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Growth and development of children

This document discusses the critical aspects of growth and development in children, emphasizing the interplay between genetic and environmental factors. It outlines the various stages of growth, key developmental milestones, and the importance of continuous assessment to identify potential delays. Additionally, it highlights the role of nurses in understanding these processes to promote child health effectively.

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Presented by: Ms. Manisha Thakur Child Health Nursing
INTRODUCTION Growth is an essential feature of life of a child that distinguishes him/her from an adult.  The process of growth starts from the time of conception and continues until the child grows into a fully mature adult.
Cont…  Growth & Development are closely related to one another.  Each child is having individualized growth & development pattern.  Promotion of child health & care of child depends upon understanding of growth & development.  So, understanding of growth & development is necessary for nurses.
DEFINITION  Growth denotes a net increase in the size or mass of the tissues. It is largely attributed to the multiplication of cells and increase in the intracellular substance.  Development specifies maturation of functions. It is related to the maturation and myelination of the nervous system and indicates acquisition of a variety of skills for optimal functioning of the individual.  Maturation is an enhancement in ability & modification in behavior & ability to function at a maximum level. It also depend upon the genetic pattern.
Cont…  Differentiation is the process by which early cells & structures are systematically modified & altered to achieve specific & characteristic physical & chemical properties
FACTORS AFFECTING GROWTH AND DEVELOPMENT GENETIC FACTORS:  Phenotype : The parental traits are usually transmitted to the offspring. Thus, tall parents have tall children and so on.  Characteristics of parents: Parents with high I.Q. are more likely to have children with higher level of inherent intelligence. This is further enhanced because of a greater degree of environmental stimulation in homes of intelligent parents.
Cont…  Race: Growth potential of children of different racial groups is different to a varying extent.  Sex: Boys are generally taller and heavier than girls at the time of birth. At age of one year there is no perceptible difference in their length and weight as related to sex. The growth spurt occurs earlier in girls.  Biorhythm and maturation: Daughters often reach menarche at a similar age as their mother. They may have a similar length of menstrual cycle.
FACTORS AFFECTING GROWTH AND DEVELOPMENT  Genetic Disorders: Growth and Development are adversely affected by certain genetic disorders. E.g. Chromosomal abnormalities and gene mutation.  Children of multiple pregnancies: Ultimate growth of these children is related to the difference in birth weights of twins. Smaller newborn babies are likely to attain lower height and weight.
FACTORS AFFECTING GROWTH AND DEVELOPMENT Prenatal Period:  The fetus grows in the maternal environment in utero.  The health status of the mother has direct effect on the growth of the fetus. Maternal tobacco and alcohol abuse produces fetal growth restriction.  Average birth weight of infants born to mothers receiving nutrition supplements during pregnancy is higher than babies born to mothers who did not receive nutritional support in the antenatal period.
Cont…  Obstetric disorders retard fetal growth.  Certain drugs can be teratogenic.  Maternal rubella during first trimester of pregnancy can cause fetal malformations.
ENVIORNMENTAL FACTORS: Hormonal Influence on Growth:  Thyroxine: Human fetus secretes thyroxine from 12th week of gestation onwards. Its deficiency significantly retards the skeletal maturation of fetus. Administration of anti-thyroid drugs and iodides during the later part of pregnancy may induce fetal goiter and hypothyroidism.
 Insulin: It stimulates fetal growth. In mothers with overt or latent diabetes, the fetus is usually large with excessive birth weight. As maternal blood sugar is high, the fetal blood sugar is also elevated. This leads to hyperplasia of islets cells of fetal pancreas leading to excessive insulin secretion resulting in macrosomia.
Cont… Postnatal period: Environment experiences of the child after birth determine the pace and pattern of growth and development.  Nutrition: PEM, Anemia and vitamin deficiencies retard growth. Overeating and obesity accelerates somatic growth.  Infections and Infestations: Decreases growth.
Cont… Social factors:  Socioeconomic level: Children from families with high socioeconomic level usually have a superior nutritional state. They suffer from fewer infections because of more hygienic living conditions.  Climate: The velocity of growth may alter in different seasons and is usually high in spring and low in summer months. Infections and infestations are common in hot and humid climate.
Cont…  Emotional factors: Children from broken homes and orphanages do not grow and develop at an optimal rate. Anxiety, insecurity, lack of emotional support and love from family prejudice the neurochemical regulation of the growth hormone. Children from broken homes and orphanages.  Cultural Factors: Methods of child rearing and infant feeding in community are determined by cultural habits and conventions. There may religious taboos against consumption of particular types of food stuffs. These affect the nutritional state and growth performance of children.
Cont…  Chemical Agents: Administration of androgenic hormones may affect growth.  Trauma: Fracture of the end of bone damages the growing epiphysis and thus hampers the skeletal growth. Head injury may cause brain damage and seriously jeopardize the mental development of a child.
GROWTH PERIOD  Prenatal Period:  Ovum : from conception to 2 weeks.(0 -14 days)  Embryo: 14 days to 8 weeks  Fetus: 8 weeks to birth (8-40 weeks)  Post natal period:  Perinatal: From birth to 1 week.  Neonate/ newborn: from birth to 4 weeks.(0-28 days)  Infancy: from birth to 1 year (1 month – 1 year)
GROWTH PERIODS  Toddler: 1-3 years  Pre school child: 3-6 years (early childhood)  School age: 6-12 yrs.( middle childhood)  Adolescence: from puberty to adulthood  Early adolescence : 12-14 years  Middle Adolescence: 14-16 years  Late adolescence: 16-20 years
PRINCIPLES/ LAWS OF GROWTH & DEVELOPMENT  Growth and development is a continuous and orderly process.  Growth pattern of every individual is unique.  Sequence of development is same but rate of development varies : Different tissues of body grow at different rates. Growth & development proceed by stages & its sequence is predictable & same in all children. There may be difference in time of achievement.
PRINCIPLES/ LAWS OF GROWTH & DEVELOPMENT  There is co-ordination between increase in size & maturation of organ & system.  They proceed in cephalocaudal (i.e from the head down to tail) & proximodistal (i.e. from center or midline to periphery) direction.  Growth proceeds from the center or midline of the body to the periphery in a proximo distal direction. Eg. During antenatal period the limb buds develop before the rudimentary fingers & toes.
PRINCIPLES/ LAWS OF GROWTH& DEVELOPMENT  Involuntary movements give way to voluntary responses.  Initial mass activities & movements are replaced by specific responses or actions by the complex process of individualized changes.(Simple to complex)  Progresses from dependence to independence.  Growth & development depend on combination of many interdependent factors especially by hereditary & environment.
PRINCIPLES/ LAWS OF GROWTH& DEVELOPMENT  Society has strong influence on child’s growth & development. Development is affected by cultural status.  There is a positive correlation between physical, mental, emotional development & they are interrelated.  Growth is sometimes rapid & at times it slows down.
ASSESSMENT OF GROWTH & DEVELOPMENT  Continuous & timely assessment of child’s growth parameters are very essential to find out the deviations, abnormalities & need for future care of children.  Assessment of physical growth can be done by :  Anthropometric measurement :weight, length/height, circumferences.
Cont…  Body mass index, body ratio, fontanel closure, skin fold thickness, dentition & bone age.  Nurses role is very important in these parameters for good evaluation.
INDICATIONS OF DEVELOPMENTAL ASSESSMENT  Follow up of high risk neonates for early detection of cerebral palsy and/or intellectual disability.  Complete evaluation of children with developmental, chromosomal or neurological disorders.  To differentiate children with retardation in specific fields of developmental opposed to those with global retardation.  Evaluation of children with learning disabilities.
Goal of Developmental Assessment  The goal of developmental assessment is not only to generate a diagnosis, but equally important to analyze the pattern of strengths and weaknesses in the child, family, and available developmental, educational, and social support systems, in order to direct treatment.  The maturation of central nervous system is characterized by coordination of motor activity and as infants grow they respond to their environment in a purposeful manner with the help of special senses (acoustic and auditory inputs), integrity of labyrinthine, vestibular and musculoskeletal systems.
CONT…  Children achieve neuro-motor milestones of development at predictable ages within a narrow range of few weeks or months.  Development is dependent upon interaction between innate genetic potential and environmental factors like emotional security, love and attention, stimulating home environment, optimal nutrition, ethnic and cultural factors.  Neuro-motor retardation may occur due to gestational immaturity, perinatal hypoxia, birth trauma, metabolic disorders (inborn errors of metabolism), hypoglycemia, kernicterus, intrauterine infections, postnatal CNS infections, hypothyroidism, developmental and chromosomal disorders.
Developmental Screening  The American Academy of Pediatrics recommends that all children be screened for developmental delays and disabilities during regular well-child doctor visits at:  9 months  18 months  24 or 30 months  Additional screening might be needed if a child is at high risk for developmental problems due to preterm birth, low birth weight, or other reasons.
CONT…  Developmental Screening Developmental delay  Developmental delay occurs in up to 15% of children under 5 years of age. This includes delays in speech and language development, motor development, social- emotional development and cognitive development.  It is has been estimated that only about half of the children with developmental problems are detected before they begin school.
Different Domains of Development  Gross motor development.  Fine motor development.  Social/ cognitive/ intellectual development.  Speech and language development.  Vision and hearing development.
AREAS OF DEVELOPMENT  Motor-development: depends upon maturation of muscular, skeletal & nervous system. It is usually termed as: • Gross motor development – involves control of child over his/her body by increasing mobility. It includes head holding, sitting, standing, walking, climbing stairs etc. • Fine motor development – depends upon neural tract maturation. Initial neurological reflexes are replaced by purposeful activities. It includes eye coordination, hand coordination & hand to mouth coordination.
 Language development: The first signs of communication occur when an infant learns that a cry will bring food, comfort, and companionship. Newborns also begin to recognize important sounds in their environment, such as the voice of their mother or primary caretaker.
AREAS OF DEVELOPMENT  Personal & social development : It includes personal reactions to his own social & cultural situation with neuromotor maturity & environmental stimuli. It is related to environmental and social skill as social smile, recognition of mother, use of toys, play & mimicry.  Sensory development: it depends upon myelination of nervous system & responds to specific stimuli as taste, smell, touch and hearing are initial senses present in newborn babies. The visual system is last to mature at 6-7 yrs.
 Intellectual development: depends upon genetic inheritance and environmental influences through mental maturation and achievement of intelligence.  Moral development: respect of rules & sense of justice.
AREAS OF DEVELOPMENT  Spiritual development  Emotional development.
Developmental Milestones 4 fields with a sequence of development  Gross Motor - the development of locomotion  Vision and fine manipulation - the development of eye- hand control  Hearing & speech - the development of language.  Personal & social - integration of acquired abilities to reflect understanding of environment.
Gross motor development “Locomotion” • Locomotion begins with head control. • The gross motor development is development is assessed by placing the babies in various postures and positions. They are:- • Ventral Suspension • Prone Position • Supine Posture and Sitting • Vertical Suspension, Standing and Walking
Assessing Locomotion S.no. Positions Months/years 1. Ventral suspension NB-3m 2. Sitting position NB-8m 3. Prone position NB-9m 4. Standing/forward walking 9m-18m 5. Running/backward walking 2 years 6. Balancing 3 years +
Ventral suspension The examiner suspends the infant in a prone position by supporting the abdomen of the baby on his palm. The extension of neck and flexion of the extremities is observed.
Cont…  4 weeks- 6 weeks  12 weeks newborn Head hang completely and back is rounded 4 weeks Head momentarily lifted up, elbow flexed 6 weeks Head held momentarily in the same plane as rest of the body 8 weeks Head maintained in same plane as that of the body and momentarily lifted beyond this. 12 weeks Head maintained well beyond the plane of the rest of the body
Prone Position Newborn Head is kept to one side, pelvis is raised, knees are drawn up under the abdomen.
Cont..  4-6 weeks- Hips and knees are partially extended, can lift chin off the couch momentarily.  8 weeks- Head maintained in midline with chin lifted off the couch.  16 weeks- Chest is maintained off the couch, arms are stretched out in full extension.  20 weeks- The body is supported on forearms.  24 weeks- Weight is supported on hands, and baby rolls prone to supine. Indian babies first learn roll from supine to prone because they are usually not nursed in a prone position.
Supine Position and sitting The infant is placed supine on the couch and pulled to sitting position by lifting at the forearms (traction response).
Cont….  Newborn- Complete head lag.  4 weeks- Head maintained in plane of the body momentarily when baby is held in a sitting position, back is rounded. Chin may be lifted up momentarily.  12 weeks- Head held up when supported in a position but it tends to bob (bend) forwards.  16 weeks- When pulled up, there is slight head lag during the beginning and then head is flexed beyond the plane of the body. When held in sitting position and baby is swayed (swung), the head wobbles.
Cont….  20 weeks- No head lag, head is stable without wobbling (shaking) and back is straight. 24 weeks When about to be pulled up, lifts head off the couch in anticipation. Can sit supported in a pram (baby carriage) or high chair.  28 weeks- Can sit on the floor with hands forward for support.  32 weeks- Can sit momentarily on the floor without support.  36 weeks- steadily without support and can lean forward and recover his balance.
Cont….  40 weeks- Can sit up from supine position.  48 weeks- Can turn side ways and twist around to pick up an object.
Vertical suspension, standing and walking  Newborn- Walking reflex for 2 to 3 weeks  8 weeks- Can hold head up more than momentarily  24 weeks- Puts almost all weight of the body on the legs  28 weeks- Bounces with pleasure  36 weeks- Pulls self to stand, can stand with support.  44 weeks- Lifts one foot while standing  48 weeks- Walks two hands held or on holding the furniture.  1 year- Walks few steps independently  15 months- Creeps upstairs, can kneel without support.
cont…  18 months –Run, can crawl up and down the stairs without help, pull a wheeled toy  2 years- Walks up and down the stairs with two feet on each step, walks backwards on imitation, picks up objects from floor without falling, runs, can kick a ball  2 ½ years- Can walk tiptoes, jumps on both feet  3 years- Goes upstairs with one foot on each step, jumps off the bottom step  4 years - Comes down stairs with one foot on each step, can skip on one foot  5years - Skips on both feet, can jump over low obstacles.
FINER MOTOR DEVELOPMENT  Newborn- Grasp reflex is present.  4 weeks- Hands mostly closed.  8 weeks- Hands kept open more often.  12 weeks- Hands mostly open, grasp reflex disappears, plays with rattle when it is placed in the hand.  16 weeks- Tries to reach objects but overshoots, hands come together during play.  20 weeks- puts objects into mouth, plays with toes.  24 weeks- Drops one object when other is given, holds rattle, picks up a cube with crude palmer grasp.
Cont…  28 weeks – transfer objects from one hand to other, feeds self with the biscuit, bangs object with each other.  40 weeks- Pincer finger thumb fine grasp to pick a pellet.  1 year- gives toy to examiner, puts one object after another into the basket.
 15 months- self feeds with the cup, builds tower of 2,3 cubes, holds two cubes in one hand.  18 months- can self feed with spoon, makes tower of 3, 4 cubes, turns 2-3 pages of a book at a time.
Cont…  3 years- makes tower of 9-10 cubes, can dress and undress, can manage buttons, can draw a circle.  4 years- copies a square and cross, make a bridge, can dress self completely, catches a ball.  5 years- copies a triangle, can tie shoe laces, can spread butter on the toast.
SOCIAL AND ADAPTIVE DEVELOPMENT  2 months –Social and interative smile.  3 months- Recognizes mother; anticipates feeds.  6 months- Recognizes strange/ stranger anxiety.  9 months- Waves ‘bye-bye’  12 months- Comes when called; plays simple ball game  15 months –Jargon speech  18 months- Copies parents in task
Cont…  2 years- Asks for food, drink, toilet; pulls people to show toys  3 years -Shares toys; knows full name and gender  4 years- Plays cooperatively in a group; goes to toilet alone  5 years- Helps in household tasks; dresses and undresses
LANGUAGE DEVELOPMENT MILESTONES  1 month- Turns head to sound.  3 months- Cooing 6 months Monosyllables (‘ma’, ‘ba’)  4 months- laugh loud  6 months- monosyllables  9 months- Bisyllables (‘mama’, ‘baba’)  12 months- Two words with meaning.  18 months- Ten words with meaning
Cont…  24 months- Simple sentence, 2-3 words sentence.  36 months- Telling a story  4 years- says song or poem  5 years- asks meaning of words
0-1 Year: Cognitive Skills  Responds to sounds (0-1 mo)  Inspects hands (2-3 mo)  Uses hands and mouth to explore objects (3-6 mo)  Can find a partially hidden object (4- 6 mo)  Brings feet to mouth (5-6 mo)  Attempts to obtain desired object that is out of reach (5-9 mo)
Cont…  Looks for familiar people/pets when named (6-8 mo)  Plays 2-3 minutes with one object/toy (6-9 mo)  Plays “peek-a-boo” (6-10 mo)  Responds to simple requests with gestures (7-12 mo)  Throws objects, understands “no” and responds (9-12 mo)  Enjoys looking at picture books (10-14 mo)
Developmental Delay  During periodic visits of the child to the physician for health assessment and immunization, the child should always be screened for behavioral development by a relatively simple method which could be performed rapidly and accurately even by a non-professional clinical assistant.
 If this behavioral assessment indicates delayed development, the child should be examined in detail to determine the cause for such delay.  A developmental delay should be suspected if a child is not able to perform the given tasks by the indicated ages.
CONT…  Developmental delay should be suspected if the child is not able to :  Pull up to sit by 4 months.  Roll over by 5 months.  Sit without support by 7-8 months.  Stand holding on by 9-10 months.  Walk by 15 months.  Climb up or down the stairs by 2 years.  Jump with both feet by 2.5 years.  Stand momentarily on one foot by 3 years.  Hop (step) by 4 years and walk in a straight line back and forth or balance on one foot for 5-10 seconds by 5 years.
ASSESSMENT OF MUSCLE TONE  Healthy newborn have physiological hypertonia and there is gradual reduction of muscle tone during 1st year of life.  Alterations in the muscle tone especially hypertonia is common in cerebral palsy.  Muscle tone should be assessed when baby is alert, wide awake, not crying and should lie in supine position with head in midline.
Body posture Square window Arm recoil Scarf sign
Heel to earPopliteal angle
DEVELOPMENTAL SCREENING TOOL  A no. of parent completed questionnaire are available for developmental screening like parents evaluation of developmental status(PEDS) and age and stages qustionnaire (ASQ).  A smiplified developmental tool for angan wadi has been introduced for 18-36 months of age for anganwadi workers.
INDIAN ORIGIN INTERNATIONAL ORIGIN  Trivandrum developmental screening chart.  Baroda developmental screening test.  ICMR psychosocial developmental screening test 1. Parents evaluation of developmental status. 2. Denver developmental screening test ii. 3. Bayley infant neuro- developmental screen (bins). 4. Ages and stages questionnaire DEVELOPMENTAL SCREENING TOOLS
TRIVANDRUM DEVELOPMENTAL SCREENING CHART  Designed and developed at the child cevelopment centre, govt. me  It is used for developmental screening of children below 2 years by paramedical health workers.  Administration time: 5-7 mins  It is based on 17 simple test items carefully chosen from 67 motor items of Bayley scales of infant development( baroda norms).
 A plastic ruler or a pencil is kept vertically to the level of chronological age of the child being tested.  If the child fails to pass any marker, the child is considered to have developmental delay.  Most suited for one year of age children.
BARODA DEVELOPMENTAL SCREENING TEST  The test was developed by Promila Phatak in 1991 at Department of Child Development, University of Baroda.  Items: 54  Age : 0-30 months  Screening domains: motor and cognitive  Dr. Pathak selected items from Baley Scale of Infant Development (1961)
 Age and format : 0-6 years and parent interview  Items: 64 items  Screening domains: gross motor, vision, hearing, fine motor, gross motor and social skills.  D:PEADITRICSGROWTH AND DEVELOPMENTSTUDY ICMR.pdf ICMR PSYCHOSOCIAL DEVELOPMENTAL SCREENING TEST
PARENTS EVALUATION OF DEVELOPMENTAL STATUS  Age and format: It includes o-8 years, parent report.  Screening domains: Cognitive, language, gross motor, social emotional behaviour.  Items included: 10
 PEDS questions cover:  speech and language  how your child gets along with others  learning for school (babies learn from the moment they are born and it is important to support parents to help children reach their full potential)  what your child can do for themselves  behavior  how your child uses their hands, fingers, arms and legs  health, and  how you think your child is going overall.
 PEDS is used by health and education practitioners by :  childcare centres.  preschools and kindergartens  child and family health centres.  community health centres.  general practice clinics  pediatric clinics  schools  early parenting centres.
 PEDS-brief-administration-and-scoring-guide.pdf
 DENVER DEVELOPMENTAL SCREENING TEST II The Denver Developmental Screening Test was introduced in 1967 to identify young children, up to age six, with developmental problems. A revised version, Denver II, was released in 1992 to provide needed improvements. Age and format: o-6 years , directly administered. Screening domains: cognitive, receptive, gross motor, fine motor, social, language, personal. Items included: 125
 DENVER 2
 Dr. Diane Bricker from the University of Oregon heeds the call to design economical, valid and culturally sensitive screening tools for young children at risk for developmental delays.  Age and format: 1-66/3-66 months, parent report.  Screening domains: communication, gross motor, fine motor, problem solving and personal adaptive skills.  Items: 22-36 AGES AND STAGES QUESTIONNAIRE
Feautres of ASQ  are available in Arabic, Chinese, English, French, Spanish, and Vietnamese  take just 10–15 minutes for parents to complete and 2–3 minutes for professionals to score  capture parents’ in-depth knowledge  highlight a child’s strengths as well as concerns  teach parents about child development and their own child’s skills  highlight results that fall in a “monitoring zone,” to make it easier to keep track of children at risk  can be completed at home, in a waiting room, during a home visit, or as part of an in-person or phone interview.
 Programs across the country rely on ASQ-3 because it’s  highly valid, reliable, and accurate  cost-effective  easy to score in just minutes  researched and tested with an unparalleled sample of diverse children  a great way to partner with parents and make the most of their expert knowledge  fun and engaging for kids
 There are two screeners in the ASQ family: 1. ASQ®-3, which looks at key areas of early development. 1-66 months for ASQ-3, 21 questions. 2. ASQ®:SE-2, which focuses on social-emotional development. 3-66 moths for ASQ:SE, 8 questions ASQ®-3 ASQ®:SE-2 1. Communication 2. Gross Motor 3. Fine Motor 4. Problem Solving 5. Personal-Social 1. Autonomy 2. Compliance 3. Adaptive functioning 4. Self-regulation 5. Affect 6. Interaction 7. Social-communication
 D:PEADITRICSGROWTH AND DEVELOPMENTAges and Stages 3 Master Set.pdf
BAYLEY SCALE OF INFANT DEVELOPMENT  BSID-II: Mental, Motor, and Behavior scales.  Bayley-III revision includes Cognitive, Language, Motor, Social-Emotional, and Adaptive Behavior scales.  Administration: 50 min for children aged 12 months and younger to 90 min for children aged 13 months and older.
 Bayley Scales of Infant and Toddler Development - individually administered instrument  assesses developmental functioning – infants & young children – between 1 month and 42 months of age  Five major areas of development 1. Cognitive 2. Communication 3. Motor 4. Social/Emotional 5. Adaptive
 Age and format: 3-24 months, directly administered.  Screening domains: neurological process, expressive and receptive, functional and cognitive.  Items: 11-13  The BINS was developed contemporaneously with the Bayley Scales of Infant Development—Second Edition (BSID-II)  It consists of items from the BSID-II Scales that assess cognitive, social, language, gross, and fine motor skills.
 The BINS consists of six item sets grouped by age (3 to 4 months, 5 to 6 months, 7 to 10 months, 11 to 15 months, 16 to 20 months, 21 to 24 months), each containing 11 to 13 items.  Basic neurological functions/intactness (posture, muscle tone, movement, asymmetries, abnormal indicators)  Expressive functions (gross motor, fine motor, oral motor/verbal)  Receptive functions (visual, auditory, verbal)  Cognitive processes (object permanence, goal-directedness, problem solving).  The total number of items failed places the infant in a category of low, moderate, or high risk for developmental delay.
 Each item in the BINS is scored “optimal” or “nonoptimal,” based on a priori decision rules; the number of optimal responses for a given item set are then added to provide a summary score.  The infant’s total score is then compared to the norms in order to classify the infant into low, moderate, or high risk for developmental delay or neurological impairment
“It is a smile of a baby that makes life worth living.”