Pediatrics I

Module on Growth and Development Dr. Rosalina Q. De Sagun Dr. Noemi T. Salazar Dr. Rosalia M. Buzon

Growth And Development

Growth - refers to physical development and measured with the weight, height, etc . Development - refers to maturation, acquisition of competence or change in childs behavior

Assessment
1. Physical Growth - weight - length / height - head circumference
2. Development Motor- gross and fine Language - comprehension - expression Personal/Social

0 - 2 months
Physical development - newborn weight decreases 10% below BW in
the 1st wk - regains or exceeds BW by 2 wks - Wt gain = 30 gm/day during the 1st month - BW doubled = by 4-5 months - BW 3x = 1 year - BW 4x = 2nd yr

0 2 months
Cognitive Development - Recognizes human face and smiles
- Increased attention when stimulus changes

Emotional Development - Basic trust vs mistrust 1st Ericksons

Psychosocial stage - develops as infants learn that their urgent needs are met regularly

2 - 6 months
Physical development - By 3-4 months - rate of growth = 20 gm/day
- Early reflexes disappear - Voluntary movements appear

Cognitive Development - More interested socially

- Becomes distracted with stimuli

6 - 12 months
Physical development
- Increased mobility and exploration - Growth slows wt gain of 15g/d (6-9mos), 12g/d (9-12mos) - Tooth eruption usually starts with the mandibular central incisors maxillary central incisors mandibular lateral incisors maxillary lateral incisors cuspids 1st molars 2nd molars - Tooth development partly reflects skeletal maturation and bone age

Emotional Development - Starts to have emotions of fear,

anger, joy

6 - 12 months
Cognitive Development - Increased cognitive understanding &
communications - Complex plays - Object constancy starts at 9 months

6 to 12 months

Emotional Development - Separation anxiety - Tantrums start Others - Language development

12 18 months
Physical development
- Growth rate decreases further in the 2nd year (8g/d for 1-3 yrs old) - Appetite decreases - Baby fat burned up with increased mobility - Exaggerated lumbar lordosis - Brain growth & myelination continues - Motor development

12 18 months
Cognitive Development - Mastery of reaching, grasping & releasing
- Imitates elders

- Make- believe play centers on his body

Emotional Development - Attachment to parents

- Temperament depends on attachment to

& comfort given by parents

Others - Receptive language precedes expressive

18 - 24 months
Physical development
- Improved balance & agility i.e. running / climbing stairs - Weight/height increase at a steady rate

Cognitive Development - 18 months end of sensorimotor development - Object permanence firmly established Emotional Development - Increased awareness of possibility of separation Others - Start asking What is this?

2 - 5 years (Pre-school yrs)

Physical development
Somatic & brain growth slows with decrease in nutritional requirement & appetite By 2-5 years, child gains 2 Kg in wt/yr., 7 cm in height/ year Abdomen flattens -

2 5 yrs All 20 primary teeth have erupted by 3 years Handedness established by 3 years old; bowel/bladder control established by average 3 years. Bedwetting normal up to 4 years in girls ; 5 years in boys

Cognitive Development - Pre-school magical thinking - Egocentricism - Play complex, imaginative

2 5 years
Emotional Development

- Acceptance of limits, interacts with

adults & peers - They learn what behaviors are acceptable and not - Learn how to adapt to new rules - Control is a central issue

Others -Visual acuity: 20/30 by 3 years

20/20 by 4 years
-Language development: occurs most rapidly 2-5 yrs. - As a rule, # of words in a typical sentence equals the childs age(2 by 2 years; 3 by 3 years); 4 years old can use past tense; 5 yrs old can use future tense

6 - 12 years (School yrs)

Physical development - Growth averages 3 - 3.5 Kg/yr and 6
cm/year - Loss of deciduous teeth with eruption of 1st molar (by 6 years) rate of replacement with adult teeth approx. 4/yr - Lymphoid tissues hypertrophy

Cognitive Development - Learning centers on reading, writing and math - Apply rules based on observable phenomena

6 12 years
Emotional Development - More and longer separation from home
- Influence of peer group increases - Seeks acceptance from teachers - Self esteem a central issue with popularity as its central component

Formulas for Approximate Average Weight & Height of Normal Infants & Children

Weight : - at birth: 3.25 Kg

- for 3-12 months: age (mo) + 9 / 2 - for 1-6 yrs: age (yr) x 2 + 8 - for 7-12 yrs: age (yr) x 7 5 / 2

Height : - at birth: 50 cm - at 1 yr: 75 cm - at 2-12 yrs: age (yr) x 6 + 77

All 20 primary teeth have erupted by 3 years - Handedness established by 3 years old; bowel/bladder control established by average 3 years. Bedwetting normal up to 4 years in girls ; 5 years in boys

Developmental Milestones
Newborn: lies in flex attitude, turns head from side to side head lags on pull can fixate face or light in line with vision Moro , grasp , stepping reflexes active Visual preference to a human face

Developmental Milestone
At 1 month: Holds head up momentarily Tonic neck posture predominates Follows moving object Reflex smile Body movements in cadence with voice of others in social contact

Developmental Milestone
At 2 months: Head sustained on ventral suspension Tonic neck posture predominates Follows moving objects past midline- 180 degrees Smiles on social contact (social smile) Listens to voice and coos

Developmental Milestone
At 4 months: Symmetric posture No head lag on pull to sit (good head control) When held erect, pushes with feet Reaches & grasps objects and brings them to mouth Laughs out aloud Shows displeasure when social contact is broken

Developmental Milestone
At 7 months: Rolls over; crawls or creeps Sits briefly with support Transfers objects from hand to hand Polysyllabic vowel sounds Prefers mother

Developmental Milestone
At 10 months: Sits alone; pulls to stand Cruises; walks holding on to furniture Pincer grasp; looks for hidden toy Repetitive consonant sounds( mama, dada) Responds to sound of name Waves bye-bye; plays peek-a-boo

Developmental Milestone
At 12 months: Walks with 1 hand held Obeys simple commands on request or gesture Speaks few words besides mama, dada Makes postural adjustment to dressing Plays simple ball game

Developmental milestones
At 15 months: Walks alone; crawls up stairs Makes a line with crayon Jargon; follows simple commands May name a familiar object (ball) Indicates needs by pointing

Developmental Milestone
At 18 months: Runs stiffly; walks up stairs with 1 hand held Imitates scribbling and vertical stroke Names pictures; identifies 1 or more body parts Average of 10 words Feeds self Seeks help when in trouble

Developmental milestones
At 24 months (2 yrs): Runs well; walks up & down stairs one step at a time; climbs to furniture Circular scribbling Puts 3 words together ( subject-verbobject) Handles spoon well; listens to stories with pictures

Developmental Milestone
At 30 months: Goes upstairs with alternating feet Imitates circular stroke Knows full name; refers to self as I Helps put things away; pretends in play

Developmental Milestones
At 36 months (3 yrs): Rides tricycle Copies a circle; imitates a cross Knows age and sex; counts 3 objects correctly Plays simple games with other children; helps in dressing

Developmental Milestone
At 48 months (4yrs): Hops on one foot Copies cross and square; draws a man with 2 to 4 parts besides the head; names longer of 2 lines Tells a story Goes to toilet alone.

Developmental Milestones
At 60 months:

Skips Copies a triangle; names heavier of 2 weights Names 4 colors Dresses and undresses Asks questions about meaning of words Domestic role-playing

Thank You