Knowledge of normal growth and development of children

Is essential

for preventing and detecting disease by recognizing overt deviations from normal pattern

GROWTH AND DEVELOPMENT

Many people use the terms growth and development interchangeably

In reality they are different, though they inseparable, neither take place alone

GROWTH
Growth refers to quantitative changes Increases in size and structure

Not only does the child become larger physically, but the size and structure of the internal organs and the brain increase As result of the growth of the brain, the child has a greater capacity of learning, for remembering, and for reasoning The child grows mentally as well as physically

DEVELOPMENT

Development refers to quantitative and qualitative changes

It may defined as a progressive series of orderly, coherent changes

Progressive signifies that the changes are directional, that they lead forward rather than backward Orderly and coherent suggest that there is a definite relationship between the changes taking place and those that preceded or will follow them

Fig 1 . The interacting of development Physical, intellectual, and psychosocial developments should not be viewed as separate entities because they operate interdependently, each strongly influencing the others

PRINCIPLES OF DEVELOPMENT

Development involves changes Early development is more critical than later development Development is the product of maturation and learning The developmental pattern is predictable The developmental pattern has predictable characteristics

There are individual differences in development There are periods in the developmental pattern There are social expectations for every developmental period Every area of development has potential hazards

Hurlock EB. Child Development. Auckland : McGraw-Hill International Book Co, 1978. P.22-47.

DEVELOPMENT INVOLVES CHANGES

Changes in size Physical : height, weight, circumference, internal organ Mental : memory, reasoning, perception, creative imagination Changes in proportion Physical : see Fig. 3 Mental : imaginative capacity is better developed than reasoning capacity; while the reverse is true in adults

1/2

1/3

1/4

1/5

1/6

1/7

1/8

2 mo (fetal) 5 mo

Newborn

2 yr

6 yr

12 yr

25 yr

Fig 2. Changes in body proportions from the 2nd fetal mo to adulthood. (From Robbins WJ, Brody S, Hogan AG, et al: Growth New Haven, Yale University Press, 1928)

Disappearance of old features Physical : thymus gland, baby hair and teeth Mental : babyish locomotion and speech Acquisition of new features Physical : second teeth, primary and secondary sex characteristics Mental : interest in sex, moral standards, religious beliefs

EARLY DEVELOPMENT IS MORE CRITICAL THAN LATER

Conditions affecting early foundations a. Favorable interpersonal relationship b. Emotional states c. Child - training methods d. Early role - playing e. Childhood family structure f. Environmental stimulation

Fig 3. UNIVERSAL FACIAL EXPRESSIONS Infants show these types of facial expressions relating to basic emotions, regardless of the culture in which they are raised (Feldman RS, 2000)

DEVELOPMENT IS THE PRODUCT OF MATURATION AND LEARNING

MATURATION Intrinsic maturation.The unfolding of characteristics potentially present in the individuals genetic endowment Phylogenetic functions Functions common to the race, such as creeping, crawling, sitting and walking. Development comes from maturation Ontogenetic functions. Functions specific to the individual, such as swimming, ball throwing, riding bicycle, writing. Training is essential

Fig 4. MILESTONES OF MOTOR DEVELOPMENT

.development is the product of maturation and learning

LEARNING Learning is development that comes from exercise and effort. Through learning, children acquire competence in using theirs hereditary resources. They must have opportunity to learn Some learning comes from practice or the mere repetition of an act

THE DEVELOPMENT PATTERN IS PREDICTABLE

Developmental direction
Cephalocaudal - proximodistal law (fig.5) Specific areas of development likewise follow predictable patterns Motor development, emotional behavior, speech, social behavior, concept development, goals, interests, and identification with others

TWO PRINCIPLES OF DEVELOPMENTAL DIRECTION

Cephalocaudal principle
Fig 5

Principle that development proceeds in a headto - tail direction : the upper body parts develop before the lower parts Proximodistal principle Principle that development proceeds in a nearto-far manner : the parts of body near its center (spinal cord) develop before the extremities

Fig 5. The laws of developmental direction

THE DEVELOPMENT PATTERN HAS PREDICTABLE CHARACTERISTICS

Similarity in developmental patterns All children follow a similar developmental pattern with one stage leading to the next General pattern is not altered by individual variations in the speed of development Development proceeds from general to specific responses In mental as well as in motor responses, general activity always precedes specific activity In emotional behavior babies first response to strange and usual objects with general fear

.the development pattern has predictable characteristics

Development is continuos

Development is continuous from the moment of conception to death but it occurs at different rates, sometimes slowly and sometimes rapidly
Developmental changes donot always go forward in straight line but, in the end, the changes lead forward

.the development pattern has predictable characteristics

Different areas develop at different rates Fig 6. shows the pattern of development for four different parts of the body (Brain and head, General, Lymphoid, Reproduction)
There is correlation in development When physical development is rapid, so in mental development

200

180
160 140 120

LYMPHOID TYPE

NEURALTYPE

100
80 60 40 20 0 0
GENITAL TYPE GENERAL TYPE

12

16

20

AGE IN YEARS
Fig 6. Main types of postnatal growth of the various parts and organs of the body. (After Scammon: The measurement of the body in childhood. In: Harris B et al (eds): The Measurement of Man. Minneapolis, University of Minnesota Press, 1930)

THERE ARE INDIVIDUAL DIFFERENCES IN DEVELOPMENT

Although the pattern of development is similar for all children all children follow the predictable pattern in their own way and at their own rate all children do not reach the same point of development at the same age

there are individual differences in development

Causes of differences

Every person is indeed biologically and genetically different from every other No two people have identical environmental influences, even identical twins Individual differences are caused by both internal and external conditions

THERE ARE PERIODS IN THE DEVELOPMENTAL PATTERN

There are five major developmental periods in childhood (See Table 1) Although eachperiod has its own characteristic events and issues, the ages given for each time span are only approximate and somewhat arbitrary

Table 1
PHASE Prenatal period

The Chronological Phases of Childhood and Their Major Characteristics

TIME SPAN Conception to birth CHARACTERISTICS Child begins as a single cell and emerges 9 months later as a multimillion-cell functioning person

Infancy

Birth to 18 months (up to 24 months)

Changes in brain functioning result from an increased number of neural connections, leading to a period of intense development of motor abilities, language acquisition, and socialization
Through exploration, play, and the development of self-sufficiency, children become increasingly willful and independent

Early childhood

18 months to 6 years

PHASE Middle childhood

TIME SPAN 6 to 11 years

CHARACTERISTICS Emphasis is on learning the fundamental skills of reading, writing, and mathematics; more complex thinking and reasoning abilities become evident, and children become capable of logical thought and of seeing the world from the point of view of others
Dramatic physical and psychological changes occur; key issues are separation, independence, and peer relationships

Adolescence

11 to 18 years

Tabel 2. Tahap-tahap Tumbuh Kembang Anak

1. Masa pranatal (Prenatal period) a. Masa zigot / mudigah: konsepsi 2 minggu b. Masa embrio: 2 minggu 8 / 12 minggu c. Masa janin / fetus: 9 / 12 minggu lahir - Masa fetus dini: 9 minggu trimester ke-2 - Masa fetus lanjut: trimester akhir kehamilan 2. Masa bayi (Infancy) : usia 0 1 tahun a. Masa neonatal: usia 0 28 hari - Masa neonatal dini: 0 7 hari - Masa neonatal lanjut: 8 28 hari b. Masa pasca neonatal: 29 hari 12 / 15 bulan 3. Masa anak dini (Early childhood) a. Toddlerhood: usia 1 3 tahun b. Masa pra sekolah (Preschool period): usia 3 6 tahun 4. Masa sekolah (School period): usia 6 18 / 20 tahun a. Masa pra remaja (Middle and late childhood): usia 6 11 tahun b. Masa remaja (Adolescence): 1. Masa remaja dini (Early adolescence): 11 - 13 tahun 2. Masa remaja pertengahan (Middle adolescence): 14 17 tahun 3. Masa remaja lanjut (Late adolescence): 17 20 tahun

THERE ARE SOCIAL EXPECTATIONS FOR EVERY DEVELOPMENTAL PERIOD

Social expectations are known as developmental task Factors influencing mastery of developmental tasks Aids to mastery Accelerated physical development Strength and energy above average to age Above average intelligence An environment that offers opportunities for learning Guidance from parents and teachers in learning A strong motivation to learn Creativity accompanied by a willingness to be different

.there are social expectations for every developmental period

Obstacles to mastery Retardation of developmental level (physical or mental) Poor health A handicapping physical defect Lack of opportunity to learn Lack guidance in learning Lack motivation to learn Fear of beeing different

EVERY AREA OF DEVELOPMENT HAS POTENTIAL HAZARD

Even when developmental pattern is progressing normally, there are likely to be, at every age, hazards in some areas of development that interfere with this normal pattern Individual hazards arising from the childs genetic endowment or environment Forewarning of potential hazards associated with different areas of development is important

BIOLOGI MASYARAKAT

FISIK

KELUARGA

INDIVIDU

SOSIAL DAN BUDAYA

EKONOMI DAN POLITIK

Fig 7. The influence of environment on child growth and development

Fig 8. Bronfenbrenners Chronosystem

The pattern of developmental can be interfered with either temporarily or permanently, by environmental or physical conditions

This interference may take the form of delaying or accelerating the speed or it may alter the pattern

FURTHER READING

1. Soetjiningsih,Tumbuh Kembang Anak, 1995 2. Nelson Text book of Pediatrics, 2007 3. Rudolphs Pediatrics, 2003 4. Soetjiningsih, Tumbuh Kembang Remaja dan Permasalahannya, 2004 5. Hurlock EB, child Development, 1978