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! Subject:! PEDIATRICS! First!Semester!A.Y.!2015I2016!

! 1.2!GROWTH!AND!DEVELOPMENT!
Topic:!
Lecturer:! Maria!Consuelo!MaramagIManuel,!MD!
!

OVERVIEW'AND'ASSESSMENT'OF'VARIABILITY' WEEK' MILESTONE'


• Monitor!children’s!progress!! 1' Embyronic!period!–!fertilization!and!implantation!
• Identify!delays!or!abnormality!! 2' Endoderm!and!ectoderm!appear!
• Counsel!parents!! 3' Mesoderm!appear;!Somite!formation!
• Prescribe!treatments!! 4' Fusion!of!neural!folds,!folding!of!embryo!to!humanIlike!
! shape!
GROWTH' 5' Lens!Placode;!Primitive!mouth!
• Increase!in!size! 6' Primitive!nose;!philtrum;!CR!length!=!21!–!23!mm!
! 7' Eyelids!begin!
DEVELOPMENT' 8' Ovaries!and!testes!distinguishable!
• Increase!in!function!of!processes!related!to!body!and!mind! 9' FETAL'PERIOD'BEGINS;'!CR!length!=!5!cm;!Weight!=!8!
! gms!
BIOPSYCHOSOCIAL'MODELS'OF'DEVELOPMENT' 10' External!genitalia!distinguishable!
• Involves!Extrinsic!and!Intrinsic!Forces!! 20' Lower!limit!of!viability;!Length!=!19!cms;!Weight!=!460!
• Interrelationship!involving!! gms!
o BIOLOGIC'! 25' THIRD'TRIMESTER'BEGINS;!Length!=!25!cms;!Weight!=!
o PSYCHOLOGIC'! 900!gms!
o SOCIAL'! 28' Eye!opens;!Fetus!turns!head!down;!Weight!=!1300!gms!
! 38' TERM'
A.'BIOLOGIC'INFLUENCES' !
• Genetics! PERIODS'OF'GROWTH'
• In!utero!exposure!to!teratogens! !
• Postpartum!illnesses! PRENATAL' 0'–'280'days'
• Exposure!to!hazardous!substances! POSTNATAL' !
• Maturation!! '''''''INFANCY' Birth'to'2'years'
! ''''''''''''''NEONATE' First!4!weeks!after!birth!
B.'PSYCHOLOGIC'INFLUENCES' ''''''''''''''INFANT'NURSLING' First!year!
• Attachment!and!Contingency!! ''''''''''''''TODDLER'TRANSITION' 2!years!
• ChildIrearing!environment! '''''''CHILDHOOD' Girls:'2'–'10;'Boys:'2'Q'12'
! ''''''''''''''EARLY'CHILDHOOD' 2!–!6!years!
C.'SOCIAL'FACTORS'
''''''''''''''LATE'CHILDHOOD'' Girls:!6!–!10;!Boys!6!–!12!
• Family!factors!
'''''''ADOLESCENT' Girls:'10'–'18;'Boys:'12'Q'20'
• Influences!outside!of!motherIchild!dyad!!
''''''''''''''PREPUBESCENT' Girls:!10!–!12;!Boys!12!I14!
!
''''''''''''''PUBESCENT' Girls:!12!–!14;!Boys:!14!I16!
TEMPERAMENT'
'''''''''''''''''''''''PUBERTY' Girls:!13;!Boys:!15!
• Refers!to!child’s!characteristic!style!of!responding!!
• Concept!is!useful!to!help!parents!understand!and!accept!the! ''''''''''''''POSTPUBESCENT' 13!I!18!
characteristics!of!their!children!! !
• Behavior!and!emotional!problems!often!develop!once!it!is!not! NEWBORN'PERIOD'
address!accordingly!! • From!birth!up!to!1st!month!of!life.!
! • Marked!physiologic!transitions!in!all!organ!systems!
FETAL'GROWTH'AND'DEVELOPMENT' • Infant!learns!to!respond!to!many!forms!of!external!simuli!
• Deals!with!transformation!of!fertilized!egg!into!embryo!! • Parenting!of!newborn!requires!dedication!and!many!factors!
• Elaboration!of!the!NS!! influence!parents!ability!to!assume!the!role!
• Emergence!of!behavior!in!utero!! • Physical!examination!include!
! o Evaluation!of!growth!
! o Observation!of!behavior!
! • 3.4'kg!(7½'lb)!–!average!weight!of!term!newborn!
! • 50'cm!(20'in)!–!average!length!
! • 35'cm(14'in)!–!average!head!circumference!
! • Newborn!parameters!should!be!plotted!on!growth!curves!
!

Trans!By:!Tony!Tagacay!II! Page!1!of!6!
:!
FIRST'YEAR' ! WEIGHT!=!AGE!(years)!x!2!+!8!
• Marked!by:! o 6!–!12!years!
o Physical!growth! ! WEIGHT!=!AGE!(years)!x!7I5/2!
o Maturation! • Usual!changes!in!weight!at!different!ages!
o Acquisition!of!competence! o 4!months:!2!x!birth!weight!
o Psychologic!reorganization! o 2!years:!4!x!birth!weight!
• Children!acquire!new!competencies!in!all!developmental! o 3!years:!5!x!birth!weight!
domains! o 5!years:!6!x!birth!weight!
• Concept!of!developmental!trajectories!highlights!complex!skills! o 7!years:!7!x!birth!weight!
build!on!simpler!ones!! o 10!year:!10!x!birth!weight!
! !
AGE'0'–'2'MONTHS' HEIGHT'
• Tremendous!growth!occur! • HEIGHT!(cm)!=!AGE!(years)!x!5!+!80!
• Establishment!of!effective!feeding!routine!and!a!predictable! • HEIGHT!(in)!=!AGE!(years)!x!2!+32!
sleepIwake!cycle! • Total!average!gain!during!the!first!year!=!25'cm!
• PHYSICAL'DEVELOPMENT' o Birth!–!3!months:!9!cm!
o Newborn!weight!decreases!10%!below!birth!weight!in!the!1st! o 3!I!!6!months:!8!cm!
week! o 6!–!9!months:!5!cm!
o Nutrition!improves!as!infants!learn!to!latch!on!and!suck! o 9!–!12!months:!3!cm!
efficiently! !
o Birth!weight!regains/exceeds!at!2!weeks! HEAD'CIRCUMFERENCE'
! • First!year!of!life:!10!cm!
DENTITION' o 1!–!4!months:!½!inch/month!
• Hard!tissue!formation:!4!months!! o 5!–!12!months:!¼!inch/month!
• Number'of'teeth!='age'in'months'–'6!! • Second!year!of!life:!1!inch/year!
rd th
• Teeth!eruption!and!shedding:!GIRLS>!boys!! • 3 !–!4 !year!of!life:!½!inch/year!
th th
• Primary!teeth:!Central!Incisors!! • 6 !–!12 !year!of!life:!½!inch!in!5!years!
• Permanent!teeth:!erupts!at!6!–!7!years!! !
o First!molars!and!incisors! ORGAN'GROWTH'AND'DEVELOPMENT'
! MUSCLES'
MEASUREMENTS' • Growth!in!muscle!mass!follows!maximal!growth!in!height!
• AT'BIRTH'' • Largest!increment:!4th!month!of!Age!of!Gestation!(AOG)!
o Weight:!3000!g!! • Relation!to!body!size:!
o Height:!50!cm! o MidIpregnancy:!1/6!
o Head!Circumference:!35!+/I!2!cm! o Birth:!1/5!to!1/4!
• NEWBORN'' o Adolescence:!1/3!
o Weight!may!drop!10%!during!first!week!! o Adulthood:!2/5!
nd
o Regains!or!exceed!birth!weight!by!2 !week!! • Strength!doubles:!12!I!16!years!
st
o Gain!30g/day!during!1 !month! !
• 8Q12'YEARS' CUTANEOUS'STRUCTURES'
o Girls!surpass!boys!! • 3rd'fetal'month:!
• 14'YEARS' o Hair!matrix!
o Boys!take!the!lead!! o Sebaceous!gland!
• Females'enters!growth!spurt!2!years!earlier!than!boys!! o Apocrine!gland!
! • 5th'fetal'month:!
WEIGHT' o Eccrine!sweat!glands!
• FORMULA'FOR'AVERAGE'APPROXIMATE'WEIGHT:! • Birth:!
o INFANTS!<!6!months! o Lanugo!
! WEIGHT!=!AGE!(months)!x!600!+!BIRTH!WEIGHT! • 1'month:!
o INFANTS!(6!–!12!months)! o Sweat!glands!for!temperature!regulation!
! WEIGHT!=!AGE!(months)!x!500!+!BIRTH!WEIGHT! • 2'yrs'old:!
o 1!–!6!years! o Scalp!hair!lost!and!replaced!by!permanent!hair!

!! Page!2!of!6!
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• Pubescence'and'adolescence:! o Largest!lymphoid!organ!
o Pubic!and!axillary!hair! !
! FORMAL'CLOSURE'OF'FONTANELLES'AND'SUTURES'
SUBCUTANEOUS'FAT' !
• Appears:!last!3!months!AOG! 3'months' Posterior'fontanelle'closed'
• Doubles:!first!year!of!life! 6'months' Fibrous!union!of!suture!lines!occurs!
• Increases!in!amount!during!adolescence! 20'months' Anterior'fontanelle'closed'
! 8'years' Ossification!of!craniobasal!bones!complete!
NERVOUS'SYSTEM' 12'years' Sutures!cannot!be!separated!by!ICP!
• 4!weeks:!Brain!starts!to!develop!! 20'years' Sutures!still!visible!on!XIray!
• 5!weeks!AOG:!3!main!brain!divisions!! 8th' Solid!body!union!of!all!suture!complete!
• 7!years:!Complete!myelinization!! !
• 10!years:!Calcification!of!pineal!gland!! DEVELOPMENTAL'REFLEXES'
• Rapid!brain!growth!during!infancy!and!childhood!! !
! REFLEX' APPEARS' DISAPPEARS'
SENSORY'SYSTEM'
Moro! Birth! 4!–!5!months!
• VISION!
Rooting! Birth! 3!months!
o Not!wellIdeveloped!at!birth!!
Palmar!Grasp! Birth! 4!–!5!months!
o BIRTH:'20/400!vision!!
! 1!month:!Regards!! Tonic!Neck! Birth! 6!–!7!months!
! 3!months:!Fixation/Tracking!! Plantar!Grasp! Birth! 9!–!10!months!
! 3I7!months:!Binocular!! Parachute! 4!–!9!months! Persist!
! 3!years:!20/30!! Landau! 10!months! 24!months!
! 4!years:!20/20! !
• 3I5!yrs!old! ADOLESCENCE'
• AUDITORY! • Rapid!change!in!body!size,!shape,!physiology,!psychological!and!
o Functional'at!birth!! social!functioning!!
o 6!months:!Localizes!sound! • Hormones!play!an!important!role!!
• TACTILE! • Gender!and!culture!has!profound!effect!
o NO!tactile!sensation!during!the!first!week!of!life! • First!sign!of!puberty:!!
o More!localized!response!to!pain!during!the!next!months! o Girls:!breast'budding!–!8!years!!
• TASTE! o Boys:!testicular'enlargement!–!9.5!years!
o Newborn:'Unable!to!distinguish!flavors!' !
o 3!months:!Acute!taste!discrimination! DEVELOPMENT'
• OLFACTORY! PRINCIPLES'OF'DEVELOPMENT'
o Present!at!birth!! • CONTINUOUS'PROCESS!
o More!acute!in!later!stage! o Birth!to!maturity!!
! • SEQUENCE!
DIGESTIVE'SYSTEM' o Same!for!all!children!but!rate!varies!from!child!to!child!!
• Birth:!30I90!ml!! • Intimately!related!to!MATURATION'of!the!NS!!
• 1'month:'90Q150'ml'! • GENERALIZED'mass!activity!replaced!by!SPECIFIC'individual'
• 1!year:!210I360!! responses!
• 2!years:!500I750!ml!! • PRIMITIVE'REFLEXES!have!to!be!lost!before!voluntary!
• Late!childhood:!750I900!ml! movement!is!acquired!
! !
URINARY'SYSTEM' CORE'CONCEPT'OF'DEVELOPMENT'
• NEWBORN:!may!not!normally!void!in!first!12I24!hours!! • Interaction!between!biology!and!experience!
• 5!I!6!years:!Mature!function!is!observed! • Influenced!by!culture!and!reflected!in!child!rearing!beliefs!and!
! practices!
LYMPHATIC'SYSTEM' • Children!are!active!participants!in!their!own!development!
• Peak!increases:!6I7!years!! • Human!relationships!and!its!effects!are!the!building!blocks!of!
• SPLEEN! health!development!

!! Page!3!of!6!
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• There!is!interplay!between!vulnerability!and!resilience!! DEVELOPMENTAL'DOMAINS'
• It!can!be!altered!by!interventions!! • Gross!and!Fine!Motor!!
! • Language!!
REQUIRMENTS'FOR'SATISFACTORY'DEVELOPMENT' • Daily!Living!!
! • Social!!
!
GROSS'MOTOR'DEVELOPMENT'
• Dependent!on!brain!maturity!
• Sequence:!Gross:!CEPHALOCAUDAL!
• Weakest!correlate!to!IQ!
'
Mean'Age' Milestones' Mean'Age' Milestones'
3!months! Good!head!control! 15!months! Walk!alone!
5!months! Roll!over! 24!months! Runs!well,!
walk!up!stairs!
1!step!at!a!
time!
6!months! Sit!with!support! 36!months! Rides!a!trike;!
! Stand!on!1!
! foot!
• Nervous!System! 8!months! Sit!without!support! 48!months! Hop!on!1!foot;!
o WellIformed!and!functioning! Climbs!well!
• Opportunities! 9!months! Pulls!to!stand;! 60!months! Skips!
o To!learn!and!act! Holding!on!
• Environmental! '
o Appropriate!and!adequate!nutrition!at!all!stages! FINE'MOTOR'SKILLS'
• Challenges!and!Rewards! • Eye!I!hand!coordination!!
! • Sequence:!Proximal'to'Distal!!
PRIMARY'CARE'PHYSICIAN' • Coordination!of!small!muscles!!
• GOOD'PRIMARY'CARE'PHYSICIAN' • Related!to!selfIhelp!skills!!
o Has!a!thorough!knowledge!of!normal!child!development!! • Upper!extremity!and!manipulative!hand!abilities!to!dress!and!
o Understand!factors!that!might!interfere!with!it!! play!!
o Actively!monitors!symptoms!that!should!elicit!concerns!! '
! Mean'Age' Milestones' Mean'Age' Milestones'
DEVELOPMENTAL'MONITORING'IN'PRIMARY'CARE' 3!months! Hands!open!grasp! 2!years! Make!strokes!
• DEVELOPMENTAL'MONITORING' Towers!of!7!
o Integral!part!of!a!child!health!supervision!! cubes!
• GOAL:' 4!months! Reaches!for!objects! 3!years! Copy!Circle!
o Early!detection!of!children!with!developmental!disabilities! Tower!of!10!
and!those!at!high!risk!for!adverse!developmental!and! cubes!
behavioral!outcomes!!
5!months! Transfer!objects! 3!½!years! Copy!Cross!
!
6!months! Holds!bottle! 4!years! Copy!Square!
DEVELOPMENTAL'SURVEILLANCE'
Draws!man!with!
• Flexible,!longitudinal,!continuous!and!cumulative!process!!
2!–!4!body!parts!
• Knowledgeable!health!care!professionals!identify!children!who!
9!months! Pincer!grasp! 5!years! Copy!Triangle!
may!have!developmental!problems!!
12!months! Turn!pages!of!book! 6!years! Copy!Diamond!
• Components:!!
o Eliciting!and!attending!to!parents’!concern!! 13!months! Scribble! 9!years! Copy!Cylinder!
o Maintaining!and!developmental!history!! spontaneously!
o Making!accurate!and!informed!observations!! '
o Identifying!presence!of!risk!and!protective!factors!! '
o Documenting!the!process!and!findings!! '

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LANGUAGE' AGE!(months)! MILESTONES!
• Sequence:!simple'to'complex'! Newborn! Identify!mother’s!voice!and!smell!
• Correlates!with!IQ!! 3! Reach!for!the!dangling!ring!
• Language!delay:!! 6! Respond!playfully!to!mirror!
o Most!common!reason!for!referral!! 10! Object!permanence!
o Part!of!most!neurodevelopmental!disabilities!! 12! Understand!spatial!relationships!
!
18! Understand!cause!and!effect!
• RECEPTIVE'LANGUAGE'
24! Categorize!similarities!(e.g.!vehicles,!animals)!
AGE' MILESTONES'
36! Knows!full!name!
1!month! Startles,!alert!to!sound!
48! Knows!color!or!any!letters!
4!months! Turns!to!noise!and!voice!
!
7!months! Respond!to!name!
DAILY'LIVING/PERSONAL'
9!months! Repsond!to!word!“no”! • Performance!of!activities!of!daily!living!!
11!months! Follows!1Istep!commands!with!gesture! • Can!be!affected!by!culture!and!childIrearing!practices!!
12!months! Follows!1Istep!commands!without!gesture! !
18!months! Identifies!1!or!more!body!parts! AGE' MILESTONES' AGE' MILESTONES'
24!months! Follow!2Istep!commands! 3!months! Opens!mouth! 2!years! Express!need!to!go!
36!months! Identifies!action!in!pictures! expectantly! to!bathroom!
48!months! Knows!4!colors! Cooperates!in!
60!months! Follows!3!–step!commands! dressing!
! 6!months! Holds!bottle! 3!years! Puts!on!shirt!and!
• EXPRESSIVE'LANGUAGE! FingerIfeeds! shorts!
AGE' MILESTONE' AGE' MILESTONE' Feeds!self!cracker! Dry!night!
3!months! Vocalizes!and!coos! 2!years! 2Iword! Use!fork!to!pierce!
phrases! 12!months! Drinks!well!from! 4!years! Dresses!without!
6!months! Monosyllabic! 3!years! 3Iword! cup! supervision!
babbles! sentences! Begins!to!hold! Brush!teeth!with!
Give!full! spoon! assistance!
name,!age,!sex! 18!months! Feeds!self!with! 5!years! Ties!shoelaces!
8!months! Says!dada,!mama! 4!years! Tells!a!story! spoon!
nonIspecifically! Speech!100!%! !
intelligible! SOCIAL'
10!months! First!words!other! 5!years! Uses!past! • How!child!interacts,!forms!and!maintains!relationships!!
than!mama,!dada! tense!of!eat,! • Concerns!would!manifest!as!behavioral!problems!
run,!go! !
12!months! Speaks!first!real! 6!years! Repeats! AGE' MILESTONES' AGE' MILESTONES'
word! sentence!of!10! 3!months! Smiles!responsibly! 2!years! Parallel!play!
syllables! 6!months! Imitates!action! 3!years! Likes!to!play!make!
Names!4! believe!
colors! 9!months! Plays!patty!cake! 4!years! Respond!to!
15!months! Jargons! ! ! PeekIaIboo! instructions!
! Imitates!task!
COGNITIVE'DEVELOPMENT' 12!months! Comes!when! 5!years! Plays!games!with!
• Learn,!understand!and!solve!problems!! called!by!name! simple!rule!(tag)!
• Verbal!and!nonIverbal!reasoning!! 18!months! Follows!directions! 6!years! Plays!board!game!
• Meeting!daily!living!demands!! related!to!routine! Domestic!role!
• Infants!&!toddlers:!Motor'&'Language'Milestone!! playing!
• PreIschool!child:!Reasoning'abilities!! !
• School!age!child:!Neuropsychological'assessment! DETECTION'OF'CONCERNS'
! • History!and!Physical!Examination!!
! • Checklist/questionnaires:!!

!! Page!5!of!6!
!
o Pediatric!Symptom!checklist!! PSYCHOSOCIAL'THEORY'
o Pediatric!Evaluation!of!Developmental!status!(PEDS)!! !
• Formal!Screening!tools!! STAGE' ISSUES' VIRTUES'OR'
o Barley!Infant!Neurodev!Screener!! QUALITY'OF'
o Denver!II!! STRENGTH'
o Early!Language!Milestones!! Infancy' Trust!vs.!Mistrust! Hope!
o Early!Childhood!Care!and!Development!Tool! Toddler' Autonomy!vs.!Shame! Will!
! Preschool' Initiative!vs.!Guilt! Purpose!
DEVELOPMENTAL'RED'FLAGS' School'Age' Industry!vs.!Inferiority! Competence!
• Limit!ages!! Adolescence' Identity!vs.!Role!confusion! Fidelity!
• Age!at!which!you!expect!almost!every!child!to!have!mastered!a!
!
particular!skill!
COGNITIVE'THEORY'
• Warning!signs!or!signals!that!something!may!not!be!right.!! !
• It!should!not!incite!panic!
AGE' STAGES' ISSUES'
• If!absent!or!doubtful,!do!further!evaluation!
Infancy' Sensorimotor!I!–!IV! Object!permanence!
!
Toddler' Sensorimotor!V!–!VI! Spatial!relations!
CLASSIC'THEORIES'
! Preschool' PreIoperational! EgoIcentrism!
AGE' PSYCHOSEXUAL' PSYCHOSOCIAL' COGNITIVE' School'Age' Concrete!Operational! Concrete!thinking!
Infancy! Oral! Basic!trust! Sensorimotor! Adolescence' Formal!Operational! Scientist!or!philosopher!
(0!–!1!yr)! I!–!IV! !
Toddler! Anal! Autonomy!vs.! Sensorimotor! !
(2!–!3!yrs)! Shame!and! V!–!VI! !
doubt! !
!
Preschool! Phallic! Initiative!vs.! PreI
!
(3!–!5!!yrs)! Guilt! operational!
!
School!Age! Latency! Industry!vs.! Concrete!
!
(6!–!12!yrs)! Inferiority! Operational!
!
Adolescence! Adolescence! Identity!vs.! Formal! !
(12!–!20!yrs)! Identity! Operational! !
confusion! '
! !
PSYCHOSEXUAL'THEORY' “THE!PRACTICE!OF!MEDICINE!IS!AN!ART,!NOT!A!TRADE;!A!CALLING,!
! NOT! A! BUSINESS;! A! CALLING! IN! WHICH! YOUR! HEART! WILL! BE!
STAGE' ISSUES' ' EXERCISED!EQUALLY!WITH!YOUR!HEAD”!
Infancy' Oral! Food,!love,!care,! !
nurturance,! SIR!WILLIAM!OSLER!
dependency!! 1849!I!1919!
Toddler' Anal! Control!power!limits! !
Preschool' Oedipal! Boyness,!girlness,! PRAYER'BEFORE'STUDYING''
masculinity,! Holy!Spirit,!Giver!of!all!good!gifts,!enter!into!my!mind!and!heart.!
femininity! Give!me!the!gift!of!knowledge!and!the!grace!to!use!it!wisely.!
School'Age' Latency! Storm!of! Help!me!in!all!my!endeavors.!
adolescence! Give!me!perseverance!and!fortitude.!
Adolescence' Genital! True!genitality! Help!my!memory,!that!I!may!remember!what!I!learn!
! and!recall!it!when!necessary.!
! Guide!me!in!the!classroom.!
! You!who!are!the!Way,!the!Truth,!and!the!Life,!
! Let!me!not!be!deceived!by!false!teaching.!
! Our!Lady!of!Good!Studies,!pray!for!me.!
! Amen.!
! !

!! Page!6!of!6!
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