g and d lecture

8/2/2019 G and D lecture

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Pediatrics I

Module on Growth and Development

Dr. Rosalina Q. De Sagun

Dr. Noemi T. Salazar

Dr. Rosalia M. Buzon


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Growth And Development

Growth - refers to physical

development and measured with theweight, height, etc .

Development - refers to maturation,acquisition of competence or changein childs behavior


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Assessment

1. Physical Growth

- weight

- length / height

- head circumference

2. Development

Motor- gross and fine

Language - comprehension

- expression

Personal/Social


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0 - 2 months

Physical development

- newborn weight decreases 10% below BW inthe 1st wk

- regains or exceeds BW by 2 wks

- Wt gain = 30 gm/day during the 1st month

- BW doubled = by 4-5 months

- BW 3x = 1 year- BW 4x = 2nd yr


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0 2 months

Cognitive Development

- Recognizes human face and smiles

- Increased attention when stimulus changesEmotional Development

- Basic trust vs mistrust 1stEricksons

Psychosocial stage- develops as infants learn that their urgent

needs are met regularly


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2 - 6 months


- By 3-4 months - rate of growth = 20 gm/day

- Early reflexes disappear

- Voluntary movements appear


- More interested socially

- Becomes distracted with stimuli


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6 - 12 months

Physical development- Increased mobility and exploration

- Growth slows wt gain of 15g/d (6-9mos),

12g/d (9-12mos)- Tooth eruption usually starts with themandibular central incisors maxillarycentral incisors mandibular lateral incisors maxillary lateral incisors cuspids 1stmolars 2nd molars- Tooth development partly reflects skeletalmaturation and bone age


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Emotional Development

- Starts to have emotions of fear,

anger, joy


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6 - 12 months

Cognitive Development- Increased cognitive understanding &

communications

- Complex plays- Object constancy starts at 9 months


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6 to 12 months

Emotional Development- Separation anxiety- Tantrums startOthers

- Language development


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12 18 months


- Growth rate decreases further in the 2nd year

(8g/d for 1-3 yrs old)

- Appetite decreases

- Baby fat burned up with increased mobility

- Exaggerated lumbar lordosis

- Brain growth & myelination continues

- Motor development


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12 18 months


- Mastery of reaching, grasping & releasing

- Imitates elders- Make- believe play centers on his body


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- Attachment to parents

- Temperament depends on attachment to& comfort given by parents

Others

- Receptive language precedes expressive


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18 - 24 months


- Improved balance & agility i.e. running /climbing stairs

- Weight/height increase at a steady rate


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- 18 months end of sensorimotordevelopment

- Object permanence firmly established

Emotional Development- Increased awareness of possibility of

separation

Others- Start asking What is this?


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2 - 5 years (Pre-school yrs)


Somatic & brain growth slows with decrease

in nutritional requirement & appetite

By 2-5 years, child gains 2 Kg in wt/yr., 7 cmin height/ year

Abdomen flattens-


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2 5 yrs

All 20 primary teeth haveerupted by 3 years

Handedness established by 3

years old; bowel/bladdercontrol established by average3 years.

Bedwetting normal up to 4 yearsin girls ; 5 years in boys


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- Pre-school magical thinking

- Egocentricism

- Play complex, imaginative


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2 5 years


- Acceptance of limits, interacts with

adults & peers

- They learn what behaviors are

acceptable and not

- Learn how to adapt to new rules- Control is a central issue


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Others

-Visual acuity: 20/30 by 3 years

20/20 by 4 years

-Language development:occurs most rapidly 2-5 yrs.

- As a rule, # of words in atypical sentence equals the

childs age(2 by 2 years; 3 by 3years); 4 years old can use pasttense; 5 yrs old can use futuretense


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6 - 12 years (School yrs)

Physical development- Growth averages 3 - 3.5 Kg/yr and 6

cm/year

- Loss of deciduous teeth with eruption of 1stmolar (by 6 years) rate of replacementwith adult teeth approx. 4/yr

- Lymphoid tissues hypertrophy


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CognitiveDevelopment- Learning centers onreading, writing and

math- Apply rules based onobservable phenomena


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6 12 years


- More and longer separation from home

- Influence of peer group increases- Seeks acceptance from teachers

- Self esteem a central issue with popularity

as its central component


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Formulas for Approximate Average Weight& Height of Normal Infants & Children

Weight :

- at birth: 3.25 Kg

- for 3-12 months: age (mo) + 9 / 2- for 1-6 yrs: age (yr) x 2 + 8

- for 7-12 yrs: age (yr) x 7 5 / 2


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Height :- at birth: 50 cm

- at 1 yr: 75 cm- at 2-12 yrs:

age (yr) x 6 + 77


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All 20 primary teeth haveerupted by 3 years

- Handedness established by 3years old; bowel/bladdercontrol established by average3 years. Bedwetting normal upto 4 years in girls ; 5 years in

boys


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Developmental Milestones

Newborn:

lies in flex attitude, turns head from

side to sidehead lags on pull

can fixate face or light in line with vision

Moro , grasp , stepping reflexes activeVisual preference to a human face


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Developmental Milestone

At 1 month:

Holds head up momentarily

Tonic neck posture predominatesFollows moving object

Reflex smile

Body movements in cadence with voice ofothers in social contact


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At 2 months:

Head sustained on ventral suspension

Tonic neck posture predominates

Follows moving objects past midline- 180degrees

Smiles on social contact (social smile)

Listens to voice and coos


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At 4 months:Symmetric posture

No head lag on pull to sit (good head

control)When held erect, pushes with feet

Reaches & grasps objects and brings themto mouth

Laughs out aloud

Shows displeasure when social contact isbroken


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At 7 months:

Rolls over; crawls or creeps

Sits briefly with supportTransfers objects from hand to hand

Polysyllabic vowel sounds

Prefers mother


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At 10 months:

Sits alone; pulls to stand

Cruises; walks holding on to furniturePincer grasp; looks for hidden toy

Repetitive consonant sounds( mama,

dada)Responds to sound of name

Waves bye-bye; plays peek-a-boo


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At 12 months:

Walks with 1 hand held

Obeys simple commands on requestor gesture

Speaks few words besides mama, dada

Makes postural adjustment to dressing

Plays simple ball game


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Developmental milestones

At 15 months:

Walks alone; crawls up stairs

Makes a line with crayonJargon; follows simple commands

May name a familiar object (ball)

Indicates needs by pointing


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At 18 months:Runs stiffly; walks up stairs with 1 handheld

Imitates scribbling and vertical strokeNames pictures; identifies 1 or more bodyparts

Average of 10 words

Feeds self

Seeks help when in trouble


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Developmental milestones

At 24 months (2 yrs):Runs well; walks up & down stairs onestep at a time; climbs to furniture

Circular scribbling

Puts 3 words together ( subject-verb-object)

Handles spoon well; listens to storieswith pictures


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At 30 months:

Goes upstairs with alternating feet

Imitates circular strokeKnows full name; refers to self as I

Helps put things away; pretends in play


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At 36 months (3 yrs):Rides tricycle

Copies a circle; imitates a cross

Knows age and sex; counts 3 objectscorrectly

Plays simple games with other children;helps in dressing


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At 48 months (4yrs):

Hops on one foot

Copies cross and square; draws a manwith

2 to 4 parts besides the head; names

longer of 2 linesTells a story

Goes to toilet alone.


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At 60 months:

Skips

Copies a triangle; names heavier of 2weights

Names 4 colors

Dresses and undressesAsks questions about meaning of words

Domestic role-playing


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Thank You

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