normal growth & development

Normal Growth & Development

Presented by:

Dr. Khaled Sadeq

Assistant Professor of pediatrics

Growth is the increase in size.

Development is an increase in function of processes related to body and mind.

STAGES OF GROWTH AND DEVELOPMENT

Infancy• Neonate

• Birth to 1 month• Infancy

• 1 month to 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 ≈ 18 years

Growth parameter:

Weight Height

Head Circumferance

Growth parameter…cont’:

o Each growth parameters should be plotted on growth curves specific for that age to determine the appropriateness of size.

Weight:o The average term newborn

weighs approximately 3.4 kg

o Boys are slightly heavier than girls are.

o A newborn's weight may decrease 10% below birth-weight in the 1st week as a result of excretion of excess extravascular fluid and limited intake.

o Infants regain or exceed birth weight by

2 week of age and

o Should grow at ≈ 30 g (1 oz)/day during

the 1st month.

“This is the period of fastest postnatal growth”

o Between 3 and 4 month of age, the rate of growth slows to approximately 20 g/day.

“Growth slows more”

o By 4 month, birth weight is doubled.

o By the 1st year, birth-weight has tripled.

o Birth-weight quadruples by 2½ year of age.

o A suggested formula to calculate weight after age of one year is:

Age in years X 2 + 8

o The average term newborn length is about 50 cm.

Length (Height):

o By the 1st year, length has increased by 50%, (= 75 cm)

o By 2nd year, children are about ½ of their ultimate adult height.

o In adolescence, growth accelerates above the prepubertal rate of 6–7 cm per year.

o By 4 years of age, birth length is doubled.

o The average term newborn head circumference is 35 cm.

Head Circumference:

o By the 1st year, head circumference has increased by 12 cm. (=47 cm)

o Brain growth, with continuing myelinization, results in an increase in head circumference of 2 cm over the 2nd year. (=49 cm)

o 90% of adult head circumference is

achieved by age 2 yr.

o The head will grow only an additional 5 cm

between ages 3 and 18 yr.

o Measuring head circumference in infants

at birth till age of 3 years.

BMI (Body Mass Index):

• Dividing the weight in kilograms by the height in meters squared (kg/m2).

• Body mass index (BMI) in children >= 2 years.

AGE APPROXIMATE DAILY WEIGHT GAIN (g)

GROWTH IN LENGTH (cm/mo)

GROWTH IN HEAD CIRCUMFERENCE

(cm/mo)

RECOMMENDED DAILY ALLOWANCE

(Kcal/kg/day)

0–3 mo 30 3.5 2 1153–6 mo 20 2 1 1106–9 mo 15 1.5 0.5 100

9–12 mo 12 1.2 0.5 100

1–3 yr 8 1 0.25 1004–6 yr 6 3 cm/yr 1 cm/yr 90–100

Developmental Milestone:

Gross MotorIn Prone Position:By 1 month:Head may be lifted for an instant

In Prone Position:

By 2 month: Head can be raised to 45◦

In Prone Position:By 3 month: Head can be raised to 90 ◦

In Prone Position:By 5 month:

Weight placed on arms with elbows flexed

In Prone Position:By 6 month:

Weight placed on arms with elbows extended

Pulling to sitting Position:o The newborn can be pulled to sit with head lag

to about 45◦

o By 3-5 months there should be No head lag.

Pulling to sitting Position:

Ventral suspension:

Newborn: Arched back

Ventral suspension:6 weeks: Head held in line with trunk.

Ventral suspension:3 months: Head held above plane of body.

Rolling over: 4-5 months: From front to back.

5-6 months: From back to front.

Sitting: Newborn: Unable to sit, back arched.

5-6 months: Sits with support.

Sitting: 7-8 months: Tripod sitting, with arms

extended anteriorly between both legs.

Crawling:o Most are crawling by 9-10 months.

oBy 6 months: almost complete weight bearing.

oBy 15 months: Walks alone.

oBy 2 years: Runs well.

oBy 3 years: Rides tricycle.

Vision & Fine Motor

By first few weeks: fix and follow through range of 45 ◦

By 1 month: Follows through range of 90 ◦

By 3 months: Follows through full range of movement in one plane.

VISION

FINE MOTOR SKILLS Birth to 1 month:

Hands are held closed 2-3 months:

Hands are held open

4 months: Hands meet in midline

5 months: intentional voluntary grasp of objects

6 months: Looking at hands; Transfers from one hand to the other; Holds feet

12 months: Hands in mouthCasting objects to ground

18 months: Turns 2-3 pages at a time

2 years: Turns pages singly

3 years: Catching with extended armsCopies circles

4 years: Draws a man with head, trunk and leg; Copies cross & square

By 5 years: copies triangle

Catching, drawing:

Social behavior 6 weeks: smiling

2 months: Coos responsively

6 months: Responds to mirror image of self

10 months: Waves bye-bye

12 months: Plays simple ball game;Makes postural adjustment to dressing

15 months: Indicates some desires or needs by pointing; Hugs parents

18 months: Feeds self; Seeks help when in trouble

2 years: Handles spoon well; Helps to undress

3 years: Helps in dressing

4 years: Goes to toilet alone

5 years: Dresses and undresses

Language 2 months: Listens to voice and coos

3 months: Says “aah, ngah”

4 months: Laughs out loud

10 months: Repetitive consonant sounds (“mama,” “dada”)

12 months: Says a few words besides “mama,” “dada”

15 months: Jargon; follows simple commands

18 months: 10 words (average); names pictures; identifies one or more parts of body

30 months: Refers to self by pronoun “I”; knows full name

3 years: Knows age and sex; Counts 3 objects correctly; Repeats 3 numbers or a sentence of 6 syllables

4 years: Tells story

5 years: Names 4 colors; Repeats sentence of 10 syllables; Counts 10 pennies correctly

Presented by:

Dr. Khaled SadeqAssistant Professor of pediatrics