I N F A N C Y

GROWTH & DEVELOPMENT

Growth and Development as a unit expresses the

sum of numerous changes that take place during the life cycle of an individual.

The entire course is a dynamic process that

encompasses several inter-related dimensions.

WHY STUDY GROWTH & DEVELOPMENT?

Know what to expect of a child at any age Know certain behaviours that are likely to

emerge in mature forms Assess the sequence and norms of G & D of a

child Know how to influence G & D favourably Diagnose undernutrition, infectious and other

diseases affecting G & D Recognize the potential problems and

strengths of individual children & their parents Plan for comprehensive care of the child Work with children effectively in health &

disease

STAGES OF GROWTH & DEVELOPMENT

• Prenatal period (Conception to Birth)

• Infancy ( Birth to 12 months of age )

• Early Childhood ( 1 – 6 years)

• Middle Childhood (6 – 12 years)

• Late Childhood (12 – 19 years)

PRENATAL GROWTH

Zygote – Increased cell organization and differentiation into three basic layers – Ectoderm, Mesoderm, Endoderm.

Embryo – Marked organization upto 8 weeks.

Fetal phase – 8 weeks to 40 weeks (birth).

- Increases in length and weight

- Linear growth with maximum velocity

at 4 months

GROWTH & DEVELOPMENT IN

INFANCY

INFANCY

♣ Neonate – Birth – 28 days ( Early and late neonatal period)

♣ Infancy - 28 days – 12 months

- Rapid motor, cognitive, and social development

- Trust, physical adjustment to outside

- Psychological adjustment of parents

GROWTH & PHYSICAL MATURATION

WEIGHT

NBB – 2.7 – 3.9 Kg ( Av 2.5 Kg )

0 – 7 days – 10% loss of Birth weight

10th day - Lost weight wt regained

0 – 6/12 yr - > by 30 gms / day OR 150 gms / wk

5 – 6/12 yr – Birth weight doubled

7 – 12 “ - > by 15 gms / day OR 75 gms / wk

1 year - Birth weight trebled

There after - > by 2.2 Kg / year

2½ Year - Birth weight Quadrupled

HEIGHT (LENGTH)

NBB – 50 cms (20”) + 2 cms First 6 months - > by 2.5 cms / month Later 6 months- > by 1.25 cms / month 1 – 2 year - + 12.5 cms (5”) 2 – 12 years - 6.25 – 7.5 cms / yr 4 years - Birth height doubled 13 years - Birth height trebled

OCCIPITO-FRONTAL CIRCUMFERENCE (OFC)

NBB – 35 cms ( 1.25 – 2.5 cms > Chest Circumference) 0 – 3 months - > by 2 cms / month 3 – 12 months - > by 2 cms / 3 months 1 – 3 years - > by 1 cm / 6 month (Equals chest

circumference 1 yr) 3 – 5 years - > by 1 cm / year 5 – 6 year - Adult head size

Thus, OFC at - 1 year - 47 cms 2 years - 49 cms 3 years - 50 cms 4 years - 50.4 cms 5 years - 50.8 cms 10 years - 53 cms 15 years - 55 cms

• Fontanelle closure –

Post - 6 – 8 wks

Ant – 12 – 18 months

• Increase of brain weight –

By 2½ times in the first year

CALCULATION OF ANTHROPOMETRICAL PARAMETERS

• WEIGHT –

3 – 12 MONTHS – Age ( months ) + 9 Kg

2

1 – 6 YEARS - Age ( Years) x 2 + 8 Kg

7 – 12 YEARS - Age (Years) x 7 + 5 Kg

2

• HEIGHT –

2 – 12 YEARS – Age (Years) x 6 + 77 (cms)

Future (Adult) height – Girls – Ht at 2 yrs x 2

Boys – Ht at 2½ yrs x 2

• OFC

Infant - Length (cm) + 9.5 cms

2

Mnemonic for Growth and Development

Age

(yrs)

0 3/12 5/12 1 2 3 4 5 7 10

Wt

(Kg)

3 X 2 X 3 X 4 X 5 X 6 X 10

Ht (Cm)

50 75 90 100

OFC 35 40 45 48 50 52

CHEST CIRCUMFERENCE & MUAC

• Chest Circumference - 33 cms at birth, barrel shaped - At 1 year Transverse diameter > AP diameter by 25 % - At 6 years transverse diameter > AP diameter by 33 % 6 months – 39 cms 1 year - 45 cms (Equals OFC) 2 years - 49 cms 5 years - 55 cms 10 years - 64 cms 15 years - 77 cms

• MUAC (Mid upper arm circumference) – NBB – 14.5 cms 1 year – 16 cms. Then > by 0.25 cm / yr

BODY PROPORTIONS

Big heads, large trunk, short extremities upto 2 years

Mid point of body - In infants - 1.8 cms above umbilicus - At 2 years - Just below umbilicus - In adults - At symphysis pubis

Sitting Height - At Birth – 70% of total length - At 3 years – 57% - At Puberty - 53%

CARDIO-CASCULAR SYSTEM

Heart – Transversely placed, Apex beat at IV ICS

H R – NBB – 140/mt, 5 yrs – 100/mt, 10 yrs – 90/mt, 12 yrs – 85/mt, 15 yrs – 80/mt

Sleeping Pulse Rate – 10 – 20 beats lower

BP – 80/50 …. 90/60 mm Hg Systole rises in the 2nd month Diastole falls in the first 3 months, then gradually rises

• Hematological system Hb F – The primary Hb for the first 2 -3 months ( >>> Physiological Anemia ) then Hb A increases upto 6 months

• Respiratory System Resp rate – 50 – 35/ mt Abdominal & diaphragmatic Trachea close to bronchi, narrow lumen Short straight eustachean tube < IgA in mucosal lining

• Lymphatic System – Hyperplastic in children. Resolves after puberty

• Nervous System –

NBB – Brain wt – 10% of body weight Infancy – Rapid brain growth. 80% achieved by 4

yrs Myelination begins after 3 months, completed by 2

years Primitive reflexes replaced by righting reflexes &

voluntary, purposeful movements

GASTRO-INTESTINAL SYSTEM

Salivation begins at 3 months

Stomach capacity – 90 ml at birth, 360 ml at 1 yr

Enzyme amylase inadequate – Poor digestion of complex CHO

Liver immature throughout infancy

By 1 yr – 3 meals + 1 bed time feed - 1 or 2 bowel movements

• Immunologic System - Maternal IgG upto 3 months - Synthesizes IgG (40% of adult levels) by 1 year - IgM produced at birth. Adult levels by 9 months - IgA production gradual. Adult levels by puberty

• Skin – Absent shivering and sweating at birth - Accumulation of adipose tissue in 6 months ( helps insulation)

• Fluid & Electrolytes NBB – 75% of total body wt is water - ECF vol is 40% which <es to 20% in adulthood

• Renal System – Immature at birth Complete maturity in 18 to 24 months Urine Sp.Gr – 1000 – 1010

• Dentition – Begins at 6 – 12 months By 3 yrs – all 20 teeth Rule – Age (months) -6 = No of teeth Permanent teeth by 6 – 12 years

SPECIAL SENSES

Hearing – Acuity at adult levels at infancy 6 months – can differentiate familiar voices 7 months – vestibular function begins Short ext auditory meatus & Eustachian canal

Visual – Low acuity. Hypermetropic 6 wks – 4 months – Binocularity well estd. 7 -12 months – Stereopsis ( depth perception) begins to

develop

MOTOR DEVELOPMENT

GROSS MOTOR(Devt.al maturation in posture)

General movements

Head balance (3/12)Rolling over (5/12)

Sitting with support (4/12)

Crawling & Creeping (8/12)

Standing (10/12)Walking (1 yr)

Sitting without support…

Standing with support

Coo, that’s How it looks

to Ma and Pa!

FINE MOTOR

• Use of hands and fingers in prehension

Grasp reflex at 0 – 3months

Palmar grasp

Crude pincer grasp – 8-9 months

Neat pincer grasp – 11 months

Builds a tower of 2 blocks by 1 year

PSYCHOLOGICAL DEVELOPMENT

Psychosocial Development

Reflex behaviour – parent, peer response

1 month – Social smile, 4 months – laughs aloud

Play helps socialize

Attachment- Indiscriminate response. cry, smile

Vocalize more to mother, distinct preferences

6 months – ‘peekaboo’, asks to be carried

- Stranger anxiety & separation anxiety

Eric Erickson- Trust Vs Mistrust

- 3-4 months – Oral phase (pri narcissism)

- 5-12 months – Social phase

Language Cry – for displeasure and pleasure 2 months – ah, eh, uh…. 3 months – coos, gurg;es, laughs (n,k p, g) 8 months – Imitates sounds t,d,w 9-10 months – Understands ‘NO’, obeys simple commands 1 yr – 3-5 words with meaning

Play – Sensorimotor, narcissistic, dependant, solitary - Laughs, peekaboo, pat-a-cake, repetition, imitation - Selective after 6-8 months ( No strangers!)

Sleep – 0-6 months – 18-20 hrs /day - 6-12 months – 16-18 hrs/day - 2-4 yrs - 12-16 hrs/ day - 5-10 yrs - 10-12 hrs/ day

IMPORTANT – Not only ‘to play’, but to be ‘played with’.

• Psycho- sexual development

Sigmund Freud – Oral phase

• Cognitive ( Intellectual) development

Jean Piaget – Sensorimotor Phase ( 0-2 yrs)

- Use of reflexes, deliberate acts, repetitive acts(4-8 months), object permanence(10 months), develops self image by 1 yr

SUMMARY OF MILESTONES OF DEVELOPMENT

• 1 Month - Social Smile• 2 Months - ah, eh, uh sounds• 3 months - Head holding• 4 Months - Grasps objects, sits with support• 5 Months - Rolls over• 6 months - Sits without support• 7 Months - Crawls & creeps• 8 Months - Thumb- finger prehension• 9 months - Pulls up to sit, stands with support• 10 Months - Walks with support• 11 Months - Stands with support• 12 months - Takes a few steps by self

NEEDS & SPECIAL CONCERNS IN INFANCY

• Love & security ( warmth, support to head & neck)• Nutritional needs – 120 Cal/Kg (0-6 month), 100 Cal/Kg (6-12

months), Protein 5-3 gm/Kg. Weaning, prevent obesity• Protection from infection (skin, eye, ear, oral, GIT, Resp, umbilical).• Personal hygiene• Protection from accidents• Promotion of growth & development• Promotion of play• Care in teething, thumb sucking• Sleep & activity, infant shoes• Dental health• Regular medical check up• Psychological needs - Care to prevent separation anxiety - Encourage inquisitive behaviour - Develop sensory perception - Avoid unpleasant tastes - Avoid painful experiences