Growth And Development Of Paediatrics

UNIT 2

CHILD HEALTH NURSING

GROWTH AND DEVELOPMENT

GROWTH:
It refers to an increase in the size of physical structure of body. There is an increase in body cells, so it is a quantitative increase in size of body.

COMPONENTS OF GROWTH:
Height  ( measured in cm or inches)
Weight  (measured in kg or pounds lb)
Head circumference  ( measured in cm or inches)
Dentition  process of teeth eruption( measured in number of teeth eruption)

HEIGHT:
Average height at birth is 50 cm (20 inches)
Age
Height in cm

At birth
1 year
2 year
3 year
4 year
50 cm
75 cm
85 cm
95 cm
100 cm

Height increases about 25 cm in 1st year of life.
At third year height is about 3 feet (90 cm)
At 4th year height is about 100 cm
NOTE: Height increases after 3 years by 5 cm per year up to puberty, during puberty it increases by 9-10 cm per year for 2 to 3 years.

WEIGHT:
At birth an average weight is 2.5 kg to 3.5 kg
Age
Weight in pounds / lbs

At birth
6 months
1 year
2 year
3 year
7 year
10 year
7 lbs
14 lbs
21 lbs
28 lbs
35 lbs
49 lbs
70 lbs


Birth weight is doubled at 6 months of age
Birth weight is tripled at 1 year of age
Birth weight is fourfold at the age of 2 years
After 2 years weight increases by 5 lbs (2.5 kg) per year up to puberty.
At birth new born looses 10% of birth weight and regains on 10th day.
Weight increases about 200 g/week during first 3 months, and then 150 grams / week up to age of 1 year of life.

HEAD CIRCUMFERENCE:
Normally head circumference is larger than chest circumference at birth.
Chest circumference becomes equal to head circumference at the age of 1 year and becomes larger thereafter.
Age
 Head circumference

At birth
3 months
6 months
9 months
1 year
2 year
3 years
5 years
35 cm
41 cm
44 cm
46 cm
47 cm
49 cm
50 cm
51 cm


Note: after the age of 5 years head circumference is increased by 0.5 cm per year until 12 years (54-55 cm)

DENTITION:
It is a process of teeth eruption, on the average first deciduous tooth erupts at 6 months of age and eruption is completed at the age of 2.5 years (20 teeth). Shedding of deciduous teeth starts at 6 years and is completed by the age of 12 years.

DECIDUOUS/MILKY TEETH
Maxillary teeth
Mandibular teeth

Central incisors   7 months
Lateral incisors    8 months
Canines              18 months
First molars       15 months
2nd molars           2 years
6 months
9 months
18 months
15 months
2 years


PERMANENT TEETH
1st molars 
Central and lat incisors 
1st premolars
2nd premolars
Canines
2nd molars
Wisdom tooth
6 years
8 years
9 years
10 years
11 years
12 years
22 years


DEVELOPMENT:
It refers to progressive increase in the body function and acquisition of skills. It is a qualitative and functional maturation of organs in body.It is a functional change.
Growth and development are so closely associated that they are assessed simultaneously at the same time. Land marks provide best evaluation of health of an individual.

COMPONENTS OF DEVLOPMENT:
Gross motor development
Fine motor vision development
Hearing and speech development
Social behavior


FACTORS AFFECTING GROWTH AND DEVELOPMENT:

Hereditary factors
Diet
Chronic illness
Environment
Family
Ordinal position.

GROWTH AND DEVELOPMENT AS PER DIFFERENT AGE:
Age
Growth
Development

At birth
Weight: 2.5  3.5 kg
Height: 50 cm
H.C : 33-35 cm
Dentition: Nil
GROSS MOTOR:
  Turns head to one side.
  Elbows   flexed, hands fisted, Head lagg
FINE-MOTOR VISION:
 Pupils react to light.
 Closes eyes to sudden bight light
HEARING AND SPEECH:
Cry vigorously, social smile at 4-6 weeks.


Age
Growth
Development

3 Months
Weight : 5 Kg
H.C : 51 cm
GROSS MOTOR:
Head in midline
limbs move symmetrically
Little or no head lag
Sags at knees
FINE MOTOR-VISION:
Defensive blink present
Recognizes mother face
HEARING AND SPEECH:
Pleased when spoken.
Becomes quiet with sound of spoon.
SOCIAL BEHAVIOUR:
Happy response to mothers face when feeding,




Age
Growth
Development

6 Months
Weight:6.5-7.5 kg
H.C:44 cm
Dentition: Central incisors erupt (Mandibular)
GROSS MOTOR:
 Sits with support
 Grasp feet.
Rolls prone to supine ( 5 months)
 Rolls supine to prone  (6 months)
Lifts head and chest with support of arms. Takes wt on extended legs.
FINE MOTOR AND VISION:
Follows dangling ball in all directions.
Transfers objects hand to hand.

HEARING AND SPEECH :
Shouts to attract
Vocalizes tunefully as dah-ah ba
SOCIAL BEHAVIOR:
Takes every thing to mouth
No fear from  strangers.
Begins to masticate and drinks from cup.


Age
Growth
Development

7 months



8 months


9months


10 months












11 months

SOCIAL BEHAVIOR:
Fears from strangers.


GROSS MOTOR DEVELOPMENT:
Can sit without support.

GROSS MOTOR DEVELOPMENT:
Reaches for toys in front.
Starts crawling.

GROSS MOTOR DEVELOPMENT:
Reaches for toys at behind.
Can crawl.
FINE MOTOR & VISION:
Alert to peripheral visions.
Watches rolling ball at 10 feet.
Looks for hidden toys
HEARING & SPEECH:
Says Baba, dada, mama.
Imitates sounds.
SOCIAL BEHAVIOR:
Holds bites and chews biscuits.
Imitates hand clapping.
Finds out partially hidden toys.

GROSS MOTOR:
Can walk holding furniture.



Age
Growth
Development

1 year
Wt  10.5 kg
Ht  73-75 cm ( 29 inches)
HC 46-47 cm
DENT: Central incisors 4
Lat incisors 4
Premolar 2-4
Total 10-12
GROSS MOTOR:
Can walk few steps with one hand held.
HEARING & SPEECH:
Knows own name.
Says 2-3 words
SOCIAL BEHAVIOR:
Drinks from cup with assistance.
Co-operates in dressing.
Waves bye-bye.
Can masticate well, begins to feed himself.
Loves tearing paper.



Age
Growth
Development

15 months

GROSS MOTOR:
Walks alone  wit uneven steps with feet apart



Age
Growth
Development

18 months

GROSS MOTOR:
Walks upstairs with one hand held two feet per steps.
FINE MOTOR & VISION:
Turns several pages.
Holds pencil at mid point.
HEARING & SPEECH
Uses 6-20 words and understands many more
Obeys simple instructions.
Shows his body part i.e. nose. ear mouth
SOCIAL BEHAVIOR:
Feeds self with spoon.
Takes off shoes and socks.
Still wets clothes







Age
Growth
Development

2 years









2.5 years
Wt 11-14  kg
Ht  85 cm
HC 49 cm
DENT: 2nd molar (Maxillary Mandibular)
Total teeth = 20
GROSS MOTOR:
Runs well, starts and stops safely.
Climbs on furniture
Walks downstairs with one hand held two feet per step.
Good bladder control
HEARING & SPEECH:
Joins two or three words to make a sentence.

Gross motor
Can jump two feet together
Fine motor &vision
Picks up pins and threads
Turns pages singly
Hearing and speech
Forms sentence of 2-3 words
Refers self by name
Asks names of objects and people.
Social behavior
Lifts and replaces cup safely.
Verbalizes toilet need
Can pull down pant, knickers but unable to redress.
Imitates mothers domestic activities
Enjoys picture books and stories



Age 
Growth
Development

3 years
Ht  95 cm ( 29 inches)
HC 50 cm

GROSS MOTOR:

Walks upstairs with alternative feet
Can ride tricycle using pedal

FINE MOTOR & VISION:

Builds up tower of 9 cubes
Gives full name and sex, counts up to 10
HEARING & SPEECH:

Has large vocabulary of about 1500 words
SOCIAL BEHAVIOR:
Can pant up and down but cant button-up





Age 
Growth
Development

4 years
Ht  100 cm
GROSS MOTOR:

Walks downstairs with alternating  feet
Stands on foot for 3-5 seconds
Can run on tiptoe
HEARING & SPEECH:

Gives home address, speaks grammatically.
Counts up to 20.



Age
Growth
Development

5 years
HC 51 cm

GROSS MOTOR:
Hops and skips on one foot
Walks in straight line
FINE MOTOR & VISION:
Threads large needle
Can copy rectangle and square
HEARING & SPEECH:

Gives age, and birth day
Defines nouns correctly
SOCIAL BEHAVIOR:

Can dress & undress alone
Helpful to younger children


DIFFERENCE B/W PRE TERM AND FULLTERM INFANTS:
PRE TERM
FULL TERM

Babies born before 37 weeks of gestation.
Their weight is below than 2 kg.
They dont show any activity after birth Crying.
They appear to be pale, or bluish.
Their heart rate is less than 100 b/min
The skin is wrinkled.
Respiratory rate less than normal.
The babies born b/w37-42 weeks of gestation.
Their weight is normal 2.5-3.5 kg.
They cry immediately after birth.

They are pink in color.
The heart rate is greater than 100 b/min
The skin is not wrinkled.
Respiratory rate is b/w 40 60 rates/min.