Growth and Development

Goitom Gebreyesus, MD

Introduction

• Growth • The increase in size and development of a living

organism from a simple to a more complex form

• Development • An increase in skill and complexity of function

• Growth and development in • physical, intellectual, emotional and social terms are

the essential Biological characteristics of childhood

Intro…

• A child is not a small adult, but is• A developing human being who changes from a new

born through infancy, toddlerhood and early school years in to and adolescent and finally, a mature adult

• One needs to understand Growth and Development in 3 ways:

Intro…

• Understanding – The normative pattern allows one to monitor

children's progress– Of how biological and environment forces interact

to shape development allows one to target factors that increase risks

– Of how parents conceptualize development facilitates guidance and intervention

Developmental Theories

Theory/Stage Infancy (0–1 yr)

Toddlerhood (2-3)

Preschool (3-6)

School age (6-12)

Adolescence (12-20))

Freud: psycho-sexual

Oral Anal oedipal latency Genital

Erikson: psycho-social

Basic trust Autonomy vs. shame & doubt

Initiative vs. guilt

Industry vs. inferiority

Identity vs. ID diffusion

Piaget: cognitive Sensori -motor Sensori -motor Preoperational

Concrete operation

Formal operation

Classic Developmental Stage Theories

General Principles

– The sequence of each pathway of development doesn’t vary, although the rate is variable

– The rate of development along different pathways is variable

– Motor development proceeds in a cephalo-caudal direction

– Some primitive reflexes must be lost before voluntary movement occur

Developmental Assessment

• Gross motor development• Gross muscular activity and neuro-development including posture,

independent mobilities and progress from head control to running

• Fine motor development (Manipulation)• The ability to reach for, grasp and manipulate objects

• Cognition and Social skill• Social smile, watching a mirror, waving goodbye, general alertness and

curiosity about the surrounding

• Language

Milestones at different ages

• Infancy (0-12 months) – Physical:

• Weigh an average of 10 Kg at 12 months, length increases by 25 cm, and head circumference by 12 cm

– GM: • at 3 M support head, at 6 M sit without support, at 8 M

crawl and at 12 M stand without support

– FM: • 3-4 M grasp objects, 5-6 M transfer objects from hand

to hand, at 9 M thumb-finger grasp and at 12 M scribble

Infancy…

– C & S: • at 2M social smile, at 4 M laugh, 6-8 M stranger anxiety

and at 9-12 M object permanence

– L:• first 6 M vowels, at 7 M start with consonants, at 8-9

M papa & mama, at 12 M few words

Toddlerhood (12-24 months)

– Physical: • Gain average Wt of 2 Kg, Ht 12 cm & HC 3cm

– GM: • Walk at 12-15 M, at 18 M run stiffly, walk upstairs with

one hand held, at 24 run well and walk up and down stairs one at a time

– FM: • at 15 M make a line, insert pellet in a bottle, at 18 M

imitate vertical stroke and at 24 M imitate horizontal stroke

Toddlerhood…

– C & S: • at 15 M indicate desire by pointing, at 18 M feeds self,

complain when wet or soiled, at 24 M helps undress and listens to stories with picture

– L: • at 15 M start to speak in jargons, at 18 M 10-15 words

and at 24 M two word sentence

Preschool (2-5 years)

– Physical: • Gain 2 Kg/yr and Ht 7 cm/yr; by end of 3 yr all primary

teeth have erupted

– GM & FM: • at 2 & half yr walk upstairs alternating feet, at 3 yr ride

tricycles & copy circle, at 4 hop on one foot, throw ball over head & copy cross; at 4 & half yr copy square; at 5 yr skip & copy triangle

2078

1630

Preschool…

– C & S: • at 2 & half yr Know full name and pretend plays; at 3 yr

know age and sex, count 3 objects, wash hands & put shoe; at 4 yr tell a story; at 5 yr name 4 colors, count 10 objects correctly and dress &undress; think in prelogical operations

– L: • language develop most rapidly between 2-5 yr,

vocabulary increases from 50-100 to about 2000 words; number of words in a sentence equals age in yrs

School age (6-12 yrs)

– Physical:• Average weight and height gain per year is 3-3.5 kg and

6 cm respectively, HC increase by 2-3

– Motor:• coordination and stamina increase progressively, and

are able to perform complex movements such as dancing

– C&L:• start thinking in concrete logical operations

Adolescence (10-20)

• Rapid change in – body size, shape, physiology, psychologic and

social functioning

• Three distinct periods– Early, middle and late

• Common changes that occur during the three periods are:

Adolescence…

Variable Early Adolescence

Middle Adolescence Late Adolescence

Age/yrs 10-13 14-16 17-20& beyond

Somatic 20 sexual charac., beginning of rapid G

Ht peak, acne & odor, menarche, spermarche

Slower growth

Sexual Sexual interest Sex drive urges experimentation

Consolidation of sexual identity

Cognitive & Moral

concrete operation, conventional morality

Abstract thought, self-centered

Idealism, absolution

Family Bids for independence

Continued struggle for greater autonomy

Practical, independent, family remains secure base

Peers Same sex groups, conformity, cliques

Dating, peer groups less important

Intimacy, possibly commitment

Adolescence…

– The sequence of somatic and physiologic changes that occur can be used to assess developmental maturity according to Tanners’ staging: • Sexual Maturity Rating (SMR)

Adolescence…

Fig. A – Sex maturity ratings of pubic hair changes in adolescent boys and girlsFig. B – Sex maturity ratings of breast changes in adolescent girls

A B2 3

4 5

2 3

4 5

1

2

3

4

5

Adolescence…

SMR Stage

PUBIC HAIR BREASTS

11 Preadolescent Preadolescent

22 Sparse, lightly pigmented, straight, medial border of labia

Breast and papilla elevated as small mound; areola diameter increased

33 Darker, beginning to curl, increased amount

Breast and areola enlarged, no contour separation

44 Coarse, curly, abundant, but amount less than in adult

Areola and papilla form secondary mound

55 Adult feminine triangle spread to medial surface of thighs

Mature, nipple projects, areola part of general breast contour

Classification of sex maturity stages in girls

Adolescence…

SMR Stages

PUBIC HAIR PENIS TESTES

11 None Preadolescent preadolescent

22 Scanty, long and slightly pigmented

Slight enlargement

Enlarged scrotum, pink, texture altered

33 Darker, beginning to curl, small amount

Longer larger

44 Resembles adult type but less in quantity, coarse, curly

larger; glans and breadth increase in size

Larger, scrotum dark

55 Adult distribution, spread to medial surface of thigh

Adult size Adult size

Classification of sex maturity stages in boys