Growth and Development in Children

GROWTH AND DEVELOPMENT
I. INTRODUCTION
Growth is an essential feature of life of a child that distinguishes him or her

from an adult. The process of growth starts from the time of conception and
continues until child grows into adult. The term “growth” and “development” are
often used together but they represent two different facets of the dynamics of
change, ie, quantity and quality. The growth and development of the human being
is a continuous process that begins before birth. Each state depends upon the
preceeding stages. The term developmental sequence means that these changes are
specific, progressive and orderly and lead eventually to maturely. All infants and
children progress similarly, but the ages at which they achieve these stages vary,
since achievement depends upon inherent maturational capacity interacting with
physical environment.
Growth and development usually proceed concurrently. While they are discussed
separately, both growth and development are closely related; hence, factors
affecting one also tend to have an impact on the other. During early embryonic
period of life, an exponential increase in the number of cells occurs. At the early
embryonic stage, fetal cells divide and differentiate to form tissues and organs. In
the later half of pregnancy and early childhood, there is also an increase in cell
size. This manifests as increase in the protein to DN A ratio. The cell size
continues to enlarge until about ten years of age. The body cells remain in a state
of dynamic equilibrium; hence aging cells are continuously replaced by new cells.
The rate of turnover of cells in different tissues is variable.
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II.DEFINITION
1.Growth: The term growth denotes a net increase in the size or mass of tissues. It
is largely attributed to multiplication of cells and increase in the intra cellular
substances.
2.Development: Development specifies maturation and myelination of the nervous

system and indicates acquisition of a verity of skills for optimal functioning of
individual.
3.Maturation: It is an increase in competence and change in behaviour and

ability to function at a higher and depending upon the genetic inheritance.
III. PRINCIPLES OF GROWTH AND DEVELOPMENT
1. Cephalocaudal principle
Development Proceeds from the Head Downward. This is called the

Cephalocaudal Principle. This principle describes the direction of growth
and development. According to this principle, the child gains control of the
head first, then the arms, and then the legs. Infants develop control of the
head and face movements within the first two months after birth. In the next
few months, they are able to lift themselves up by using their arms. By 6 to
12 months of age, infants start to gain leg control and may be able to crawl,
stand, or walk. Coordination of arms always precedes coordination of legs.
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2. Proximodistal principle
Development Proceeds from the center of the Body Outward This is
the principle of proximodistal development that also describes the direction
of development. This means that the spinal cord develops before outer parts
of the body. The child’s arms develop before the hands and the hands and
feet develop before the fingers and toes. Finger and toe muscles (used in fine
motor dexterity) are the last to develop in physical development.
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3. Development Depends on Maturation and Learning
The child maturation refers to the sequential characteristic of
biological growth and development. The biological changes occur in
sequential order and give children new abilities. Changes in the brain and
nervous system account largely for maturation.
These changes in the brain and nervous system help children to

improve in thinking (cognitive) and motor (physical) skills. Also, children
must mature to a certain point before they can progress to new skills
(Readiness). For example, a four-month-old cannot use language because the
infant’s brain has not matured enough to allow the child to talk. By two
years old, the brain has developed further and with help from others, the
child will have the capacity to say and understand words. Also, a child
cannot write or draw until he has developed the motor control to hold a
pencil or crayon. Maturational patterns are innate, that is, genetically
programmed.
The child’s environment and the learning that occurs as a result of the
child’s experiences largely determine whether the child will reach optimal
development. A stimulating environment and varied experiences allow a
child to develop to his or her potential.
4. Development Proceeds from the Simple (Concrete) to the More

Complex
Children use their cognitive and language skills to reason and solve
problems. For example, learning relationships between things (how things
are similar), or classification is an important ability in cognitive
development. The cognitive process of learning how an apple and orange
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are alike begins with the In Simplistic or concrete thought of describing the
two. Seeing no relationship, a Preschool Child will describe the objects
according to some property of the object, such as color. Such a response
would be, 'An apple is red (or green) and an orange is orange.’
The first level of thinking about how objects are alike is to give a
description or functional relationship (both concrete thoughts) between the
two objects. 'An apple and orange are round' and 'An apple and orange are
alike because you eat them' are typical responses of three, four and five year
olds.
As children develop further in cognitive skills, they are able to

understand a higher and more complex relationship between objects and
things; that is, that an apple and orange exist in a class called fruit. The child
cognitively is then capable of classification.
5. Growth and Development is a Continuous Process

 As a child develops, he or she adds to the skills already
acquired and the new skills become the basis for further
achievement and mastery of skills.
 Most children follow a similar pattern. Also, one stage of
development lays the foundation for the next stage of
development. For example, in motor development, there is a
predictable sequence of developments that occur before
walking.
 The infant lifts and turns the head before he or she can turn
over.
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 Infants can move their limbs (arms and legs) before grasping
an object. Mastery of climbing stairs involves increasing skills
from holding on to walking alone.
 By the age of four, most children can walk up and down stairs
with alternating feet As in maturation, in order for children to
write or draw, they must have developed the manual (hand)
control to hold a pencil and crayon.
6. Growth and Development Proceed from the General to Specific
In motor development, the infant will be able to grasp an object with the
whole hand before using only the thumb and forefinger.
The infant’s first motor movements are very generalized, undirected, and
reflexive, waving or kicking before being able to reach or creep toward an
object. Growth occurs from large muscle movements to more refined (smaller)
muscle movements.
IV. CHARECTERESTICS OF GROWTH AND DVELOPMENT
a) Development is similar for all: All children follow similar pattern of

development with one stage leading into the mint. Every child passes
through similar stages. For Eg: baby learns to stand before he walks,
similarly baby draws circle before a square.
b) Development proceeds from general to specific: In motor as well as

mental response, general activity always proceeds specific activity . Before
birth fetes moves the whole body but is incapable of making specific
momentary. Generalized body movements occur before fine motor control is
achieved. For Eg. First the infant moves the whole body movements in the
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womb and later starts moving his hands. Similarly infants more hands first
and them learn using fingers .
c) Development is continues : Development is a continues process starting

from conception and ending at death. It is continuous but sometimes rapid
and times slow. For Eg. Speech in a child does not develop all right, the
child coos, gurgles and makes sounds first and them slowly and gradually
learns words and then language develops.
d) Development proceeds at different rates: Growth and development is a

continuous process which is rapid at times and times slow down. Rapid
growth occurs during fetal life and improving and it slows down during
school age. A growth spurt occurs in puberty and early adolescence but its
slow down during adult hood and old age.
e) There is correlation in growth and development: Correlation in physical

and mental abilities is especially marked. There is a marked relationship
between sexual maturation and patterns of interest and behaviour.
f) Development come from maturation and learning: Sudden appearance of

certain trails that develop through maturation is quite common. For
example a baby may start walking overnight . Behavioural changes occur at
the time of puberty suddenly without any reason. Hearing comes from
excurses and efforts and part of an individual unless the child had
opportunity for learning many of his hereditary potential will never reach
their optimum development.
g) There are individual differences: Although pattern of development is

similar for all children, each child follows a predictable pattern in his own
way and at his own rate. Each child with his unique heredity and nature will
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progress at his own rate in terms of size, shape, capacity and development
stages.
h) Early development is more significant than rather development : If the
function of a building is strong, the building will be strong. Similarly
favourable conditions during infancy lead to growth of child with a healthy
adult.
i) Development proceeds in stages: Development is not abrupt, it proceeds in
stage that are as follows.
DEVELOPMENTAL CYCLE
from
conception to
birth
Birth to 4
13-18 years
weeks
four weeks to
6-12 years
1 year
3-6 years 1-3 years
j) There are predicable patterns of growth and development : Both during

prenatal and postnatal period growth and development follow two patterns.
1. Cephalocaudal - Development speeds over the body from head to foot.
2. Proximodistal - Development proceeds from near to far, in from central aims
of body towards the periphery or extremities
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V. PURPOSES OF ASSESSING GROWTH AND DEVELOPMENT
1. To identify the Developmental delay: The assessment of growth and

development is mainly doing for the purpose checking any developmental delay
is their in the children. The child is gaining weight and height at appropriate
time and to determine whether any delay in that. So that the early detection of
the problem can be done and proper remedies can be taken.
2. To identify strength and developmental needs: The assessment can be

done to identify the strength and needs of the child. It is a process of acquiring
variety of competencies for the optimal functioning in the society. While doing
assessment the nurse understand the needs of the child.
3. To develop strategies for intervention: Development is qualitative as well

quantitative change. If developmental delay is recognized early, intervention to
reduce long term sequele can be started early. So that for some extend the
problem can be solved earlier.
4. To serve as a basis for reporting to parents: It is important to monitor

growth and development at every stage. A child is said to have developmental
delay if the child does not reach the expected developmental milestones for the
age. Parents especially mothers need an awareness regarding each stages of
development, to assess whether the child is attaining the growth at correct time.
If they noticed the growth delay earlier then accurate measures can be taken at
correct time.
5. To determine the progress: It helps to look the child’s progress in all the
areas of development. The development can be done by achievement listed for
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the normal children with the data collection. If any abnormalities should be
noted and take for consideration.
VI.ASPECTS OF GROWTH AND DEVELOPMENT
Growth and development have the following aspects.
Growth Development
Biologic
Intellectual
growth
Sensory
Moral
growth
Motor
Emotional
growth
Sexual
Social
Language
A) Growth
i. Biological growth
Changes in body result from growth of difficult parts of body. The main
parameters for assessing growth in children are following
a) Length or height
Length or height increases from birth to maturity. Rapid increase in height

occurring during infancy and adolescence . The arrange length of a newborn is 45-
50 cm. AT the age of 1 year length is 75 cm. the height of the infant doubles at the
age of 4 years.
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b) Weight
Weight is the best index of health and maturational status of children. The average
weight of a newborn is 2.5-3.5 kg. Thus is initially loss of weight during first 10
days of life due to adjustment of extra uterine life inadequate feeds and digestive
adaptation. The baby to double his/her weight by about age of 5 months. By one
year of age the baby will weight about 3 times birth weight.
c) Head circumference
The head circumference is in important measurement it is related to intractional

volume. An in head circumference indicates the rate of brain growth.
d) Chest circumference
The chest is shaped at birth and the anterior posterior and transverse diameters are
equal her ducally the transverse diameter increases reansing width to become
greater than the anterio posterior diameter.
e) Motor growth
Motor development depends on maturation of nuclear, skeletal and nervous

system. The motor development follows cephalocaudal and proximodistal pattern.
Motor development is of two types.
f) Gross Motor
Gross motor development leads to acquisition of increasing mobility and

independent movements gross motor activities include tuning sitting standing and
walking.
g) Fine motor
Fine motor development leads to acquisitions of motor directly like use of hand
and fingers palmar grasp and release, pincel grasp etc..
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h) Sensory growth
Although sensory system is functional at birth, the child gradually learns the
process of associating meaning with a perceived stimulus. Most active senses at
birth are sense of taste and smell. As myellinization of nervous system, the child is
able to respond to specific stimuli. The visual system is last to nature at about 6-7
years of age.
B) Development
Many theories have been devised to student development of different aspects in

children
1. Intellectual development theory in children

2. Moral development theory by jean piaget
3. Psychosocial Development theory by Eric H Erikson
4. Spiritual development theory by james W Folex
5. Sexual Development theory by Sigmund Frend
6. Emotional development theory by Eric H Erikson
VII.THEORIES OF GROWTH DEVELOPMENT
1. INTELLECTUAL DEVELOPMENT
Mental development is demonstrated in problem solving and in general

understanding of what to do in a given situation. It is important to let children
solve problems that they can by themselves and to teach them how to solve the
problems that are within their abilities but for which they lack necessary
experience and practice. Also problems which are too difficult for them should
be solved for them.
According to piaget (Gruber voneche, 1977) maturation and growth have

certain sign posts. Although newborn babies perceives the world as a vague mass,
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the child gradually, develop in integration or coordination of various sensory
infants from touch, taste smell, sign and sound into an organized and objection
understanding of reality. Also the child does not understand that objects which
cannot be seen still exist. The adult knows that house is there even when the hones
is not present to be observed. To a young child the concept of constancy slowly.
The ability to use symbols to represent reality is another important stage in

development. The use of symbol leads to language development in child.
2. MORAL DEVELOPMENT
Piaget and Kohlberg gave their theories discussing the complicated process
by which values are formed how they affect behaviour and how they are changed
through experience
Kohlberg’s theory of normal development
Kohlberg believed that development of moral reasoning occurs step by step in

sequence. Kohlberg postulated sin stages of potential normal development
organized within 3 types pre conventional morality, environmental morality and
post environmental morality
Level I: pre conventional / Morality : Ego – children make moral judgements

only on the basis of what will bring them reward. This level is admixed in 3
stages.
a) Stage 0 (0-2 yrs) : In this stage the child feels that good is want and bad is
what hurts
b) stage 1 (2-3yrs) :This stage is punishment – obedience oriented. The older to
older and preschool children believe that if they are not punished, the act
was right and if they all punished the act was wrong.
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c) Stage 2 (4-7 yrs): Instrumental Hedonism and in this stage child consider
those actions right that meet own needs or those of others. They rules to
satisfy themselves or because what others might do or thinks if they do not
them out.
Level 2Conventional Morality: In this stage children think that correct behaviour
is that, which those in authority approve and accept in this level three is 1 stage
d) Stage 3 (7-9 yrs): orientation to interpersonal relationship occur in this age.

Children at early school age are becoming socially sensitive so they try to
do actives with the help of parents, peers or teachers
Level 3 : Post conventional morality : Adolescents make choices on the bring

of principles that are thought to them about acceptable behaviours. The level
includes two stage.
e) Stage 4: Higher laws and conscience orientation- Adolescents follow

culturally appropriate values and perform actions that benefit the society
involving good for all
f) Stage 5: Universal ethical principle orientation this is the height level of
moral values and standards Adolescents develop internalization standards
and self actualization
3. PSYCHOSOCIAL DEVELOPMENT
The theory of Erikson concerning ‘Psychosocial development’ states that

emotional or personality development is continuous process which has the
following stages.
1. Trust / Mistrust : Infant learn the adults, usually the presents who care for
them and are sensitive to their needs
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2. Authority/ shame: Infants develop from dining dependent creators into
individuals with mind and will of there own
3. Initiation/ guilt: This is a period of very energetic play and active
imagination. The child can develop a sense of accomplishment and
satisfaction in his or her activities
4. Industry/ inferiority : Children in this age have a strong sense of duty. This
energy is cancelled into activates such as school projects, sports and hobbies
5. Identify/ role diffusion: two major facts for adolescents are iguring out who
they are and what is their place in the world
6. intimacy/ self- absorption – absorption: in the stage the adolescent process
on forming intimate relationship with others. They develop a sense of
intimacy with peers
4. SPIRITUAL DEVELOPMENT
Religious belief are based on theories of atheism or agnosticism. Flower

(1974, 80,83) has given stage theory of faith which parallels the normal
development process proposed by piget and kohlberg. According to flower faith is
an ongoing universal feeling that is expressed traditions. It is multidimensional
and in way of learning about life. As described by flower, faith is an ongoing
process in which individuals from and reform their way of serving the world.
Stage I Primal Faith (infancy)
Paralinguistic and preconception this stage embodies trust between parents and
infants parents and child form mutual attachment and progress through a period of
growth.
Stage II: intuitive – projective faith (3-7 yrs)
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This stage is characterized by child forming long lasting images and feelings.
Imagination, perception and feelings the mechanism by which child explores and
learns about the world at large.
Stage III. Mythic- Literal faith (childhood and beyond)
Beginning at about age of 7 years, children belief are derived from perspective of
others. During this stage they are later to differntiate them thinking from that of
others.
Stage IV: Synthetic – Conventional faith (Adolescence)
In this stage person experience extenders beyond the family to peers, teachers and
other members of society. As a result of cognitive abilities the individual becomes
aware of emotions, personality patterns ideas thought and experience of self and
others.
5. PSYCHOSEXUAL DEVELOPMENT
In accordance with the view that basic human motivation is sexual drive Sigmund
Fraud developed a psychosexual theory of human development from infancy
onward, divided into series of psychosexual stages.
1. Oral Stage:
This stage expands from zero to one-and-a-half years. During this period mouth is
the sensitive zone of the body and the main source of joy and pleasure for the
child. How the infant is being cared for by the mother makes the infant trust or
mistrusts the world (represented by mother) around him. If his wants are frequently
satisfied, he develops trust and believes that the world will take care of him. In
case of frequent dissatisfaction, mistrust develops leading the infant to believe that
the people around him cannot be believed, relied on, and that he is going to lose
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most of what he wants. After the first six months (sucking period), the remaining
one year (biting period) is fairly difficult for the child and mother because of
eruption of teeth and weaning. If properly handled, infant’s trust gets reinforced
and he develops an in-built and lifelong spring of optimism and hope. Persons,
who had an unpleasant (abandoned, unloved and uncared) babyhood, are likely to
find parenthood as burdensome and may express dependent, helpless, abusive
behaviour, and angry outbursts i.e., oral character. To such people, caseworker is
like parents, who helps the client to verbalise his anger and distrust and later
provides emotional support and protective services. The caseworker has to fill the
voids (mistrust) created by the early mother and child relationship. The caseworker
presents himself as a trustworthy person, and, as a by-product of this relationship
the client starts trusting himself and others, around him. Care should be taken that
the client does not feel deprived at the hands of the caseworker who presents
himself as a mothering person to the client. It may be made clear that the feeling of
trust or mistrust (task of oral stage) is not totally dependent upon mother-child
relationship during oral stage. It continues to be modified, reinforced or
impoverished according to the experiences of the client in the subsequent years of
life also.
2. Anal Stage:
Towards the end of biting period of oral stage, the child is able to walk, talk, and
eat on his own. He can retain or release something that he has. This is true of
bowel and bladder function also. He can either retain or release his bowel and
bladder contents. Now, the child no more depends upon the mouth zone for
pleasure. He now derives pleasure from bowel and bladder (anal zone) functioning,
which entails anxiety because of toilet training by parents. Child is taught where to
pass urine and where to go for defecation etc. In this training of bladder and bowel
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control, child may develop autonomy, or shame and doubt. The task of anal is to
develop autonomy. If the parents are supportive without being overprotective and
if the child is allowed to function with some independence, he gains some
confidence in his autonomy probably by the age of three and prefers love over
hate, cooperation over willfulness, and self-expression over suppression.
Autonomy, thus, overbalances shame and doubt and leads to development of
confidence that he can control his functions, and also, to some extent, the people
around him. Contrary to this, the child may feel angry, foolish and ashamed if
parents criticise his faeces and over-control his bowel and bladder functioning
during the training for toilet. Observations of sanskaras convey acceptance to the
child and help the parents to train them in appropriate manner. The children (with
more mistrust and doubt in their share) when adults may need help in accepting
failures and imperfection as an inherent part of one’s life. By accepting the client
as he is, the caseworker can reduce his feeling of self-hatred and perfectionism.
Over-demanding adults or those who express temper tantrums when asked to
assume responsibility may need to be helped to control their impulsive acts. They
should be rewarded when they exhibit controls, and one should reinforce their
autonomy and independence when exercised. Autonomy and independence are
totally different from impulsive acts as these involve rationality and not
emotionality.
3. Genital (Oedipal) Stage:
The task for this period is to develop and strengthen initiative, failing which the
child develops a strong feeling of guilt. This period extends from 3rd to 6th years
of life, i.e., pre-school period. He is now capable of initiating activity, both
intellectual as well as motor on his own. How far this initiative is reinforced
depends upon how much physical freedom is given to the child and how far his
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curiosity is satisfied. If he is led to feel bad about his behaviour or his interests, he
may grow with a sense of guilt about his self-initiated activities. Erikson (1950)
opines that the child takes first initiative at home when he/she expresses passionate
interest in his/her parent of opposite sex. The parents ultimately disappoint
him/her. They should try to help the child to identify with the same sex parent, e.g.,
the girl should be encouraged to identify with mother and the son with the father.
In addition to this initiative, the child also attempts to wrest a place for self in the
race of siblings for parents affection. He sees the difference between what he wants
and what he is asked to do. This culminates into a clear-cut division between the
child’s set of expanded desires and the parental set of restrictions. He gradually
“turns these values (restrictions, i.e.,. don’ts) into self-punishment”. Slowly and
gradually, he extracts more initiative from the conflict and grows happily if his
initiative gets proper and adequate reinforcement. The caseworker encourages the
clients burdened with guilt feelings to take initiative in family as well as in other
situations, and works with his social environment to strengthen his capacity to take
initiative.
4. Latency Stage:
This stage covers the period from 6 to 11 years, i.e., school age. The child can
reason out rationally and can use the tools that adults use. The sexual interests and
curiosity (common in genital period) get suppressed till puberty. If encouraged and
given opportunity, he gains confidence in his ability to perform and use adult
materials. This leads to feeling of industry in him. When unable to use adult
materials, he develops inferiority feelings. Such children may develop problems
with peers. They need to be encouraged to interact with classmates and be less
dependent upon others. If the child has mastered the task of genital period
(initiative in place of guilt) he will be able to master the tasks of latency (industry
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in place of inferiority) also provided he is encouraged to undertake and helped to
execute the responsibilities entrusted to him.
5. Adolescence Stage:
This period, regarded as a period of turmoil, usually starts at 12-13 years and can
extend up to 18-19 years. The adolescents, during this transitional process from
childhood to maturity, behave something like an adult and sometimes like a child.
Parents too show their ambivalence to accept them in their new role of an adult in-
the-making. This stage exhibits all the psycho-social characteristics of earlier
period and only towards the end, all these get resolved into a new set of role
(identity) for the adolescent. In order to develop a personal identity, he becomes
fan of some hero, starts following certain ideologies, and tries his luck with
opposite sex. Indecision and confusion are not uncommon in this stage.
Identification with a wrong person shall create problems for him. The task of this
age is to develop identity, i.e., values, strengths, skills, various roles, limitations,
etc., failing which his identity gets diffused and he fails to know how to behave in
different situations. He needs to be helped to deal with the physiological,
emotional pressures along-with pressures from parents, peers, etc. Group work is
more helpful with problem-adolescents. When showing confusion about their role,
they can be helped to emulate the group leader or identify with group worker.
Parents can handle adolescents properly if educated adequately about the needs and
problems of this age. Similarly, tasks for young adulthood, adulthood and old age
are intimacy vs. isolation, generativity vs. stagnation, and ego-integrity vs. despair.
These psycho-analytical concepts are helpful in understanding behaviour of the
individuals. Apart from these, there are some other tasks described by some other
scholars for each stage which according to them are to be achieved for a normal
human development.
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1. DEVELOPMENT OF LANGUAGE AND SPEECH
The ability communicate is a significant factor is a signification factor in

child’s intellectual, emotional and social development Broadly speaking, the team
language development refers to increasing quantity, range and complexity of
speech over a period of time. Language is a complex system of grammatical
semantic properties and the actual difference of language is speech. Children are
able to understand language before they are able to speak it.
Children are born with physiologic ability to speak if they name normal oral
and nasal abilities and speech control outer in brain. They can learn to speak it.
Children are born physiologic ability to speak if they have normal oral and
nasal cavities and speech control counter in brain. They are learn to speech if they
have intelligence and motivation and are stimulated by other people’s speech in
their environment.
Prelingual speech is same all children, which includes refers vocalization, babbling
limitation of sounds and finally and use of grammatical rules depends on child’s
level of intelligence.
VIII.FACTORS INFLUENCING GROWTH AND DEVELOPMENT

1.Fetal Growth
Fetal growth is influenced primarily by fetal, placental and maternal factors. In
humans, 40% of variation in the birth weight is due to the genetic factors while the
rest is due to environmental factors. The fetus has an inherent growth potential, and
under normal circumstances, grows into a healthy appropriate sized newborn. The
maternal placental-fetal unit acts in harmony to provide the needs of the fetus.
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Genetic potential. Parental traits are usually transmitted to the offspring. Thus, tall
parents have tall children; the size of the head is more closely related to that of
parents than are the size and shape of hands and feet. Similarly, the structure of the
chest and fatty tissue has better genetic association than other somatic
characteristics.
Sex. Sex of the child is another major determinant among the factors affecting the
physical growth of the child. Boys and girls grow in different ways, especially
nearing puberty. Boys tend to be taller and physically stronger than girls, however
girls have faster growth during adolescence and excel boys who mature over a long
period of time. The physical structure of their bodies also has differences which
make boys more athletic and suited for physical rigors. Their temperaments also
vary making them show interest in different things.
Fetal hormones. Human fetus secretes thyroxin from the 12th week of gestation.
Thyroxin and insulin have an important role in regulating tissue accretion and
differentiation in the fetus. Both hormones are required for normal growth and
development particularly during late gestation. Glucocorticoids also play an
important role, primarily towards the end of gestation and influence the prepartum
maturation of organs such as liver, lungs and gastrointestinal tract. Growth
hormone, though present in high levels in fetus, is not known to influence fetal
growth.
Fetal growth factors. A large number of growth factors are synthesized locally in
fetal tissues, and act principally by autocrine and paracrine mechanisms. Their
prime effect is on cell division, though they also influence other aspects of tissue
growth. These factors can be both growth promoting or inhibitory. The insulin like
growth factor (IGF)-1 and IGF-11 are among the most extensively studied fetal
growth factors. Other growth promoting factors include epidermal growth factor
(EGF), transforming growth factor (TGF-a), platelet derived growth factor
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(PDGF), fibroblast growth factor (FGF) and nerve growth factor. Inhibitory factors
include TGF-􀁡, Mullerian inhibitory substance and inhibin/ activin family of
proteins.
Placental factors. As in most species, fetal weight directly correlates with
placental weight at term. Fetal growth is highly dependent on the structural and
functional integrity of the placenta. With advancing gestation, the weight of the
placenta increases to cater to the increased needs of the baby. There are important
functional and structural changes in the placenta that make this adaptation more
efficient. The total villous surface area increases, the diffusion distance decreases,
the fetal capillaries dilate and the resistance in fetoplacental vasculature falls. This
positive remodeling facilitates nutrient transport across the placenta.
Maternal factors. The mother's own fetal and childhood growth and her nutrient
intake and body composition at the time of conception and during pregnancy, play
an important role in determining fetal size. Teenage or advanced age, recent
pregnancy, high parity and anemia negatively influence fetal size and health.
Maternal intake of tobacco (smoked or chewed) and drug or alcohol abuse also
retard fetal growth. Obstetric complications such as pregnancy induced
hypertension, pre-eclampsia and multiple pregnancies produce fetal growth
restriction. Preexisting chronic systemic disease (chronic renal failure, congestive
heart failure) and acquired infections (rubella, syphilis, hepatitis B, HIV, CMV,
toxoplasmosis) may influence fetal growth.
2.Postnatal Period
The growth of the child during postnatal life is determined by genetic potential as
well as internal and external influences.
Genetic factors. Both chromosomal disorders and mutations in specific genes can
affect growth. Chromosomal defects like Turner syndrome and Down syndrome
manifest as growth retardation. Mutation of single genes may result in inherited
23
retardation of growth, e.g. Prader-Willi syndrome and Noonan syndrome. While
most disorders lead to short stature, some genetic defects can also result in tall
stature, e.g. Klinefelter syndrome and Sotos syndrome.
Intrauterine growth restriction (IUGR).IUGR resulting in low birth weight
(LBW) constitutes an important risk factor for postnatal malnutrition and poor
growth. LBW increases the odds of underweight, stunting and wasting in the first 5
yr of life by 3 to 5 times. At 6 months of age, approximately one-third each of
underweight (28%), stunting (28%) and wasting (22%) are attributable to LBW. At
ages between 1 and 5 yr, LBW accounts for 16-21 % of wasting, 8-16% of stunting
and 16-19% of underweight. It was recently reported that a third and a fifth of
infants have wasting and stunting, respectively, even at birth. During early infancy,
exclusive breastfeeding provides adequate nutrition, prevents infections and
protects the infants from further undernourishment. However, at 3-5 months, the
common practice of supplementing the infants with animal milk increases
morbidity due to infections leading to underweight and stunting. Subsequently,
faulty complementary feeding practices (starting too late, using too little and very
less calorie dense foods) along with poor hygiene lead to a further rise in rates of
underweight and stunting.
Hormonal influence. Normal development cannot proceed without the right
milieu of hormones in the body throughout childhood and adolescence. Absence of
growth hormone or thyroxin results in dwarfism, underscoring the importance of
these factors in promoting growth. These hormones influence both somatic and
skeletal growth during adolescence, androgens and estrogens have an important
influence on the growth spurt and final adult height.
Sex. The pubertal growth spurt occurs earlier in girls. However, their mean height
and weight in girls are usually less than those in boys of corresponding ages at the
time of full maturity.
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Nutrition. Growth of children suffering from protein-energy malnutrition, anemia
and vitamin deficiency states is retarded. Calcium, iron, zinc, iodine and vitamins
A and D are closely related to disorders of growth and development and their
deficiency is associated with adverse health events in childhood. On the other
hand, overeating and obesity accelerate somatic growth.
Infections. In low resource settings, one of the commonest contributors to poor
childhood growth are infections. Persistent or recurrent diarrhea and respiratory
tract infections are common causes of growth impairment. Systemic infections and
parasitic infestations may also retard the velocity of growth. The risk of stunting at
2 yr of age is shown to increase with each episode of diarrhea and with each day of
diarrhea before 2 yr of age. It was also shown that the attributable risk for stunting
for 5 or more episodes of diarrhea before 24 months of age was 25%.
Chemical agents. Administration of androgenic hormones initially accelerates the
skeletal growth. However, androgens cause the epiphyses of bones to close
prematurely, leading to early cessation of bone growth.
Trauma. A fracture at the end of a bone may damage the growing epiphysis, and
thus hamper skeletal growth.
3.Social Factors
Socioeconomic level. Children from families with high socioeconomic level
usually have better nutritional state. They suffer from fewer infections because of
better nutrition and hygienic living conditions.
Poverty. Hunger, under nutrition and infections, often associated with poverty,
cause poor growth.
Natural resources. Plentiful natural resources encourage industrial and
agricultural enterprise in the country. Improved nutrition of children in the
community is facilitated when there is a climb in gross national product and per
capita income is high.
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Climate. The velocity of growth may alter in different seasons and is usually
higher in spring and low in summer months. Infections and infestations are
common in hot and humid climate. Weather also has a pivotal effect on
agricultural productivity, ready availability of food and capacity for strenuous
labor by the population.
Emotional factors. Children from broken homes and orphanages do not grow and
develop at an optimal rate. Anxiety, insecurity and lack of emotional support and
love from the family prejudice the neuro chemical regulation of growth hormone
release. Parents who had happy childhood and carry a cheerful personality are
more likely to have children with similar countenance.
Cultural factors. Methods of child rearing and infant feeding in the community
are determined by cultural habits and conventions. There may be religious taboos
against consumption of particular types of food. These affect the nutritional state
and growth performance of children.
Parental education. Mothers with more education are more likely to adopt
appropriate health promoting behaviors which have direct and indirect influences
on growth and development.
IX.ASSESSMENT OF GROWTH AND DEVELOPMENT
Weight: Newborns come in range of healthy sizes. Most babies born between 37
and 40 weeks and weight between 2.5-3.5kg considers as normal. Boys are usually
a little heavier than girls. The weighing scale should have a minimum unit of 100
g. It is important that child be placed in the middle of weighing pan. The weighing
scale should be corrected for any zero error before measurement. Serial
measurement should be done on the same weighing scale. The simple linear
equations were derived to calculate mean weight for age.
For infants <12 months:
26
Weight (kg) = (age in months+9)/2
For children aged 1-5 years:
Weight (kg)= 2x (age in years+5)
For children aged 5-14 years:
Weight (kg)= 4x age in years
Length: Length is recorded for children under 2 yr of age. Hairpins are removed
and braids undone. Bulky diapers should be removed. The child is placed supine
on a rigid measuring table or an infantometer. The head is held firmly in position
against a fixed upright head board by one person. Legs are straightened, keeping
feet at right angles to legs, with toes pointing upward. The free foot board is
brought into firm contact with the child's heels. Length of the baby is measured
from a scale, which is set in the measuring table. Measurement of length of a child
lying on a mattress and/ or using cloth tapes, is inaccurate and not recommended.
27
Standing height: For the standing height, the child stands upright. Heels are
slightly separated and the weight is borne evenly on both feet. Heels, buttocks,
shoulder blades and back of head are brought in contact with a vertical surface
such as wall, height measuring rod or a stadiometer. The head is so positioned that
the child looks directly forwards with Frankfort plane (the line joining floor of
external auditory meatus to the lower margin of orbit) and the biauricular plane
being horizontal. The head piece is kept firmly over the head to compress the hair.
Head circumference: Hair ornaments are removed and braids undone. Using a
non-stretchable tape, the maximum circumference of the head from the occipital
protuberanceto the supra orbital ridges on the forehead is recorded. The crossed
tape method, using firm pressure to compress the hair, is the preferred way to
measure head circumference.
28
Chest circumference: The chest circumference is measured at the level of the
nipples, midway between inspiration and expiration. The crossed tape method, as
recommended for head circumference measurement, is used for measuring chest
circumference .
Mid upper arm circumference: To measure the mid upper arm circumference,
first mark a point midway between the tip of acromian process of scapula and the
olecranon of ulna, while the child holds the left arm by his side . Thereafter, the
crossed tape method is used for measuring the circumference. It should be ensured
that the tape is just tight enough to avoid any gap as well as avoid compression of
soft tissues.
NORMAL GROWTH
Biological Growth
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It is difficult to precisely define the normal pattern of growth. Generally, it implies
an average of readings obtained in a group of healthy individuals, along with a
permissible range of variation, i.e. between the third and ninety-seventh
percentiles. Most healthy children maintain their growth percentile on the growth
charts as the years pass by. Significant deviation in a child's plotted position on the
growth chart can be due to a recent illness or over- or under nutrition. It is also
important to take into account the gestation age of infants born prematurely. The
duration of prematurity is subtracted from the infant's chronological age. This
correction, however, is not required after 2 yr of age.
Weight: The average birth weight of neonates is about 3kg. During the first few
days after birth, the newborn loses extracellular fluid equivalent to about 10% of
the bodyweight. Most infants regain their birth weight by the age of10 days.
Subsequently, they gain weight at a rate of approximately 25-30 g per day for the
first 3 months of life. Thereafter, they gain about 400 g weight every month for the
remaining part of the first year. An infant usually doubles his birth weight by the
age of 5 months. The birth weight triples at 1 yr and is four times at 2 yr of age.
Thus, the weight at 5 months, 1 yr and 2yr is approximately6, 9 and 12 kg,
respectively. The weight of a child at the age of 3 yr is approximately five times
that of the birth weight. At 5 yr, the expected weight can be calculated by
multiplying the birth weight by 6, at 7 yr by 7 and at 10 yr by 10. It follows that the
expected weight at 3, 5, 7 and 10 yr is approximately 15, 18, 21 and 30 kg,
respectively. On an average, a child gains about 2 kg every year between the ages
of 3 and 7yr, and 3 kg per year after that till the pubertal growth spurt begins.
Length or height. The infant measures approximately 50 cm at birth, 60 cm at 3
months, 65 cm at 6 months 70 cm at 9months, 75 cm at 1 yr and 90 cm at 2 yr. A
normal Indian child is 100 cm tall at the age of 4 yr. Thereafter, the child gains
about 6 cm in height every year, until the age of 12 yr. After this, increments in
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height vary according to the age at the onset of puberty. There is a marked
acceleration of the growth during puberty.
Head circumference (HC). Head growth is rapid, especially in the first half of
infancy. It reflects the brain growth during this period. The head growth slows
considerably there after. Beginning at 34 cm at birth, the head circumference
increases approximately 2 cm per month for first 3 month,1 cm per month between
3-6 month and 0.5 cm per month for the rest of the first year of life. The head
circumference is approximately 40 cm at 3 month, 43 cm at 6 month 46-47cm at 1
yr, 48 cm at 2 yr. By 12 yr it is 52 cm.
Chest circumference. The circumference of chest is about 3 cm less than the head
circumference at birth. The circumference of head and chest are almost equal by
the age of 1 yr. Thereafter, the chest circumference exceeds the head
circumference.
Body mass index (BMI).The formula to calculate BMI is weight (kg) /height
(meter)2. BMI is primarily used to assess obesity. BMI at or above the 95th centile
for age or more than 30 kg/m2 is obesity.
Growth Monitoring
The Indian Academy of Pediatrics has given guidelines to monitor growth during
childhood. During infancy the monitoring is conveniently done during visits for
vaccination. Later it can be integrated into visits for vaccination, minor illnesses or
into school health program. During adolescence sexual maturity rating (SMR)
staging is an additional measure to be monitored.
31
A) GROWTH AND DEVELOPMENT AT DIFFERENT AGE
i. GROWTH IN NEW BORN
Adjustment to Extra uterine Life
The loss of the placental connection means the loss of complete metabolic support,
especially the supply of oxygen and the removal of carbon dioxide. The normal
stresses of labor and delivery produce alterations of placental gas exchange
patterns, acid-base balance in the blood and cardiovascular activity in the infant.
Factors that interfere with this normal transition or that interfere with fetal
oxygenation (including conditions such as hypoxemia, hypercapnia, and acidosis)
affect the fetus s adjustment to extra uterine life.
Respiratory System
The most critical and immediate physiologic change required of newborns is the
onset of breathing. The stimuli that help initiate the first breath are primarily
chemical and thermal. Chemical factors in the blood initiate impulse that excite the
respiratory center in the medulla. The primary thermal stimulus is the sudden
chilling of the infant, who leaves a warm environment and enters a relatively
cooler atmosphere. This abrupt change in temperature excites sensory impulses in
the skin that are transmitted to the respiratory center.
Circulatory System
As important as the initiation of respiration are the circulatory change that allow
blood to flow through the lungs. These changes, which occur more gradually, are
the result of pressure changes in the lungs, heart and the major vessels. The
transition from fetal to postnatal circulation involves the functional closure of the
fetal shunts: the foramen ovale, the ductus arteriosus, and eventually the ductus
venosus. Increased blood flow dilates the pulmonary vessels, pulmonary vascular
32
resistance decreases, and systemic resistance increases, thus maintaining BP. As
the pulmonary vessels receive blood, the pressure in the right atrium, right
ventricle, and pulmonary arteries decreases. Left atrial pressure increase above
right atrial pressure, with subsequent foramen ovale closure. With the increase in
pulmonary blood flow and dramatic reduction of pulmonary vascular resistance,
the ductus arteriosus begins to close. The foramen ovale closes functionally at or
soon after birth. The ductus arteriosus is dosed functionally by the fourth day
Anatomic closure takes considerably longer. Failure of the ductus arteriosus or
foramen ovale to close results in persistence of fetal shunting of blood away from
the lungs.
Physiologic Status of Other Systems
Thermoregulation
The newborn· s large surface area facilitates heat loss to the environment, although
this is partially compensated for by the newborn’s usual position of flexion, which
decreases the amount of surface area exposed to the environment. The newborns
thin layer of subcutaneous fat provides poor insulation for conservation of heat.
The newborns mechanism for producing heat is different from that of the adult,
who can increase heat production through shivering. A chilled neonate cannot
shiver but produces heat through non shivering thermogenesis (NST), which
involves increased metabolism and oxygen consumption. Some predisposing
factors causes infants to lose body heat, so it is essential that newly born infants are
quickly dried and either placed skin-to-skin with their mothers or provided with
warm, dry blankets after delivery. Although newborns· ability to conserve heat is
usually a matter of concern, they may also have difficulty dissipating heat in an
overheated environment, which increases the risk of hyperthermia.
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Hematopoietic system
The blood volume of the newborn depends on the amount of placental transfer of
blood. The blood volume of a full-term infant is about 80-85 ml/kg of body weight.
Immediately after birth) the total blood volume averages 300 ml, but depending on
how long umbilical cord damping is delayed or if the umbilical cord is milked, as
much as 100 ml can be added to the blood volume.
Fluid and electrolyte balance
Changes occur in the total body water volume, extracellular fluid (ECF) volume,
and intracellular fluid volume during the transition from fetal to postnatal life. At
birth, the total weight of an infant is 73% fluid compared with 58% in an adult.
Infants have a proportionately higher ratio of ECF than adults. An infants rate of
metabolism is twice that of an adult in relation to body weight. As a result, twice as
much acid is formed, leading to more rapid development of acidosis. In addition,
immature kidneys cannot sufficiently concentrate urine to conserve body water.
These three factors make infants more prone to dehydration, acidosis, and possible
over hydration or water intoxication.
Gastrointestinal system
The ability of newborns to digest, absorb, and metabolize food is adequate but
limited in certain functions. Enzymes are adequate to handle proteins and simple
carbohydrates but deficient production of pancreatic amylase impairs use of
complex carbohydrates. Deficiency of pancreatic lipase limits absorption of fats,
especially with ingestion of foods with high saturated fatty acid content, such as
cow’s milk. Human milk, despite its high fat content, is easily digested because the
milk itself contains enzymes, which assist in digestion.
34
Renal system
All structural components are present in the renal system, but there is a functional
deficiency in the kidneys ability to concentrate urine and to cope with conditions of
fluid and electrolyte stress, such as dehydration or a concentrated solute load. Total
volume of urine per 24 hours is about 200-300 ml by the end of the first week.
However, the bladder voluntarily empties when stretched by a volume of 15 ml,
resulting in as many as 20 voiding per day. The first voiding should occur within
24 hours. The urine is colorless and odorless and has a specific gravity of about
1.020.
Integumentary system
At birth, all of the structures within the skin are present, but many of the functions
of the integument are immature. The sebaceous glands are active late in fetal life
and in early infancy because of the high levels of maternal androgens. They are
most densely located on the scalp, face, and genitalia and produce the greasy
vernix caseosa that covers infants at birth. Plugging of the sebaceous glands causes
milia. The exocrine glands, which produce sweat in response to heat or emotional
stimuli, are functional at birth, and by 3 weeks of age, palmar sweating on crying
reaches levels equivalent to those of anxious adults. Growth phases of hair follicles
usually occur simultaneously at birth. During the first few months, the synchrony
between hair loss and regrowth is disrupted, and there may be overgrowth of hair
or temporary alopecia. Because the amount of melanin is low at birth, newborns
are lighter skinned than they will be as children. Consequently, they are more
susceptible to the harmful effects of the sun.
35
Musculoskeletal system
At birth, the skeletal system contains more cartilage than ossified bone, although
the process of ossification is fairly rapid during the first year. The nose, for
example is predominantly cartilage at birth and may be temporarily flattened or
asymmetric because of the force of delivery. The six skull bones are relatively soft
and are separated only by membranous seams. The sinuses are incompletely
formed in newborns,
DEVELOPMENT OF NEWBORN
1. Physical Growth
 Weight: Average birth weight of newborn is 2.5 kg. It decreases by
10% in first 10 days of life and then increases at the rate of 500-600
grams per month during first 6 months.
 Length: At birth the length of newborn is 45-50 cm. It increases
approximately 2-2.5cm per month during first six months.
 Head circumference: At birth it is approximately 33-35cm and
increases at the rate of 1.5 cm per month during first six months.
 Chest circumference: It is about 31-33cm
 Pulse rate is 130+ 20/minute.
 Respiration is 35 +10/minute.
 Blood pressure is 80/50 + 20/10 mm Hg.
 Reflexes: The baby has well developed sucking, rooting, swallowing,
and extrusion reflex. Baby also has Moro’s, Tonic neck and Crossed
Extensor reflex.
2. Motor Development
a. Gross Motor
36
 Lies in flexed position with hands clenched.
 Turns head when in prone position.
 Head lags behind when baby is pulled up from spine to sitting
position.
b. Fine Motor
 Grasp reflex in strong. Child may grasp tightly but drop it suddenly.
 Baby can grasp an object placed in hand but drops it immediately.
3. Sensory Development
 Protective blinking reflex is present.
 Indefinite stare at surroundings.
 Notices faces and bright objects but only if they are in line of vision.
4. Languages development
 Startles to loud noises.
 Responds to human voice
 Makes comfort sounds during feeding.
 Begins to Coo.
ii) INFANCY ( 1 MONTH TO 12 MONTHS)
GROWTH OF INFANTCY
Propotional changes
During the first year of life, especially the initial 6 months, growth- is very rapid. ).
Infants gain 150 to 210 g (::::5-7 oz) weekly until approximately age 5 to 6
months, when the birth weight has at least doubled. An average weight for a 6-
month-old child is 7.3 kg (16 pounds). Weight gain slows during the second 6
months. By l year of age, the infants birth weight has tripled, for an average weight
of 9.15kg. Infants who are breastfed beyond 4 to 6 months of age typically gain
37
less weight than those who are bottle fed, yet their head circumference is more than
adequate. There is evidence that breastfed infants tend to self-regulate energy
intake. This self-regulation of intake with breastfeeding is believed to have further
significance in the development of childhood obesity subsequent cardiovascular
disease.
Height increases by 2.5 cm (1 inch) a month during the first 6 months of life and
also slows during the second 6 months. Increases m length occur in sudden spurts,
rather than in a slow, gradual pattern. Average height is 65 cm (25.5 inches) at 6
months and 74 cm at 12 months. By 1 year of age, the birth length has increased by
almost 50%.
Head growth is also rapid. During the first 6 months, head circumference increases
approximately 1.5 cm (0.6 inch) per month, but the rate of growth declines to only
0.5 cm (0.2 inch) monthly during the second 6 months. The average size is 43 cm
(17 inches) at 6 months and 46 cm ( 18 inches) at 12 months. By 1 year, head size
has increased by almost 33%. Closure of the cranial sutures occurs, with the
posterior fontanel fusing by 6 to 8 weeks of age and the anterior fontanel closing
by 12 to 18 months of age.
Nervous system. By the end of the first year, the brain has increased in weight
about 2.5 times. Maturation of the brain is exhibited in the dramatic developmental
achievements of infancy. Primitive reflexes are replaced by voluntary, purposeful
movement, and new reflexes that influence motor development appear.
The chest assumes a more adult contour, with the lateral diameter becoming larger
than the anteroposterior diameter. The chest circumference approximately equals
the head circumference by the end of the first year.
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The heart grows less rapidly than does the rest of the body. Its weight is usually
doubled by 1 year of age in comparison with body still large in relation to the chest
cavity; its width is approximately 55% of the chest width.
MATURATION SYSTEM
The respiratory rate slows somewhat and is relatively stable. Respiratory

movements continue to be abdominal. Several factors predispose infants to more
severe and acute respiratory problems than older children. The close proximity of
the trachea to the bronchi and its branching structures rapidly transmits infectious
agents from one anatomic location to another. The short, straight Eustachian tube
closely communicates with the ear, allowing infection to ascend from the pharynx
to the middle ear. In addition, the inability of the immune system to produce
immunoglobulin A (lgA) in the mucosal lining provides less protection against
infection in infancy than during later childhood.
Hematopoietic changes occur during the first year of life. Fetal hemoglobin (HgbF)
is present for the first 5 months, with adult hemoglobin steadily increasing through
the first half of infancy.
Fine Motor development
Fine motor behavior includes the use of the hands and fingers in the prehension
(grasp) of objects. Grasping occurs during the first 2 to 3 months as a reflex and
gradually becomes voluntary. At 1 month of age, the hands are predominantly
closed, and by 3 months, they are mostly open. By this time, infants demonstrate a
desire to grasp objects, but they grasp objects more with the eyes than with the
hands. If a rattle is placed in the hand, infants will actively hold on to it. By
months of age, infants regard both a small pellet and the hands and then look from
the object to the hands and back again. By 5 months, infants are able to voluntarily
39
grasp objects. By 6 months of age, infants have increased manipulative skill. They
hold their bottles, grasp their feet and pull them to their mouths, and feed
themselves crackers. By 7 months, they transfer objects from one hand to the other,
use one hand for grasping, and hold a cube in each hand simultaneously. They
enjoy banging objects and explore the movable parts of toys.
The palmar grasp ( using the whole hand) is replaced by ). By 8 to 10 months of

age, infants use a crude pincer grasp, and by 11 months, they have progressed to a
neat pincer grasp. BY 10 months of age, pincer grasp is sufficiently established to
enable infants to pick up raisins and other finger foods. They can deliberately let
go of an object and offer it to someone. By 11 months, they put objects into
containers and like to remove them. By age 1 year, infants try to build towers of
two blocks but fail.
Gross motor development
Head control: Full-term newborns can momentarily hold their heads in midline
and parallel when their bodies are suspended ventrally and can lift and turn their
heads from side to side when they are prone. By 3 months of age, infants can hold
their heads well beyond the plane of their bodies. By 4 months of age, infants can
lift their heads and front portion of their chests approximately 90 degrees above the
table, bearing their weight on the forearms. Only slight head lag is evident when
infants are pulled from a lying to a sitting position, and by 4 to 6 months, head
control is well established.
Rolling Over: Newborns may roll over accidentally because of their rounded
backs. The ability to willfully turn from the abdomen to the back occurs around the
age of 5 months, and the ability to turn from the back to the abdomen occurs at the
age of approrimately 6 months. Infants put to sleep on their sides may easily roll
40
over to a prone (face-down) position, thus placing them at high risk for sudden
infant death syndrome (SIDS).
Sitting: The ability to sit follows progressive head control and straightening of the
back. As the spinal column straightens, infants can be propped in a sitting position.
By the age of 7 months, infants can sit alone, leaning forward on their hands for
support. By the age of 8 months, they can sit well while unsupported and begin to
explore their surroundings in this position rather than in a lying position. By the
age of IO months, they can maneuver from a prone to a sitting position.
Locomotion: Locomotion involves acquiring the ability to bear weight, propel

forward on all four extremities; stand upright with support; cruise by holding on to
furniture; and finally walk alone. By the ages of 6-7 months, they are able to bear
all of their weight on their legs with assistance. Crawling progresses to creeping on
hands and knees by age of 9 months. At this time, they stand while holding on to
furniture and can pull themselves to the standing position, but they are unable to
maneuver back down except by falling. By the age of 11 months they walk while
holding on to furniture or with both hands held; and by the age of 1 year, they may
be able to walk with one hand held.
Psychosocial Development: Developing a Sense of Trust
Eriksons phase I (birth to 1 year old) is concerned with acquiring a sense of trust
while overcoming a sense of mistrust. The trust that develops is a trust of self, of
others, and of the world. Infants ‘trust” that their feeding, comfort, stimulation, and
caring needs will be met. The crucial element for the achievement of this task is
the quality of both the parent ( caregiver )-child relationship and the care the infant
receives. The provision of food, warmth, and shelter by itself is inadequate for the
development of a strong sense of self. The infant and parent must jointly learn to
41
satisfactorily meet their needs for mutual regulation of frustration to occur. When
this synchrony fails to develop, mistrust is the eventual outcome.
Cognitive Development: Sensorimotor Phase {Piaget}
The theory most commonly used to explain cognition, or the ability to know, is
that of Piaget. The period from birth to the age of 24 months is termed the
sensorimotor phase and is composed of six stages; however, because this
discussion is concerned with age from birth to the age of 12 months, only the first
four stages are discussed. During the sensorimotor phase, infants progress from
reflexive behaviors to simple repetitive acts to imitative activity. Three crucial
events take place during this phase. The first event involves separation, in which
infants learn to separate themselves from other objects in the environment. They
realize that others besides themselves control the environment and that certain
readjustments must take place for mutual satisfaction to occur. This coincides with
Eriksons concept of the formation of trust.
Development of Body Image
The development of body image parallels sensorimotor development. Infants

kinesthetic and tactile experiences are the first perceptions of their bodies, and the
mouth is the principal area of pleasurable sensations. Other parts of their bodies are
primarily objects of pleasure the hands and fingers to suck and the feet to play
with. As their physical needs are met, they feel comfort and satisfaction with their
bodies.
Social Development
Infants social development is initially influenced by their reflexive behavior, such

as the grasp, and eventually depends primarily on the interaction between them and
their principal caregivers. Attachment interaction between them and their principal
42
caregivers. Attachment to their parents is increasingly evident during the second
half of the first year. In addition, tremendous strides are made in communication
1d personal-social behavior. Whereas crying and reflexive behavior are methods to
meet ones needs in early infancy, the social smile is an early step in social
communication. This has a profound effect on family members and is a
tremendous stimulus for evoking continued responses from others. By the age of 4
months, infants laugh aloud.
Language Development
Infants· first means of verbal communication is crying. In the first few weeks of
life, crying has a reflexive quality and is mostly related to physiologic needs.
Infants cry for 1-1.5 hours a day to 3 weeks old and then build up to 2-4 hours by 6
weeks old. Vocalizations heard during crying eventually become syllables and
words ( e.g., the mama’ heard during vigorous crying). Infants vocalize as early as
5-6 weeks old by making small throaty sounds. By the age of 2 months, they make
single vowel sounds, such as ah, eh, and uh. By the ages of 3-4 months, the
consonants n, k, g, p, and b are added, and infants coo, gurgle, and laugh aloud. By
the age of 6 months, they imitate sounds; add the consonants t, d, and w; and
combine syllables ( e.g., “dada”), but they do not ascribe meaning to the word until
the age of 10-11 months. By the ages of 9-10 months, they comprehend the
meaning of the word “no’’ and obey simple commands. By the age of l year, they
can say 3-5 words with meaning and may understand as many as I 00 words.
Because language development is based on expressive skills (ability to make
thoughts, ideas, and desires known to others) and receptive skills (ability to
understand the words being spoken), it is important that infants are exposed to
expressive speech and that infants with delays in achieving milestones are carefully
evaluated for potential hearing loss.
43
1 MONTH
1.Physical Development
 Weight gain of 150-210gms weekly for 6 months

 Height gain of 2.5cm monthly for first 6 months
 Primitive reflexes present and strong
 Doll’s eye reflex and dance reflex fading
2.Motor Development
a. Gross Motor
 Assumes flexed position with pelvis high but knees not under
abdomen when prone.
 Can turn head from side to side when prone lifts head momentarily
from bed
 Has marked head lag, especially when pulled from lying to sitting
position
 Holds head momentarily parallel and in midline when suspended in
prone position
 Assumes asymmetric tonic neck flex position when supine
 When held in standing position. Body is limp at knees and hips
 In sitting position, back is uniformly rounded, with absence of head
control
c. Fine Motor
 Hands predominantly closed
 Grasp reflex strong
 Hand clenches on contact with rattle
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 Able to fixate on moving object in range of 45 degrees when held at
a distance of 20-25 cm (8-10 inches)
 Visual acuity approaches 20/100 and Follows light to midline
 Quiets when hears a voice
4. Language Development
 Cries to express displeasure
 Makes small, throaty sounds
 Makes comfort sounds during feeding
5. Social Development
 Is in sensorimotor phase – stage I, use of reflexes
 Circular reactions
 Watches parent’s face intently as she or he talks to infant
2 MONTHS
1. Physical Development
 Posterior fontanel closes at 6-8 weeks ago.
 Tears start appearing
 Drooling begins
 Obligate (Preferential) nose breathers.
a. Gross Motor
 Less fixed prone position. Arms flexed, hip flat and legs extended
 Lifts head almost to 45’ above flat surface when lying prone.
b. Fine Motor
 Hands may be open
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 Holds a rattle when placed in hand.
 Turns head to side when sound occurs at ear level.
 Eyes follow moving objects ad persons nearby.
 Visual acuity is hyper optic.
 Laughs and squeals
 Crying becomes differentiated varying with reason for crying. E.g.
hunger, sleep, pain etc.
 Utters single vowel sounds such as ‘ah’ and ‘eh’
 Smiles to mother/caregiver.
 Knows that cry will bring attention.
3 MONTHS
 Flexion posture is reduced.
 Grasping, Crossed Extensor and Moro’s reflex disappears.
 Landau reflex appears.
a. Gross Motor
 Able to lift head to 90’ when in prone position.
 Able to hold head erect but head still bobs forward.
 Rolls over from back to side.
b. Fine Motor
 Can grasp a toy but lacks firm hold.
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 Hands open and closed loosely.
 Carries objects and hands to mouth at will
 Turns head and looks in same direction to locate sound.
 Blinks at objects that threaten the eyes.
 Beginning of ability to coordinate various sensory stimuli.
 Cries less
 Shows pleasure in making sound
 Chuckles and coos.
5. Special Development
 May laugh loud.
 Looks in direction of speaker.
4 MONTHS
 Drooling indicates appearance of saliva.
 Tonic neck and rooting reflex disappears.
a. Gross Motor
 Holds head erect and steady when place in sitting position
 Sits for short time with adequate support.
 Lifts head and shoulders at 90’ when prone and looks around.
 Head lag disappears when pulled to sit.
b. Fine Motor
 Brings hands together in midline and plays with fingers.
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 Reaches for objects.
 Follows objects to 180’.
 Fairly good binocular vision.
 Beginning of hand-eye coordination.
 Utters two syllable vowel sounds.
 Can vocalize consonants like ‘m,b,g.’
 Responds differently to pleasant and angry voice.
 Initial social play by smiling.
5 MONTHS
 Weight almost double of birth weight
 Can breathe through mouth when nose is obstructed.
a. Gross Motor
 Sits with slight support
 Holds back straight when pulled to a sitting position.
 Pulls feet up to mouth when in supine.
 Rolls from back to abdomen.
b. Fine Motor
 Attempts to ‘catch’ dangling objects with two hands.
 Begins use of forefinger and thumb in a printer grasp.
 Tries to obtain objects belong reach.
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 Can hold one object while looking at another.
 Looks in direction of sound made below ear.
 Stops crying in response to music.
 Visual acuity is 20/20.
 Responds to his/her name.
 Vocalizes displeasure when desired object is taken away.
 Begins to mimic sound.
 Cries on seeing strangers.
 Smiles to self in mirror.
 Differentiates strangers from family members.
6 MONTHS
 Weight gain is about 300-400 gms/month during next 6 months.
 Length increases at the rate of 1.25 cm/month.
 Head circumference increases at the rate of 0.5-1cm/month.
 Pulse rate is 120+ 20/minute.
 Respiration is 31 + 9/minute.
 Teeth eruption starts with lower two central incisors
a. Gross Motor
 Sits leaning forward on both hands.
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 Moves from place to place by rolling.
 Back is straight when sitting in high chair.
b. Fine Motor
 Can grasp at will.
 Drops one object when offered another.
 Begins to transfer objects from one hand to another.
 Manipulates small objects.
 Bangs objects that are held.
 Localizes sound made above ear level.
 Enjoys more complex visual stimuli.
 Moves in order to see an object.
 Babbling
 Vocalizes monosyllable like ma, da, ba.
 Recognizes familiar words.
 Talks to own image in mirror.
 Recognizes parents.
 Extends arms to be picked.
7 MONTHS
 Parachute reflex appears.
 Ultimate color of iris is established.
 Mashes food with jaws.
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a. Gross Motor
 Lifts head as if trying to sit-up when supine position.
 Rolls more easily from back to abdomen.
 Sustains all weight on feet when held in standing position.
 Early stepping movements.
b. Fine Motor
 Holds two toys together.
 Transfers a toy from one hand to another.
 Bangs objects that are held.
 Has preference in taste for food.
 Depth perception is beginning to develop.
4. Language Development.
 Recognizes own name.
 Responds with gestures to words such as “come”.
 Vocalizes ‘baba’ ‘dada’.
 Shows fear of strangers.
 Closes lips tightly when disliked food is offered.
8 MONTHS
 Begins to show pattern in bladder and bowl elimination.
 Eruption of upper central incisors.
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a. Gross Motor
 Pulls to standing position with help.
 Raises self to sitting position.
 Palmar grasp disappears.
b. Fine Motor
 Holds two objects while looking at third.
 Releases objects from hands at will.
 Uses index finger and thumb like pincers.
 Feeds self with finger foods.
 Drinks from cup with assistance.
 Depth perception is developing.
 Recognizes familiar words and sounds.
 Begins to understand meaning of “NO”.
 Continues syllable ‘dada, mama’ without specific meaning.
 Babbles to produce consonant sounds.
 Vocalizes to toys.
 Fear of strangers.
 Dislike dressing and diaper change.
 Separation anxiety develops.
9 MONTHS
 Eruption of upper lateral incisors
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a. Gross Motor
 Sits down.
 Drinks from cup or glass with help.
 Crawls and creeps.
 Holds own bottle.
b. Fine Motor
 Rings bell.
 Holds bottle and places nipple in mouth when wants it.
 Head turns directly to source of sound.
 Recognizes by looking or moving towards familiar objects when
named.
 Stops activity in response to “NO”.
 Dislikes face wash.
 Cries when scolded.
 Wants to please caregiver.
10 MONTHS
 Drooling stops.
 Macula is well developed and fine visual discrimination can be made.
a. Gross Motor
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 Walking skill development continues.
 Creeps and cruises well.
 Does not want to lie down unless sleepy.
 Makes stepping movements forward when tow hand are held.
b. Fine Motor
 Fine pincer grasp of tiny objects.
 Brings hands together and plays.
 Bangs two cubes together.
 Tits head backward to see up.
 Localizes sound from above or below ear.
 Searches for a lost toy.
 Says dada, mama with meaning.
 Comprehends “Bye – bye”.
 Imitates sounds of animals.
 Plays social games with adults.
11 MONTHS
 Sleeps 14-16 hours per day and still naps.
a. Gross Motor
 Stands erect with minimum support.
 Walks holding on to furniture.
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 Pushes toys.
 Cruises well.
b. Fine Motor.
 Explore objects carefully.
 Removes covers from boxes and takes toys out of box.
 Beginning to hold pen and make marks on paper.
3. Sensory Developments
 Can follow rapidly moving objects.
 Responds to simple questions.
 Understands simple directions.
 Imitates specific sounds of others.
 Reacts to restriction with frustration.
 Enjoy playing with empty dish and spoon after meals.
12 MONTHS
 Weight becomes triple of birth weight.
 Height is increased about 50% of birth.
 Head circumference is about 46 cm’ increased by 1/3rd since birth.
 Chest circumference becomes equal to head circumference.
 Pulse rate is 115 + per minutes.
 Respiration is 30+ per minutes
 Babinski reflex disappears.
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 Landau reflex also disappears.
 Has 6-8 deciduous teeth.
a. Gross Motor
 Stands alone for variable length of time.
 Walks few steps with help or alone.
 Can sit down from standing position without help.
 Improved competence in motor skills through practice.
b. Fine Motor Development
 Good pincer grasp.
 Picks up small bits of food and transfer to mouth.
 Enjoys eating with fingers.
 Can drink himself with cup.
 Tries to feed himself/herself with spoon but spills contents.
 Releases one or more objects inside another object to container.
 Full binocular vision well established.
 Follows fast moving object with eyes.
 Has one word or a few in vocabulary.
 Comprehends ‘give’ and stops when told ‘no’.
 Has receptive vocabulary of several words.
 Says 3-5 words besides dada, mama.
 Recognizes object by name.
 Imitates animal sounds.
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 Vocalization decreases as walking increases.
 Responds to request for affection such as kissing.
 Attachment developed to primary caregiver.
 Cooperates in dressing, e.g. puts arms through sleeves, feet into shoes
etc.
iii) TODDLERS (1-3 YEARS)
Biological development
Physical growth slows considerably during toddlerhood. The average weight gain
is 1.8-2.7 kg ( 4-6 pounds) per year. The average weight at the age of 2 years is 12
kg (26.5 pounds). The birth weight is quadrupled by the age of 2 and half years.
The rate of increase in height also slows. The usual increment is an addition of 7.5
cm (3 inches) per year and occurs mainly in elongation of the legs rather than the
trunk. The average height of a 2-year-old child is 86.6 cm (34 inches). In general,
adult height is about twice the 2-year-old child s height. Accurate measurement of
height and weight during the toddler years should reveal a steady growth curve that
is step like in nature rather than linear ) which is characteristic of the growth spurts
during the early childhood years.
The rate of increase in head circumference slows somewhat by the end of infancy,
and head circumference is usually equal to : best circumference by the age of 1-2
years. The usual total increase in head circumference during the second year is 2.5
cm (1 inch). Then the rate of increase slows until at age 5 years, and the increase is
less than 1.25 cm (0.5 inch) per year. The anterior fontanel closes between the ages
of 12 and 18 months.
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Chest circumference continues to increase in size and exceeds head circumference
during the toddler years, The chest’s shape also changes as the transverse, or
lateral, diameter exceeds the anteroposterior diameter. After the second year, the
chest circumference exceeds the abdominal measurement, which, in addition to the
growth of the lower extremities, makes the child appear taller and leaner.
Sensory Changes
Visual acuity of 20/ 40 is considered acceptable during the toddler years. Full
binocular vision is well developed, and any evidence of persistent strabismus
requires professional attention as early as possible to prevent amblyopia. Depth
perception continues to develop, but because toddlers lack of motor coordination,
falls from heights continues to be a persistent danger. The senses of hearing, smell,
taste, and touch become increasingly well developed, coordinated with each other,
and associated with D the experiences.
Gross and fine motor development
The major gross motor skill during the toddler years is the development of
locomotion. By the ages of 12-13 months, toddlers walk alone using a wide stance
for extra balance, and by the age of 18 months, they try to run but fall easily. At the
age of 2 years, toddlers can walk up and down stairs, and by the age of 2 1/2 years,
they can jump using both feet, stand on one foot for a second or two, and manage a
few steps on tiptoe. By the end of the second year, they can stand on one foot, walk
on tiptoe, and climb stairs with alternate footing.
Fine motor development is demonstrated in increasingly skillful manual dexterity.

For example, by the age of 12 months, toddlers are able to grasp a very small
object. At the age of 15 months, they can drop a raisin into a narrow-necked bottle.
Casting or throwing objects and retrieving them become almost obsessive activities
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at about the age of 15 months. By the age of 18 months, toddlers can throw a ball
overhand without losing their balance. Mastery of gross and fine motor skills is
evident in all phases of toddlers- activity, such as play, dressing, language
comprehension) response to discipline, social interaction, and propensity for
injuries. Activities occur less in isolation and more in conjunction with other
physical and mental abilities to produce a purposeful result. For example, the
toddler walks to reach a new location, releases a toy to pick it up or to choose a
new one, and scribbles to look at the image produced. The possibilities of the
exploration, investigation, and manipulation of the environment – and its hazards –
are endless.
Psychosocial development
Toddlers are faced with the mastery of several important tasks. If the need for basic
trust has been satisfied, they are ready to give up dependence for control,
independence, and autonomy.
Developing a Sense of Autonomy (Erikson)
According to Erikson ( 1963), the developmental task of toddlerhood acquiring a

sense of autonomy while overcoming a sense of doubt and shame. As infants gain
trust in the predictability and reliability of their parents, environment, and
interactions with others, they begin to discover that their behavior is their own and
that it has a predictable, reliable effect on others. Although they are aware of their
will and control over others, they are confronted with the conflict of exerting
autonomy and relinquishing the much-enjoyed dependence on others. Exerting
their will has definite negative consequences, whereas retaining dependent,
submissive behavior is generally rewarded with affection and approval. On the
other hand, continued dependency creates a sense of doubt regarding their potential
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capacity to control their actions. This doubt is compounded by a sense of shame for
feeling this urge to revolt against others will and a fear that they will exceed their
own capacity for manipulating the environment. Skillful monitoring and balance of
controls by parents allows a growing rate of realistic successes and the emergence
of autonomy.
Cognitive Development: Sensorimotor and Preoperational Phase (PIAGET)
In the fifth stage of the sensorimotor phase, tertiary circular reactions ( 13-18
months old), the child uses active experimentation to achieve previously
unattainable goals. Newly acquired physical skills are increasingly important for
the function they serve rather than for the acts themselves. The child incorporates
the old learning of secondary circular reactions with new skills and applies the
combined knowledge to new situations with emphasis on the results of the
experimentation. In this way there is the beginning of rational judgment and
intellectual reason1ng. During this stage, the child further differentiates self from
objects. This is evident in child s increasing ability to venture away from their
parents and to tolerate longer periods of separation.
Spiritual development
The child’s family and environment strongly influence the child’s perception of
the world around him or her, and this often includes spirituality. Furthermore,
family values, beliefs, customs, and expressions of these influence the child s
perception of his or her spiritual self (Mueller, 2010). Neuman (2011) proposes
that Fowler s ( 1981) stages of faith be used to better understand children and
spirituality; she provides an excellent overview of the stages of faith in childhood.
The relationship between spirituality, illness in childhood, and nursing has been
studied in the context of suffering terminal illness such as cancer, and end-of-life
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care. In the past decade there has been an increased interest in and focus on
spiritual care in adults and children as further understanding of the influence of
one’s spirituality on health illness, and well-being has progressed. Toddlers learn
about God through the words and the actions of those closest to them. They have
only a vague idea of God and religious teachings because of their immature
cognitive processes. Toddlers begin to assimilate behaviors associated with the
divine. Routines such as saying prayers before meals or at bedtime can be
important and comforting. Because toddlers tend to find solace in ritualistic
behavior and routines, near the end of toddler hood, when children use
preoperational thought, there is some advancement of their understanding of God.
Social development
Toddlers have an increased understanding and awareness of object permanence

and some ability to withstand delayed gratification and tolerate moderate
frustration. As a result, toddlers react differently to strangers than do infants. The
appearance of unfamiliar people does not represent such a significant threat to their
attachment to mothers. The separation-individuation phase of the toddler
encompasses the phenomenon of rapprochement; as a toddler separates from the
mother and begins to make sense of experiences in the environment. Transitional
objects, such as a favorite blanket or toy, provide security for children, especially
when they are separated from their parents, dealing with a new stress, or just
fatigued. During separations, such as daycare, hospitalization, or even staying
overnight with a relative, transitional objects should be provided to minimize any
fear or loneliness.
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Language development
At the age of l year, children use one-word sentences or holophrases. The word up
can mean pick me up” or “look up there:’ For children, the one word conveys the
meaning of a sentence, but to others, it may mean many things or nothing. At this
age, about 25% f the vocalizations are intelligible. By the age of 2 years, children
use multiword sentences by stringing together two or three words, such as the
phrases · mama go bye-bye or all gone, and approximately 6 5 o/o of the speech is
understandable. By the age of 3 years, children put words together into simple
sentences, begin to master grammatical rules, know his or her age and gender, and
can count three objects correctly.
DEVELOPMENT OF TODDLER
15 Months
 Legs Appear bowed.
 Height increases at the rate of 3 inches per year for next 7 years.
 Weight increases 4-6 pounds per year.
2. Motor Development.
a. Gross Motor
 Stands without help.
 Walks well.
 Creep-up stairs.
b. Fine Motor
 Scribbles
 Builds tower of 2 blocks.
 Pokes finger in hole.
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 Turn pages.
 Holds cup.
 Removes socks.
 Comprehends more than communicating.
 Recognizes names of body parts.
 Says 2-6 words.
 Responds to simple commands.
 Egocentric
 Hugs and kisses.
 Imitates parents.
18 Months
 Anterior fontanel closes.
 10-14 deciduous teeth present.
 Toilet training may begin as voluntary control of anal and urethral
sphincter occurs.
a. Gross Motor
 Wild gait.
 Walk upstairs.
 Pulls and pushes toys.
b. Fine Motor
 Can make tower 3-4 cubes.
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 Tums 2-3 pages at a time
 Can eat with spoon.
 Plays with food.
 May untie shoes.
 Removes simple garments.
 Uses gestures more than words to make needs known.
 Use words may be quite inconsistent.
4. Social development.
 Imitates adult roles.
 Imitates house works.
 Enjoys solitary play.
24 Months.
 Has 16 temporary teeth.
 Weight gain is 1.8 – 2.7 kg.
 Average weight is 12 kg.
 Height increases about 10-12.5 cm of birth length.
 Pulse rate is 110 + 20 per minutes.
 Respiration is 26 to 28/minute.
a. Gross Motor
 Steady gilt.
 Walks on heel – toe.
 Walks up and down stairs holding wall.
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b. Fine Motor
 Picks up objects from floor.
 Can build tower of 6-7 cubes.
 Imitates vertical line.
 Tums pages, one at a time.
 Drinks with glass.
 Pulls garments, e.g. socks
 Can brush teeth with help.
 Enjoys story.
 Knows at least 4 body parts.
 Has vocabulary of 300 words.
 Refers to self by name.
 Enjoy parallel play.
 Enjoys play with doll.
 Will do simple household tasks.
30 Months
 Average length is 92 cm.
a. Gross Motor
 Can stand on one foot.
 Jumps well.
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b. Fine Motor
 Can make tower of 6-8 cubes.
 Can feed self.
 Can throw large ball overhead.
 Can button and unbutton clothes.
 Places simple shapes in correct holes.
 Knows at least 5 body parts.
 Can speak sentence of 4-5 words
 Uses plural.
 Ask “why”.
 Knows own sex.
 Parallel play continues.
 Shows temper tantrums.
iv. PRE-SCHOOL (CHILD 3-6 YEARS)
Biological development
The rate of physical growth slows and stabilizes during the preschool Years. The
average weight is 14.5 kg ( 3 2 pounds) at the age of 3 years 16.7 kg (36.8 pounds)
at the age of 4 years, and 18.7 kg (41.5 pounds) at the age of 5 years. The average
weight gain per year remains approximately 2-3 kg (4.5-6.5 pounds). Growth in
height also remains steady, with a yearly increase of 6.5-9 cm (2.5-3.5 inches), and
generally occurs by elongation of the legs rather than of the trunk. The average
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height is 95 cm (37.5 inches) at the age of 3 years, 103 cm (40.5 inches) at the age
of 4 years, and 110 cm (43.5 inches) at the age of 5 years.
Gross and Fine Motor Skills
Walking, running, climbing, and jumping are well established by the age of 36
months. Refinement in eye-hand and muscle coordination is evident in several
areas. At an age of 3 years, preschoolers can ride a tricycle, walk on tiptoe, balance
on one foot for a few seconds and do broad jumps. By the age of 4 years, children
can skip and hop proficiently on one foot. By the age of 5 years, children can skip
on alternate feet and jump rope and begin to skate and swim.
Fine motor development is evident in the child’s increasingly skillful manipulation,

such as in drawing and dressing. These skills provide readiness for learning and
independence for entry into school.
Psychosocial development
Developing a Sense of Initiative (Erikson)
Erikson maintained that the chief psychosocial task of this period is acquiring a
sense of initiative. Children are in a stage of energetic learning. They play, work,
and live to the fullest and feel a real sense of accomplishment and satisfaction m
their activities. Conflict arises when children overstep the limits of their ability and
inquiry and experience a sense of guilt for not having behaved appropriately.
Feelings of guilt, anxiety, and fear may also result from thoughts that differ from
expected behavior. Development of the superego, or conscience, begins toward the
end of the toddler years and is a major task for preschoolers. Learning right from
wrong and good from bad is the beginning of morality.
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Cognitive development
Many of the thought processes of this period are crucial for achieving such
readiness, and it is intentional that children begin school between the ages of 5 and
6 Years rather than at an earlier age.
Preoperational Phase (Piaget)
The preoperational phase covers the age span from 2 to 7 years and is divided into
two stages: the preconceptual phase, ages 2-4 years, and the phase of intuitive
thought, ages 4-7 years. One of the main transitions during these two phases is the
shift from totally egocentric thought to social awareness and the ability to consider
other viewpoints. However, egocentricity is still evident. Language continues to
develop during the preschool period. Speech remains primarily a vehicle of
egocentric communication. Preschoolers increasingly use language without
comprehending the meaning of words, particularly concepts of left and right,
causality, and time.
Moral development
From the ages of approximately 4 to 7 years, children are in the stage of naïve
instrumental orientation in which actions are directed toward satisfying their needs
and, less frequently, the needs of others. They have a concrete sense of justice and
fairness during this period of development. They have little, if any, concern about
why something is wrong. They behave because of the freedom or restriction that is
placed on actions. If children are punished for any actions the action is bad. If they
are not punished the action is good.
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Spiritual development
Development of the conscience is strongly linked to spiritual development. At this

age, children are learning right from wrong and behaving correctly to avoid
punishment. Wrongdoing provokes feelings of guilt, and preschoolers often
misinterpret illness as a punishment for real or imagined transgressions. Observing
religious traditions and participating in a religious community can help children
and their families cope during stressful periods, such as illness and hospitalization.
Social Development
Preschoolers have overcome much of the anxiety associated with strangers and the
fear of separation of earlier years. They relate to unfamiliar people easily and
tolerate brief separations from their parents with little or no protest. However, they
still need parental security, reassurance, guidance, and approval, especially when
entering preschool or elementary school. Prolonged separation, such as that
imposed by illness and hospitalization, is difficult, but preschoolers respond to
anticipatory preparation and concrete explanation. They can cope with changes in
daily routine much better than toddlers, although they may develop more
imaginary fears. Preschoolers gain security and comfort from familiar objects, such
as toys, dolls, or photographs of family members. They are able to work through
many of their unresolved fears, fantasies, and anxieties through play, especially if
guided with appropriate play objects (e.g., dolls, puppets) that represent family
members, health care professionals, and other children.
Language
Children aged between 3 and 4 years form sentences of about three or four words
and include only the most essential words to convey a meaning. Such speech is
often termed telegraphic for its brevity. Three-year-old children ask many
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questions and use plurals, correct pronouns, and the past tense of verbs. They name
familiar objects, such as animals, parts of the body, relatives, and friends. They can
give and follow simple commands. From the ages of 4 to 5 years, preschoolers use
longer sentences of four or five words and use more words to convey a message,
such ; prepositions, adjectives, and a variety of verbs. They follow simple
directional commands, such as “Put the ball on the chair,” but can carry out only
one request at a time.
DEVELOPMENT OF PRESCHOOLERS
3 Years
 Physical growth is relatively slow. They becomes tall and thin
without gaining much weight.
 At the age of 3 years, weight is approximately 14 kg.
 Height is about 95 cm.
 Heart rate is similar to adults.
 Respiration is same as adults.
 Walks erect, swings arms,
 Rapid skeletal development.
 Loses baby fat and tummy.
a. Gross Motor
 Hops on one foot.
 Rides tricycle
 Can undress self in most situations.
 Catches soft objects with both hands.
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 Goes upstairs using ultimate feet but may still come down by placing
both feet on each step.
b. Fine Motor
 Can build tower of 9-10 cubes.
 Puts beads on string.
 Copies a circle.
 Can go to toilet alone.
 Brushes teeth with help.
 Begins to use blunt scissors.
3. Cognitive Development
 Egocentric.
 Thinking is concrete and tangible.
 Able to follow directional commands.
 Omnipotence (inability to distinguish between one’s own perception
and that of someone else).
 Centration (inability to consider several aspects of situation
simultaneously).
 Vocabulary of 800-1000 words.
 Asks many questions.
 Names body parts.
 Uses 4-5 word sentences.
 Recognizes colors.
5. Psychological Development
 Separates easily from mother.
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 Knows own set and that of other.
 Begins to share.
 Learns simple games but follows own rules.
 Fears dark.
6. Sensory Development.
 Vision is 20/30.
 Color vision fully intact.
4 Years
 Weight is 16 kg.
 Growth is slow
a. Gross Motor
 Skips and hops on foot.
 Catches bounced ball (2 out 3 tries).
 Dresses without supervision.
 Walks downstairs using ultimate feet.
b. Fine Motor
 Cuts pictures with scissors.
 Copies a square.
3. Cognitive Development
 Highly imaginative.
 Obeys commands because of parents fear and not because of
understanding between right and wrong.
 Uses sentences of 4-6 words.
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 Questioning is at peak.
 Tells exaggerated stories.
 Knows nursery rhymes and simple songs.
 Very independent.
 Tends to be selfish and impatient.
 Is Aggressive.
 Tells family talks to others without any restraints.
 Sibling rivalry present.
5 Years
 It is half adult height.
 Tooth decay may be present.
a. Gross Motor
 Walks backward heel to toe
 Skips and hops on alternate feet.
 Throws and catches ball well.
 Jumps ropes.
b. Fine Motor
 Copies a square, triangle and diamond shape.
 Ties shoe laces.
 Uses Scissors and simple tools.
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3. Intellectual Development
 Accurately describes events.
 Classify objects according to relationships that are similar.
 Time orientation present.
 Uses sentences of 4-6 words with all parts of speech.
 Describes pictures with much comments and description.
 Play is associative.
 Tries to follow rules but may cheat to avoid losing.
 Very industrious.
 Independent and looks for parental support and encouragement.
6 Years
 Begins to lose deciduous teeth, first permanent teeth erupts.
 Brain is 90% of adult size.
a. Gross Motor
 Rides bicycles
 Jumps, runs, climbs and hops well.
b. Fine Motor
 Improved hand and eye coordination.
 Draws a man with 6 parts.
 Can brush teeth.
 Comb hair.
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 Dresses self.
 Responds to praise and recognition.
 Has a sense of humor.
 Follows commands.
 Counts numbers.
 Recognizes shapes.
 Uses all forms of sentences.
 Enjoys telling jokes.
 Bossy
 Insist on being first in everything.
 Jealous siblings.
 Loves active and group play.
v. GROWTH IN SCHOOL AGED CHILDREN (6-11 YEARS)
Biologic development
During middle childhood, growth in height and weight assumes a slower but steady
pace as compared with the earlier years. Between the ages of 6 and 12 years,
children grow an average of 5 cm per year to gain 30-60 cm (1-2 feet) in height
and almost double their weight, increasing 2-3 kg (4.4-6.6 pounds) per year. The
average 6-year-old child is about 116 cm (46 inches) tall and weighs about 21 kg
(46 pounds); the average 12-year-old child is about 150cm tall and weighs about
40kg. Toward the end of the school-age years, both boys and girls begin to
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increase in size, although most girls begin to surpass boys in both height and
weight, to the acute discomfort of both girls and boys.
Physical changes
The most pronounced changes that indicate increasing maturity in children are a
decrease in head circumference in relation to standing height, a decrease in waist
circumference in relation to height, and an increase in leg length in relation to
height. These indicators often provide a clue to a child s degree of physical
maturity. There appears to be a correlation between physical indications of
maturity and success in school. Their body proportions take on a slimmer look,
with longer legs, varying body proportion and a lower center of gravity. Posture
improves over that of the preschool period to facilitate locomotion and efficiency
in using the arms and trunks.
Prepubescence
Preadolescence is the period that begins toward the end of middle childhood and
ends with the 13th birthday. Puberty signals the beginning of the development of
secondary sex characteristics, and prepubescence, the 2-year period that precedes
puberty, typically occurs during preadolescence.
Psychosocial devefopment: Developing a Sense of Industry (Erikson)
Freud described middle childhood as the latency period, a time of tranquility

between the oedipal phase of early childhood and the eroticism of adolescence. A
sense of industry, or a sense of accomplishment, occurs somewhere between the
ages of 6 years and adolescence. School-age children are eager to develop skills
and participate in meaningful and socially useful work. A sense of accomplishment
also involves the ability to cooperate, to compete with others, and to cope
effectively with people. Middle childhood is the time when children learn the value
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of doing things with others and the benefits derived from division of labor in the
accomplishment of goals. Peer approval is a strong motivating power.
Cognitive Development (Piaget)
During this stage, children develop an understanding of relationships between

things and ideas. They progress from making judgments based on what they see
(perceptual thinking) to making judgments based on what they reason ( conceptual
thinking). They are increasingly able to master symbols and to use their memories
of past experiences to evaluate and interpret the present. School-age children learn
the alphabet and the world of symbols called words, which can be arranged in
terms of structure and their relationship to the alphabet.
Moral development (Kohlberg)
Older school-age children are able to judge an act by the intentions that prompted
it rather than just its consequences. Rules and judgments become less absolute and
authoritarian and begin to be founded on, the needs and desires of others. For older
children, a rule violation is likely to be viewed in relation to the total context in
which it appears. The situation, as well as the morality of the rule itself, influences
reactions. Although younger children judge an act only according to whether it is
right or wrong, older children take into account different points of view. They are
able to understand and accept the concept of treating others as they would like to
be treated.
Spiritual Development
Children at this age think in concrete terms but are avid learners and have a great
desire to learn about their God or deity. They picture Go aid, as human and use
adjectives such as “loving’’ and “helping’’ to describe their deity. They are
fascinated by the concepts of hell and heaven, with a developing conscience and
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concern about rules, and they may fear going to hell for misbehavior. School-age
children want and expect to be punished for misbehavior and, when given the
option, tend to choose a punishment that “fits the crime.” Often they view illness
or injury as a punishment for a real or imagined misdeed. The beliefs and ideals of
family and religious persons are more influential than those of their peers in
matters of faith.
Social development
Peer group identification is an important factor in gaining independence from

parents. Peer groups have a culture of their own with secrets, traditions, and codes
of ethics that promote feelings of solidarity and detachment from adults. Through
peer relationships, children learn how to deal with dominance and hostility, how to
relate to persons in positions of leadership and authority, and how to explore ideas
and the physical environment. The aid and support of the group provide children
with enough security to risk the moderate parental rejection brought about by small
victories in the development of independence.
DEVELOPMENT OF SCHOOLERS
6-8 Years
 Weight is approximately 17.5 – 25.5 kg.
 Height is approximately 110-124 cm.
 Pulse is 90 + 15 beats/minute.
 Respiration is 21+ 3 breaths/minute.
 Starts losing temporary teeth and acquires first permanent molars,
medical incisors, talent incisors.
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a. Gross Motor
 Rides bicycles without training wheels
 Jumps, runs, climbs and hops.
 Constantly keeps moving.
 Clumsy and awkward movement.
b. Fine Motor
 Has improved hand-eye coordination.
 Breaths self un assisted.
 Learns cursive writing.
 Continually refines previously learned skills.
 Can brush and comb hair.
 Attention span increased.
 Can describe objects in picture, knows their use.
 Concept of cause and effect is developing.
 Can tell time.
 Is learning to read.
 Follows rules to avoid punishment
 Receptive language
 Can follow series of 3 commands, Response is dependent on mood.
 Responds to praise and recognition.
 Can repeat sentences of 10-12 words.
 Develops a sense of humor and enjoys telling jokes.
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 Development of sense of industry begins.
 Continues to be egocentric and bossy.
 Has a “know it all” attitude.
 Insists on being first in everything.
 Wants other children to play with.
 Jealous of siblings.
 Return of temper tantrums, may use verbal or physical attack.
 Has 20/20 vision.
9-10 Years
 Weight is approximately 22-32 kg.
 Height is approximately 121.5- 136.5 cm.
 Pulse is 85 + 10 beats/minute.
 Respiration is 20+ 3 /minute.
a. Gross Motor
 Performs tricks on bicycles.
 Races.
 Throws a ball skillfully, overhead.
b. Fine Motor
 Uses both hands independently.
 Cursive writing improved.
 Handles eating utensils skillfully.
 Dresses self completely.
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 Learns to understand and use abstract symbols and carries out mental
operations.
 Shows interest in casual relationships.
 Ashamed of failures.
 Interested in schoolwork.
 Memory span increasing.
 Rebels against authority.
 Follows suggestions better than commands.
 Is gregarious.
 Begins to use shorter and more compact sentences.
 Sense of industry is present.
 Curious about everything.
 Concerned about relationships with others.
 Becomes peer-oriented.
 Begins hero worship.
 Considers peer opinion more important that parents.
 Relationship with sibling improved.
 Have reasonable fears.
 Aware of appropriate sexual role.
10-12 Years
At 10 years
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 Weight is approximately 25-40 kg.
 Height is approximately 131.5-147.5 cm at 10 years
At 12 Years.
 Weight of boys: 30-40 kg.

 Weight of girls: 30-50 kg.
 Height of boys: 142-158 cm
 Height of girls: 144-160 cm
 Pulse is 90 + 20 beats/minute
 Respiratory is 19 + 3/minute
 At about 12 years molars erupt.
 Secondary sex characteristics begins to develop.
a. Gross Motor
 Enjoy all Physical activities.
 Balances on one legs with eyes closed.
 Catches tennis ball with one hand.
b. Fine Motor
 Dressing and grooming skills develop.
 Bathes frequently and unassisted.
 Movements are more graceful.
 Develops abstract and deductive reasoning.
 Uses problem – solving method.
 Can define abstract terms.
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 Interested in “why” and “how”.
 Short-interested span.
 Preoccupied with right and wrong.
 Oral vocabulary 7200 words.
 Reading vocabulary of 50,000 words.
 Uses parts of speech correctly.
 Able to give practice dictionary definitions of words.
 Enjoys riddles.
5. Psychosocial Development
 Is sincere and confident.
 Has grater self-confident.
 Respects parents and their role.
 Has short burst of anger.
 Able to control anger.
 Hero worship of adults continues.
 Still fears the dark.
vi. GROWTH IN ADOLESCENTS (12-18 YEARS)
Adolescence is a period of transition between childhood and adulthood a time of

rapid physical, cognitive, social, and emotional maturation. Several terms are used
to refer to this stage of growth and development. Puberty refers to the maturational,
hormonal, and growth process that occurs when the reproductive organs begin to
function and the secondary sex characteristics develop.
Biologic development
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The physical changes of puberty are primarily the result of hormonal activity and
are controlled by the anterior pituitary gland in response to a stimulus from the
hypothalamus. The obvious physical changes are noted in increased physical
growth and in the appearance and development of secondary sex characteristics;
less obvious are physiologic alterations and neurogonadal maturity, accompanied
by the ability to procreate. Physical distinction between the sexes is made on the
basis of distinguishing characteristics. Primary sex characteristics are the external
and internal organs that carry out the reproductive functions, secondary sex
characteristics are, the changes that occur throughout the body as a result of
hormonal (e.g., voice alterations, development of facial and pubertal hair, fat
deposits) but that play no direct part in reproduction.
Neuroendocrine Events of Puberty
The events of puberty are caused by a cluster of events that trigger the production
of gonadotropin-releasing hormone (GnRH) by the hypothalamus. GnRH travels to
the anterior pituitary gland, where it stimulates the production and secretion of
follicle-stimulating hormone (FSH) and luteinizing hormone (LH).Increasing
levels of FSH and LH stimulate a gonadal response, which for females consist of
growth of ovarian follicles, production of estrogen, and initiation of ovulation; for
males, it consists of maturation of the testicles and testosterone and stimulation of
sperm production.
Estrogen, the feminizing hormone, is found in low quantities during childhood.

Beginning in early puberty, FSH stimulates estrogen production by the ovaries;
however, estrogen levels are not high enough to cause ovulation until mid-puberty.
The increasing quantity of estrogen in early puberty causes a building of the
endometrial lining of the uterus and first menstruation, or menarche. As puberty
progresses, one ovarian follicle becomes dominant during each menstrual cycle
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and produces increasing amounts of estrogen that releases an ovum, a process
called ovulation.
Androgens, the masculinizing hormones, are also secreted in small and gradually
increasing amounts up to the age of about 7 or 9 years, at which time there is a
more rapid increase in both sexes, especially boys, until the age of about 15 years.
These hormones have tremendous growth-promoting properties that result in rapid
increases of muscle mass, skeletal growth, and bone density.
Sexual Development
The visible evidence of sexual maturation is achieved in an orderly sequence, and

the state of maturity can be estimated on the basis of the appearance of these
external manifestations. The age at which these changes are observed and the time
required to progress from one stage to another may vary among children. The time
from the appearance of breast buds to full maturity may be 1½ to 6 years for
adolescent girls.
Sexual maturation in girls: In most girls, the initial indication of puberty is the
appearance of breast buds, an event known as thelarche, which occurs between the
ages of 8 and 13 Years. This is followed in approximately 2-6 months by growth of
pubic hair on the mons pubis, known as adrenarche. In a minority of normally
developing girls, however, pubic hair may precede breast development. The
average age of thelarche for white girls is 9 .7 Years, Hispanic girls is 9.3 years,
and African-American girls is 8.8 years.
The initial appearance of menstruation, or menarche, occurs about 2 years after the
appearance of the first pubescent changes approximately 9 months after attainment
of peak height velocity, and 3 months after attainment of peak weight velocity.
There is evidence that girls are developing secondary sex characteristics at a
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younger age among various ethnicities. The explanation for this is not yet clear but
appears to be influenced by being overweight as well as environmental influence·
Sexual maturation in boys: The first pubescent changes in boys are testicular
enlargement accompanied by thinning, reddening and increased looseness of the
scrotum. These events usually occur between the ages of 9½ and 14 Years. Early
puberty is also characterized by the initial appearance of pubic hair. Penile
enlargement begins, and testicular enlargement and pubic hair growth continue
throughout mid-puberty. During this period, there is also increasing muscularity,
early voice changes, and development of early facial hair. Temporary breast
enlargement and tenderness, gynecomastia, are common during early to mid-
puberty, occurring in up to 70% of boys. Late puberty, there is a definite increase
in the length and width of the penis, testicular enlargement continues, and first
ejaculation occurs. Axillary hair develops, and facial hair extends to cover the
anterior neck, Final voice changes occur secondary to the growth of the larynx.
Physical growth during puberty
A number of physiologic functions are altered in response to some of the pubertal

changes. The size and strength of the heart, blood volume, and systolic BP
increase, whereas the heart rate decreases. Blood volume, which has increased
steadily during childhood reaches a higher value in boys than in girls, a fact that
may be related to the increased muscle mass in pubertal boys. Adult values are
reached for all formed elements of the blood. The lungs increase in both diameter
and length during puberty. Respiratory rate decreases steadily throughout
childhood and reaches the adult rate in adolescence. Respiratory volume and vital
capacity are increased to a far greater extent in males than in females. The rate of
steady decline in BMR from birth to adulthood slows during puberty. During this
period, physiologic responses to exercise change drastically: performance
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improves, especially in boys, and the body is able to make the physiologic
adjustments needed for normal functioning after exercise is completed. These
capabilities are a result of the increased size and strength of muscles and the
increased level of cardiac, respiratory, and metabolic functioning.
Cognitive development Emergence of Formal operational Thought (Piaget)
Cognitive thinking culminates with the capacity for abstract thinking. This stage,
the period of formal operations, is Piaget’s fourth and last stage. Adolescents are
no longer restricted to the real and actual, which was typical of the period of
concrete thought; now they are also concerned with the possible. They think
beyond the present. Without having to center attention on the immediate situation,
they can imagine a sequence of future events that might occur, including college
and occupational possibilities; how things might change in the future, such as
dropping out of school. At this time, their thoughts can be influenced by logical
principles rather than just their own perceptions and experiences. They become
increasingly capable of scientific reasoning and formal logic.
Moral Development (Kohlberg)
Late adolescence 1s characterized by serious questioning of existing moral values

and their relevance to society and the individual. Adolescents can easily take the
role of another. They understand and obligation based on reciprocal rights of others
and the concept of justice that is founded on making amends for misdeeds and
repairing or replacing what has been spoiled by wrongdoing. However, they
seriously question established moral codes, often as a result of observing that
adults verbally ascribe to a code but do not adhere to it.
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Psychosocial Development
Identity Development (Erikson)
Adolescence begins with the onset of puberty and extends to relative physical and
emotional stability at or near graduation from high school. During this time,
adolescents are faced with the crisis of group identity versus alienation. In the
period that follows, individuals strive to attain autonomy from the family and
develop a sense of personal identity as opposed to role diffusion. A sense of group
identity appears to be essential to the development of a personal identity. Young
adolescents must resolve questions concerning relationships with a peer group
before they are able to resolve questions about who they are in relation to family
and society.
Group identity: During the early stage of adolescence, pressure to belong to a

group is intensified. Teenagers find it essential to belong to a group from which
they can derive status. Belonging to a crowd helps adolescents establish the
differences between themselves and their parents. They dress as the group dresses
and wear makeup and hairstyles according to group criteria, all of which are
different from those of the parental generation.
Individual identity: As adolescents establish identity within a group, they also

attempt to incorporate multiple body changes into a concept of the self. Body
awareness is part of self-awareness. In their search for identity, adolescents
consider the relationships that have developed between themselves and others in
the past, as well as the directions they hope to take in the future.
Sex-role identity: Part of adolescent identity formation involves the development

of sexual identity. As they begin to integrate changes involved with puberty, young
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adolescents also develop emotional and social identities separate from their
families. For young adolescents, the process of sexual identity development
usually involves forming close friendships with same-sex peers. Sexual orientation
is an important aspect of sexual identity. Sexual orientation is defined as a pattern
of sexual arousal or romantic attraction toward persons of the opposite gender
(heterosexual), of the same gender (homosexual), or of both genders (bisexual).
Social environments
The biologic, cognitive, and social changes of adolescence are shaped by the social
environment in which the changes takes place.
 Families
As teenagers assert their rights for grown-up privileges, they frequently
create tensions within the home. They resist parental control, and conflicts
can arise from almost any situation or any subject. Favorite topics of dispute
include internet use, the need for a personal cell phone, manners, dress,
chores and duties, homework, disrespectful behaviour, friendships, dating
and relationships, money, automobiles, alcohol and other substance abuse,
They absent themselves from home and family activities and spend an
increasing amount of time with the peer group. They confide less in their
parents, but parents continue to play an important role in the personal and
health-related decision-making of adolescents.
 Peer groups
The peer group has an intense influence on adolescents self evaluation and
behaviour. Peers serve as credible sources of information role models of new
social behaviours sources of social reinforcement, and bridges to alternative
lifestyles. To gain acceptance by a group, younger adolescents tend to
conform completely in such things as mode of dress, hairstyle, taste in
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music, and vocabulary. Peers can also be a positive force in health
promotion by encouraging healthy behaviours, serving as role models, and
promoting positive health norms.
 Schools
The school is psychologically important to adolescents as a focus of social
life. Teenagers usually distribute themselves into a relatively predictable
social hierarchy. They know to which groups they and others belong. A
sense of school connectedness and optimal social. Within the larger groups
are smaller, distinct, and exclusive crowds or cliques of selected close
friends who are emotionally attached to one another.
 Work
The jobs tend to require little initiative or decision making and rarely use
skills learned in school. Adolescent work may negatively affect development
as it fails to link adolescents to vocational mentors, is not intellectually
stimulating, may take time away from other activities that could contribute
to identity development, and can lead to fatigue, decreased interest in school,
and poorer grades. These detrimental effects are likely to affect adolescents
who work more than 20 hours a week.
DEVELOPMENT IN ADOLESCENTS
12-13 YEARS (Early Adolescence)
 Weight
Males – Approximately 38-60 kg
Females – Approximately 40-60 kg
 Height
 Males – Approximately 154-175 cm
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 Females – Approximately 153 – 167 cm.
 Pulse - 65 +8 beats/minute.
 Respiration -19+ 3/minute.
 Blood pressure
Males 114/68 + 10/14 mm Hg
Females 112/66 + 10/12 mm Hg
 Eruption of second molars.
 Secondary sex characteristics develop.
 Clumsiness due to rapid physical growth.
 Motor functions comparable to adults.
 Eye-hand coordination like adults.
 Manual dexterity is attained.
 Formal operational thoughts.
 Generates hypotheses.
 Uses scientific method for problem solving.
 Uses slangs within and outside peer group.
 Uses distinct meanings for words.
 Beginning of development of sense of identity.
 Has intense loyalty to peer group.
 Shows mood swings and extremes of behavior.
 Hero worship continues.
 Masturbation starts.
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14-16 YEARS (Middle Adolescence)
 Weight
 Height
 Pulse - 63 + 8 beats/minute.
 Respiration - 17+ 3/minute.
 Same as adults.
 Expresses concern for education and vocation.
 Sense of identity develops.
 Egocentrism diminishes.
 Heterosexual relationships are common.
 Verbally attacks parent’s beliefs and values
5. Moral Development
 Fixed rules in moral decisions.
 Obligation to do no harm and to do duty.
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17-21 YEARS (Late Adolescence)
 Weight
 Height
 Pulse - 70 + 10 beats/minute.
 Respiration - 17+ 3 breaths/minute.
 Blood pressure is 126/74 +26/16 mm Hg.
 Possesses manual dexterity
 Pursues further education or enters job market.
 Severs ties with parents.
 Establishing interdependent relationship with parents.
 Have fewer but close friends.
 Heterosexual relationships are the rule.
5. Moral Development
 Social contracts understood and formulated.
 Laws recognized as changeable.
 Correct actions depend on standards are individual rights.
6. Sexual Development During Adolescence
 Girls attain puberty at around 10-15 years of age.
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 Boys attain puberty between 12-16 years of age.
Girls
8-9 years
 Sex Hormones begin to release
9-10 years
 Hips start rounding out

 Breast nipples start growing.
10-11 Years
 Internal and external genitalia grows.

 Pubic hair become darker and coarser.
12-13 Years
 Underarm hair growth appears.

 Onset of menstruation.
13-14 Years
 At times underpants are wet with clear mucus especially during ovulation
and sexual arousal.
14-15 Years
 Growth spurt complete

 Pregnancy is possible.
Boys
 9-10 Years
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 Testes become larger.
 Scrotal skin becomes dark in color and coarse in texture.
11-12 Years
 Prostate begins to function.

 Penis begins to lengthen.
12-13 Years
 Pubic hair growth.

 May experience wet dreams, spontaneous erection, ejaculations.
 Growth spurt begins.
13-14 Years
 Rapid growth of penis occurring about 1 year after testes begins to grow.
 Testes color deepens.
 Two-third of boys may experience slight growth of breast tissue which
generally subsides within 1 year.
14-15 Years
 Underarm hair appears.

 Moustache begins as fine hair starting at outside tip edges about 2 years after
pubic hair appears.
 Voice change begins.
15-16 Years
 Sperm matures and can cause pregnancy.

 Majority of growth spurt is complete.
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16-17 years
 Chest and shoulder fill out.

 Facial and body hair becomes heavier.
 Acne occurs.
C) DEVELOPMENTAL MILESTONES
Normal development is a complex process and has altitude of facets. However, it is
convenient to understand and assess development under the following domains:
i. Gross motor development
ii. Fine motor skill development
iii. Personal and social development and general understanding
iv. Language
v. Vision and hearing
i)GROSS MOTOR DEVELOPMENT
Motor development progresses in an orderly sequence to ultimate attainment of
locomotion and more complex motor tasks thereafter. In an infant it is assessed and
observed as follows:
Supine and pull to sit: The infant is observed in supine and then gently pulled to
sitting position. Control of head and curvature of the spine is observed. In the
newborn period, the head completely lags behind and back is rounded. Starting at 6
weeks, the head control develops and by 12 weeks there is only a slight head lag.
The spine curvature also decreases accordingly. The child has complete neck
control by 20 weeks. This can be ascertained by swaying him gently 'side-to-side'
.when sitting. At this age, the baby loves to play with his feet, and may take his
foot to mouth as well. Infant lifts head from the supine position when about to be
pulled at 5 months.
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Ventral suspension: The child is held in prone position and then lifted from the
couch, with the examiner supporting the chest and abdomen of the child with the
palm of his hand. Up to 4 weeks of age, the head flops down. At 6 weeks, the child
momentarily holds head in the horizontal plane and by 8 weeks, he can maintain
this position well. By 12 weeks, he can lift his head above the horizontal plane.
Prone position: At birth or within a few days, the newborn turns the head to one
side. At 2 weeks, the baby lies on the bed with high pelvis and knees drawn up. At
4 weeks, the infant lifts the chin up momentarily in the midline. The infant lies
with flat pelvis and extended hips at 6 weeks. By 8 weeks, face is lifted up at 45°
and by 12 weeks, the child can bear weight on forearms with chin and shoulder off
the couch and face at 45°.At 6 months, he can lift his head and greater part of the
chest while supporting weight on the extended arms. Between 4 and 6 months, he
learns to roll over, at first from back to side and then from back to stomach. By the
age of 8 months, he crawls (with abdomen on the ground) and by 10 months,
creeps (abdomen off the ground, with weight on knees and hands).
Sitting: By the age of 5 months, the child can sit steadily with support of pillows
or the examiner's hands. At first the back is rounded but gradually it straightens.
He independently sits with his arms forward for support (tripod or truly 'sitting
with support') by the age of 6-7 months. Steady sitting without any support
generally develops at around 8 months. By 10-11 months, he can pivot in sitting
position to play around with toys.
Standing and walking: By 6 months, the child can bear almost all his weight
when made to stand. At 9 months, the child begins to stand holding onto furniture
and pulls himself to standing position. By 10 and 11 months, the child starts
cruising around furniture. At about 12-13 months the child can stand independently
and can walk with one hand held. Between the ages of 13 and 15 months the child
starts walking independently. He runs by 18 months and at this age he can crawl up
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or down stairs and pulls a doll or wheeled toy along the floor. By 2 yr, the child
can also walk backwards. He climbs upstairs with both feet on one step at 2 yr. By
3 yr he can climb upstairs with one foot per step and by 4 yr he can move down the
stairs in the same fashion. He can ride a tricycle at 3 year. He can hope at 4 yr and
skip at 5 yr.
ii) FINE MOTOR DEVELOPMENT
This primarily involves the development of fine manipulation skills and
coordination with age.
Hand eye coordination: Between 12 and 20 weeks, the child observes his own
hands very intently, this is called hand regard. Its persistence after 20 weeks is
considered abnormal. At 3 to 4 months, hands of the child come together in
midline as he plays. If a red ring is dangled in front of him, he fixes his attention
on it, and then tries to reach for it. Initially he may overshoot but eventually he gets
it and brings it to his mouth.
Grasp is best assessed by offering a red cube to the child. A 6-month-old infant
reaches and holds the cube (larger object) in a crude manner using the ulnar aspect
of his hand. He can transfer objects from one hand to other by 6-7 months. The
child is able to grasp from the radial side of hand at 8--9 months. By the age of 1 yr
mature grasp (index finger and thumb) is evident. By offering pellets (smaller
object), finer hand skills are assessed. By 9-10 months, the child approaches the
pellet by an index finger and lifts it using finger thumb apposition, termed 'pincer'
grasp.
Hand-to-mouth coordination: At 6 months, as the ability to chew develops, the
child can take a biscuit to his mouth and chew. At this age, he tends to mouth all
objects offered to him. This tendency abates by around 1 yr of age. By this age, he
tries to feed self from a cup but spills some of the contents. By 15 months, the
98
child can pick up a cup and drink from it without much spilling. By 18 months, he
can feed himself well using a spoon.
Advanced hand skills: With advancing age, the child can use hands to perform
finer activities. Much of the advanced skills depend partly on the opportunity given
by the caretakers to the child. At around 15 months, he turns 2-3 pages of a book at
a time and scribbles on a paper if given a pencil. By 18 months, he can build a
tower of 2-3 cubes and draw a stroke with pencil. By 2 yr, he can unscrew lids and
turn door knobs and his block skills also advance. He now draws a circular stroke.
He now can turn pages of a book, one at a time. In general copying of the skill
comes 6 months after imitating the skills (doing it while seeing).
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3yr 4yr
41/2 yr
5yr 6yr 7yr
8yr 9yr 11yr
Table no. 1: Drawing skills at various ages
100
Dressing: Between 18 and 30 months of age, children are very eager to learn
dressing skills. Understanding being easier, is learned before dressing. At 1 yr of
age the child starts to pull off mittens, caps and socks. At around 18 months, he can
unzip, but fumbles with button. By 2yr, he can put on shoes or socks and can
undress completely. By 3 yr, he can dress and undress fully, if helped with buttons.
By 5 yr, he can tie his shoelaces as well.
iii) PERSONAL AND SOCIAL DEVELOPMENT
Much of the cognitive development and understanding is reflected by the
attainment of important milestones in this sphere. Beginning at around 1 month,
the intently watches his mother when she talks to him. He starts smiling back
(social smile) when anyone talks to him or smiles at him by 6-8 weeks of age. It is
important to differentiate social smile from spontaneous smile (smile without any
social interaction), which is present even in neonates. By 3 months, he enjoys
looking around and recognizes his mother. By 6 months, he vocalizes and smiles at
his mirror image and imitates acts such as cough or tongue protrusion. The child
becomes anxious on meeting strangers (stranger anxiety) by 6-7 months of age. At
this age he inhibits to "no". At 9 months, he waves "bye-bye" and also repeats any
performance that evokes an appreciative response from the observers. By 1 yr, he
can understand simple questions, such as "where is papa", "where is your ball", etc.
By 15 months, he points to objects in which he is interested. By 18 months, he
follows simple orders and indulges in domestic mimicry (imitates mother sweeping
or cleaning). At 2 yr, when asked he can point to 5-6 familiar objects, name at least
2-3 objects and point to 3--4 body parts. He begins to count, identify 1-2 colors and
sing simple rhymes by age of 3 yr. Much of these milestones depend on the
caretaker's interaction and opportunities provided to the child. The left and right
discrimination develops by 4 yr. By this age, play activities are also very
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imaginative. By 5 yr of age, children can follow 3 step commands, identify four
colors and repeat four digits.
iv) LANGUAGE
Throughout the development of language it is the receptive ability and
understanding which precedes expressive. abilities. Soon after appearance of social
smile at around 6 to 8 weeks, the child begins to vocalize with vowel sounds such
as 'ah, uh'. At 3-4 months, he squeals with delight and laughs loud. He begins to
say 'ah-goo', 'gaga' by 5 months of age. By 6 months, he uses monosyllables (ba,
da, pa). Later, he joins consonants to form bisyllables (mama, baba, dada). Before
developing true meaningful speech, at around 9-10 months the child learns to
imitate sounds derived from his native language. At his first birthday, he can
usually say 1-2 words with meaning. At 18 months, he has a vocabulary of 8-10
words. Thereafter, the vocabulary increases rapidly to around 100 words by 2 yr, at
which time 2-3 words are joined to form simple sentences. By 3 yr, the toddler
continually asks questions and knows his full name. He can give a coherent
account of recent experiences and events by the age of 4 yr.
v) VISION AND HEARING
Adequate sensory inputs are essential for development. Both normal vision and
hearing are of paramount importance for child development. The ability to see and
hear is apparent even in the newborn. Thereafter maturation of visual and hearing
pathways are reflected by specific visual and auditory behaviors.
Vision: The best stimulus to check visual behavior is the primary caretaker's face.
At birth, a baby can fixate and follow a moving person or dangling ring held 8-10
inches a way up to a range of 45°. This increases to 90° by 4 weeks and 180° by 12
weeks. At around 1 month, the baby can fixate on his mother as she talks to him.
At about 3-4 months, the child fixates intently on an object shown to him('
grasping with the eye') as if the child wants to reach for the object. Binocular
102
vision begins at around 6 weeks and is well established by 4 months. By 6 months,
the child adjusts his position to follow objects of interest, can follow rapidly
moving objects by 1 yr. Later the child displays more maturity in vision by not
only identifying smaller objects but also being able to recognize them.
Hearing: Newborns respond to sounds by startle, blink, cry, quieting or change in
ongoing activity. By 3 to4 months, the child turns his head towards the source of
sound. Hearing, may be checked by producing sound 11h feet away from the ear
(out of field of vision), and a pattern of evolving maturity of hearing can be
observed. At 5 to 6 months the child turns the head to one side and then
downwards if a sound is made below the level of ears. One month later he is able
to localize sounds made above the level of ears. By the age of 10 months the child
directly looks at the source of sound diagonally.
X. DEVELOPMENT NEEDS OF CHILDREN
A) EMOTIONAL – SOCIAL NEEDS
The kind of person the infant will because depends largely upon the characteristic
of the parents their relations with each other and emotional atmosphere of their
home. The parents attitude towards the infant is of fundamental importance to the
child’s future.
1.Love and security
The most important emotional need to infant and children of all ages is to be found
and to feel secure in that lone. Love is communicated to them through actions and
words. They eventually learn that they are loved just because they exist and not
because of others they do.
103
2.Dependence Progressing To Independence
Neonates are totally dependents at birth during the first year of life, their beginning
independence is see in attempting to feed themselves and in co operating in
dressing.
6. Discipline Leading To Self – Control
Changes to kind normally cause degree of anxiety. Parents who do not help their
infants handle the anxiety connected with physical and emotional growth parent
them from changing and developing
7. Developing Self- Esteem
Self esteem develops gradually through the appraisals of significant others and the
infant’s achievement of developmental milestone infants with loving parents who
can communicate their deep feelings of long through actions and words and
enough their children to develop their abilities have already begin their journey
toward developing health self esteem.
B) BIOLOGICAL NEEDS
Infants have their own physical biologic needs as do all other family members. The
man for the infant’s call must consider ways adjusting all these common and
conflicting requirements parents and other family members should not feel that.
They must do all the adjusting when a new baby comes into the family. If they do
their care may intimately lack spontaneity and warmth.
C) PLAY NEEDS OF CHILDREN
Play is an activity which is very essential for the growth and maturation of
the physical and mental powers of the child. Play is the work of children and is the
vehicle for their development. A child cannot resist himself from play. He needs to
104
run, jump and climb, and he needs to feel the wind, the sight and smell of plants
and trees. Through play, he learns about himself and the world in which he lives.
i. Characteristics of Children’s Play.
There are certain universal characteristics of children’s play. Children’s Play

is informal. Children play spontaneously whenever they wish and with whatever
toy they have, and it is informal.
Play Follows a Pattern of Development
Studies reveal that play occurs in a more or less regular order and ends at
predictable times in the child’s pattern of development. We all know that a 2-3
months old child plays by looking at people and objects and by making random
movements to grab objects held before him. Afterwards, when he gains control, he
can grasp, hold and examine small objects and toys.
Tradition influences Play
Certain forms of play are passed on from one generation to another in every
culture. Younger ones observe and imitate the play of older children.
Time Spent to Play Decreases with Age
As the age advances, a child gets more assignments and the leisure time he gets to
play reduces. Socioeconomic states to some extend influences the time he receives
to play
Play Activities Decrease in Number with Age.
Gradually the play activities decrease in number as the child grows older. He gets
less time to spend for play and has a greater understanding of his interests and
abilities. His attention span is also longer.
105
Time Spent in a Specific Activity increases with Age.
The younger the child, the lesser is the concentration he has on one toy. He moves
from one play to another and one toy to another within a short period, But as the
child grows older, he gets more concentration on one activity/play and the time he
spends in one activity increases.
Younger Children Engage in a More Vigorous Active Play
Play becomes less physically active as the child grows older. Preschool and school-
age children are more vigorous, energetic and active in their play.
ii. TYPES OF PLAY
Type of play depend upon the child’s age and level of development.
Solitary play
This type of play is seen mostly in infants and toddlers. The child plays alone,
independent of other nearby children or adults. He concentrates fully in the play,
not knowing what is happening around him. Though it is prominent in infants and
toddlers, it has a place at every age. The child engages in activities such as fishing,
making clay models, painting, walking alone, etc. Adolescents do not consider
these activities as play.
As the child grows and develops, play characteristics also change. Babies
play by themselves with moving objects. Toddlers play by themselves but they
enjoy playing near other children. The child plays alongside others but not with
them.
106
Onlooker Play
The child watches other children playing without engaging him in the play. He sits
or stands nearby and watches what is going on with much interest.
Cooperative Play
Children begin to play together in simple direct ways by the age of 3 years.
Preschoolers begin to play together cooperating each other such as one child acts
as ’police’ and the other one as a ‘thief’. There are leaders and followers in such
groups. During school years, they play in groups, such as ‘hide and seek’, board
games, etc.
Associative Play
In this type of play, social interaction occurs between children. There is no

organization of activity or division of play tasks. They are no organization of
activity or division of play tasks. They are interested in the associations with other
children. Each one plays in whatever way he or she wants. This type of play is
more common among children of 3-4 years of age.
Play can be classified as:
Motor Play: Use of larger and smaller muscles, e.g. pushing and pulling, drawing.
Creative play: Manipulation of certain things, e.g. mud, sand.
Quiet play: Listening to stories, singing.
Dramatic play: Initiating others or animals.
iii) SELECTION OF PLAY MATERILS
While selecting play material for the child, parents/adults should consider the child
parent/adults should consider the child’s physical, Intellectual and emotional
107
capabilities. Play material should be provided based on the child’s age, abilities,
interests, safety, environment, etc. The smaller the child the larger the toy should
be,
Points to be remembered while selecting the toys:
 Materials used for making toys should be sturdy and should not be
inflammable.
 It should not have any sharp edges which may injure the child.
 It should have no sharp points that can puncture.
 No toy should be used as weapons.
 It should be such that it is easy to clean.
 It should be safe.
 It should not have any small parts that can be removed, which may be
swallowed or inhaled.
 It should not be making excessive noise, which may damage hearing
capability.
 Avoid darts or arrows for children younger than 5 years.
 It should have no elements that can cause burns.
 Protruding bolt ends should have protective plastic caps.
 Electrical toys may cause shock or burns. Such toys should not be given to
children carelessly: preferably avoid such toys.
 It should have no toxic paints or other toxic materials in it.
 It should be suitable for the age of the child. Check the label hat indicates
the intended age group.
 It should be simple, uncomplicated and expensive.
108
 Dispose of the plastic wrapping around toys as it may cause accidental
suffocation
 Avoid toys with strings or cords that are longer for smaller children as it
may cause strangulation.
 It needs to be light enough that they will cause no harm if it falls over the
child.
Teach the children how to use and store toys. Children should be able to
follow the directions while using the playthings. They should develop a habit
of keeping their toys in a safe place each time after use. Make sure that the
playthings are in good condition broken toys can cause harm to the child. Do
not keep the toys of children of different ages at same place. Parents should
constantly supervise the children while playing. Set rules for pay. Keep the
bolts of toys tightened and joints lubricated.
The nurses should observe the children while they play, in the hospital. She
gets ample opportunities to observe their growth and development, their
physical and emotional health and their relationship with parents, siblings and
peers. When children are aware that they are being observed, they become self-
conscious, shy and embarrassed. She should record their observations
completely and accurately.
109
XI. ROLE OF CARE TAKER
Direct care
giver
Observer
Monitor
Care
Supporter
taker Teacher
Guider Councellor
Fig no:1 Role of care taker
DIRECT CARE GIVER: parents are primary care giver of the baby. As children
develop from infants to teens to adults they go through a series of developmental
stages that are important to all aspects of their personhood including physical,
intellectual, emotional and social. The proper role of the parent is to provide
encouragement, support, and access to activities that enable the child to master key
developmental tasks.
TEACHER: A parent is their child’s first teacher and should remain their best
teacher throughout life. Functioning as a coach, the parent exposes a child to age-
appropriate challenges to encourage development as well as to experiences that
110
allow the child to explore on their own and learn from interacting with their
environment.
SUPPORTER: Children’s development of the cognitive and social skills needed

for later success in school may be best supported by a parenting style known as
responsive parenting. Responsiveness is an aspect of supportive parenting
described across different theories and research frame works as playing an
important role in providing a strong foundation for children to develop optimally.
GUIDER: Parenting that provides positive affection and high levels of warmth and
is responsive in ways that are contingently linked to a young child’s signals
(“contingent responsiveness”) are the affective-emotional aspects of a responsive
style. These aspects, in combination with behaviors that are cognitively responsive
to the child’s needs, including the provision of rich verbal input and maintaining
and expanding on the child’s interests, provide the range of support necessary for
multiple aspects of a child’s learning.
MONITOR: parents should be a good monitor. They must acceptance of the

child’s interests with responses that are prompt and contingent to what the child
signals supports learning, in part, by facilitating the child’s development of
mechanisms for coping with stress and novelty in his or her environment.
COUNSELLOR: With repeated positive experiences, a trust and bond develop

between the child and parent that in turn allow the child to ultimately internalize
this trust and then generalize their learning to new experiences. This sensitive
support promotes the child’s continued engagement in learning activities with his
or her parent. This will help to motivate their skill of problem solving.
111
OBSERVER: parents must be a good observer. They should immediately
understand when the child is having any changes in their behavior. So they must
closely watch the child and ask them to understand their problems.
XII. ROLE OF CAREGIVER
The pediatric nurses’s role is unique because of developmental

immaturity and vulnerability of children. The goals of nursing care of
children, based on primary health care are:
primary care
giver
nurse health
researcher teacher
nurse
consultant
care nurse
counsellor
nurse
recreationist giver social
worker
co-ordinator
nurse &
manager
child care collaborator
advocate
Fig. 2 Role of nurse
1. Primary Caregiver: Pediatric nurses are providing basic care to children

Like hospitalized Child physical, Growth and developmental assessment,
Immunization, feeding. It should be focused on
112
1. Preventive aspect of care
2. Promotive aspect of care
3. Curative aspect of care
4. Rehabilitative aspect of care
2. Health Teacher: A child health teaching is very basic duty for nurses since
they are the ones responsible for monitoring the child as well as carry out the
Physician’s discharge orders. She must be anticipating parent’s doubts
regarding improvement of their children’s health status such as parenting
and disease process so as to prevent future hospital admission as such as
much as possible.
3. Nurse Counsellor : On Providing guidance to parents in health hazards of
children and health them for own decision making in different situations.
Nurse counsellor must be active listeners in order to establish a therapeutic
relationship between parents and child, making health care plans easier.
Nurse counsellor will be solving the parent’s problem towards their child
care. She help the parents to take the independent decision for betterment of
their child health care.
4. Social Worker : Pediatric nurse can participate in social services or refer
child family to Child welfare agencies for necessary support. In child health
care, sometimes, pediatric nurse act as a social worker, try to reduce the
social problems which is going to affect the child health. She should guide
the parents related to child welfare agencies for improvement of Child
health.
5. Coordinator and Collaborator: Pediatric nurses are sometimes or most of
the time works with other health care team members, where he or she is the
113
avenue of important information that other health team members need in
delivering competent care. 80 it is a must that pediatric nurses need to be a
good information giver and communicator among health team members to
promote a harmonious working environment.
There are many roles that a pediatric nurse could perform as health care
settings evolved from one stage to another. The challenge lies behind the
application of evidenced-based practice to provide competent care to
children. Last but not the least, having a heart for children matters a lot when
the work load at the area seems to be heavy children could make you smile
no matter how harsh the world could be.
6. Child Care Advocate : Pediatric nurses are expected to be sensible enough
in voicing out the needs of their child and folks in behalf of them when it is
impossible for them to readily address their needs. She can help the child
and parents to receive the best quality of care from the hospital.
7. Nurse Manager: A pediatric nurse managers should help the child and
parents by managing the nurses who care for them. While these nurses are
mainly responsible for recruitment and retention of the nursing staff and
overseeing them, they should be collaborate with doctors on child care, and
help to assist child and their families when needed.
8. Nurse Recreationist : The pediatric nurse plays supportive role for the child
to provide play facilities for recreation and diversion. It helps to decrease
crisis imposed by illness or hospitalization.
9. Nurse Consultant: The pediatric nurse can act as consultant to guide
parents and family members for maintenance and promotion of health. For
example, Guiding parents about feeding practices, accident prevention,
drowning and childhood poisoning.
114
10.Nurse Researcher: Pediatric nurse researchers are more important in
pediatric nursing field for improvement Of Child health status. A change is
constant in the health care setting, so it is must to practice evidenced-based
practice. This means that pediatric nurses should have the ability to improve
themselves in order to give updated care to children.
115
XII SUMMARY
By the end of this seminar we studied all the developments like language
cognitive moral, spiritual, psychosexual which plays an important role to make the
child a perfect individual. Displace also have great infants on child behaviour a
slight deviation in these developments may have a great impact on the and the
nurse has to know all the developmental stages to implement in the care of her
patients. Also she should aware about the accident an occur to children and she is
after to educate the prevents measures to avoid that accidents to the percent.
116
XV CONCLUSION
Growth and development is continuous process which extends through the life
cycle. Each child has the different pattern of growth and development it follow
some method and principles and some development theories – growth proceeds in
various stages majority divided in prenatal period and post natal period. There are
various factors which infant the growth and development like 1) genetic factor 2)
Prental factors 3) postnatal factors 4) social factors 5) environmental factors etc
child growth and development can be measured by weight, length , body mass
index, head circumference by these growth measurement.
117
XVI BIBLIOGRAPHY
1. Ghai. O.P. The text book of Essential pediatrics. 7th edition, CBS
publishes&distribbuters Pvt Ltd,23-41
2. Gupte Suraj. The text book of Short textbook of pediatries. 10th edition.
Jaypee publications, 31-61
3. Sharma Rimple .The text book of Essentials of pediatric Nursing. 2nd
edition, Jaypee publication,49-71
4. Gupta Piyush. the text book of PG text book of pediatrics Volume 1.The
health science publisher, 701-736
5. Marlow. R. Dorothy, Reding A. Barbara, The text book of “Pediatric
Nursing: 6th edition saunders an infants of Esevier, 547-598
6. Yadav Manoj, The text book of “chld Health Nursing, 2013 edition PV
books publishers,69-132
7. Varghese Susamma, Susmitha Anupama. (2015). Text book of Pediatric
Nursing. 1st Edition. New Delhi: Jaypee publications,41-42
8. Sudhakar a. ( 2017). Essentials of pediatric nursing. 1st edition. New
delhi.Jaypee publications, 21-23.
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Growth and Development in Children

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GROWTH AND DEVELOPMENT

Growth is an essential feature of life of a child that distinguishes him or her

2.Development: Development specifies maturation and myelination of the nervous

3.Maturation: It is an increase in competence and change in behaviour and

III. PRINCIPLES OF GROWTH AND DEVELOPMENT

Development Proceeds from the Head Downward. This is called the

These changes in the brain and nervous system help children to

4. Development Proceeds from the Simple (Concrete) to the More

As children develop further in cognitive skills, they are able to

5. Growth and Development is a Continuous Process

IV. CHARECTERESTICS OF GROWTH AND DVELOPMENT

a) Development is similar for all: All children follow similar pattern of

b) Development proceeds from general to specific: In motor as well as

c) Development is continues : Development is a continues process starting

d) Development proceeds at different rates: Growth and development is a

e) There is correlation in growth and development: Correlation in physical

f) Development come from maturation and learning: Sudden appearance of

g) There are individual differences: Although pattern of development is

3-6 years 1-3 years

j) There are predicable patterns of growth and development : Both during

1. To identify the Developmental delay: The assessment of growth and

2. To identify strength and developmental needs: The assessment can be

3. To develop strategies for intervention: Development is qualitative as well

4. To serve as a basis for reporting to parents: It is important to monitor

VI.ASPECTS OF GROWTH AND DEVELOPMENT

Growth and development have the following aspects.

Length or height increases from birth to maturity. Rapid increase in height

The head circumference is in important measurement it is related to intractional

Motor development depends on maturation of nuclear, skeletal and nervous

Gross motor development leads to acquisition of increasing mobility and

Many theories have been devised to student development of different aspects in

1. Intellectual development theory in children

VII.THEORIES OF GROWTH DEVELOPMENT

Mental development is demonstrated in problem solving and in general

According to piaget (Gruber voneche, 1977) maturation and growth have

The ability to use symbols to represent reality is another important stage in

Kohlberg’s theory of normal development

Kohlberg believed that development of moral reasoning occurs step by step in

Level I: pre conventional / Morality : Ego – children make moral judgements

d) Stage 3 (7-9 yrs): orientation to interpersonal relationship occur in this age.

Level 3 : Post conventional morality : Adolescents make choices on the bring

e) Stage 4: Higher laws and conscience orientation- Adolescents follow

The theory of Erikson concerning ‘Psychosocial development’ states that

Religious belief are based on theories of atheism or agnosticism. Flower

Stage I Primal Faith (infancy)

Stage II: intuitive – projective faith (3-7 yrs)

Stage III. Mythic- Literal faith (childhood and beyond)

Stage IV: Synthetic – Conventional faith (Adolescence)

3. Genital (Oedipal) Stage:

The ability communicate is a significant factor is a signification factor in

VIII.FACTORS INFLUENCING GROWTH AND DEVELOPMENT

Adjustment to Extra uterine Life

Physiologic Status of Other Systems

Fluid and electrolyte balance

ii) INFANCY ( 1 MONTH TO 12 MONTHS)

The respiratory rate slows somewhat and is relatively stable. Respiratory

Fine Motor development

The palmar grasp ( using the whole hand) is replaced by ). By 8 to 10 months of

Gross motor development

Locomotion: Locomotion involves acquiring the ability to bear weight, propel

Psychosocial Development: Developing a Sense of Trust

Cognitive Development: Sensorimotor Phase {Piaget}

Development of Body Image

The development of body image parallels sensorimotor development. Infants