Engidaw Ambelu

1. GROWTH AND DEVELOPMENT
ASSESSMENT IN CHILDREN
For Anesthesia 2nd yr
Yordanos Girma (MD)
April 18,2018
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2. Outline
• Objectives
• Introduction
• Principles of growth and development
• Growth and development assessment for each
age group
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3. Objectives
By the end of this session, we are expected to:
•Define growth and development
•Identify the significances of knowing age expected growth
and development .
•Mention the principles of growth and development.
•List factors affecting growth and development.
•Mention types of growth and development.
•Describe the stages of development.
•Be able to do developmental and growth assessment.
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4. Growth
• Growth refers to an increase in physical size of
the whole body or any of its parts.
• It is simply a quantitative change in the child’s
body.
• It can be measured in Kg, pounds, meters,
inches, ….. etc
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5. Development
• Development refers to a progressive increase in
skill and capacity of function.
• It is a qualitative change in the child’s
functioning.
• It can be measured through observation.
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6. Importance of Growth and
Development Assessment
• Knowing what to expect of a particular child at
any given age.
• Gaining better understanding of the reasons
behind illnesses.
• Helping in formulating the plan of care.
• Helping in parents’ education in order to achieve
optimal growth & development at each stage .
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7. Principles of Growth & Development
• Continuous process
• Predictable Sequence
• Don’t progress at the same rate
• Not all body parts grow in the same rate at the
same time.
• Each child grows in his/her own unique way.
• Each stage of growth and development is
affected by the preceding types of development.
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8. Cont……
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9. Determinants of Growth and
Development
I. Biologic influences
a. Genetic
b. Intelligence
c. Pre & postnatal conditions
d. Sex – girls tend to learn to walk speak &
acquire sphincter control early and boys
heavier and longer
e. Hormonal influences
f. Temperament
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10. Cont….
II. Psychologic influences
a. Bonding
b. Attachment
III. Social & environmental factors
a. Familial conditions
b. Order of birth
c. Handicaps – deafness, blindness,
illnesses
d. Mothering
e. Environment
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11. Periods of growth and development
Embryo 0-8 weeks
Fetus 9 wk – birth
Neonate birth – 28 days
Infant birth – 12 month
Toddler 1-2 yrs
Pre school 2-5 yrs
School age 6-10yrs
Adolescence 10-18 yrs
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12. Types of growth and development
• Types of growth:
- Physical growth (Ht, Wt, head & chest
circumference)
- Physiological growth (vital signs …)
• Types of development:
- Motor development
- Cognitive development
- Social and Emotional development
- Language development
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13. Growth assessment
• Growth in children is usually steady and predictable, and
good references are available for assessment and comparison.
• Growth is a key component of nutritional status and indicator
of health and well-being for the individual.
• The most powerful tool in growth assessment is the growth
chart
• Selecting the correct growth chart for sex, age is essential to
the assessment.
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14. Comparison of the World Health Organization (WHO)
Child Growth Standards and the National Center for
Health Statistics ( NCHS) Growth curves.
▫ Weight-for-age
▫ Length/height-for-age
▫ Weight-for-length/height
▫ BMI
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16. 4/21/2018
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17. Normal vital signs according to age
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Age Heart rate
(beatsmin)
Respiratory
rate
(breaths/min)
Blood
pressure(mm
Hg)
Birth-28
days
100-160 30-60 60-80/40-50
1-12
months
110-150 35-45 60-100/40-60
1-3 year 70-110 20-30 90-105/55-70
3-6 year 65-110 20-25 95-110/60-75
6-12 years 60-95 14-22 100-120/60-75
12+ years 55-85 12-18 110-135/65-85

18. Development
Motor development
Gross motor Fine Motor
-the child's ability to control - level of coordination of the
different parts of the body different body parts
- require normal neurological - Governed by large cerebral
area & usually not affected
in nutritional disorders.
development as well as
adequate muscle mass and tone.
.
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19. Cont….
Important domains of fine motor development
inorder of maturity include
i) Eye coordination e.g. visual fixation
ii) Eye-hand coordination e.g. reaching- out for
objects
iii) Hand coordination e.g. grasp maturity
iv) Hand-hand coordination e.g. transfer of
objects
v) Hand-mouth coordination e.g. feeding
himself.
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20. Cognitive development
• Cognitive development is the foundation of intelligence.
• Intelligence as the ability to learn or understand or to
deal with new situations.
• The foundational aspects of cognitive development
include
▫ memory
▫ representational competence
▫ attention
▫ processing speed
• Successful cognitive development requires progress in all
these domains.
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21. Cont…
The assessment of infant and child intelligence
depends on progression through two
developmental domains: problem-solving and
language
Problem-solving involves the manipulation of
objects to achieve a specific goal.
Language - broad concept that involves the
representation of thoughts and ideas using
culturally agreed upon arbitrary signals for the
exchange of ideas.
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22. Cont…..
• Language skills are the single best indication of
intellectual ability, and evidence exists that early
language skills are related to later reading skills.
- Expressive language – The ability to produce or use
language.
- Guttural, prelinguistic, and
linguistic
▫ Receptive language – The ability to understand
language.
• Speech – is a manifestation of language that uses
decodable vocal sounds as the medium of exchange.
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23. Social and Emotional development
• The infant is surrounded by a social network. Sensory
processing is influenced by the infant’s social needs.
• Social milestones begin with bonding, which reflects the
feeling of the caregiver for the child. Attachment takes
place within a few months and represents the feeling of
the infant for the caregiver.
• Coinciding with the development of social skills is a
child’s emotional development
• Emotion has three elements: neural processes, mental
processes (feelings), and motor expression (facial,
verbal)
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24. 0-2 months
Physical growth
▫ Average birth weight = 3.4kg
▫ Average length = 50cm
▫ Average head circumference= 35cm
▫ weight may initially decrease 10% below birth
weight in the 1st wk
▫ Infants regain or exceed birth weight by 2 wk of
age and should grow at approximately 30 g/day
during the 1st mo
▫ This is the period of fastest postnatal growth
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25. Cont….
Physiological growth
 Respiration – The prime need of the new born
 Circulation - Pulmonary vascular resistance falls &
peripheral vascular resistance increases
- The existing right to left should be
reversed
- Transition from fetal to adult type of
circulation
- Normally new born hearts beats 120-
160 min.
 Hematology - High hemoglobin level 17 -19 gm/dl
- Life span of RBCS is short
- High leukocyte count
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26. Cont…
3. Language & social
- Cries
- Protrudes tongue
- Hearing is well developed & prefers
high pitched sound
- Near sighted
- Spontaneous smile
4. Cognitive/ Behavioral development
- Regards on face
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27. Infancy
1. Physical growth
 Weight Birth weight doubles by 5th mn and
triples by11-12mn
Weight 3-12mn= age in mn + 9
2
 Length increase by 25 = 75 cm at 12mn
 Head circumference = increase by 12cm in 1st yr
increase by 2cm/mn in 1st 3mn
increase by 1cm/mn 3-6mn
increase by o.5cm/mn 6-12mn
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28. Cont…..
2. Dentition starts at age 5-6mn
no teeth at age 4mn then erupts
4 teeth every 4 month till 20
teeth.
milk/ temporary/ deciduous teeth
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29. Cont…
3. Motor development
Gross motor
• At 2 months
• Hold head erects in mid-position
• Turn from side back
• At 3 months
• Hold head erects and steady
• Open or close hand loosely
• Hold object put in hand
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30. Cont…..
4 months
• Sit with adequate support
• Roll over from front to back
• Hold head erect and steady while in sitting
position
• Bring hands together in midline and plays with
fingers
• Grasp objects with both hands
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31. Cont…..
5 months
• Balance head well when sitting
• Sit with slight support
• Pull feet up to mouth when supine
• Grasp objects with whole hand (Rt. or Lt.)
• Hold one object while looking at another
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32. Cont….
At 6 months
• Sit alone briefly
• Turn completely over(abdomen to abdomen)
• Lift chest and upper abdomen when prone
• Hold own bottle
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33. Cont….
7 months
• Sit alone
• Hold cup
• Imitate simple acts of others
8 months
• Sit alone steadily
• Drink from cup with assistance
• Eat finger food that can be held in one hand
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34. Cont…..
9 months
• Rise to sitting position alone
• Crawl (i.e., pull body while in prone position)
• Hold one bottle with good hand-mouth
coordination
10 months
• Creep well (use hands and legs)
• Walk but with help
• Bring the hands together
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35. Cont…..
11 months
• Walk holding on furniture
• Stand erect with minimal support
12 months
• Stand-alone for variable length of time
• Sit down from standing position alone
• Walk in few steps with help or alone (hands held
at shoulder height for balance)
• Pick up small bits of food and transfers them to
his mouth
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36. Cont……
Fine motor
- 6-7 mn Transfers object from one hand
to the other
- 9-10 mn pincer grasp
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37. Cont……
4. Language
• 1-2 months: coos
• 2-6 months: laughs and squeals
• 8-9 months babbles: mama/dada as sounds
• 10-12 months: “mama/dada specific
5. Social development
• He learns that crying brings attention
• The infant smiles in response to smile of others
• 7mn shows fear of stranger (stranger anxiety).
• He responds socially to his name
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38. Toddler
Physical growth
• During this period, growth slows considerably
• Physical growth
▫ Weight for age > 1yr
Weight= (age in yrs X 2)+8
▫ Height – increases by 1cm/mn
(Age in yrs X 5) +80
▫ Head circumference increases 10cm from 1yr till
adulthood
▫ HC increases 2cm from 1st -2nd year
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39. Cont…….
Neurodevelopment growth
Gross motor
15 months
• Walk alone
• Creep upstairs
• Assume standing position without falling
18 months
• Runs stiffly, walks up stairs with one hand held
24 months
 Runs well, walks up and down stairs, one step at a
time, jumps
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40. Cont…..
Fine motor
15mn- Hold a cup with all fingers grasped around it
scribble
18mn- Hold cup with both hands
Transfer objects hand-to hand at will
24mn
-Can hold a crayon and color vertical strokes
-Turn the page of a book
-Build a tower of six blocks
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41. Cont……
Adaptive/cognitive
15 mn
Makes tower of 3 cubes
18mn
Makes tower of 4 cubes, imitates
scribbling, imitates vertical stroke
24mn
Makes tower of 7 cubes, scribbles in
circular pattern, imitates horizontal stroke
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42. Cont……
Social development
▫ 15mn hugs parents
▫ 18mn Feeds self
▫ 24mn Handles spoon well, helps to undress
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43. Cont…….
5. Language
15 mn
▫ follows simple commands, may name a familiar
object, responds to name
18mn
▫ 10 words (average), names pictures, identifies one
or more parts of body
24mn
▫ Puts 3 words together (subject, verb, object)
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44. Preschool stage
Physical growth
▫ Weight: - 2 kg per year,
▫ Wt gain in the age 2-5 yrs
1-6 yr= (age in yr x 2)+ 8
▫ Linear growth: - height  by 6-7 cm per year
▫ Brain growth: HC increases by 1-2 cm per year
Dental development: - all 20 10 tooth erupted by
the age 3 yr
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45. Cont……
2. Neurodevelopment
Gross motor:
30mn Goes up stairs alternating feet
3 yr Rides tricycle, stands momentarily on
one foot
4yr Hops on one foot; throws ball
overhand, uses scissors to cut out
pictures, climbs well
5yr Skips
Fine motor: - 3rd year copies circle
- 3rd year rides tricycle
- 4th year copies a square
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46. Cont…..
3. Social/Language
- language dev’t is rapid during the age of 2-3y
- From 100 to 2,000 words
- From 3 word to complex sentences
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47. Summary of Stages of Gross motor
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48. Cont…….
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49. Summary of stages of Fine Motor
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50. Cont…….
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51. School age
▫ Age between 6-12 years referred as middle
child hood or latency
▫ Self esteem becomes a central issue
- Able to evaluate themselves
- perceive others’ evaluation of them
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52. Cont….
• Muscular strength, coordination & stamina
increases progressively
• Sexual organs remain physically immature but
interest in gender differences & sexual behavior
become active & increase progressively until
puberty
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53. Cont….
Physical growth
▫ Weight gain is 3-3.5Kg/ year
▫ Wt for age 7-12yr = (age (yr)x7)-5
2
▫ Height: -increase by 6cm per year
▫ Brain growth:- HC ↑ by 2-3 cm throughout this period
Dental development
▫ Loss of deciduous teeth starts by 6 year
▫ First molar (6year molar) erupts (The 1st permanent
teeth)
▫ Replacement with & adult teeth occurs at a rate 4 per
year for the next 5 years.
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54. Cont….
2.Neurodevelopment
Gross motor
6-8 ride bicycle, sporty
Fine motor
6th year copies a diamond & draws a
man with 12 details
At 7th yr draw a man with 16 detail
9-10yr draw man with many details
Typing skill
Musical instrument
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55. Cont……
3. Social/language
▫ Receptive language
▫ Expressive language
▫ Identify with same sex parents adopting
them as role models
▫ Further separation from the family
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56. Adolescent
▫ The age group of 10 -18 years
▫ Growth spurt occurs here
- Height increase by 6-7 cm
▫ Puberty occurs early in females
▫ Sexual Maturity Rating (SMR)/Tanner stage
- Rated from 1-5
1. Boys - Testes
- Penis
- Pubic hair
2. Girls - Breast
- Pubic hair
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57. Cont…..
. Physical growth
Weight:
• Growth spurt begins earlier in girls (10–14
years, while it is 12–16 in boys)
• Males gains 7 to 30kg, while female gains 7 to
25kg
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58. Cont….
Height:
• By the age of 13, the adolescent triples his birth
length
• Males gains 10 to 30cm in height.
• Females gains less height than males as they
gain 5 to 20cm.
• Growth in height ceases at 16 or 17 years in
females and 18 to 20 in males
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59. Secondary sexual characteristics
Male
• Genital changes
• Appearance of pubic, axillary, and facial hair
• Voice change
Female
• Breast changes, pelvic diameter widens
• Growth of pubic and axillary hair
• Onset of menarche
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60. Classification of sexual maturity states
in girls
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62. Classification of sex maturity states in
boys
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63. Cont….
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64. Red Flags
• It is a quick reference guide for assessing development.
• It outlines a range of functional indicators or domains
commonly used to monitor healthy child development.
• It will assist in identifying when a child could be at risk
of not meeting developmental milestones, triggering an
alert for the need for further investigation.
• It can be used in conjunction with validated
developmental screening tools.
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65. Motor Red flags
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Age Red Flags
4 months Lack of steady head control
while sitting
9 months Inability to sit
12 months Inability to transfer objects
from hand to hand
15 months Abnormal pincer grasp
18 months Inability to walk
independently

66. Cognitive red flags
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Age Red Flag
2 months Lack of visual fixation
4 months Lack of visual tracking
6 months Failure to turn to sound or
voice
9 months Lack of babbling consonant
sounds
24 months Failure to use single words
36 months Failure to speak in three-
word sentences

67. Social- Emotional Red Flags
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Age Red Flag
6 months Lack of smile or other joyful expressions
9 months Lack of reciprocal vocalizations, smiles , or other facial
expressions
12 months Failure to respond to name when called
Absence of babbling
Lack of reciprocal gestures( showing, reaching, waving)
15 months Lack of single words
Lack of proto-declarative pointing or other showing gestures
18 months Lack of simple pretend play
Lack of spoken language/gesture combinations
24 months Lack of two-word meaningful phrases(without imitating or
repeating)
Any age Loss of previously acquired babbling, speech or social skills

68. Failure to thrive (FTT)
• It is a term used to describe inadequate growth or
inability to maintain growth.
• It is not a disease, but a sign that is better thought of
as a final common pathway of many medical,
psychosocial, and environmental processes that lead
to poor growth in a young child.
• Criteria for FTT have become more specific.
• Today, there are three distinct criteria to describe a
child who has FTT, using the standard growth charts
of the National Center of Health Statistics: these are
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69. 1)A child younger than 2 years of age whose weight
for height is below 2SD or below the 3rd or 5th
percentile for age on more than one occasion.
2) A child younger than 2 years of age whose
weight is less than 80% of the ideal weight for
age.
3) A child younger than 2 years of age whose
weight crosses two major percentiles downward
on a standardized growth grid.
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70. Causes of FTT
• Etiologies of failure to thrive were grouped as
organic and nonorganic.
• Organic failure to thrive refers to a major disease
process or a single or multiple organ
dysfunction.
• Nonorganic failure to thrive suggests insufficient
emotional or physical nurturing without distinct
pathophysiologic abnormality.
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71. Developmental Delay
o A child who doesn’t reach his or her
developmental milestones at the expected age
oOccur in 2-3% of the population having with
enormous impact on the affected children
oGross Motor delay vs Global Developmental Delay
oDevelopmental Regression
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Thank You!!!!!!