of great help for medical students

1. Nahom W. Teshager, MD

2.  At the end of this lesson , students should :
 Define growth and development
 Identify principles & stages of growth and
development
 Be able to assess growth and development.

3.  The goal of pediatrics is to optimize growth and
development.
 Health professionals working in the area of
pediatrics should have basic knowledge of
normal and abnormal growth and development.

4.  Net increase in the size or mass of a tissue.
 Attributed to multiplication of cells and increase in
intracellular substance
 Measured in kg ,lb , meter etc.
 Quantitative change.

5.  Acquisition of skills and maturation of already
formed organs.
 related to the maturation and myelination of the
nervous system.
 Goes simultaneously with growth.
 Qualitative change
 Measured by observation

6.  Continuous process in a predictable pattern.
 Cephalocaudal and proximodistal.
 Depends on maturation and learning.
 General to specific.
 Simple to complex
 Sequence of development is the same, while the
rate varies.

9.  Congenital factors(hereditary and non hereditary)
 Hereditary
 Non hereditary (intra uterine conditions)
 Environmental factors

10.  Genetics
 Race
 Sex
 Temperament
 Intelligence
 Hormonal factors

11.  Nutrition
 Climate
 Season
 Home ,neighborhood and school condition
 Birth order

12.  Two growth spurts:
I. In the 2nd year of life
II. Near adolescence

13. 1. Intra uterine
2. Extra uterine

14. 1. Embryonic(1st Tm)
2. Early fetal(2nd Tm)
3. Late fetal(3rd Tm)

15. 1. Neonatal : birth -28 days
2. Infancy : 1st year of life
3. Toddler : 1-2 years
4. Preschool : 2-5 years
5. School age : 6-10 years
6. Adolescence : 10-18 years

16.  What are the hazards for each stage of growth?
 Is adolescence the same with puberty?

17. 1. Physical growth
2. Physiologic growth

18. Domains of physical growth:
1. Anthropometrics
2. Dentition
3. Osseous growth
4. Fontanels
Domains of development:
1. Gross and fine motor development
2. Mental development (speech, psychosocial,
intellectual)
3. Hearing
4. vision

19.  Weight
 Height
 Head circumference
 MUAC
 BMI

20. weight :
 Average birth weight is 3.4 kg.
 A healthy term infant may lose up 10% of birth
weight in the first week of life.
 Regain birth weight by 2 weeks of age or sooner
 Grow at a rate of 30 g /day in the first
month(period of fastest post natal growth)
 Birth weight doubles at 4months and triples at 1
year of age.

21.  From 3mo -12mo:
Wt(kg) =Age(mo)+9
________
2
 from 1-6 year:
Wt(kg)=Age(yr)x2+8
 From7-12 yr
Wt(kg)=Age(yr)x7-5
_________
2

22. Height:
 Average length of a full term newborn is 50cm
 Increases by 50% by 1 year and doubles by 3 to
4 years of age(75cm)
 Length approximately increases by 5cm/year
after the 3rd year of life .
 Increases by 2.5cm/mo in the 1st 6mo and by
1.25/mo in the 2nd 6 month.
 Ht =Age(yr)x5+80 after infancy.

23. Head circumference:
 Reflects the growth of the brain
 Av HC at birth is 35cm(32-38cm) for full term
infants
 Increases by 1cm per month in the 1st 6months
 ½ cm from 6 to 12 months.
 Increases by 12 cm at the end of 1 yr.
 Increase by 10 cm from 1 yr to adulthood.
 Increases by only 2cm from 1-2yr.

24.  Important for nutritional assessment of under five
children
 Midway b/n the shoulder and elbow joint
Interpretation?

25.  Six ossific centers at birth:
 Lower femur
 Upper tibia
 Talus
 Calcaneous
 Cuboids and
 Humeral head

26.  Take the x-ray of the wrist(carpal bones) to
calculate bone age.
 Bone age =chronological age +1
 Ossification starts at carpal bone and scaphoid is
the 1st to ossify

27.  Causes of retarded bone age:
 prematurity
 PEM
 Hypothyroidism
 Hypopitutarism
 Causes of advanced bone age
 Post maturity
 Androgenital syndrome
 Hyperthyroidism
 hyperpitutarism

28.  Decideous (milk) teeth:
 central lower incisor is the first milk teeth to
appear
(at 6mo)
 Small ,White and weak
 4 teeth every 4mo until 20 in number(3yr)
 Temporary
 Permanent teeth:
 Big ,yellow , strong and permanent
 Rate of replacement is 4teeth/yr for 5 consecutive
yrs after 6yrs of age
 32 in number
 The 1st premolar appears first( at 6yr)

29.  No teeth at 1 yr of age
 Due to local or general cause:
Local causes:
 Rigid gum
 Supernumerary teeth
 Gum cyst
General causes:
 Rickets
 Achondroplasia
 Osteogenesis imperfecta

30.  Teeth at birth
 Remove only if it has no root on x-ray.

31.  Confluence point of sutures
 6 in number
 anterior and posterior fontanels are the clinically
important ones.
 Anterior fontanel:
 2x3 cm at birth
 Closes at the age of 18mo
 Flat

32.  Posterior fontanel
 Closed or <0.5 cm at birth
 Indicates some pathologies if it is not closed at
2mo
-hydrocephalus
-hypothyroidism

33.  Used to assess growth of children
 Centile curves:
 Each parameter matched with age
 Has lower and upper normal limits
W/A- for growth velocity when multiple
readings are taken
H/A-for chronic malnutrition
HC/A-for brain development
W/H- for acute malnutrition
BMI/A-for acute malnutrition

34.  Failure to meet expected standards of growth
 could be:
 Persistently under weight
 Crossing two centile lines down or
 Arrested growth
 Two types:
1. Primary FTT- Wt was low since birth
2. Secondary FTT- Wt was normal at birth

35.  Prematurity:
 All anthropometric parameters affected
 IUGR:
 Symmetric
 Asymmetric

36.  Non organic(caloric failure)-80%
 e.g. malnutrition
 Organic causes-20%
 e.g. Malabsorption syndrome,RTA, metabolic
diseases etc.

37.  History :
 Dietetic
 Chronic disease
 Family history
 Physical examination:
 Any abnormal feature
 Thorough systemic evaluation
 Basic laboratory investigations.
 OFT and others as indicated.

38.  Respiration :
 Normal RR at birth is 30-60bpm.
 Decreases with age.
 Circulation :
 Pulmonary vascular resistance falls and peripheral
vascular resistance increases
 The existing right to left shunt reverses
 Normal HR at birth is 120-160 bpm.

39.  Hematology :
 Normal Hgb level at birth is 17-19g/dl.
 Short RBC life span
 High leukocyte count.

40.  Gross motor development:
 Head support ___________3mo
 Sitting ____________6mo
 Crawling ____________9mo
 Standing _____________12mo
 Walk _______________15 mo
 Run ______________18mo
 Go upstairs _____________21 mo
 Go downstairs and jumps _____24mo

41.  Ride tricycle , stand on one foot___3yr
 Hops on one foot, climbing, throw a ball over
head__4yr
 Skips______________5yr
 Rides bicycle and sporty_________6-8yr

42.  For gross motor development to be achieved,
there should be:
 Normal CNS
 Normal MSS and
 Good systemic environment

43. Newborn Age 6 months

44. Age 2 months
Age 8 months

45. 13 month old
Nine to 12-months

46. 6-month-old
12-month-old

49.  Suspect gross developmental delay if there is no:
 Head support _____at 5 mo
 Sitting ______10 mo
 Standing _______15mo
 walking. ________18mo

50.  Causes of delayed loco-motor development:
 Abnormalities in the CNS
e.g. Cerebral palsy
 Abnormalities of the MSS
e.g. Rickets
 chronic systemic disorders
e.g. renal failure, liver failure, pulmonary
failure, cardiac failure and congenital heart
diseases.

51.  When do neonatal reflexes go?
 moro reflex ______at 3-4mo
 Palmar grasp------4mo
 Plantar grasp-------7mo
 Suckling reflex

53.  Fine motor development:
 Hand to hand transfer_____6mo
 Pincer grasp and drink with two ear cup—10-12
mo
 Scribbling, self feeding and 3box tower ____18
mo
 6 box tower ,draw two lines & turns a page of a
book -24mo
 Copies a circle___3yr
 Copies a square__4yr
 Copies a triangle___5yr
 Copies a diamond and draw a man with 12 details

54.  Draw a man with 16 details___7
 Draw a man with many details, use musical
instruments and
typing___9-10 yrs

55.  Language development:
 Cooing_______2mo
 Mamma and papa ___10-12 mo
 Two word sentence and point to body
parts__18mo
 Three word sentence and count to
hundred___24mo
 Knows his full name______3yr
 Full address _____________5yr
 Language development is rapid from 2-3 yr
they can even use complex sentences.

56.  For a normal speech development the baby
should be able to:
 Hear
 Understand
 vocalize

57.  Psychosocial development:
 Social smile_______40 days
 Laughing__________2mo
 Mother recognition___4mo
 Stranger anxiety______7mo
 Responds to own name by smiling _7mo
 Father recognition ________9mo.

58. ◦ Cognitive/Adaptive
 handedness established_____3 year
 bowel and bladder control___ 24-30mn
 Knows sex and age___ 3 yr
Gender role _____ 4 yr

59. School age:
Develop self esteem
Lymphoid tissue hypertrophy occurs
Increase in muscle strength stamina and coordination
Active but immature sexual organs

60.  Social/language
 Receptive language
 Expressive language
 Identify with same sex parents adopting them as role models
 Further separation from the family

61.  .Cognitive/adaptive
 Concrete logical operation
Long-term memory
 Selective attention
 Reads one syllable printed word__6yr
Knows morning & afternoon _____6yr

62.  10-18yrs
 Growth spurt
 Earlier in girls than boys (10-14yrs Vs 12-16yrs)
 Males gain 7-30kg while females gain 7-25kg

63.  Birth length triples at 13 yr.
 Boys gain 10-30 cm while girls gain 5-20 cm
 Vertical growth ceases at 16-17yrs in girls while at
18-20yr in boys
 Puberty
 Occurs earlier in females.

64.  Secondary sexual characteristics develop
Boys :
 penile and testicular enlargement
 Pubic ,axillary and facial hair appears
 Coarse voice
Girls
 Breast develops
 Pubic and axillary hair appears
 Onset of menarche

65.  Rated from 1-5
 Parameters :
 Boys -Testis
-Penis
-pubic hair
 Girls
-Breast
-Pubic hair

70.  Global developmental Delay:
Delay in two or more domains of development
 Isolated developmental Delay:
Delay in one field of development
e.g. Delayed speech---18 mo with out talking any
word.
 Delayed speech could be due to
-hearing defect
-mental retardation
-articulation defect

71.  What are the warning signs at each stage of
growth and development?
 What is developmental regression?