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I. INTRODUCTION
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.
1. Cephalocaudal principle
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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.
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.
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.
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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.
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womb and later starts moving his hands. Similarly infants more hands first
and them learn using fingers .
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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
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V. PURPOSES OF ASSESSING GROWTH AND DEVELOPMENT
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.
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
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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
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
f) Gross Motor
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
1. INTELLECTUAL DEVELOPMENT
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
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
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
Paralinguistic and preconception this stage embodies trust between parents and
infants parents and child form mutual attachment and progress through a period of
growth.
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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.
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.
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.
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
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.
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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
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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:
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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.
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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.
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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.
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A) GROWTH AND DEVELOPMENT AT DIFFERENT AGE
i. GROWTH IN NEW BORN
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
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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.
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.
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.
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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.
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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
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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.
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
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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
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 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
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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.
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
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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.
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
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satisfactorily meet their needs for mutual regulation of frustration to occur. When
this synchrony fails to develop, mistrust is the eventual outcome.
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.
Social Development
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.
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1 MONTH
1.Physical Development
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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3. Sensory Development
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.
2. Motor Development
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.
3. Sensory Development
Turns head to side when sound occurs at ear level.
Eyes follow moving objects ad persons nearby.
Visual acuity is hyper optic.
4. Language Development
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’
5. Social Development
Smiles to mother/caregiver.
Knows that cry will bring attention.
3 MONTHS
1. Physical Development
Flexion posture is reduced.
Grasping, Crossed Extensor and Moro’s reflex disappears.
Landau reflex appears.
2. Motor Development
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
3. Sensory Development
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.
4. Language Development
Cries less
Shows pleasure in making sound
Chuckles and coos.
5. Special Development
May laugh loud.
Looks in direction of speaker.
4 MONTHS
1. Physical Development
Drooling indicates appearance of saliva.
Tonic neck and rooting reflex disappears.
2. Motor Development
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.
3. Sensory Development
Follows objects to 180’.
Fairly good binocular vision.
Beginning of hand-eye coordination.
4. Language Development
Utters two syllable vowel sounds.
Can vocalize consonants like ‘m,b,g.’
Responds differently to pleasant and angry voice.
5. Social Development
Initial social play by smiling.
5 MONTHS
1. Physical Development
Weight almost double of birth weight
Can breathe through mouth when nose is obstructed.
2. Motor Development
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.
3. Sensory Development
Looks in direction of sound made below ear.
Stops crying in response to music.
Visual acuity is 20/20.
4. Language Development
Responds to his/her name.
Vocalizes displeasure when desired object is taken away.
Begins to mimic sound.
Cries on seeing strangers.
5. Social Development
Smiles to self in mirror.
Differentiates strangers from family members.
6 MONTHS
1. Physical Development
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.
Blood pressure is 90/60 + 28/10 mm Hg.
Teeth eruption starts with lower two central incisors
2. Motor Development
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.
3. Sensory Development
Localizes sound made above ear level.
Enjoys more complex visual stimuli.
Moves in order to see an object.
4. Language Development
Babbling
Vocalizes monosyllable like ma, da, ba.
Recognizes familiar words.
Talks to own image in mirror.
5. Social Development
Recognizes parents.
Extends arms to be picked.
7 MONTHS
1. Physical Development
Parachute reflex appears.
Ultimate color of iris is established.
Mashes food with jaws.
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2. Motor Development
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.
3. Sensory Development
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’.
5. Social Development
Shows fear of strangers.
Closes lips tightly when disliked food is offered.
8 MONTHS
1. Physical Development
Begins to show pattern in bladder and bowl elimination.
Eruption of upper central incisors.
2. Motor Development
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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.
3. Sensory Development
Depth perception is developing.
Recognizes familiar words and sounds.
4. Language Development
Begins to understand meaning of “NO”.
Continues syllable ‘dada, mama’ without specific meaning.
Babbles to produce consonant sounds.
Vocalizes to toys.
5. Social Development
Fear of strangers.
Dislike dressing and diaper change.
Separation anxiety develops.
9 MONTHS
1. Physical Development
Eruption of upper lateral incisors
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2. Motor Development
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.
3. Sensory Development
Head turns directly to source of sound.
Recognizes by looking or moving towards familiar objects when
named.
4. Language Development
Stops activity in response to “NO”.
5. Social Development
Dislikes face wash.
Cries when scolded.
Wants to please caregiver.
10 MONTHS
1. Physical Development
Drooling stops.
Macula is well developed and fine visual discrimination can be made.
2. Motor Development
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.
3. Sensory Development
Tits head backward to see up.
Localizes sound from above or below ear.
Searches for a lost toy.
4. Language Development
Says dada, mama with meaning.
Comprehends “Bye – bye”.
Imitates sounds of animals.
5. Social Development
Plays social games with adults.
11 MONTHS
1. Physical Development
Sleeps 14-16 hours per day and still naps.
2. Motor Development
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.
4. Language Development
Responds to simple questions.
Understands simple directions.
Imitates specific sounds of others.
5. Social Development
Reacts to restriction with frustration.
Enjoy playing with empty dish and spoon after meals.
12 MONTHS
1. Physical Development
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
Blood pressure is 96/66 + 30/24 mm Hg.
Babinski reflex disappears.
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Landau reflex also disappears.
Has 6-8 deciduous teeth.
2. Motor Development
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.
3. Sensory Development
Full binocular vision well established.
Follows fast moving object with eyes.
4. Language Development
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.
5. Social Development
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.
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.
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.
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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.
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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.
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
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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
1. Physical Development
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.
3. Language Development
Comprehends more than communicating.
Recognizes names of body parts.
Says 2-6 words.
Responds to simple commands.
4. Social Development
Egocentric
Hugs and kisses.
Imitates parents.
18 Months
1. Physical Development
Anterior fontanel closes.
10-14 deciduous teeth present.
Toilet training may begin as voluntary control of anal and urethral
sphincter occurs.
2. Motor Development
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.
3. Language Development
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.
1. Physical Development
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.
Blood pressure is 100/65 + 25/20 mm Hg.
2. Motor Development
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.
3. Language Development
Enjoys story.
Knows at least 4 body parts.
Has vocabulary of 300 words.
Refers to self by name.
4. Social Development
Enjoy parallel play.
Enjoys play with doll.
Will do simple household tasks.
30 Months
1. Physical Development
Average weight is 13 kg.
Average length is 92 cm.
2. Motor Development
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.
3. Language Development
Knows at least 5 body parts.
Can speak sentence of 4-5 words
Uses plural.
Ask “why”.
4. Social Development
Knows own sex.
Parallel play continues.
Shows temper tantrums.
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.
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.
Psychosocial development
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.
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
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
1. Physical Development
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.
2. Motor Development
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).
4. Language Development
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
1. Physical Development
Weight is 16 kg.
Growth is slow
2. Motor Development
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.
4. Language Development
Uses sentences of 4-6 words.
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Questioning is at peak.
Tells exaggerated stories.
Knows nursery rhymes and simple songs.
5. Psychological Development
Very independent.
Tends to be selfish and impatient.
Is Aggressive.
Tells family talks to others without any restraints.
Sibling rivalry present.
5 Years
1. Physical Development
It is half adult height.
Average weight is 18 kg.
Tooth decay may be present.
2. Motor Development
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.
4. Language Development
Uses sentences of 4-6 words with all parts of speech.
Describes pictures with much comments and description.
5. Psychological Development
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
1. Physical Development
Average weight is 20 kg.
Begins to lose deciduous teeth, first permanent teeth erupts.
Brain is 90% of adult size.
2. Motor Development
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.
3. Intellectual Development
Responds to praise and recognition.
Has a sense of humor.
Follows commands.
4. Language Development
Counts numbers.
Recognizes shapes.
Uses all forms of sentences.
Enjoys telling jokes.
5. Psychological Development
Bossy
Insist on being first in everything.
Jealous siblings.
Loves active and group play.
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.
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
DEVELOPMENT OF SCHOOLERS
6-8 Years
1. Physical Development
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.
Blood pressure is 100/60 + 16/10 mm Hg.
Starts losing temporary teeth and acquires first permanent molars,
medical incisors, talent incisors.
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2. Motor Development
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.
3. Intellectual Development
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
4. Language Development
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.
5. Psychological Development
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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.
6. Sensory Development
Has 20/20 vision.
9-10 Years
1. Physical Development
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.
Blood pressure is 102/60 + 16/10 mm Hg.
2. Motor Development
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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3. Intellectual Development
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.
4. Language Development
Follows suggestions better than commands.
Is gregarious.
Begins to use shorter and more compact sentences.
5. Psychological Development
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
1. Physical Development
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.
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Interested in “why” and “how”.
Short-interested span.
Preoccupied with right and wrong.
4. Language Development
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.
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.
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.
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
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.
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.
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Psychosocial Development
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.
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)
1. Physical Development
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.
2. Motor Development
Clumsiness due to rapid physical growth.
Motor functions comparable to adults.
Eye-hand coordination like adults.
Manual dexterity is attained.
3. Intellectual Development
Formal operational thoughts.
Generates hypotheses.
Uses scientific method for problem solving.
4. Language Development
Uses slangs within and outside peer group.
Uses distinct meanings for words.
5. Psychosocial Development
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)
1. Physical Development
Weight
Males – Approximately 50-60 kg
Females – Approximately 42-64 kg
Height
Males – Approximately 164-180 cm
Females – Approximately 155 – 169 cm.
Pulse - 63 + 8 beats/minute.
Respiration - 17+ 3/minute.
Blood pressure is 116/70 + 12/14 mm Hg.
2. Motor Development
Same as adults.
3. Intellectual Development
Expresses concern for education and vocation.
4. Psychosocial Development
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)
1. Physical Development
Weight
Males – Approximately 56-80 kg
Females – Approximately 48-72 kg
Height
Males – Approximately 163-182 cm
Females – Approximately 156 – 170 cm.
Pulse - 70 + 10 beats/minute.
Respiration - 17+ 3 breaths/minute.
Blood pressure is 126/74 +26/16 mm Hg.
2. Motor Development
Possesses manual dexterity
3. Intellectual Development
Pursues further education or enters job market.
4. Psychosocial Development
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
9-10 years
10-11 Years
12-13 Years
13-14 Years
At times underpants are wet with clear mucus especially during ovulation
and sexual arousal.
14-15 Years
Boys
9-10 Years
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Testes become larger.
Scrotal skin becomes dark in color and coarse in texture.
11-12 Years
12-13 Years
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
15-16 Years
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16-17 years
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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
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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
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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
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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.
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.
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.
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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.
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
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.
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
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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.
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.
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.
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
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.
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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.
Play becomes less physically active as the child grows older. Preschool and school-
age children are more vigorous, energetic and active in their 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.
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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
Motor Play: Use of larger and smaller muscles, e.g. pushing and pulling, drawing.
While selecting play material for the child, parents/adults should consider the child
parent/adults should consider the child’s physical, Intellectual and emotional
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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,
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.
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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.
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XI. ROLE OF CARE TAKER
Direct care
giver
Observer
Monitor
Care
Supporter
taker Teacher
Guider Councellor
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
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allow the child to explore on their own and learn from interacting with their
environment.
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.
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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.
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
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1. Preventive 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
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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.
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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.
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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.
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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.
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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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