NORMAL GROWTH

AND DEVELOPMENT
Fetal landmarks
landmark

Day 0 Fertilisation by sperm forming zygote initiating embryogenesis

Week 1 Hcg secretion begins after implantation of blastocyst

Week 2 Bilaminar disc

Week 3 Trilaminar disc.notochord mesoderm and its organisation and neural plate
begin to form
Week 3-8 Neural tube formed by neuroectoderm and closes by week 4 ,organogenesis

Week 4 Heart begins to beat ,upper limb and lower limb buds begin to form

Week 8 Fetal movement , fetus looks like a baby

Week 10 Genitalia have male female characteristics

Growth
• Increase in size of organs and body
• It is a quantitative change
• Refers to physical maturation of the body
Rate of growth
• Growth is more rapid in the last 3months of gestation and first 4-5
months after birth
age Rate of growth

Birth to 2 yrs rapid

3-10yr slow

puberty Growth spurt

adult Almost zero

Variation of growth –type of tissue
• Brain growth- rapid growth rate in the third trimester and first year of
life
• Gonadal growth- maximum growth occurs in the pubertal period
• Lymphoid tissue- rapid growth occurs in mid childhood
weight
• Important factor in assessing well being and nutritional status
• Assess weight with /WHO GROWTH CHARTS
• Gross method for assessing-
-3-12months- age in months +9/2
-1-6yr- 2times age in yr +8
7-12 yr - 7 times age in yr -5/2
Approximate weight gain 0-12yr
Age Wt gain
10d -3m 30g/d
3-6m 20g/d
6-9m 15g/d
9-12m 12g/d
1-3y 3kg/y
4-12y 2kg/y
Above 12y 5-6kg/y
Height
Age Growth velocity

0-6m 16cm

6-12m 9cm

1-2y 12cm/y

2-5yr 6cm/y

5-10y 5-6cm/y
height
• Weechs formula
expected height – age in yr times 6 +77
Prediction of adult height-
Fathers height +mothers height /2 then add 6.5cm for boys and
subtract 6,5 cms for girls from the same
dentition
• Lower central incisors erupt first followed by upper central then
upper lateral
• /lower l/ateral incisors
• First deciduous molar
• Canine
• Second deciduous molar
Dentition
age eruption

birth nil

6-8m Central incisors

By 10 m Lateral incisors

12-15m f/irst molars

15-21m canine

21-24m Second molar

Appearance of ossification centres
• Earliest ossification centre intrauterine –os calcis and talus bones
between /22-26/ weeks
• By 6m ossificat/ion centres for carpal bones appear
• Number of ossification centres in the wrist =age in year +1
Normal development
• Refers to maturation of functions and acquisition of var/ious skills for
optimal functioning of an individual
• Maturatiion ad myelination of the nervous system /is reflected in the
sequential attainmet of developmental milestones
Rules of development
• De/velopment is a continuous process
• Depends on the functionl maturation of the nervous system
• Sequenceof attainment of m/ilstones is same in all childr/en
• Progresses in cephalocaudad fashion
• Primitive reflexes need to be lost
• Disorganised mass activity is replaced by wilful act/ions
 Key gross motor developmetal milestones’
• 3m – neck holding
• 5m-roll over
• 6m –tripod sitting
• 8m-sit without support
• 9m –stands holding on
• 12m-creeps well.walks but falls
• 18m- runs explores drawers
• 2yr –walks up and downstairs
• 3y-rides tricycle
• 4yr hops on one foot
 Fine motor
• 4m-bidextrous reach
• 6m-unidextrous reach
• 9m –immature pincer
• 12m –mature pincer
• 15m –imitates scribbling
• 18m-scribbl/es, tower of 3 blocks
• 2ytower of 6 blocks
• 3y- copies cirecle/
• 4y-copies cross
• 5yr –copies triangle
 Social and adaptive
• 2m –social smile
• 3m –recognises mother
• 6m-recognises stranfers
• 9m –waves bye bye
• 12m –comes when called
• 15m –jargon
• 18m –copies parents in task
• 2y-asks for food drink toilet
• 3yr –shares toys ,knows full name and gen/der
• 4r –plays cooperatively in a group
• 5yr –helps in household task
 language
• 1m-alert to sound
• 3m-coos
• 4m-laugh /loud
• 6m-monosyllable
• 9m-bisyllables
• 12m-1-2 words with meaning
• 18m - 8-10 words
• 2yr -2-3 word sentences
• 4yr –song or poem
• 5yr –asks meaning of words
Sexual maturation female
• 1- prepubertal breast , no terminal hair in pubic area
• 2-appearance of breast bud, sparse straight hair along the l/abia
• 3-Generalised breast enlargement, pigmented coarse pubic hair
• 4- nipple and arola form second mound ,hair increase spread over
mons
• 5- mature adult breast,adult pubic triangular hair
 Sexual maturation male
• 1-prepubertal gonads
• 2-reddening of scrotum , testicular vo/lume 4ml
• 3-increase in length of penile shaft,furtherincrease in testicular
volume,hair begin to curl and darken
• 4-increase in girth of penis and glans,darkening of scrotum,coarse
abundant curly hair
• 5-adult type scrotum penis and hair
Conclusion

• Disorders of growth and development are often associated with

chronic or severe illness
• Processes of growth and developmet are intertwined ,but it/ is
convenient to refer to growth as increase in size and development as
increase in function
• Being familiar with normal patterns of growth and developmet allows
you to recognise and manage abnormal variations