Growth and development

Growth and
development

Growth
Growth involves 2 major different phenomena –enlargement and maturation
of a child's body.
The evaluation of growth includes the assessment of both this indicators:
Growth Maturation
Length/height Bone age
Weight Dentition
Head circumference Puberty
Chest circumference
Body surface
Body proportions
Growth velocity

Growth charts

Length/height
The length of a normal full term newborn is 50+/-2 cm.
During the first year of life the length increases as follows:
3 cm per month in the first trimester
2.5 cm per month during the second trimester
2 cm per month during the third trimester
1 cm per month during the last trimester of the first year
At the end of the first year the average increase of the length is 25 cm.
There is a quick formula to calculate the average length during the first year
of life: Length = Length at birth + months X 2
For example: the birth weight of a child is 50 cm. It is now 6 months old. The
approximate length at 6 months would be 50+6 X 2= 62 cm.

Length/height
During the second year of life length increases with 10-12 cm.
After the second year of life we ca use a quick formula
75+ years X 6.
For example –we want to calculate the quick formula for a child who is 5 years
old. It is 75+5x6 = 105 cm.
The target height of a child is calculated based on the height of his parents
Target height for boys = (Father’s height + Mothers height +13) / 2
Target height for girls = (Father’s height + Mothers height -13) / 2

Weight
A full term newborn’s weight is normally 2500-4000 gr.
During the first year of life the daily weight gain is as it follows (in
trimesters):
First trimester –25 gr per day
Second trimester –20 gr per day
Third trimester -15 gr per day
Fourth trimester –12 gr per day
Normally the child doubles it’s birth weight at 4-5 months of age and triples it at
12 months of age.

Weight
After the first year the average weight gain is approximately 2-2.5 kg yearly.
There is a formula fox approximate calculation of the weight after one year
of age:
Weight = 10 + years X 2 (For example a 5 year old child’s weight = 10+ 5 X 2, which
is 15 kg).

Head circumference
Very important indicator –growth of the brain
Wrap the tape around the widest possiblecircumference-from the most
prominent part of the forehead (frontal eminence) around to the widest part
of the back of thehead (external occipital protuberance).
Normal head circumference of a full term newborn at birth is 34 cm /32-
36sm/
During the first six months of life the head circumference increases with 1,5
cm/month and during the next 6 months –0.5 cm/month.

Growth velocity

Bone age
Shows the degree of bone maturation
The "bone age" of a child is the average age at which children reach
this stage of bone maturation.
The most commonly used method is based on a single x-ray of the
left hand, fingers, andwrist
The bones in the x-ray are compared to the bones of a standard atlas
Appearance of the epiphyseal nuclei (centers of ossification) of the
patient and compare them to the standards of the atlas.

Dental development and teeth eruption

Clinical case 1
A 12 month old boy
Normal pregnancy and
delivery
Birth weight 3200gr, length –
52 cm, HC –35 cm

Question
What are the approximate expected weight, length and head circumference
at 12 months?

Answer
Weight ~ 9600 gr (triples it’s birth weight)
Length ~ 76 cm (length of birth + months X 2)
Head circumference ~ 47 cm.

Clinical case 2
6 months old girl
Fifth, pathological and unsupervised pregnancy
Term delivery with birth weight 2700 gr, length
–50cm, HC –33 cm
Very low income family
She is systemically malnourished
Upon arrival her weight is 3000 gr., length –60
cm, HC –40cm
Rhagadesaround the mouth, skin is dry, weak
cry, muscular hypotonia

Questions
Do you think that the growth of the child is normal?
Which of the anthropometric measures is most affected?
Which is the most probable cause?
What should be the normal weight of the child?

Development
Child developmentrefers to the sequence of physical, language,
behaviouraland emotional changes that occur in achildfrom birth to
the beginning of adulthood.
During this process achildprogresses from dependency on their
parents/caregivers to increasing independence.
Based on the biopsychosocialmodel child’s development is a result of
and influenced a lot by the interaction of biological environmental
factors.

Developmental milestones and
developmental domains
Developmental milestones are a set of functional skills or age-specific tasks that most
children can do at a certain age range.
Development:
Gross motor skills:using large groups of muscles to sit, stand, walk, run, etc., keeping balance
and changing positions
Fine motor skills:using hands to be able to eat, draw, dress, play, write, and do many other
things
Language skills:speaking, using body language and gestures, communicating, and
understanding what others say
Cognitive skills:thinking skills including learning, understanding, problem-solving, reasoning,
and remembering
Social skills:interacting with others, having relationships with family, friends, and teachers,
cooperating and responding to the feelings of others.

Developmental surveillance vs.
screening vs. assessment
Surveillanceoccurs when developmental attainment is reviewed and recorded with
all well-child visits (based on the developmental milestones).
Formal screening using standardized tools. It is recommended that children
underwent developmental screening on a regular basis.
Concerns elicited by surveillance or abnormal developmental screening scores
should be referred for further evaluation.
It's better to refer if you are not sure than to falsely reassure the parent that the
child will "grow out of it" because developmental interventions work best if
started early.
Developmental assessment, on the other hand, is detailed standardized testing in
various developmental sectors done by a physician and/or allied health disciplines. It
is often performed by a multi-disciplinary team that may include a developmental

Developmental milestones

Fine motor milestones

Expressive language milestones

Expressive language milestones

Receptive language development