Growth and Development PhasesYudianita Kesuma

Growth & Develoment phases1. Prenatal periodEmbryonic period (1 - 8 weeks of gestational)Fetal period (9 weeks birth)2. Newborn (neonatal period) 0-28 days3. Infant period (1-2 years)4. Chilhood periodPrescool periodSchool-age periodAdolescence period

Prenatal Growth & DevelopmentFigure 1/ Overview of fetal development

Embryonic period (1-8 weeks of gestational age)WeekFertilisation, implantationEndoderm and ectoderm appearMesoderm appear, somite begin to formNeural fold fuse, folding of embryo into human-like shape, arm and leg bud appearLens placodes, primitive mouth, digital rays on handPrimitive nose, philtrum, primary palateEyelids beginOvaries and testes distinguishableEnd of the period, the rudiments of all major organ systems have developed, the average weight 9 g, and length of 5 cm

Fetal period (9 weeks to birth)Week10 The face is recognizably human12 External genital distinguishable Breathing and swallowing motions17 Grasp reflex Primitive alveoli and surfactant production. Eyes open, turns head downMidgestation, full range of movement3 rd trimester, respond to external stimuli38 Aterm, weight 2500-4500 g, length 45-55 cm

The newborn (Neonatal period) (0-28 days of age)

Birth weight average 3000 g (2500-4500g)Birth length average 50 cm (45-55 cm)Birth head cicumference 34 35 cmTransition from Intrauterine to extrauterin Soon after birth, alert and ready to interact

After 40 minutes period of alertness, follow by somnolence, and sleep Skin-to-skin contact between mother and infant immediately, increased rate and longer duration of breast-feedingNearsighted, 8 12 incHearing is well developed

The first year0 - 2 months2 - 6 months6 - 12 months

Age 0 - 2 months1 st wk, weight may decrease (< 10 %)2 nd wk, regain or exceed birthweightGrow + 30 g/day during the 1 st moLimb movements uncontrolledPrimitive reflexes ex. rooting reflexSmilling involuntarilyEye gaze, head turning, sucking are under better controlCrying in response to stimuliRecognize facial expression as similar, even on different faces

Age 2 6 monthsPhysical development :3-4 mo, growth solws, + 20 g/day Primitive reflexes goneNo head lag, rolling3 mo, asymmetric tonic reflex gone, manipulate object with 2 hands in the midline4 mo, graspes rattle, palmar grasp gone, reaches for object

Cognitive development:Explore their own bodyVocalizing, blowing bubbles

Social & communication development :Primary emotions of anger, joy, interest, fear, disgust and surprise appear in facial expressions

Age 6 12 monthsPhysical development :Growth slows more (15 g/day)7 mo, sit unsupported8 mo, crawling9 mo, pincer grasp12 mo, walks alone

Cognitive development :Novel objects are picked up, inspected, passed hand to hand, banged, dropped, and then mouthed.9 mo, object constancy, understanding that objects continue to exist even when not seen

Emotional development :Look back and forth between strangers and parents may cling or cry anxiouslySeparation become more difficultA new demand for autonomy emerges self feeding, tantrumCommunication :6 mo, babbling with many syllables (ma, da, ba) 10 mo, repetitive consonant sounds (mama, papa, dada)

The second year12 18 months18 24months

Age 12 18 monthsPhysical development :The growth rate solws further, appetite declinesWalks independentlyCognitive development :Reaching, grasping, releasing, and greater mobility gives them access to more and more object, exploration increasesImitation of parents and older children is an important mode of learningPlay centers on the childs own body ( ex. pretending to drink from an empty cup)

Emotional development :Infant may be irritableToddler as intoxicated with their new ability and the power to control the distance between themselves and their parentsCommunication development :Receptive language precedes expresive12 mo, speaks the first wordRespond appropriately to simples statements (no, bye-bye, give me)15 mo, points to major body partsUses 4 6 words spontaneously and correctly

Age of 18 24 monthsPhysical develompent :Height and weight increase at a steady rateHead growth slows slightlyMotor development is incremental, improvement in balance and agility, running, stair climbingCognitive development :Object permanenceCause and effect are better understoodSymbolic transformation in play (ex. feeding the doll from the empty plate)

Emotional development :Increased clinginess, separation at bed-time are often difficultMany children use transisional object (ex. special blanket or stufled toys)Communication :18 mo, 10 15 words2 yr, 100 words or more, to make simple sentencesUnderstand two-step commands

Preschool years (2-5 yr of age)Physical development :Somatic and brain growth slowsAverage child gain + 2 kg/yr, and 7 cm/yrNutritional requirement and appettite decreases3 yr, visual acuity 20/30, all primary teeth have eruptedThrowing, catching and kicking balls, riding on bicyclesHandednessBowel and bladder control

Communication :Vocabulary 100 to more than 2.000 words21/2 yr, using possessives, progressives, guestions and negatives tenses4 yr, count to 4, and use the past tense5 yr, use the future tenseCognitive development :Magical thinkingEgocentrismThinking that is dominated by perception

Play :Increasing complexity and imagination. 2 3 yr, simple scripts (ex. shopping and putting baby to bed). 3 4 yr, more extended scenario (ex. going to the zoo, going on a trip). 4 5 yr, creation of scenario (ex. flying to the moon)Socialization from minimal social interaction to cooperative play. 1 2 yr, solo or parallel play. 3 4 yr, cooperative play, together, sharing. 5 yr, recognition the rules

Emotional development : 2 yr, behavioral limits are predominantly external5 yr, these controls need to be internalizedYoung children cannot control many aspects of their life temper tantrums

School Aged Physical development :Growth 3 3,5 kg/yr, and 6 cm/yrHead grows 2 3 cmLoss of deciduous teeth, replacement by adult teethLymphoid tissue hypertrophyMuscular strength, coordination & stamina increase progressivelySexual organ physically immature, but interest in gender differences

Cognitive & language development :Reading, writing, and basic mathematics skillsEnjoy strategic games and word play

Social & emosional development :Social & emotional development proceeds in 3 contexts : home, school & neighborhoodSeparation from the family and the increasing importance of teacher & peer relationships.

AdolescenceRapid changes in body size, shape, physiology, psychologic, ans social functioningHormones set the development agendaTransition from childhood to adultThree distinct periods : early, middle, and late

Early adolescenceBiologic development :Production of androgen development of underarm odor and genital hair (adrenarche)GnRH, LH, FSH, androgen and estrogen increasesSomatic & physiologic changes gives rise to the Sexual Maturity Rating (SMR) or Tanner stages key stages of breast, pubic hair, and testicle and penile development

Physical development at puberty

Perkembangan bentuk dan ukuran payudara (Dikutip dari Fig.14-2, Behrman et al, Nelson textbook of Pediatrics, 2000, hal.54)

Perkembangan rambut pubis (Dikutip dari Fig.14-1, Behrman et al, Nelson textbook of Pediatrics, 2000, hal.53)

Perkembangan bentuk dan ukuran genitalia (Dikutip dari Fig.18-14, Vaughan & Litt: Child Adolescent Development: Clinical Implication, 1990, hal.250)

Girls :8 13 yr, the first visible sign of puberty is the appearance of breast bud9 16 yr, menarche, around the peak in height velocityBoys :91/2 yr, testicular enlargementBreast hypertrophy occurs in 40 65% of pubertal boys

Growth acceleration begin in early adolescence, but peak growth velocities are not reached until SMR 3 or 4.Boys typically peak 2-3 yr later than girls, and continue their linear growth for + 2-3 yr after girls have stoppedAdrenal adrogens stimulate the sebaceous glands development of acne.

Sexuality :Interest in sex increasesEjaculation (during masturbation, and spontaneously)Cognitive development :Transition from the concrete preoperasional thinking to formal logical operationsSelf-concept :Self-awareness tends to center on external characteristics

Relationship with family, peers, and society:Trend toward separation from family with increasing involvement in peer activitiesSocialize in same-sex peer groupsRelationship to society centers on schoolReady access to pornography on the internet may increase the risk of premature sexual activity or exploitation

Middle AdolescenceBiologic development :Growth accelerates, rate of 6-7 cm/yrIn girls, the growth spurt peaks at 11,5 yr at a top velocity of 8,3 cm/yr, and then slows to a stop at 16 yr.In boys, the growth spurt starts later, peaks at 13,5 yr at 9,5 cm/yr, and then slows to a stop at 18 yr.

Weight gain parallels linear growthMuscle mass increases, follow by an increase in strengthMenarche, in 30% of girls by SMR3 (+ 12-14 yr), andin 90% by SMR4 (+ 13-15 yr)Sexuality :Dating becomes a normative activityHigh testosterone and low religiosity together may predict which boys become sexually active

Cognitive and moral development :With the transition to formal operational thought, they question and analyze extensively

Self-concept :Often experiment with different personae, changing style of dress, groups of friends, and interests from month to month

Relationship with family, peer & society:Adolescents may become distance from parent, redirecting emotional & sexual energies toward peer relationshipsDating increases, the need to belong to same-sex groups declinesOften begin thinking seriously about what want to do as adults

Late AdolescenceBiologic development :The somatic changes are modest by comparisonThe final stages of breast, penile, and pubic hair occur by 17-18 yr of age in 95% adolescents

Psychosocial development :Sexual experiment decreases as adolescents adopt more stable sexual identitiesCognition tends to be less self-centered, increasing thoughts about justice, patriotism and historyOften idealistic, but also may absolutist and intolerant of opposing viewsDating relationship increasingly involve love and commitmentCareer decision become pressing

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