Growth And Development PDF

# Growth and development Prepared By: Dr/Yara Mohamed Hassan ## Outlines - Introduction - Concepts and definitions of Growth, development, and maturation. - Factors influencing growth and development. - Principles of growth and development. - Patterns of growth and development. - Types of growth...

# Growth and development Prepared By: Dr/Yara Mohamed Hassan ## Outlines - Introduction - Concepts and definitions of Growth, development, and maturation. - Factors influencing growth and development. - Principles of growth and development. - Patterns of growth and development. - Types of growth & development. - Stages of growth and development. ## Introduction From conception until death, the individual is contently changing. The period of child growth and development extends from conception to the end of adolescence. Throughout childhood and adolescence, he develops into the physical and mental structure that characterizes adults. Even then, changes do not cease, but continue at a slower rate. Growth and development are not synonymous terms, but they are parallel each other and are interdependent in function. ## Growth It refers to an increase in physical size of the whole or any part of the body. It can be measured in centimeters, inches, pounds, or kilograms. It is usually used to describe the quantitative growth. ## Development Development refers to progressive increase in skills and capacity of functions. It is usually used to describe the qualitative change in the child's functioning. ## Maturation It literally means to ripen. It is described as aging or an increase in competence and adaptability. It is usually used to describe a qualitative change in a structure, i.e., the structure begins functions or to function at a higher level. ## Factors Influencing Growth And Development - Heredity and constitutional makeup. - Race and nationality. - Prenatal environments: (Hormones, German measles, smoking, drugs,...) - Postnatal environment: e.g., illness and injury and others. - Internal environment: e.g., intelligence influences mental and social development, hormonal balance, and emotional status of the child. - Nutrition: Adequate nutrition is essential for normal physical growth. ## Principles of Growth and Development - Growth and development are continuous processes. - Each child has his own growth pattern. - Children go through a normal sequence of growth, not in the same rate. - Children grow as whole beings. The different areas of growth are interrelated. - Although there is a fixed, precise order to development, it does not progress at the same rate. ## Patterns of Growth and development ### Cephalocaudal or Head to tail direction The child develops head control, then learns to sit, then becomes able to stand, and so on. Maturation starts in neck muscles before back muscles before leg muscles, and so on. ### Proximodistal or midline to peripheral development Development proceeds from the center of the body to the periphery. For example, in infants, shoulder control proceeds master of hands; the whole hand is used as a unit before the fingers can be manipulated.. ### General to specific As the child matures, general movements become specific. For example, the child can use the work hand before he can pick up a small object between thumb and forefinger. Another example: a child who is 7-8 months old when he is happy, he moves practically all his body. When he gets older, he expresses happiness with his face, which is a specialized development. ## Secular Trends Refers to worldwide trends in the rate and age of maturation. In general, children are maturing earlier and growing larger at each age as compared to their preceding generation. ## Types of Growth ### Physical growth: Includes: - Weight - Height - Head size: 1/4 of the entire length of the body at birth, whereas the adult's head size is 1/8 or his length. - Head circumference - Chest circumference ### Physiological growth: For example: - Temperature - Pulse - Respiration ## Types of Development: ### Motor development: - **Gross motor behavior:** e.g., posture, balance, sitting, standing, running. - **Fine motor behavior:** usage of hands and fingers in grasp objects. Usage of fine muscles. - **Intellectual development:** e.g., problem solving. - **Social development:** Raising and Training a child in the culture of his family group. - **Emotional/personality development:** as needs for trust, love. - **Moral development** - **Language development** ## Stages of Development: - **Prenatal period:** From Conception to Birth. - **Embryonic:** Conception to 8 weeks. - **Fetal:** 8 weeks to birth (40 - 42). - **Infancy period:** Birth to 12 months. - **Neonatal (newborn):** Birth 28 days (month). - **Infancy stage:** 1 to approximately 12 months. - **Early childhood:** 1 to 6 years. - **Toddler:** 1-3 years. - **Preschool:** 3-6 years. - **Middle childhood:** 6 to 11 or 12 years. Often referred to as “school age.” - **Late childhood:** 11 to 18 years. - **Prepubertal:** 10-13 years. - **Adolescence:** 13 to approximately 18 years (20 or 21 or 24 years in some countries). # Growth and Development of Newborn Stage This is the transition from intrauterine to extrauterine. It is from birth to 28 days. ## Physical growth - **Weight:** At birth: 2700-4000g, average: 3400g. - Newborn loss 5% to 10% of the birth weight by 3-4 days of age because: - Loss of excessive extracellular fluid - Pass of meconium and urine - Withdrawal of hormone from mother. The birth weight is regained by the tenth day of life. Gains 3/4kg by the end of the first month. - **Length:** Length of newborn is measured from the top of head to the heel. It varies from 48-53cm. - **Head circumference:** Range from 33 to 35.5cm. - **Fontanels:** - **Anterior fontanel:** Diamond shaped and it is located at the juncture of the two parietal bones and two frontal bones. It is 2-3cm in width and 3-4cm in length. It closed at 12-18 months of age. - **Posterior fontanel:** Triangular in shape and it is located between the occipital and parietal bones. It closes at the end of the first month. Both fontanels could be felt by palpitation. - **Chest circumference:** Range from 30.5 to 33 cm ## Two conditions may appear in the head - **Caput succedaneum:** An edematous swelling on the presenting portion of the scalp of an infant during birth, caused by the pressure of the presenting part against the dilating cervix. Caput succedaneum does not usually cause complications, and usually resolves over the first few days. Management consists of observation only. - **Cephalhematoma:** A subperiosteal collection of blood secondary to rupture of blood vessels between the skull and the periosteum, in which bleeding is limited by suture lines (never cross the suture lines). ## Eyes - **Eyelids:** Usually edematous. - **Color:** Slate gray, dark blue, brown, true color is not determined until the age of 3-6 months. Absence of tears. - **Corneal reflex:** In response to touch. - **Pupillary reflex:** In response to light. - **Blink reflex:** In response to light or touch. ## Ears: - **Pinna:** Is flexible, & cartilage present. - **Position:** Using a horizontal line passing through the inner canthi of the eyes, the portion of the ear should be located above this line. ## Nose: - **Ensure nasal patency:** Through observation of water condensation on the metal surface of a stethoscope. Nasal discharge appears in the form of thin white mucous. - **Mouth & throat:** Intact, high arched palate, with the oral cavity containing minimal salivation. - **Neck:** Short, thick, usually surrounded by skin folds. ## Chest: - **Bell shape:** At birth, the same circumference as abdomen and about 2-3 cm less than head. - **Thorax:** Is circular, not use thoracic cage in breathing, but use diaphragm and abdominal muscle. - **Lungs:** Respirations chiefly abdominal. - **Cough reflex:** Absent at birth; may be present by 1-2 weeks, bilateral equal bronchial breath sounds. ## Heart: - **Apex:** Fourth to fifth intercostal space, lateral to left sternal border. ## Abdomen: - **Cylindrical** in its shape. ## Female genitalia: - **Labia and clitoris:** Usually edematous. - **The labia minora:** can be quite swollen in newborn girls because of the passage of female hormones across the placenta. - **The swelling:** Will resolve in 2 to 4 weeks. - **Urethral meatus:** Behind clitoris - **Vernix caseosa:** Between labia - **Urination:** Within 24 hours. ## Male genitalia: - **Urethral opening:** At tip of glans penis - Testes palpable in each scrotum. - **Scrotum:** Usually large, edematous, pendulous and covered with rugae; usually deeply pigmented in dark-skinned ethnic groups. - **Urination:** Within 24 hours. ## Back and rectum: - **Spine:** Intact, no openings, masses or prominent curves. - **Anal reflex:** Patent anal opening. - **Passage of meconium:** Within 48 hrs. ## Extremities: - **Ten fibers and toes** - **Full range of motion** - **Nail beds:** Pink with transient cyanosis immediately after birth. - **Creases:** On anterior two thirds of sole. - **Sole:** Usually flat. - **Symmetry:** Of extremities. - **Equal muscle tone:** Bilaterally, especially resistance to opposing flexion. - **Equal bilateral brachial pulses.** ##Neuromuscular System: - **Extremities:** Usually in some degree of flexion. Extension of an extremity followed by previous position of flexion. - **Head lag:** While sitting, but momentary ability to hold head erect. - **Ability to turn head:** From side to side when prone. - **Ability to hold head:** In a horizontal line with back when held prone. ## Physiological Growth: - **Vital signs (temperature, pulse and respiration)** will be altered with internal or external stimuli. - **Temperature:** 36.5 to 37.6°C - **Pulse:** 120-160 beat minute. - **Respiration:** 30-50 / minute. Usually irregular in depth, rhythm and rate. ## Special senses - **Sight:** The neonate’s head turns towards light, and the neonate blinks and closes his or her eyes at bright light. - **Hearing:** New born stop crying at the sound of soothing voice, and cries at a loud noise. - **Smell:** Newborn turns away from smells such as vinegar, alcohol. He accepts sweet fluids and resists acid. - **Touch:** Sensitivity to touch is present from birth, particularly in the lips and tongue. ## Skin characteristics: - **General description:** - At birth, bright red, puffy, smooth. - Second to third day, pink, flaky, dry - Edema around eyes, face legs, dorsa of hands, feet, and scrotum or labia - Acrocyanosis-Cyanosis of hands and feet. - **1) Vernix caseosa:** A cheese-like, greasy, yellowish-white substance that may thickly cover the skin of the newborn, or it may be found only in the body creases and between the labia. - **2-Languo hair:** A slight downy distribution of fine hair over the body, most evident on the shoulders, back, extremities, forehead and temples, which disappears during the first weeks of life. The more premature baby is, the heavier the presence of lanugo is. - **3) Mongolian spots:** Black coloration on the lower back, buttocks, anterior trunk, & around the wrist or ankle. They usually disappear during preschool years without any treatment. - **4-Desquamation:** Peeling of the skin over the areas of bony prominence that occurs within 2-4 weeks of life because of pressure and erosion of sheets. - **5-Milia:** Small white or yellow pinpoint spots. Common on the nose, forehead, & chin of the newborn infants due to accumulations of secretions from the sweat & sebaceous glands. ## Development: - **(1) Motor development:** - **a. Movements:** Are rapid, diffuse and varied. - **b. They:** Are reflex action. Whole body is involved in his movement for relief of pain, hunger or discomfort. - **Assessment of reflexes in newborn:** - **Mouth and throat:** Sucking reflex, gag reflex, rooting reflex, extrusion reflex, and cough reflex - **Eyes:** Blinking or corneal reflex. Pupillary reflex. - **Nose:** Sneeze reflex. - **Extremities:** Crawl reflex, dance or step reflex, grasp reflex: Palmer and plantar grasp, planter grasp, Babinski reflex. ### a-Gross motor development: - The newborn can raise head (chin) up in prone position i.e., when placed on his abdomen. - He can turn head a side when prone. - He can push his feet against a hard surface to moving himself forward. ### B-Fine motor development - He does not reach with his hand, but can grasp and object placed in this hand, and drops it immediately (grasp reflex). - **2-Emotional development:** The newborn expresses his emotions just through crying for hunger, pain, or discomfort. - **3-Intellectual Development:** It is difficult to understand or observe it. ### 4-Social Development: - The newborn is socialized through vocalization, which is mainly crying. - The newborn is egocentric and depends on persons to meet his needs. Therefore, if cries bring to him a pleasant sensation, he learns through conditioning. I.e. crying means he gets the adult’s attention; so whenever he needs the adult's attention, he will cry. ## Needs of a newborn - Clear airway - Warmth - Protection from infection - Love and security - Nutritional needs