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. 


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.


         Increase in child’s competence and adaptability.

         It is describing the qualitative change in a structure.

         The level of maturation depends on child’s heredity.


By understanding what to expect during each stage of development, parents can easily capture the teachable moments in everyday life to enhance their child's language development, intellectual growth, social development and motor skills.

         Gaining better understanding of the reasons behind abnormality

         Helping in formulating the plan of care.

         Helping in parents’ education in order to achieve optimal growth & development at each stage.


         Continuous process

         Predictable Sequence

         Do not progress at the same rate (↑ periods of GR in early childhood and adolescents & ↓ periods of GR in middle childhood)

         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 G&D is affected by the preceding types of development.

         G & D proceed in regular related directions :

              - Cephalo-caudal (head down to toes)

             - Proximodistal (center of the body to the             peripheral) 

              - General to specific


The child’s pattern of growth is in a head-to-toe direction, or cephalocaudal, and in an inward to outward pattern called proximodistal.


         A model for the development of all subsequent periods

         Understand how the developing organism can be affected by mother-to-be’s health, habits, and lifestyle

Prenatal Periods

         Germinal Period

         Embryonic Period

         Fetal Period

1. Germinal period
(single-cell zygote
à morula à blastocyst)

         Conception to attachment (8-10 days later)

2. Embryonic period (embryo)

        Attachment to end of 8th week (when all major organs have taken primitive shape)

3. Fetal period (fetus)

        9th week (with first hardening of the bones) until birth


Mitotic division of zygote into multiple cells

Different parts of the organism develop at different rates

         Heterogeneity: Variability in levels of development of different parts of the organism at a given time

         Epigenetic Hypothesis:
Interactions between the cells and their environment generate the new cell forms and emergence of body organs


         Begins with implantation and lasts for about 6 weeks

        Basic organs formed; sexual differentiation occurs

        Organism begins to respond to direct stimulation (e.g., will turn its head in response to a light touch around the mouth)

         Developmental patterns

        Cephalocaudal: Proceeds from head down

        Proximodistal: From middle of organism out to the periphery


         Begins with skeletal ossification

         From week 8/9 until birth

         From 1¼ à 20 inches

         From 8 à 3250 grams

Foetal Development

         10th week: Intestines in place; breathing and jaw-opening movements

         12th week: Sexual characteristics; well-defined neck; sucking and swallowing movements

         16th week: Head erect and lower limbs well-developed

         5th month: As many nerve cells as it will ever have

         7th month: Eyes open and lungs capable of breathing

         8th month: Many folds of the brain present

         9th month: Brain more convoluted

         Fetus doubles in weight in final weeks before birth

Prenatal Development

         Sensory Capacities

         Fetal Learning

         Maternal Conditions


Brain Development

Fetal Sensory Capacities

         Sensing motion

        Sense of balance at 5 months


        Responds to light (i.e., heart rate changes, increased movement) at 26 weeks


        Responds at 5-6 months

        Can discriminate outside sounds, but hears mother’s voice best (i.e., changes in heart rate)

Fetal Learning

         Mothers read the Story “The Cat in a Hat” 2x/day for last 1½ months of pregnancy

         Method: Changes in rate of sucking turned on or off a tape recorder of mother reading (half read that story, the other half another story)

            Finding: Infants modified their rates of sucking in the direction that produced the familiar story

Maternal Conditions: Attitudes & Stress

l  Presence of a sympathetic mate and other supportive family members, adequate housing, and steady employment – factors that give a woman a basic sense of security – appear to enhance the prospects for a healthy baby (Thompson, 1990)

l  Czech study: At birth, unwanted children weighed less and needed more medical help than children in the control group

l  Psychological stress during pregnancy is associated with premature delivery and low birth weight (Hedegaard, 1993)

Teratogens: Smoking

         Increase in rate of spontaneous abortion, stillbirth, and neonatal death

         Nicotine results in abnormal growth of the placenta

         Similar effects from cigarette smoke of others

Teratogens: Alcohol

         Fetal Alcohol Syndrome

         Abnormally small head, underdeveloped brain, eye abnormalities, congenital heart disease, joint anomalies, malformations of the face

         Most serious damage from alcohol caused in first weeks of pregnancy

Teratogens: Drugs

Prescription: Thalidomide (nausea), Valium (tranquilizer), Accutane (acne), streptomycin & tetracycline (antibiotics), artificial hormones

Caffeine: Increased rate of spontaneous
abortion and low birth weight

Marijuana: Low birth weight, premature delivery; infants startle more readily, have tremors, and experience sleep cycle problems

Cocaine: More likely to be stillborn or premature, have low birth weights, have strokes, have birth defects; infants more irritable, uncoordinated, slow learners

Methadone & Heroin: Born addicted; likely to be premature, underweight, vulnerable to respiratory illness, tremors, irritable; infants have difficulty attending, poor motor control

Teratogens: Infections

Rubella: Can cause a syndrome of congenital heart disease, cataracts, deafness, and mental retardation in more than half of all babies born to mothers who suffer from the disease during the first 12 weeks of pregnancy

AIDS: Approximately 30% of the babies born to mothers who test positive for the AIDS virus acquire this disease

Also Rh incompatibility, radiation,  etc



Newborn stage is the first 4 weeks or first month of life.

It is a transitional period from intrauterine life to extra uterine environment

Normal Newborn

Physical growth

 - Weight = 2.700 – 4 kg

 - Wt loss 5% -10%  by 3-4 days after birth

 - Wt gain by 10th days of life

 - Gain ¾ kg by the end of the 1st month

 They loose 5 %  to 10 % of weight by 3-4 days after birth as result of :

      Withdrawal of hormones from mother.

      Loss of excessive extra cellular fluid.

      Passage of meconium (feces) and urine.

      Limited food intake.


         Boys average Ht = 50 cm

         Girls average Ht = 49 cm

         Normal range for both (47.5- 53.75 cm)

Head circumference

33-35 cm

Head is ¼ total body length

Skull has 2 fontanels (anterior & posterior)

 Anterior fontanel

      Diamond in shape

      The junction of the sagittal, corneal and frontal sutures forms it

      Between 2 frontal & 2 parietal bones

      3-4 cm in length and 2-3 cm width

      It closes at 12-18 months of age

 Newborn Senses


         It is the most highly developed sense.

         It is mostly at lips, tongue, ears, and forehead.

         The newborn is usually comfortable with touch.


         Pupils react to light

         Bright lights appear to be unpleasant to newborn infant.

         Follow objects in line of vision


         The newborn infant usually makes some response to sound from birth.

         Ordinary sounds are heard well before 10 days of life.

         The newborn infant responds to sounds with either cry or eye movement, cessation of activity and / or startle reaction.


Well developed as bitter and sour fluids are resisted while sweet fluids are accepted.


Only evidence in newborn infant’s search for the nipple, as he smell breast milk.

Gross Motor Development

The newborn's movement are random, diffuse and uncoordinated. Reflexes carry out bodily functions and responses to external stimuli.







Cognitive Development

The cognitive development of newborn infant is difficult to understand or observe it.

Socio-Emotional Development

The newborn infant expresses his emotion just through cry for hunger, pain or discomfort sensation


It is the period which starts at the end of the first month up to the end of the first year of age. Infant's growth and development during this period are rapid

Physical Growth

Weight : the infant gains :

            - Birth to 4 months → ¾ kg /month

           - 5 to 8 months → ½ kg / month

           - 9 to 12 months → ¼ kg /month

The infant will double his birth wt by 4-5 months and triple it by 10-12 months of age

         Length increases about 3 cm /month during the 1st 3 months of age,

         then it increases 2 cm /month at age of 4-6 months,

         Then, at 7 – 12 months, it increases 1 ½ cm per month

Eruption of teeth

Eruption of teeth starts by 5–6 months of age. It is called "Milky teeth" or "Deciduous teeth" or "Temporary teeth".

Motor Development

         At 2 months

         Hold head erects in mid-position.

         Turn from side back.

         At 3 months, the infant can

         Hold head erects and steady.

         Open or close hand loosely.

         Hold object put in hand

At 4 months, the infant can

         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.

At 9 months, the infant can

         Rise to sitting position alone.

         Crawl (i.e., pull body while in prone position).

         Hold one bottle with good hand-mouth coordination

At 11 months, the infant can

         Walk holding on furniture.

         Stand erect with minimal support

Emotional Development

         His emotions are instable, where it is rapidly changes from crying to laughter.

         His affection for or love family members appears.

         By 10 months, he expresses several beginning recognizable emotions, such as anger, sadness, pleasure, jealousy, anxiety and affection.

         By 12 months of age, these emotions are clearly distinguishable.

         He learns that crying brings attention.

         The infant smiles in response to smile of others.

         The infant shows fear of stranger (stranger anxiety).

         He responds socially to his name.

         According to Erikson, the infant develops sense of trust.

         Through the infant's interaction with caregiver (mainly the mother), especially during feeding, he learns to trust others through the relief of basic needs.

Speech Milestone

         1-2 months: coos

         2-6 months: laughs and squeals

         8-9 months babbles: mama/dada as sounds

         10-12 months: “mama/dada specific

         18-20 months: 20 to 30 words – 50% understood by strangers

         22-24 months: two word sentences, >50 words, 75% understood by strangers

         30-36 months: almost all speech understood by strangers


Toddler stage is between 1 to 3 years of age. During this period, growth slows considerably.     

Physical Development


The toddler's average weight gain is 1.8 to 2.7 kg/year.

Formula to calculate normal weight of children over 1 year of age is

 Age in years X 2+8 = ….. kg.

e.g., The weight of a child aging 4 years

       = 4 X 2 + 8 = 16 kg

Gross Motor

At 15 months, the toddler can

         Walk alone

         Creep upstairs.

         Assume standing position without falling.

         Hold a cup with all fingers grasped around it.

At 18 months:

         Hold cup with both hands.

         Transfer objects hand-to hand at will.

At 24 months:

         Go up and down stairs alone with two feet on each step.

         Hold a cup with one hand.

         Remove most of own clothes.

         Drink well from a small glass held in one hand.

Emotional Development

         Stranger anxiety – should dissipate by age 2 ½ to 3 years

         Temper tantrums: occur weekly in 50 to 80% of children – peak incidence 18 months – most disappear by age 3

Socio-emotional Development

         Sibling rivalry: aggressive behavior towards new infant: peak between 1 to 2 years but may be prolonged indefinitely

         Thumb sucking

         Toilet Training

Social Development

         The toddler is very social being but still egocentric.

         He imitates parents.

         Notice sex differences and know own sex.

         According to Erikson the development of autonomy during this period is centered around toddlers increasing abilities to control their bodies, themselves and their environment i.e., "I can do it myself".

Cognitive Development

         Up to 2 years, the toddler uses his senses and motor development to different self from objects.

         The toddler from 2 to 3 years will be in the pre-conceptual phase of cognitive development (2-4 years), where he is still egocentric and can not take the point of view of other people.


         It is the stage where child is 3 to 6 -7 years of age. The growth during this period is relatively slow.

Physical growth

Weight: The preschooler gains approximately 1.8kg/year.

 Height: He doubles birth length by 4–5 years of age.

Fine Motor

         3 year old: copy a circle and a cross – build using small blocks

         4 year old: use scissors, color within the borders

         5 year old: write some letters and draw a person with body parts

Cognitive Development

Preschooler up to 4 years of age is in the pre-conceptual phase. He begins to be able to give reasons for his belief and actions, but not true cause-effect relationship.

         Fears the dark

         Tends to be impatient and selfish

         Expresses aggression through physical and verbal behaviours.

         Shows signs of jealousy of siblings

Social Development


         Tolerates short separation

         Less dependant on parents

         May have dreams & night-mares

         Attachment to opposite sex parent

         More cooperative in play

         According to Erikson theory the preschooler is in the stage where he develops a sense of initiative.

         He wants to learn what to do for himself, learn about the world And other people.

Set Backs

         Inability to perform self-care tasks, hand washing simple dressing, daytime toileting

         Lack of socialization

         Unable to play with other children

         Unable to follow directions during exam

Middle & Late Childhood (School Age)

Physical Growth


         The child gains about 5cm/year.

         Body proportion during this period: Both boys and girls are long-legged.

Fine Motor

         Writing skills improve

         Fine motor is refined

         Fine motor with more focus

o   Building:  models – logos

o   Sewing

o   Musical instrument

o   Painting

o   Typing skills

o   Technology: computers

At 6–8 years, the school–age child:

         Rides a bicycle.

         Runs Jumps, climbs and hops.

         Has improved eye-hand coordination.

         Prints word and learn cursive writing.

         Can brush and comb hair.

At 8–10 years, the school–age child:

         Throws balls skillfully.

         Uses to participate in organized sports.

         Uses both hands independently.

         Handles eating utensils (spoon, fork, knife) skillfully.

At 10–12 years, the school–age child:

         Enjoy all physical activities.

         Continues to improve his motor coordination.

School Performance

         Ask about favorite subject

         How they are doing in school

         Do they like school

         By parent report: any learning difficulties, attention problems, homework

         Parental expectations

Cognitive Development

At 7-11 years, the child now is in the concrete operational stage of cognitive development.

He is able to function on a higher level in his mental ability.

Greater ability to concentrate and participate in self-initiating quiet activities that challenge cognitive skills, such as reading, playing computer and board games.

Emotional Development

The school–age child:

         Fears injury to body and fear of dark.

         Jealous of siblings (especially 6–8 years old child).

         Curious about everything.

         Has short bursts of anger by age of 10 years but able to control anger by 12 years.

Social Development

The school–age child is :

         Continues to be egocentric.

         Wants other children to play with him.

         Insists on being first in every thing

         Becomes peer oriented.

         Improves relationship with siblings.

         Has greater self–control, confident, sincere.

         Respects parents and their role.

         Joints group (formal and informal).

         Engage in tasks in the real world.

Set Backs

         School failure

         Lack of friends

         Social isolation

         Aggressive behavior: fights, fire setting, animal abuse


Adolescence is a transition period from childhood to adulthood.

Its is based on childhood experiences and accomplishments.

It begins with the appearance of secondary sex characteristics and ends when somatic growth is completed and the individual is psychological mature.

Physical Growth


         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.


         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 20in males


         Increase in transverse diameter of the pelvis.

         Development of the breasts.

         Change in the vaginal secretions.

         Growth of pubic and axillary hair.

         Menstruation (first menstruation is called menarche, which occurs between 12 to 13 years).


         Increase in size of genitalia.

         Swelling of the breast.

         Growth of pubic, axillary, facial and chest hair.

         Change in voice.

         Rapid growth of shoulder breadth.

         Production of spermatozoa (which is sign of puberty).

Cognitive Development

Through formal operational thinking, adolescent can deal with a problem.

Emotional Development

This period is accompanied usually by changes in emotional control.

Adolescent exhibits alternating and recurrent episodes of disturbed behavior with periods of quite one.

He may become hostile or ready to fight, complain or resist every thing.

Adolescence Teaching


         Sexuality – STD’s / AIDS

         Substance use and abuse

         Gang activity


         Access to weapons








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