Growth and Development pdf - D.Raid

Growth and development

L2+L3

Assist Prof Dr.Raid Kareem

The 1

Year

Most full-term infants regain their birthweight by the age of 10 days .

Infants regain or exceed birthweight by 2 wk of age and should grow at

approximately 30 g (1 oz)/day during the 1st mo . This is the period of

fastest postnatal growth. The full term infants generally doubles birthweight

by 4-5 mo , and triples it by 1 year . The premature infant is likely to gain

about 6-7 kg in the 1

yr , which is about the average gain for full-term

infants . The length of the normal infant increases during the 1

yr by 25 –

30 cm. There is an increase in subcutaneous tissue in the early months of life

reaches its peak at about 9 mo .

The anterior fontanel may increase in size after birth but generally

diminishes after 6 mo and may become effectively closed between 9 and 18

mo . The posterior fontanel is usually closed to palpation by 4 mo .

Formulas for Approximate Average Height and Weight of

Normal Infants and Children :

— Weight

Kilograms

— At birth

— 3 – 12 mo

— 1 – 6 yr

3.25

age ( mo ) + 9

ـــــــــــــــــــــــــــــــــــ

age ( yr ) x 2 + 8

— 7 – 12 yr

age ( yr ) x 7 – 5

ــــــــــــــــــــــــــــــــــــ

— Height

Centimeters

— At birth

— At 1 yr

— At 4 yr

— At 2 – 12 yr

100cm

age ( yr ) x 6 + 77

Head circumference ( normally 34 – 35 cm at birth ) increases to

approximately 44 cm by 6 mo and to 47 cm by 1 yr (2cm/mo. in 1

3 mo. ,

1cm/mo. in 2

3 mo. and 0.5cm/mo. in the next 6 mo.) . The head

circumference is slightly larger than that of the chest at birth , but the two

measurements become equal by the end of the first year .

The first deciduous teeth erupt in most children between 5 and 9 mo . The

first to appear are the lower central incisors , followed by the upper central

and then the upper lateral incisors . By the age of 1 yr most children have 6 –

8 teeth .

First 3 months of Life

By 12 wk there is some control of the head as the infant is drawn to a

sitting position . When held in ventral suspension, the newborn infant will be

in a posture of flexion of head and extremities around the supporting hand .

By 1 mo of age the infant will raise the head momentarily to the plane of the

body , and by 2 mo he or she will start to sustain the head in that plane . By

3 mo the head will be raise above the plane of the body , and the legs will be

extended as well .

In the first days of life infants visually fixate best on those objects that are

placed close to or moved through their line of vision . They may maintain

fixation with movement of the eyes and head to nearly 90 degrees to either

side of the midline . By 2 mo of age a supine infant will be follow an object

presented 90 degrees from the midline through an arc of 180 degrees . A

fully developed social smile becomes manifest usually between 4-6 wk of

age . The infant who does not have a social smile by the age of 8 – 12 wk

should be regarded as possibly seriously .

3 – 6 Months :

By the age of 3 mo an infant in the prone position on a firm surface is

generally able to raise the head and chest with the arms extended . When the

infant of 4 mo is pulled from a supine to a sitting position , the head is

brought up without lag ; At 5 – 6 mo of age the infant begins to roll over , at

first from the prone to the supine position and then in the reverse direction .

By 4 mo the infant becomes more adept at making contact with objects

brought within reach and often brings them to the midline and to the mouth

for visual and oral exploration . By 6 – 6 1/2 mo most infants can grasp a

large object such as a rattle and transfer it from hand to hand . By 4 mo they

begin to laugh aloud at pleasurable social contacts . By the end of the 6

normal infants have developed clear preferences for social contact with the

persons giving them the most care . Total sleep requirements are

approximately 14-16 hr/24 hr, with about 9-10 hr concentrated at night and 2

naps/day.

6 – 12 Months :

The ability to sit unsupported (6-7 mo), and by 8 – 9 mo they are able to

assume a sitting position without help . By 9 – 10 mo most infants have

learned to creep or to crawl. They are often able at 8-9 mo to stand steadily

for a short time as long as their hands are held , and by 9 mo may be able to

take some steps with both hands held .

Between 6 and 9 mo the radial – palmar grasp becomes clearly . The

index finger is used to poke at objects by 9 mo . And at this time the thumb

and forefinger can be brought into sufficiently accurate apposition to permit

a pellet to be picked up with a pincer motion . At 9 mo an infant may be able

to release an object on request . At 9 mo the infant can wave bye-bye.

By 12 mo , the pincer will be executed without ulnar support . Between 6

and 12 mo the infant's behavior becomes more imitative . A major milestone

is the achievement at about 9 mo of object permanence (constancy), the

understanding that objects continue to exist, even when not seen. At 12 mo a

child may enter into very simple games with a toy such as a ball

developmental milestones ( table below )

Age

Gross motor

Vision / fine

motor

Hearing /

speech

Personality / social

6 wks



Symmetrical limb

movements .



Ventral-head in line

with body briefly .



Supine-fencing posture.



Fixed and follows to

90 .



Turns to light .



Grasp reflexes .



Cries / Coos



Startles to

noise .



Smiles

3
months



Moves limbs

vigorously .



Head control.



Back-lumber curvature

only .



Prone-lifts upper chest

up .



Fixes and follows to

180 .



Plays with own

hands .



Holds rattles placed

in hands .



Quietens to

mother's
voice .



Turns to

sound .



Laughs and squeals .



Sits with support .



Palmar grasp .



Turns to



Laughs and screams .

months



Lifts chest up on

extended arms .



Rolls frond to back .



Downward parachute .



Transfers objects .



Shakes rattle .



Mouths objects .

quiet sound .



Says vowels

and
syllables .



Not shy .

9
months



Tripod sits-rights self if

pushed and can reach
for toy steadily .



Rolls to standing .



Stands holding on .



Forward parachute .



Reaches for small

objects .



Rolls balls .



Points with index

finger .



Early pincer grasp



Looks for fallen

objects .



Releases toys .



Distraction

hearing test .



Says mama ,

dada (non-
specifically)



Chews biscuit .



Stranger anxiety .



Play peek-a-boo .



Understands no and

bye-bye .

12
months .



Cruises around

furniture .



Walks if held , may take

few steps
unsupported .



Neat pincer grip .



Casting objects .



Banges cubs

together .



Known

name .



Understands

simple
commands .



Says few

words .



Drink from a cup .



Finger-feeds .



Waver bye-bye .



Find hidden objects .

15
months



Broad-based gait .



Kneels .



Pushes wheeled toy .



Sees small objects .



Tower of 2 bricks .



To and fro scribble .



2 – 6 words .



communicate

s wishes and
obeys
commands .



uses cup and spoon .

18
months



steady purposeful walk .



Runs , squats .



Walks carrying toy .



Pushes / pulls .



Creeps downstairs .



Circular scribble

points to pictures in
book .



Turns pages of book .



Hand preference .



6 – 20 words



Points to named body

parts .



Feeds independently .



Domestic mimickry .



Symbolic plays alone .



Takes off socks and

shoes

2 years



Kicks balls .



Walks up and down

stairs holding on .



Tower of 6 bricks .



Copies vertical line .



2 – 3 word

sentences .



Uses pivotal

grammar .



Uses

question
words .



Feeds with fork and

spoon .



Begins toilet

training .



Temper tantrums .

3 years



Walks up stairs 1 foot

per step , down with
2 .



Walks on tip-toe .



Throws ball .



Pedals tricycle .



Tower of 9 bricks .



Builds train and

bridge with bricks .



Copies circle .



Gives first

and last
name .



Knows sex .



Recognizes

colours .



Pure tone

audiometry .



Washes hands and

brushes teeth .



Eats with fork and

spoon ( + / -knife ) .



Make believe play .



Likes hearing and

telling stories .

4 years



Walks up and down

stairs 1 foot per step .



Hops .



Builds steps of

bricks .



Copies cross .



Counts to 10

or more .



Able to undress .



Draws man .

5 years



Skips .



Catches ball .



Runs on toes .



Copies triangle .



Asks how

and when .



Uses

grammatical
speech .



Uses knife and fork .



Able to put on

clothes and do large
buttons .

Developmental quotient ( DQ ) :

To assess or have simple expression of deviation from norm , use DQ
        Developing age
ــــــــــــــــــــــــــــــــــــــ  × 100
     Chronological age
Normal = > 85
Abnormal < 70
70 – 85 = gray area and warrants close follow up ( important for cognitive
function and less for motor domain ) .

The infants is able to make repetitive vowel sounds by 6 1/2 mo and by 8 mo

is likely to produce repetitive consonant sounds , such as ba-ba , ma-ma ,

and da-da . Children of 8-9 mo become attentive to the sounds of their own

names . Separation anxiety between the ages of 6 and 8 mo.

The 2

Year

During the 2nd yr of life there is a further deceleration in the rate of growth:

the average child gains about 2.5 kg and about 12 cm. After 10 mo of age

there is often a decrease in appetite extending into the 2nd yr. The result is a

loss of some of the subcutaneous tissue. With the upright posture the mild

lordosis and protuberant abdomen appear that are characteristic of the 2nd

and 3rd yr of life.

The growth of the brain continues its deceleration during the 2nd yr.

Head circumference, which increased approximately 12 cm during the 1st

yr, increases only 2 cm during the 2nd yr. During the 2nd yr more teeth

erupt, making a total of 14 – 16. By 12 mo infants are generally able to walk

a few steps alone. By 18 mo the infant is able to run stiffly. At 18 mo the

infant can climb stairs of one hand is held; by 20 mo he or she is able to go

downstairs, one hand held.

By 24 mo children normally enter the "runabout" age. They are able to

move quickly from a safe environment into danger and need constant

surveillance. At 15 mo generally be able to put the pellet into a small bottle

by 18 mo is able dump it from the bottle.

By 15 mo the child is able to put a 1 – in cube on top of another in

response to a demonstration; by 18 mo be or she is able to make a tower of

four cubes and by 24 mo a tower of seven cubes. Vertical lines at 18 mo; by

24-30 mo the child imitates circular strokes and can make a horizontal line.

During the 2nd yr the child develops a sense of self as separate from other

person. The child normally has 10 words by 18 mo with the result that most

normal children by their second birthday are able to put three words

together. During the 2nd yr imitative behavior extends to person other than

the mother, including siblings. By 18 – 24 mo most children are able to

verbalize their toilet.

Preschool Years:

During the 3rd, 4th and 5th yr of life gains in weight and height are

relatively steady at approximately 2.0 kg and about 6-8 cm / per y. Most

children are lean in comparison with their earlier body configuration. The

healthy preschooler is slender and agile, with an upright posture. The

lordosis and protuberant abdomen of late infancy tend to disappear by the

4th yr. By 2 1/2 yr the deciduous teeth have usually erupted. Major

development occurs in the area of fine motor coordination. The preschooler

is an inquisitive learner and absorbs new concepts like a sponge absorbs

water.

Myelinazation of the spinal cord allows for bowel and bladder control to be

complete in most children by age of 3 years. The number of alveoli

continues to increase, reaching the adult number at about 7 years of age.

Alternation of feet in ascending stairs by 3 yr and alternation in

descending stairs by 4 yr. By 3 yr most children can stand for a short period

on one foot; by 5 yr they are generally able to hop on foot and soon to skip.

They can kick ball forward.

18 mo 20 mo 2.5 y 3 y 4 y 5 y 6 y

| __

By the age 3 yr the child can respond to the request to draw a person. The

first figures consist of a circular head with arms and legs attached as sticks.

During the next years the child adds the trunk. Draw persons with 2-4 parts

in 4 years, and at least 6 parts in 5 years.

The child in intuitive phase can count 10 or more objects, correctly name

at least four colors, and better understand the concept of time, and he knows

about things that used in everyday life, such as money, appliance, and foods.

During the 3rd yr the child puts short sentences together to sustain a brief

conversation. Vocabulary at 3 years comprises about 900 words. The

preschool child may acquire as many as 10-20 new words/ day and at age 5

usually has 2,100 words. They start to develops fluency.

By 3 yr most children can state their ages and whether they are boys or

girls. During the 3rd yr of life children more increasingly into play activities

in which other are involved, at first in parallel play (doing the same thing)

rather than in reciprocating actions or exchanges.