increases about 2 cm/month during the
1st 3 months.
• Then, it increases ½ cm/month during the
2nd 9 months of age.
• Posterior fontanel closes by 6–8 weeks of
age.
• Anterior fontanel closes by 12–18 months
of age.
Term
Chest Circumference in infancy
Definition
- By the end of the 1st year, it will be equal
to head circumference.
- Physiological growth of infants:
• Pulse 110–150 b/min
• Resp 35 ± 10 c/min
• Breath through nose
• Blood pressure 80/50 ± 20/10 mmHg
Term
Motor Development in infancy
Definition
- At 2 months
• Hold head erects in mid-position
• Turn from side back
- At 3 months, the infant can:
• Hold head erects and steady
• Open or close hand loosely
• Hold object put in hand
-At 4 months
• Sit with adequate support
• Roll over from front to back
• Hold head erect and steady
while in sitting position
• Bring hands together in
midline and play with
fingers.
• Grasp objects with both
hands.
-At 5 months
• Balance head well when
sitting
• Sit with slight support
• Pull feet up to mouth when
supine
• Grasp objects with whole
hand (right or left)
• Hold one object while
looking at another
-At 6 months
• Sit alone briefly
• Turn completely over
(abdomen to
abdomen)
• Lift chest and upper
abdomen when prone
• Hold own bottle
-At 7 months
• Sit alone
• Hold cup
• Imitate simple acts of
others
-At 8 months
• Site alone steadily
• Drink from cup with
assistance
• Eat finger food that
can be held in one
hand
-At 9 months
• Rise to sitting position
alone
• Crawl (i.e., pull body
while in prone
position)
• Hold one bottle with
good hand-mouth
coordination
-At 10 months
• Creep well (use
hands and legs)
• Walk but with help
• Bring the hands
together
-At 11 months
• Walk holding on
furniture
• Stand erect with
minimal support
-At 12 months
• Stand alone for variable length of time
• Sit down from standing position alone
• Walk a few steps with help or alone (hands
held at shoulder height for balance)
• Pick up small bits of food and transfers
them to the mouth
Term
Ambulation (Motor Growth) of infants
Definition
• 9 month old: crawl
• 10 month old: creep
• 1 year: stand independently from a crawl
and creep position
• 13 month old: walk and toddle quickly
• 15 month old: can run
Term
Emotional Development of infants
Definition
unstable, rapidly changing
from crying to laughter.
• Affection for family members appears.
- By 10 months, expresses several beginning
recognizable emotions, such as anger,
sadness, pleasure, jealousy, anxiety, and
affection.
- By 12 months of age, these emotions are
clearly distinguishable
Term
Social Development of infants
Definition
• Learns that crying brings attention
• Smiles in response to smile of others
• Shows fear of stranger (stranger anxiety)
• Responds socially to his or her name
• The infant develops a sense of trust. Through
the infant's interaction with caregiver (mainly the
mother), especially during feeding, the infant
learns to trust others through the relief of basic
needs.
Term
Speech Milestones for infants
Definition
• 1–2 months: coos
• 2–6 months: laughs and squeals
• 8–9 months: babbles; mama/dada as sounds
• 10–12 months: mama/dada specific
• 18–20 months: 20 to 30 words—50%
understood by strangers
• 22–24 months: two-word sentences, >50 words,
75% understood by strangers
• 30–36 months: almost all speech understood by
strangers
Term
Hearing for infants
Definition
• BAER hearing test done at birth
• Ability to hear correlates with ability
enunciate words properly
• Always ask about history of otitis media
• Early referral to assess for possible fluid in
ears (effusion)
• Repeat hearing screening test
• Speech therapist as needed
Term
Red Flags in Infant Development
Definition
• Unable to sit alone by age 9 months
• Unable to transfer objects from hand to
hand by age 1 year
• Abnormal pincer grip or grasp by age 15
months
• Unable to walk alone by 18 months
• Failure to speak recognizable words by 2
years
Term
toddler weight
Definition
average weight gain is 1.8 to 2.7
kg/year.
• Formula to calculate normal weight of children
over 1 year of age is:
• Age in years X 2+8 = ….. Kg.
• For example, the weight of a child age 4 years:
• 4 X 2 + 8 = 16 kg
Term
toddler height
Definition
• The child’s height increases by
1cm/month.
• Age in years X 5 + 80 = ___cm
• For example, the length of 2-year-old child:
• 2 X 5 + 80 = 90 cm
Term
toddler Head and Chest Circumference
Definition
• The head increases 10 cm only from the
age of 1 year to adult age.
• During toddler years, chest circumference
continues to increase in size and exceeds
head circumference
Term
toddler teething
Definition
• By 2 years of age, the toddler has 16
temporary teeth.
• By the age of 30 months (2.5 years), the
toddler has 20 teeth.
Term
toddler physiological growth
Definition
• Pulse: 80–130 beats/min (average
110/min)
• Respiration: 20–30C/min
• Bowel and bladder control:
• Daytime control of bladder and bowel by 24–
30 months
Term
Fine Motor—Toddler
Definition
• 1 year old: transfer objects from hand to
hand
• 2 year old: can hold a crayon and color
vertical strokes
- Turn the page of a book
- Build a tower of six blocks
• 3 year old: copy a circle and a cross—
build using small blocks
Term
Gross Motor
At 15 months
Definition
• Walk alone
• Creep upstairs
• Assume standing position
without falling
• Hold a cup with all fingers
grasped around it
Term
Gross Motor
At 18 months
Definition
• Hold cup with both hands
• Transfer objects hand-to
hand at will
Term
Gross Motor
At 24 months
Definition
• Go up and down stairs
alone with two feet on
each step
• Hold a cup with one hand
• Remove most of own
clothes
• Drink well from a small
glass held in one hand
Term
Gross Motor
At 30 months
Definition
• Jump with both feet
• Jump from chair or step
• Walk up and down stairs,
one foot on a step
• Drink without assistance
Term
Toddler—Emotional Development
Definition
• Stranger anxiety—should dissipate by age 2½ to
3 years
• Temper tantrums: occur weekly in 50 to 80% of
children—peak incidence 18 months—most
disappear by age 3
• Sibling rivalry: aggressive behavior toward new
infant: peak between 1 to 2 years but may be
prolonged indefinitely
• Thumb sucking
• Toilet training
Term
Cognitive Development
Definition
• Up to 2 years, the toddler uses his or her
senses and motor development to
differentiate self from objects.
• The toddler from 2 to 3 years will be in the
pre-conceptual phase of cognitive
development (2–4 years), in which he or
she is still egocentric and cannot take the
point of view of other people.
Term
toddler Social Development
Definition
• The toddler imitates parents.
• The toddler notices sex differences and knows
own sex.
• The development of autonomy during this period
is centered around toddlers increasing abilities
to control their bodies, themselves, and their
environment;
i.e., “I can do it myself.”
Term
Preschool Stage
Definition
It is the stage when the child is 3 to 6 years
of age. The growth during this period is
relatively slow
Term
Preschool Stage
Physical Growth
Definition
- Weight
• The preschooler gains
approximately
1.8kg/year
- Height
• Doubles birth length
by 4–5 years of age
Term
Preschool Stage
Physiological Growth:
Definition
• Pulse: 80–120
beat/min (average
100/min)
• Respiration:
20–30C/min
• Blood pressure:
100/67±24/25
Term
Fine Motor—Older Toddler
Definition
• 3 year old: copy a circle and a cross—
build using small blocks
• 4 year old: use scissors, color within the
borders
• 5 year old: write some letters and draw a
person with body parts
Term
Fine Motor and
Cognitive Abilities Preschool
Definition
• Buttoning clothing
• Holding a pencil
• Building with small blocks
• Using scissors
• Playing a board game
• Draw picture of himself/herself
Term
Preschool Development
Cognitive
Definition
• Preschooler up to 4 years
of age is in the
pre-conceptual phase.
Child begins to be able to
give reasons for his/her
belief and actions, but not
true cause-effect
relationship.
Term
Preschool Development
Emotional
Definition
• Fears the dark
• Tends to be impatient and
selfish
• Expresses aggression
through physical and
verbal behaviors
• Shows signs of jealousy
of siblings
Term
Social Development in Preschoolers
Definition
• Egocentric
• Tolerates short
separation
• Less dependent on
parents
• May have dreams
and nightmares
• Attachment to
opposite sex parent
• More cooperative in
play
• The preschooler is in
the stage in which
he/she develops a
sense of initiative,
wants to learn what to
do for himself, and
wants to learn about
the world and other
people.
Term
Red Flags: Preschool
Definition
• Inability to perform self-care tasks, hand
washing, simple dressing, daytime toileting
• Lack of socialization
• Unable to play with other children
• Unable to follow directions during exam
Term
School-Age Child
Definition
School-age period is between the age of 6
and 12 years. The child’s growth and
development is characterized by gradual
growth.
Term
School Age
Physical
Definition
- Weight
• School-age child gains about
3.8kg/year
• Boys tend to gain slightly more
weight through 12 years of age
• Weight formula for 7–12 years
• = ( (age in yrs x 7 ) – 5 ) /
( 2 )
- Height
• The child gains about 5cm/year.
• Body proportion during this period:
Both boys and girls are longlegged
Term
School Age
Physiological
Definition
• Pulse: 90±15 beats/min
(75 to 105)
• Respiration: 21±3C/min
(18–24)
• Blood pressure: 100/60±16/10
Term
School age
Dentition
Definition
• Permanent teeth erupt during school-age
period, starting from 6 years, usually in
the same order in which primary teeth are
lost.
• The child acquires permanent molars,
medial and lateral incisors.
Term
School Years: Fine Motor
Definition
- Writing skills improve
- Fine motor is refined
- Fine motor with more focus
• Building: models—logos
• Sewing
• Musical instrument
• Painting
• Typing skills
• Technology: computers
Term
Motor Development
At age 6–8
Definition
• Rides a bicycle
• Runs jumps, climbs, and hops
• Has improved eye-hand
coordination
• Prints words and learns
cursive writing
• Can brush and comb hair
Term
Motor Development
At age 8–10
Definition
• Throws balls skillfully
• Uses hands to participate in
organized sports
• Uses both hands
independently
• Handles eating utensils
(spoon, fork, knife) skillfully
Term
Motor Development
At age 10–12
Definition
• Enjoys all physical activities
• Continues to improve motor
coordination
Term
School Performance
Definition
• Ask about favorite subject
• How they are doing in school
• Do they like school
• By parent report: any learning difficulties,
attention problems, homework
• Parental expectations
Term
older School Age: Cognitive Development
Cognitive
Definition
• At 7–11 years, the child now is
in the concrete operational
stage of cognitive
development. He/she is able to
function on a higher level in
mental ability.
• Greater ability to concentrate
and participate in self-initiating
quiet activities that challenge
cognitive skills, such as
reading, playing computer, and
board games
Term
older school age emotional development
Definition
• Fears injury to body and fear of
dark
• Jealous of siblings (especially
6–8 years old child)
• Curious about everything
• Has short bursts of anger by
age of 10 years but able to
control anger by 12 years
Term
Social Development, older school age
Definition
• Wants other children to play with him/her
• Insists on being first in every thing
• Becomes peer oriented
• Improves relationship with siblings
• Has greater self-control, confidence, sincerity
• Respects parents and their role
• Joins group (formal and informal)
• Engages in tasks in the real world
Term
Red Flags: School Age
Definition
• School failure
• Lack of friends
• Social isolation
• Aggressive behavior
- Fights, fire setting, animal abuse
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