W1-1 Growth and Development I - Lecture PDF

MODULE: CHILDREN’S HEALTH (MED 7710) LECTURE: GROWTH AND DEVELOPMENT I  OBJECTIVES To differentiate growth from development Discuss the different aspects of development in pediatrics (per age group) – Neonatal Period, Infancy, Toddler, Preschool Period Integrate the...

MODULE: CHILDREN’S HEALTH (MED 7710) LECTURE: GROWTH AND DEVELOPMENT I  OBJECTIVES To differentiate growth from development Discuss the different aspects of development in pediatrics (per age group) – Neonatal Period, Infancy, Toddler, Preschool Period Integrate the developmental milestones of pediatric patients Growth Refers to an increase in physical size of the whole body or any of its parts. It is simply a quantitative change in the child’s body. Child Growth (WHO) Changes in bodily proportions with age Development Refers to a progressive increase in skill and capacity of function Qualitative change in the child’s functioning Occurs in an orderly and predictable manner that is determined intrinsically.  Growth vs Development Physical growth is an increase in size. Development is growth in function and capability. Both processes highly depend on genetic, nutritional, and environmental factors. Development Proceeds from cephalic to caudal and proximal to distal From generalized reactions to stimuli to specific, goal-directed reactions that become increasingly precise. Extrinsic forces can modulate the velocity and quality of developmental progress. Development proceeds from cephalic to caudal and proximal to distal Arm movement comes under cortical direction and visual guidance before leg movement. – With this, the child progresses from hand-mouth to foot-mouth play. – The upper extremities become increasingly accurate in reaching, grasping, transferring, and manipulating. – Distal development is seen when the infant can isolate and use the index finger to poke and explore object parts. Growth Pattern  Growth Patterns The child’s pattern of growth is in a head-to-toe direction, or cephalocaudal, and in an inward to outward pattern called proximodistal. Types of growth and development Types of growth: - Physical growth (Ht, Wt, head & chest circumference) - Physiologic growth (vital signs …) Types of development: - Motor development - Cognitive development - Language development - Emotional development - Social/Behavioral development  Stages of Growth and Development Infancy Middle Childhood – Neonate – School age Birth to 1 month – 6 to 12 years – Infancy 1 month to 1 year Late Childhood Early Childhood – Adolescent – Toddler – 13 years to approximately 1-3 years 18 years – Preschool 3-6 years Neonatal stage Newborn stage is the first 4 weeks or first month of life. It is a transitional period from intrauterine life to extra uterine environment.  Normal Newborn Infant Physical growth - Weight = 2.700 – 4 kg - Wt loss 5% -10% by 3-4 days after birth - Wt gain by 10th day of life - Gain ¾ kg by the end of the 1st month Height/Length Boys average Lt = 50 cm Girls average Lt = 49 cm Normal range for both (47.5- 53.75 cm) Head circumference 33-35 cm Head is ¼ total body length Skull has 2 fontanels (anterior & posterior) Physiologic growth Vital signs - Temperature (36.5 to 37.5C) - Pulse (120 to 160/min) - Respiration (30 to 60/min) Simulation for vital signs Normal Newborn Infant  Gross Motor Development Motor development: The newborn's movements are random, diffuse and uncoordinated. Reflexes carry out bodily functions and responses to external stimuli. Fine motor development Holds hand in fist When crying, he draws arms and legs to body  NEONATAL PERIOD (1ST 4 WK) Prone: Lies in flexed attitude; turns head from side to side; head sags on ventral suspension Supine: Generally flexed and a little stiff Visual: May fixate face on light in line of vision; “doll’s-eye” movement of eyes on turning of the body Reflex: Moro response active; stepping and placing reflexes; grasp reflex active Social: Visual preference for human face  Reflexes Swallowing Gagging Sucking Grasp Tonic-neck One month-Reflexes  Cognitive development The cognitive development of newborn infant is difficult to understand or observe.  Emotional development The newborn infant expresses his emotion just through cry for hunger, pain or discomfort Infancy Infancy It is the period which starts at the end of the first month up to the end of the first year of age. Growth and development during this period are rapid.  Total brain volume doubles in the 1st yr of life and increases by an additional 15% over the 2nd yr. Total brain volume at age 1 mo is approximately 36% of adult volume but by age 1 yr is approximately 72% (83% by 2 yr) Myelination of the cortex begins at 7-8 mo gestation and continues into adolescence and young adulthood.  2 to 6 MONTHS Between 3 and 4 mo of age, the rate of growth slows to approximately 20 g/day. By age 4 months, birth weight is doubled. Increasing control of truncal flexion makes intentional rolling possible.  6 to 12 MONTHS Growth slows more By the 1st birthday, birth weight has tripled, length has increased by 50%, and head circumference has increased by 10 cm. The ability to sit unsupported (6-7 mo) and to pivot while sitting (around 9-10 mo) provides increasing opportunities to manipulate several objects at a time and to experiment with novel combinations of objects.  6 to 12 MONTHS These explorations are aided by the emergence of a thumb–finger grasp (8-9 mo) and a neat pincer grasp by 12 mo. Motor achievements correlate with increasing myelinization and cerebellar growth.  Physical growth of normal infant Weight : the infant gains : - Birth to 4 months → ¾ kg /month - 5 to 8 months → ½ kg / month - 9 to 12 months → ¼ kg /month The infant will double his birth weight by 4-5 months and triple it by 10-12 months of age  Calculating infant’s ideal body weight Infants from 3 to 12 months: Weight = Age in months + 9 2 Dentition Eruption of teeth starts by 5–6 months of age. It is called "Milk teeth" or "Deciduous teeth" or “temporary teeth".  Gross motor development proceeds from a sequence of prone milestones (beginning with head up and ending with rolling), to sitting, and then through a standing/ambulating sequence  Fine Motor Development In the first year of life, fine motor development is highlighted by the evolution of a pincer grasp. In the early months, the upper extremities assist with balance and mobility. As balance in the sitting position improves and the infant assumes biped mobility, the hands become more available for manipulation of objects—their ultimate function.  AT 1 MONTH Prone: Legs more extended; holds chin up; turns head; head lifted momentarily to plane of body on ventral suspension Supine: Tonic neck posture predominates; supple and relaxed; head lags when pulled to sitting position Visual: Watches person; follows moving object Social: Body movements in cadence with voice of other in social contact; beginning to smile  AT 2 MONTHS Prone: Raises head slightly farther; head sustained in plane of body on ventral suspension Supine: Tonic neck posture predominates; head lags when pulled to sitting position Visual: Follows moving object 180 degrees Social: Smiles on social contact; listens to voice and coos  Head Control Newborn Age 6 months  AT 4 MONTHS Prone: Lifts head and chest, with head in approximately vertical axis; legs extended Supine: Symmetric posture predominates, hands in midline; reaches and grasps objects and brings them to mouth Sitting: No head lag when pulled to sitting position; head steady, tipped forward; enjoys sitting with full truncal support Standing: When held erect, pushes with feet Adaptive: Sees raisin, but makes no move to reach for it Social: Laughs out loud; may show displeasure if social contact is broken; excited at sight of food  At 5 months, the infant can: Balance head well when sitting. Sit with slight support. Pull feet up to mouth when supine. Grasp objects with whole hand (Rt. or Lt.). Hold one object while looking at another  At 6 months, the infant can: Sit alone briefly. Turn completely over (abdomen to abdomen). Lift chest and upper abdomen when prone. Hold own bottle.  AT 7 MONTHS Prone: Rolls over; pivots; crawls or creep-crawls (Knobloch) Supine: Lifts head; rolls over; squirms Sitting: Sits briefly, with support of pelvis; leans forward on hands; back rounded Standing: May support most of weight; bounces actively Adaptive: Reaches out for and grasps large object; transfers objects from hand to hand; grasp uses radial palm; rakes at raisin Language: Forms polysyllabic vowel sounds Social: Prefers mother; babbles; enjoys mirror; responds to changes in emotional content of social contact  At 8 months, the infant can: Sit alone steadily. Drink from cup with assistance. Eat finger food that can be held in one hand.  At 9 months, the infant can: Rise to sitting position alone. Crawl (i.e., pull body while in prone position). Hold one bottle with good hand-mouth coordination  AT 10 MONTHS Sitting: Sits up alone and indefinitely without support, with back straight Standing: Pulls to standing position; “cruises” or walks holding on to furniture Motor: Creeps or crawls Adaptive: Grasps objects with thumb and forefinger; pokes at things with forefinger; picks up pellet with assisted pincer movement; uncovers hidden toy; attempts to retrieve dropped object; releases object grasped by other person Language: Repetitive consonant sounds (“mama,” “dada”) Social: Responds to sound of name; plays peek-a-boo or pat-a-cake; waves bye-bye  AT 1 YR Motor: Walks with one hand held; rises independently, takes several steps (Knobloch) Adaptive: Picks up raisin with unassisted pincer movement of forefinger and thumb; releases object to other person on request or gesture Language: Says a few words besides “mama,” “dada” Social: Plays simple ball game; makes postural adjustment to dressing  Emotional Development His emotions are instable, where it rapidly changes from crying to laughter. His affection for or love family members appears. By 10 months, he expresses several beginning recognizable emotions, such as anger, sadness, pleasure, jealousy, anxiety and affection. By 12 months of age, these emotions are clearly distinguishable.  Social development He learns that crying brings attention. The infant smiles in response to smile of others. The infant shows fear of stranger (stranger anxiety). He responds socially to his name.  Language Milestones 1-2 months: coos 2-6 months: laughs and squeals 8-9 months babbles: mama/dada as sounds 10-12 months: “mama/dada specific 18-20 months: 20 to 30 words – 50% understood by strangers 22-24 months: two word sentences, >50 words, 75% understood by strangers 30-36 months: almost all speech understood by strangers TODDLER Toddler Toddlers  Toddler Stage Between 1 to 3 years of age. During this period, growth slows considerably.  12 to 18 MONTHS The toddler continues to experience considerable brain growth and myelination in the 2nd yr, resulting in an increase in head circumference of 2 cm over the year Toddlers have relatively short legs and long torsos, with exaggerated lumbar lordosis and protruding abdomens. Growth in length continues at a steady rate Most children begin to walk independently at around 12-15 mo of age.  18 to 24 MONTHS Motor development during this period is reflected in improvements in balance and agility and the emergence of running and stair climbing. Height and weight increase at a steady rate during this year, with a gain of 5 in and 5 lb. By 24 mo, children are about half of their ultimate adult height. Head growth slows slightly. 85% of adult head circumference is achieved by age 2 yr, with just an additional 5 cm gain over the next few years  Physical growth Weight: The toddler's average weight gain is 1.8 to 2.7 kg/year. Formula to calculate normal weight of children over 1 year of age: (Age in years x 2) + 8 = ….. kg Height: During 1–2 years, the child's height increases by 1cm/month. The toddler's height increases about 10 to 12.5cm/year.  Formula to calculate normal height (Age in years x 5) + 80 = ____ cm. e.g., the length of a 2 year old child = (2 x 5) + 80 = 90cm  Fine Motor Development During the second year of life, the infant learns to use objects as tools during functional play. Fine motor skills are assessed by observing the manner in which the hands use objects as tools (eg, blocks to build and crayons to draw).  15 MONTHS Motor: Walks alone; crawls up stairs Adaptive: Makes tower of 3 cubes; makes a line with crayon; inserts raisin in bottle Language: Jargon; follows simple commands; may name a familiar object (e.g., ball); responds to his/her name Social: Indicates some desires or needs by pointing; hugs parents  18 MONTHS Motor: Runs stiffly; sits on small chair; walks up stairs with 1 hand held; explores drawers and wastebaskets Adaptive: Makes tower of 4 cubes; imitates scribbling; imitates vertical stroke; dumps raisin from bottle Language: 10 words (average); names pictures; identifies 1 or more parts of body Social: Feeds self; seeks help when in trouble; may complain when wet or soiled; kisses parent with pucker  24 MONTHS Motor: Runs well, walks up and down stairs, 1 step at a time; opens doors; climbs on furniture; jumps Adaptive: Makes tower of 7 cubes (6 at 21 mo); scribbles in circular pattern; imitates horizontal stroke; folds paper once imitatively Language: Puts 3 words together (subject, verb, object) Social: Handles spoon well; often tells about immediate experiences; helps to undress; listens to stories when shown pictures  30 MONTHS Motor: Goes up stairs alternating feet Adaptive: Makes tower of 9 cubes; makes vertical and horizontal strokes, but generally will not join them to make cross; imitates circular stroke, forming closed figure Language: Refers to self by pronoun “I”; knows full name Social: Helps put things away; pretends in play  36 MONTHS Motor: Rides tricycle; stands momentarily on 1 foot Adaptive: Makes tower of 10 cubes; imitates construction of “bridge” of 3 cubes; copies circle; imitates cross Language: Knows age and sex; counts 3 objects correctly; repeats 3 numbers or a sentence of 6 syllables; most of speech intelligible to strangers Social: Plays simple games (in “parallel” with other children); helps in dressing (unbuttons clothing and puts on shoes); washes hands  Issues in parenting – toddler (Emotional Development) Stranger anxiety – should dissipate by age 2 ½ to 3 years Temper tantrums: occur weekly in 50 to 80% of children – peak incidence 18 months – most disappear by age 3 Sibling rivalry: aggressive behavior towards new infant: peak between 1 to 2 years but may be prolonged indefinitely Thumb sucking Toilet Training  Cognitive development Up to 2 years, the toddler uses his senses and motor development to different self from objects. The toddler from 2 to 3 years will be in the pre- conceptual phase of cognitive development (2-4 years), where he is still egocentric and can not take the point of view of other people.  Social development The toddler is very social being but still egocentric. He imitates parents. Notices sex differences and knows own sex. According to Erikson, The development of autonomy during this period is centered around toddlers increasing abilities to control their bodies, themselves and their environment i.e., "I can do it myself". Pre-School  Preschool stage Child is 3 to 6 years of age. Growth during this period is relatively slow.  Physical Development Somatic and brain growth slows by the end of the 2nd yr of life, with corresponding decreases in nutritional requirements and appetite, and the emergence of “picky” eating habits. Increases of approximately 2 kg (4-5 lb) in weight and 7-8 cm (2-3 in) in height per year  Physical Development Birthweight quadruples by 2.5 yr of age. An average 4 yr old weighs 40 lb and is 40 inches tall. The head will grow only an additional 5-6 cm between ages 3 and 18 yr. Physical growth: Weight: The preschooler gains approximately 1.8kg/year. Height: He doubles birth length by 4–5 years of age.  48 MONTHS Motor: Hops on 1 foot; throws ball overhand; uses scissors to cut out pictures; climbs well Adaptive: Copies bridge from model; imitates construction of “gate” of 5 cubes; copies cross and square; draws man with 2-4 parts besides head; identifies longer of 2 lines Language: Counts 4 pennies accurately; tells story Social: Plays with several children, with beginning of social interaction and role-playing; goes to toilet alone  Fine Motor – Older Toddler 3 year old: copy a circle and a cross – build using small blocks 4 year old: use scissors, color within the borders 5 year old: write some letters and draw a person with body parts  Fine motor and cognitive abilities pre-school Buttoning clothing Holding a pencil Building with small blocks Using scissors Playing a board game Have child draw picture of himself  60 MONTHS Motor: Skips Adaptive: Draws triangle from copy; names heavier of 2 weights Language: Names 4 colors; repeats sentence of 10 syllables; counts 10 pennies correctly Social: Dresses and undresses; asks questions about meaning of words; engages in domestic role-playing Cognitive development Preschooler up to 4 years of age is in the pre- conceptual phase. He begins to be able to give reasons for his belief and actions, but not true cause-effect relationship. Emotional Development of Preschooler Fears the dark Tends to be impatient and selfish Expresses aggression through physical and verbal behaviors. Shows signs of jealousy of siblings.  Social development in preschoolers Egocentric Tolerates short separation Less dependant on parents May have dreams & nightmares Attachment to opposite sex parent More cooperative in play  Social development According to Erikson theory: The preschooler is in the stage where he develops a sense of initiative, Where he wants to learn what to do for himself, learn about the world And other people.  REFERENCES Kliegman, Robert et al., Nelson Textbook of Pediatrics 20th edition, 2015. Brown, Lloyd et al., Board Review Series (BRS) Pediatrics 2nd edition, 2018.  SUPPLEMENTAL READINGS Introduction to Growth and Development https://www.msdmanuals.com/professional/pe diatrics/growth-and- development/introduction-to-growth-and- development?query=growth%20and%20devel opment  INSTRUCTIONAL VIDEO Pediatrics - Growth and Development Milestones Review https://www.youtube.com/watch?v=ZG60nC3RJ wc