GROWTH AND DEVELOPMENT

Dr.P.Natarajan

Percentile
Data is arranged in ascending order from 0 to 100 to show
which percentage of the distribution is above and below the
item

Standard deviation
The Standard Deviation is a measure of how
far away a particular value is from the normal

Its symbol is (the Greek letter sigma)

It is the square root of the Variance.

S.D
Gaussian distribution

1 SD=About 68%
2 SD=About 95%
3 SD= bout 99.7%

Z score
The standard normal distribution is sometimes called
the z distribution.
A z score reflects the number of standard deviations
above or below the mean a particular score is.
For instance, if a person scored a 70 on a test with a
mean of 50 and a standard deviation of 10, then they
scored 2 standard deviations above the mean.
Converting the test scores to z scores, an X of 70
would be:

DEFINITION
Growth:
1.It is physical maturation. It is the increase in size of the
body in height, weight and other measurable areas.
quantitative
2.Rates vary during different stages of growth ; The growth
rate is rapid during the prenatal, neonatal, infancy and
adolescent stages and slows during childhood;

3.GROWTH SPURTS

Development
1. Qualitative
2. Development is physiological, social and
psychological maturation.
3. It is the gaining of behaviour and skills in all

aspects of the childs life.

Definitions
Developmental milestones are a set of
functional skills or age-specific tasks that most

children can do at a certain age range.

Domains
1. Gross motor: sit, stand, walk, run, etc.,
2. Fine motor: using hands to be able to eat, draw, erc
3. Language: speaking, using body language and gestures,
communicating, and understanding what others say & writing
4. Cognitive: Thinking skills: including learning, understanding,
problem-solving, reasoning, and remembering.
5. Social: Interacting with others, having relationships with family,
friends etc
6. Adaptive: life sustaining skills
7. Sexual development
8. Bone and dental development

RULES OF G&D
1. Definite and predictable pattern,
2. Continuous & orderly
3. Normal G&D is determined by physiological
maturity and functional integrity of CNS.
4. progressive through the same stages.
1. Child starts crawling before walking- Crawl
Creep Walk
2. Speech: Babbles Words Sentences;
Scribble Writing
3. Social: First child plays alone, then with others.

1. There is a directional Pattern in G&D:

1. Cephalocaudal Pattern ( Head to Tail)
2. Proximal to Distal (Midline to peripheral)
3. Mass to specific (Differentiation)

2. Brain takes over spine:

1. Primitive reflexes are replaced by voluntary acts.
Grasp reflex is replaced by voluntary grasp
2. Mass activity replaced by activity. Looking at a
bright object infant moves all limbs excitedly but
older child is less excited and approaches the
object with one hand

Cephalocaudal growth

Ulnar grasp

pincer grasp

Fetal Development
1. 0-8 weeks: Embryonic period: 3 layers; Paired heart tubes,
vulnerable for teratogenic and hypoxic insults
2. Fetal period: 9 weeks to birth: organogenesis
1. 10 weeks: face recognizable; rotation of gut
2. 12 weeks: gender of genitals becomes visible; budding of
bronchi and bronchioles
3. 20-24: primitive alveoli and surfactants begin to form
4. 26 weeks: eye opening
5. III trimester: respond to external stimuli by body movements
and heart rate changes; habituation with repetitive stimuli

New-born
1. Wt: 2.8 to 3.4 kg; boys heavier;
2. Length: 50 cm (20)
3. HC: 35 cm (14 )
4. Eye: Focal length: 8-12; nearsighted from breast to mothers

face; preference for faces

5. Hearing: developed well; preferential turn toward female voice
6. Gaze back at mother
7. Autonomic instability: flushing, mottling, perioral pallor,
hiccupping, vomiting, uncontrolled limb movements and
inconsolable crying

Behavioural states
by Prechtl and Beintema
1. Quiet sleep: not arousable by heel stick
2. Active sleep: arousable but gets habituated by
repeated heel stick
3. Drowsy: repeated heel stick pushes the infant to fussy
or crying state
4. Alert: fixate on object or face and follow horizontally
and vertically; turn toward a novel sound
5. Fussy
6. Crying

0-2 months: Physical

1. Weight:
1. Wt loss by 10% of birth weight in first week; regains it in 2 week
2. Gains 30 gm /day in first month (fastest growth in life)
2. Uncontrolled writhing and purposeless closing and opening of
hands
3. Active Moro response; tonic neck posture
4. Involuntary smiling
5. 6 behavioural states; sleep and wakefulness evenly distributed and
later sleep period more in nights
6. Eye gaze, head turning, sucking under some control
7. Visual preference to human face
8. Turns towards mother voice indicating some recognition memory

21

Cognitive:
Recognizes facial expression like smile
Habituates to repeated stimuli
Increase attention to changing stimulus
Discriminates rhythmic patterns in language

Emotional:
Crying in response to wet diaper
Cries while hungry and relief after feeding

2-6 months
Physical:
1. Weight gain is 20 gm/day in 3-4 months and birth weight is
doubled at the end of 4 months
2. Disappearance of asymmetric tonic neck reflex and hands are
brought to midline to examine objects
3. Grasp reflex disappear to hold and release objects voluntarily
4. Gains control over trunk muscles that helps in intentional
rolling over
5. Holds heads with bopping 3 mo, steadily at 4-5 mo while
sitting and start taking spoon feeding
6. Can gaze across at things
7. Achieves greater degree of regular sleep-wake cycle;

 Cognitive:
1. Starts shifting attention from breast feeding
mother to other things around
2. Starts exploring his own body by hands

Emotional development and communication:

1. Shows anger, fear and joy for appropriate stimuli
2. Says inga - 3 mo
3. Loughs aloud - 4 mo
4. Excited at sight of food- 4 mo
5. Shows facial imitation and hand games

6. Show sadness when parents are unavailable

6-12 months
Physical:
1. At 1 year the birth weight triples; length increase
by 50%; HC increases by 10 cm
2. Sits supported 6-7 mo; without support 10 mo;
pivots while sitting 9-10 mo; examines several
objects at a time
3. Crawl and pulling to stand 8 mo

4. Thumb finger grasp 8-9 mo; pincer grasp by 12 mo;

5. Walks by 1 yr
6. Mandibular central incisors erupt

 Cognitive:
1.

Objects are passed from hand to hand

2.

Looks down for a ball that has been dropped

3.

At 9 mo, search for objects if hidden - object permanence

4.

Plays peek-a-boo; pat-a-cake and waves bye bye -10 mo

Emotional:
1.

Look anxiously at stranger, clings to mother stranger anxiety

2.

Cry to call mother in next room

3.

Tantrums appear as a drive for autonomy and mastery

Communication:
1.

Understands and responds to vocal and facial expressions-7 mo

2.

Shows toy to parents to share the joy - 9 mo

3.

Utter syllables like ma, da, pa babbling 8-10 mo

4.

Responds to name

5.

Uses a first true word for the object permanence or a person

6.

Says mama, dada-12 mo

The second year: 12-18 mo

Physical:
1. Growth rate slows and appetite declines
2. Relatively short legs and long torsos with exaggerated
lumbar lordosis and protruding abdomen
3. Brain growth and myelinisation increase head
circumference by 2 cm
4. Walks independently with genu varus (bow leg) and gets
corrected over few months
5. Stops, pivots and stoops without toppling over
6. Increasing dexterity ( reaching, grasping and releasing) and
mobility
7. Casting: throwing away objects onto floor

 Cognitive:
1.

Stacks blocks

2.

Uses things for intended purposes: combs for hair, cups for drinking

3.

Symbolic play: pretends to drink from an empty cup

4.

Imitates parent or older children

Emotional:
1.

Orbit around parents- going away and return to parents now and then

2.

Exhibit temper tantrums reflecting their inability to verbally

communicate their emotional states

Linguistic:

1.

Receptive language precedes expressive language

2.

Unintelligible jargon

3.

Responds appropriately by words like no, bye-bye, give-me etc -12 mo

4.

Names body parts and uses 4-6 words correctly- 15 mo

Second year: 18-24 mo

Physical:
1. Gains 5 and 5 lb
2. At 24 mo they their adult height
3. 90% head circumference achieved in 2 yr
4. Casting disappears by 18 mo

Cognitive:
1. Uses a stick to get a toy out of reach 18 mo
2. Can wind a mechanical toy
3. Symbolic play: Feeds a toy from empty plate

 Emotional:
1. Shows separation anxiety when parents are missing
2. Uses a toy or blanket (transitional object) while sleeping
to represent absent parent
3. Looks at the mirror and remove an unusual thing from his
nose

4. Hand over a broken toy to parents to fix

5. Says himself no, no when touches a forbidden object

Linguistic:
1. 15-20 words at 18 mo and 50-100 words at 2 years
2. Combine two words
3. Understands 2 step commands like give the ball and take
the shoes

Age 3 years: (Preschool)

1. In 3-year-olds, growth is still slow compared to the first year.
2. Most children have become slimmer and lost the rounded
tummy of a toddler.
3. Weight: average gain of about 2 kg per year
4. Height: average growth of about 7 cm per year
5. All 20 primary teeth have erupted by 3 yr.
6. The preschooler has genu valgum (knock-knees)
7. Mild pes planus (flatfoot). The torso slims as the legs lengthen.
8. Somatic and brain growth slows
9. Decreases in nutritional requirements and appetite, and the
emergence of picky eating habits

Gross motor
1.
2.
3.
4.
5.
6.
7.
8.
9.

Walk with a mature gait

Runs steadily and jumps easily
Walks up stairs unassisted
Rides a tricycle
Washes and dries hands
Throws and kicks a ball
Dances to tunes
Stacks 10 blocks
Handedness is usually established

Fine motor:
1. Easily draws straight lines and copies a circle
2. Can stand on tip-toes
3. Uses spoon well and feeds self
4. Dresses and undresses self except for buttons and
laces
5. Holds a pencil in writing position
6. Screws and unscrews jar lids, nuts, and bolts

7. Turns rotating handles

8. Can concentrate on tasks for 8 or 9 minutes
9. Develop handedness

Adaptive
1. Has all 20 primary ("baby") teeth
2. Vision is nearing 20/20
3. Bladder and bowel control are usually established; uses potty
chair or toilet
4. May sleep 11 to 13 hours total, may still take a short afternoon
nap
5. Understands size differences (i.e., big and little)
6. Understands past tense (yesterday)
7. Understands long sentences
8. Understands prepositions (on, under, behind)
9. Uses pronouns correctly (I, you, he, me, etc.)
10. Asks "why" constantly
11. Counts up to four objects by 4 years old

Speech
1. Should be able to say about 500 to 900 words
2. Speech can be understood by others
3. Speaks in three word sentences
4. Can remember simple rhymes or lyrics
5. Uses "please" and "thank you"
6. Uses pronouns (I, you, me, we, they) and some plurals (cars,
dogs, cats)
7. Refers to self by using own name
8. Names colors
9. Says full name and age

10. More thoughts less words leave to physiological stuttering

Social:
1. Understands concept of "mine" and "his/hers
2. Begins to share and likes to play with other children
3. Can take turns
4. Role-play activity, as in playing house & increasingly governed
by rules
5. Imitates adults and playmates
6. Spontaneously shows affection for familiar playmates
7. Begins to show feelings in socially acceptable ways

8. Tantrums normally appear toward the end of the 1st yr of life

and peak in prevalence between 2 and 4 yr of age.