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 WELCOME !

CHILD HEALTH NURSING

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CHILD HEALTH NURSING

CHAPTER-2
GROWTH AND DEVELOPMENT

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 OBJECTIVES
Sr.No CONTENT Sl.No.
1 Define Growth. 06
2 Define Development. 07
3 Define Maturation. 08
4 Enlist importance of growth and development for nurses. 10
5 Describe the principles of growth and development. 11
6 Explain the factors influencing growth and development. 12
7 Explain the stages of growth and development. 15

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 OBJECTIVES
Sr.No. CONTENT Sl.No
8 Describe the types of growth and development. 18
9 Explain growth and development of normal new born. 29
10 Explain growth and development of normal infant. 39
11 Explain growth and development of normal toddler. 64
12 Explain growth and development of pre-schooler. 81
13 Explain growth and development of school aged child. 90
14 Explain growth and development of adolescents. 102

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 1. GROWTH

• Growth refers to an increase in physical size of the whole body or any of

its parts.

• It can be measured in Kg, pounds, meters, inches,.. etc.

• Growth results because of cell division and synthesis of proteins.

• It is simply a quantitative change in the child’s body.

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 2. DEVELOPMENT

• Development refers to a progressive increase in skill and capacity of

function.

• It is a qualitative change in the child’s functioning.

• It includes psychological, emotional, and social changes.

• It can be measured through observation.

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 3. MATURATION

• 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.

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 PRACTICE QUESTION -1
Q Growth refers to a ……….. Change.
a. Qualitative
b. Quantitative
c. Economical
d. Social

Rationale: Growth is a quantitative change like height, weight that can be

measure.

Reference slide no. 6

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 4. IMPORTANCE OF GROWTH AND
DEVELOPMENT FOR NURSES:

• 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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 5. PRINCIPLES OF GROWTH &
DEVELOPMENT
Growth and development proceed in regular related directions :

• Cephalo-caudal {head down to toes}

• Proximodistal {center of the body to the peripheral}
• Development is Continuous process
• Development is similar for all
• Development proceeds from general to specific
• Don’t progress at the same rate (↑ periods of Growth rate in early
childhood and adolescents & ↓ periods of Growth rate 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.
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6.FACTORS INFLUENCING GROWTH
AND DEVELOPMENT
Growth and development depends upon multiple factors. They influence it
directly or indirectly by promoting and hindering the process. The factors
influencing growth and development can be grouped as following

i} Heredity- heredity determines the extent of growth and development that is

possible but the environment determine the degree to which the potential will
be achieved. It includes the followings-

• Genetics
• Sex of the individual
• Race
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6.1. Contd….
ii} Environment
Environment include both prenatal and postnatal factors, which are following-

▪ Prenatal factors: the intra uterine environment is an important factor for

growth and development of an individual. Various conditions which
influence the fetal growth in utero, are following-

• Maternal malnutrition
• Maternal infection
• Maternal substance abuse
• Maternal illnesses
• Hormonal imbalances.

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 6.2. Contd…
▪Postnatal factors Postnatal factors which influence growth and development
are following
• Nutrition, Health
• Physical environment, Psychological environment
• Cultural factors, Socioeconomic factors
• Climate and season
• Play and exercise
• Intelligence
• Hormonal influences
✔ All these factors determine constitution of the body. Favourable factors
promote growth and development and unfavourable conditions inhibits the
process and leading to growth retardation and developments delays-

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 7.STAGES OF GROWTH AND
DEVELOPMENT
Stages of growth and development can be studied as intrauterine life or
prenatal period and extra uterine life or postnatal period.
PRENATAL PERIOD/INTRAUTERINE LIFE :
Ovum – 0 to 14 days after conception
Embryo – 14 days to 8 weeks
Fetal -8 weeks to birth
POSTNATAL PERIOD/EXTRAUTERINE LIFE
Neonate = 0-28days from birth to 4 weeks of life
Infancy = 28 days – 1year {first years of life}
Toddler = 1 – 3 years
Preschool child = 3-6 years (early childhood)

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7.1 Contd…
School going child = 6 – 10 years (girls) //6 – 12 (boys)
Adolescence = 13 – 18 years
Adolescent
from puberty to beginning of adulthood (13 – 18years)
▪Pre pubescent (early adolescent)
10 – 12 years (girls)
12 – 14 years (boys)
▪Pubescent (middle adolescent)
12 – 14 years (girls)
14 – 16 years (boys)
▪Post pubescent (late adolescent)
14 – 18 (girls)
16 – 20 (boys)
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7.2 Contd…

Adulthood
Young adulthood = 20 – 40 years of age
Middle adulthood = 40 – 65 years of age
Late/older adulthood = age 65 and above
▪Young old = 65 – 74 years of age
▪Middle old = 75 – 84 years of age
▪Old – old = 85 years – till death.

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 8. TYPES OF GROWTH AND
DEVELOPMENT
Growth:
• Biologic growth (Height, Weight, head & chest circumference)
• Motor growth
• Sensory growth

▪ Development:
• Intellectual development
• Moral development
• Psychosocial/Emotional development
• Sexual development
• Spiritual development
• Language development

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 8.1 BIOLOGIC GROWTH

Weight:

• On an average ideal birth weight is around 2.5 kg to 3.8 kg .The newborn

losses up to 10% of their weight during the first week of life, which
remains by 10 days of age after their weight gain occur at a rate of 25-30
gms a day for the first three months and 400 gms/month till 1 year of age.

• The infant double their weight by 6 months of age, triple by 1 year, four
times by 2 year, five times by 3 year, six times by 5 year, seven times by 7
year or ten times by 10 year of age.

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 8.2 LENGTH AND HEIGHT

• At birth, average length of a healthy Indian new born baby is 45-50 cm. it
increases to 60 cm at 3 months, 70 cm at 9 months and 75 cm at 1 year.
The height of infant doubles 100 cm at the age of 4 years and triples at 13
years.

• For children under 2 years, it is advisable to measure the length while the
child lies supine position with legs fully extended at hips and knees and
feet at right angles to legs in this so called “infantometer”.

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 8.3 HEAD CIRCUMFERENCE
• on an average head circumference is measure about 33-35 cm at birth. At 3
months it is about 40 cm, at 6 months 43 cm, at 1 year 45 cm, at 2 year 48
cm, at 7 year 50 cm, at 12 year it is about 52 cm almost same as adult.

• If head circumference increase more than 1 cm in 2 weeks during the first

three months of age, than hydrocephalus should be suspected. Large size
head is found in hydrocephalus and rickettsia.

• Small size head or microcephalus is usually associated with premature

closure of skull suture and founds in down syndrome and mental
retardation

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 8.4 CHEST CIRCUMFERENCE

• At birth, 31 cm of chest circumference, 2-3 cm less than head

circumference. At 6-12 month of age both become equal. After 1 year of
age, chest circumference by 2.5 cm, and by the age of 5 year it is 5 cm
larger than head circumference.

• For measuring by placing the tape measure around the chest at the level of
nipple in between inspiration and expiration.

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 8.5 MID-UPPER ARM
CIRCUMFERENCE
The measurement help to assess the nutritional status of younger children.
There is a growth retardation due to inadequate nutrition, which can be
detected by the simple practice and useful measurement. The average mid
upper-arm is 11-12 cm.

• At 1 year of age It is 12-16 cm

• At 1-5 year of age it is 16-17 cm
• At 12 year it is 17-18 cm
• At 15 year it is 20-21 cm

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 8.6 DENTITION

There is a variation for the time of eruption of teeth, first teeth commonly may
appear in 6-7 months of age. It is called "Milky teeth“ or "Deciduous teeth" or
"Temporary teeth".
• By the age of 2.5-3 year the child has full set of temporary teeth
numbering 20.
• The first permanent teeth usually expelled at the age of 6 year, than all
temporary teeth are replaced gradually
• Total permanent teeth numbering 32 usually expelled with in 12 year of
age

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8.7 Contd…

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 8.8 MOTOR GROWTH
It depends on the maturation of the muscular, skeletal and nerve system, it is
usually come as gross motor and fine motor development.

Gross motor : It involve control of the child over his/her body by increasing
mobility. The important gross motor development is standing, coping,
running, climbing up stairs, riding tricycle etc. it promotes independent local
motor and provide fine motor activity.

Fine motor : It depends upon neural tract maturation activities with fine
sensory motor adjustments and include eye coordination, head to mouth
coordination, hand skill as finger thumb opposition, grasping, dressing etc.

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 8.9 SENSORY GROWTH

It depends upon development of nerve system and response to specific stimuli.

Example : taste, smell, touch, hearing all initial senses present in new born
babies the visual system is the last to mature at about 6-7 year.

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 PRACTICE QUESTION -2

Q The normal head circumference at birth is :-

a. 33 cm
b. 39 cm
c. 36 cm
d. 31 cm

Rationale: The normal head circumference at birth is 33 to 35 cm.

Reference slide no. 21

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 9. STAGE OF GROWTH AND
DEVELOPMENT OF NEW BORN
NEW born is the first 4 week and first month of life. It is the
transitional period to intrauterine life to extrauterine life.

Physical growth
1. Weight: 2.5 kg – 3 kg
• Weight loss : 5% to 10% by 3 to 4 days
• Weight gain by 10 days of life
• Gain 3/4th kg by the end of 1st month
• Withdrawal of hormone from mother loss of excessive extracellular fluid
• Passages of meconium {feces and urine}
• Limited food intake
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9.1 Contd…

2. Height
Boys average height = 50 cm
Girls average height = 49 cm
Normal range for both 47.5 cm – 53.5 cm

3. Head circumference
33 cm – 35 cm
Head is ¼ th total body length
Skull has 2 fontanels {anterior and posterior}

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9.2 Contd…
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

Posterior fontanel
•It is triangular shape
•Located between occipital and 2 partial bone
•Closes by the end of 1st month of age

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9.3 Contd…

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9.4 Contd…

CHEST CIRCUMFERENCE
It is 30.5 cm to 33 cm ( usually 2 to 3 cm less than head circumference ).
Physiological growth
vital sign
Temperature = 36.3 – 37.2*c orally
Pulse = 100 – 160 beat/min
Respiration = 35 – 60 ( average 40 breath/ min ).
Blood pressure = 75/42 at birth.

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9.5 Contd…

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9.6 Contd…

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 9.7 NEW-BORN SENSES
1. Touch : it is the most highly developed sense
It is mostly at lips, tongue, ears and forehead
The new-born is usually comfortable with touch
2. Vision : pupils react to light
Bright light appear to be unpleasant to new born infant
Follow objects in line of vision
3. Hearing : the new born usually makes some response to sound from birth
Ordinary sounds are heard well before 10 days of life
The new-born responds to sounds with either cry or eye movement, cessation
of activity and startle reaction.
4. Taste :
well developed as bitter and sour fluids and resisted while sweet fluids are
accepted
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9.8 Contd…
5. smell :
Only evidence in new-born infants search for the nipple, as he smell breast
milk
GROSS MOTOR DEVELOPMENT
The new-born’s movement are random, diffuse and uncoordinated reflexes
carry out bodily function and responses to external stimuli.
Fine motor development
hold’s hand fist
When crying, he draws arms and legs to body
Reflexes
Swallowing, gaging, sucking, grasping, tonic neck reflex.

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9.9 Contd…

Cognitive development -
The cognitive development of new-born is difficult to understand or observe
it.

Emotional development -
The new-born express his emotions just through cry for hunger, pain or
discomfort sensation.

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 10. STAGE OF GROWTH AND
DEVELOPMENT OF NORMAL
INFANT
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

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10.1 Contd..

The infant is double his birth weight by 6 months and triple it by 10 months of
age.
Calculating infant’s weight
Infants from 3 to 12 months
weight = age in months + 9
2
Example : wt. for 7 months old infant = 7+9 = 16 = 8 kg
2 2

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10.2 Contd..

Height : it increases about 3 cm/month during the ist 3 months of age

Then it increases 2 cm/month at age of 4 – 6 months of age
Then it increases 1 ½ cm/month at age of 7 – 12 months of age
Head circumference : it increases about 2 cm/month during the ist 3 months
Then ½ cm/month increases during iind 9 month of age
Anterior fontanel closes by 12 – 18 months of age
Posterior fontanel closes by 6 – 8 week of age
Chest circumference : by the end of the 1 year, it will be equal of the head
circumference

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10.3 Contd..

Physiological growth :
Pulse = 130 + 20 beat/minute
Respiration = 35 + 10 breath/minute through nose
Blood pressure = 80/50 + 20/10 mm hg

Motor development :
At 1 -3 months = Head and leg baby pulled from supine to sitting position
Turn head to side, when prone position
Open and close hand loosely
Hold object put in hand with active grasp

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10.4 Contd..

At 4 months = roll over from front to back

Bring hands together in midline and plays with fingers
Grasp objects both hands
At 5 months = balance head well when sitting
Pull feet up to mouth when supine
Grasp objects with hold hands ( right or left )
Hold one object while look at another
At 6 months = turn completely over (abdomen to abdomen)
Lift chest and upper abdomen prone
Hold own bottle

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10.5 Contd..

Sensory development
At 7 months = Sit alone on hand surface
Hold cup
Imitate simple acts of others
At 8 months = Sit alone straight
drink from cup with assistance
Eat finger food that can be held in one hand.
At 9 months = Rise to sitting position alone
Crawling ( pull body while prone position )
Hold one bottle with good hand – mouth coordination.

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10.6 Contd…
Sensory development
At 10 months = creeping well ( use hands and legs )
Walk but with help
Bring the hands together
At 11 months = walk holding on furniture
Stand erect with minimal support
At 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 )
Picks up small bits of food and transfers them to his mouth
Takes toys out of box and turn page in a book but not one at a time

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10.7 Contd..

Age 1 month – protective blinking in response to bright light

Attentive to speech of others
indefinite stare at surroundings
Notices faces and bright objects but only if they are I n line of vision.
Age 2 month – turn head to side when sound occur at ear level
Eyes follow moving person and objects nearby.
Visual acuity is hyper optic
Age 3 month – turn head and looks in same direction to locate sound
Blinks at objects that threaten the eyes
Beginning of ability to coordinate various sensory stimuli.

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10.8 Contd…

Age 4 month – fairly good binocular vision looks briefly for toy that
disappears.
Follow objects to 180*
Beginning of hand eye coordination.
Age 5 month – looks in direction of sound made below ear
Stops crying in response to music
Visual acuity is 20/20.
Age 6 month – localizes sound made above ear level
Enjoys more complex visual stimuli.
Moves in order to see an object.

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10.9 Contd…

Age 7 month – head turns in a curving arch to localize sounds

Has preference in taste of food
Depth perception is beginning to develop
Age 8 month – depth perception is developing
Recognizes familiar words and sounds
Age 9 month – head turns directly to source of sound.
Recognizes by looking or moving toward familiar objects when named.
Able to follow objects through transition from one place to another

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10.10 Contd…

Age 10 month – marked interest in very small objects.

Tilts head backward to see upward.
Searches for a lost toy with greater persistence.
Age 11 month – can follow rapidly moving objects.
Age 12 month – listens for recurring sounds.
Full binocular vision well established
Follows fast moving objects with eyes.

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10.11 Contd…

Psychosocial Development:
Sense of trust v/s mistrust
At 1 month – beginning development of sense of trust
Complete dependence on caregivers, usually mother
At 2 month – distinguishes “mother” from other and more responsive to that
person or smile to mother/caregiver.
Has learned that crying brings attention.
AT 3 month – stops crying when familiar persons approaches
May laugh loud
Looks in directions of speaker.

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10.12 Contd…

At 4 month – initiates social play by smiling or vocalizing

Shows eagerness when feeding bottle appears.
At 5 month – smiles at self in mirror
Begins to discriminate family members from strangers
Accepts an object from another person
At 6 month – recognizes parents well and recognizes strangers as different
from family members
Begins to extend arms to be picked up.
It knows what is liked and disliked.

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10.13 Contd…

At 7 month – shows increasing fear of strangers

Unhappy when caregiver , usually mother disappears.
Close lips tightly when disliked food is offered.
At 8 month – fear of strangers and refuses to play with strangers.
Dislikes dressing and diaper change
Separation anxiety develops
At 9 month – dislikes having face washed so covers face with arms and hands
Cries when scolded
Wants to please caregiver, usually mother.

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10.14 Contd…

At 10 month – expresses several beginning recognizable such as anger,

sadness, jealousy, anxiety, pleasure, excitement and affection.
Plays social games with adults, such as “pat-a-cake” and “peek-a-boo.”
Looks at pictures in a book with another person
At 11 month – becomes frustrated when activities are restricted.
Enjoy playing with empty dish and spoon after meals
At 12 month – responds to request for affection such as kiss or a hug
Attachment develop to primary caregiver
Cooperates in dressing : puts arms through sleeves, feet into shoes.

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10.15 Contd…

Psychosexual development
Oral stage { 0 – 1 year }
At 1 – 6 month : oral – dependent or oral – passive : need for sucking pleasure
At 7 – 12 month : oral aggressiveness is evidenced by biting and chewing
Discovers genitalia.
Spiritual development
Stage – I Primal faith
At 0 – 1 year : feeling of trust, warmth and security form the foundation for
the later development of faith.

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10.16 Contd…

Moral development
▪Pre conventional morality stage 0 { 0-2 years }: the good is what I like and
want.
Intellectual development
Sensorimotor stage { 0 – 2 years }
Sub stage – I { birth – 1 month } : infant uses reflexes to begin to make
associations between an act and a sequential response; cannot distinguish self
from environment.
Sub stage – ii; primary circular reaction { 1-4 month } : begins repeat actions
of own body voluntarily { hand-to-mouth movements permits sucking }.

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10.17 Contd…
▪Substage – iii; secondary circular reaction { 4-8 month } : repeats action that
affects an object to get a response { shaking a rattle }.
Experiments with old or new responses to produce environmental changes or
to reach a goal.
Knows that objects are separate from self.
▪Substage – iv; coordination of secondary schemes { 8-12 month } : ability to
learned earlier are combined and extended to deal with new situations :
behavioral and perceptual patterns are coordinated and applied to new
situations.
Able to follow objects through transition from one place to another
Problem solving beginning to develop, although the infant has not learned to
“think” per se

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10.18 Contd…

▪Language and speech development

▪at 1 month
Receptive language – responds to human voices
Expressive language – open and closes mouth as adult speaks
Utters small throaty sounds
Cry pattern developing. Cries when hungry or uncomfortable
Begins to coo.

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10.19 Contd…

▪At 2 month- Receptive language – alert expression when listening.

Soothed by caregiver’s or mother’s voice
Expressive language – crying becomes differentiated, varying with the reason
for crying. Ex- hunger, pain
Responds vocally to caregiver’s voice – “ah”, “eh”, “uh”, cooing
▪At 3 month - Receptive language – look in direction of speaker
Expressive language – shows pleasure in making many sounds.
Vocalizes in responds to other; coos
May laugh a loud.

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10.20 Contd…
▪At 4 month – receptive language – responds differently to pleasant or angry
voice
Does not cry when scolded.
Expressive language – vocalizes socially : coos and gurgles when spoken to
very “talkative” to self, people or toys.
Talking or crying follow each other quickly
Can vocalize consonants: b, g, h, n, p.
▪At 5 month – receptive language – responds when own name is spoken
Expressive language – squeals when happy or excited
Sounds like vowels appear with consonants : “goo”
Begin to mimic sounds.

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10.21 Contd…

▪At 6 month – receptive language – recognizes familiar words.

Expressive language – actively vocalizes pleasure with cooing or crowing
Shows enjoyment in hearing own vocalization
“talks” to image in mirror
▪At 7 month – receptive language – responds with gestures to words such as
“come.”
Expressive language – vocalizes “m-m-m” when crying; or vocalizes “da”,
“ma”, “ba”.
Imitates simple noises and sounds.
Some jargon { own language }

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10.22 Contd…

▪At 8 month – receptive language – stop activity when own name is spoken
Beginning to understand meaning of “no”
Expressive language – shouts for attention limitation sound sequences
Can vocalizes consonants d, t, and w
▪At 9 month – receptive language – stops activity in response to “no”
Beginning to respond to simple commands given verbally
Expressive language – association of words with persons or objects. Says
“ma-ma”, “da-da” as name of persons.

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10.23 Contd…

▪At 10 month – receptive language – understand simple command : gives a toy

on a request that is accompanied by gestures.
Expressive language – may speak 1 word besides “ma-ma”, “da-da”, such as
“no”, “hi”.
Understands meaning of “bye – Bye” and waves
Imitates sounds of animals.
▪At 11 month – receptive language – responds to simple question : for
example, “where is the ball !” by pointing and looking toward object.
Expressive language – imitate specific speech sounds of others.
Jargon well established.

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10.24 Contd…

▪At 12 month
Receptive language – responds with gestures or actions to more complex
verbal requests. Such as “please give it to me”.
Expressive language – may speak 2 or more words besides “ma-ma” and
“da-da”.
Understands meaning of many more words than can be spoken.
Imitate sounds of animals make.
Continues using jargon indicates “no” by shaking head.

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 11. STAGE OF GROWTH AND
DEVELOPMENT OF TODDLER

TODDLER STAGE IS between 1 – 3 years of age. During this period, growth

slows considerably.
Physical growth
Weight – the toddler weight gain is 1.8 – 2.7 kg/year
Formula to calculate normal weight 0f children over 1 year of age
Age in years x 2 + 8 = …… kg
ex – the weight of a child ageing 4 years
= 4 x 2 + 8 = 16 kg

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11.1 Contd…

Height – during 1 – 2 years, the child’s height increases by 1 cm/month.

the toddler’s height increases about 10 – 12.5 cm/year.
Formula to calculate normal height
Age in years x 5 + 80 = …. Cm
ex – the length of 2 years old child
= 2 x 5 + 80 = 90 cm
Head circumference = the head increases 10 cm only from the age of 1 year to
adult age.
Chest circumference = during toddler years, chest circumference to increase in
size and exceeds head circumference

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11.2 Contd…

•Teething - By 2 years of age, the toddler has 16 temporary teeth.

•By the age of 30 months (2.5 years), the toddler has 20 teeth
Physiological growth :
Pulse : 80–130 beats/min (average 110/min).
Respiration : 20–30C/min.
Bowel and bladder control :
Daytime control of bladder and bowel control by 24–30 months.

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11.3 Contd…

Gross motor
At 15 months – standing position without help
Walks without support at 13 months
Creep-up stairs
Fine motor
Builds a tower of 2-3 cubes.
Pokes finger in whole
Turns pages, holds cup
Removes socks

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11.4 Contd…
Gross motor – at 18 months
Walk upstairs with one hand held.
Jumping with both feet
Pulls and pushes toys
Throws ball overhead without falling
Fine motor – build tower of 3-4 cubes.
Turns 2-3 pages at a time
Self care feeding skills ; hold cup with both hands , can eat with spoon , may
play with food.
Dressing skills ; removes simple garments and unzip garments
Toileting and grooming skills ; may complain when wet or soiled or give
indication toned to toilet

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11.5 Contd…
Gross motor – at 24 months
more grown up, steady gait.
Can walks with heals-toe
Walks up and down stairs, both feet on one step at a time, holding on railing
or on wall
Fine motor - Picks up objects from floor without losing balance.
Can build a tower of 6-7 cubes.
Imitate circular and vertical line
Turns pages of a book one at a time
Drink well from a small glass held in one hand
Pull on simple garments and remove most of own clothing
Can brush teeth with help

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11.6 Contd…

Motor development – at 30 months

Can stands on one foot
Jumps well in place with both feet off floor
Fine development – builds a tower of 8 cubes
Self feeding
can button and unbutton clothes.
Can throw large ball overhead
Places simple shapes in correct whole.

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11.7 Contd…
AT 3 YEARS
Gross motor – rides tricycle using pedals
Can dress self in most situations
Catches ball with both hands
Goes upstairs using alternate feet but may still come down by placing both
feet on each step
Fine motor – can builds tower of 9-10 cubes
Can help with simple households
Uses blunt scissors with one hand to cut
Can pull pants up and down
Brushes teeth with help

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11.8 Contd…
Sensory development
At 15 months – sound localization indicated by head movement in all planes
binocular vision fully developed
Looks at pictures intently for prolonged periods of time
Can geometric forms and place round object into its appropriate place or hole
At 18 months – can see better, thus have intense interest in pictures
Identifies various shapes
Some depth perception
At 24 months – visual acuity : 20/40
May developed esotropia
At 30 months – visual acuity : 20/ 30
Convergence smooth recalls visual images
At 3 years – visual acuity 20/20
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11.9 Contd…

Psychosocial development
sense of autonomy v/s shame and doubt { 1 – 3 years }
At 15 months – egocentric
hugs and kisses parents
Begins to imitate parents doing housekeeping {dusting, folding clothes}
At 18 months – imitates behavior of parents
Begins to have temper tantrum if things go wrong
Enjoys solitary play
Thumb sucking may peak, especially before and during sleep.

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11.10 Contd..
At 24 months – behave as though other children were physical objects may
huge or push them
Enjoys play with balls, dolls etc.
Would like to make friends but does not know how
At 30 months – independent behaviour increases
Knows own sex
temper tantrum may or may not decrease
Parallel playing
At 3 years – able to share but expresses idea of “mine”
Less dependent on parents, separates easily from mother
Fears the dark, knowns own sex and that of other

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11.11 Contd..

Psychosexual development
Anal stage { 1 – 3 years } : pleasure gain from anal region by passing urine
and motion
Spiritual development
Intuitive – projective faith : child forms long lasting images & feeling
Moral development
Preconventional morality stage 0 {0-2 years} : the good is what I like and
want !
Preconventional morality stage 1 {2-3 years} : if punished for doing it is
wrong , if not punished it must be right

75
11.12 Contd..

Intellectual development
Sensorimotor stage – substage v – tertiary circular reaction {12-18 months} :
experiences only the present
Substage vi – invention o new means mental combinations {18-24 months} :
begins to “think”. Beginning traces of memory
Concept of object permanence fully developed.
Experiments actively to achieve goals.
Pre-operational stage {2-4 years} : preoccupation with symbols in language,
dreams and fantasy.
Memory increases. Very early understanding of past, present and future

76
11.13 Contd…
Language and speech development
At 15 month - Receptive language – recognizes names of various parts of
body
Responds to familiar, simple commands
Expressive language – says 2 – 6 words
Names of familiar picture or objects such as “ball”
Communicate “no” even when following request
At 18 months – receptive language – identifies one or more parts of body
when named
Expressive language – speaks 10 real words {average}
One word to communicate sentence length
About 25% of vocalizations are intelligible.

77
11.14 Contd…

At 24 months – receptive language – obeys 1 directional preposition { “on” or

“under”} & 2 commands { pick up your coat and put it on the chair}.
Enjoys stories with pictures
Identifies 4 body parts when named
Expressive language – knows about 300 words
Uses pronouns “I”, “me” or mine . Tries out new power of speech asks
“what’s/who’s that”
Verbalizes need for drink, food or toileting
About 66% of vocalization are intelligible

78
11.15 Contd…

About 30 months – receptive language – identifies 5 body parts when named

Expressive language – gives full { first and last } name if asked
Uses 4-5 word sentences
About 75% of vocalizations are intelligible
About 3 years – receptive language – can obey 2 prepositional commands {ex
– on under}
Expressive language – gives full name and sex
Has vocabulary of 800-1000 words
about 90% of vocalization are intelligible

79
 PRACTICE QUESTION -3
Q By the age of 2 years, the child has about ……….. Temporary
teeth.
a. 18
b. 12
c. 10
d. 16

Rationale: By the age of 2 years, the child has about 16 temporary teeth

Reference slide no. 66

80
 12. STAGE OF GROWTH AND
DEVELOPMENT OF PRE-SCHOOLER
It is the stage where child is 3 to 6 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.
Physiological growth
•Pulse = 80–120 beat/min. (average 100/min).
•Respiration = 20-30 b/min.
•Blood Pressure = 100/67 + 24/25.

81
12.1 Contd…
Motor development –
4 year old
Gross motor - balance on one foot 3-5 seconds
Pedals a tricycle quickly; turns sharp corners.
Climbs ladders, trees, playground equipment’s
Fine motor – cuts around pictures with scissors
Draw a square
Manage spoon and Eats with fork held in fingers
Puts on shoes { not laces } without help
Knows front or back of clothes
Washes and dries hand without supervision

82
12.2 Contd…

At 5 year
Gross motor – imitates dance steps if taught
Catches a ball smoothly with hands
Roller skates
Fine motor – copies latter’s; may be able to write own name
May be able to lace shoes.
Draw a triangle
Flushes toilet each use
Bathes self
Combs hair with help

83
12.3 Contd…

At 6 year
Gross motor – rides bicycle without training wheels.
Runs, jumps, climbs and hopes well
Fine motor – has improved hand and eye coordination
Draw a person with 6 parts
Can brush teeth and hair comb
Can dresses self
sensory development
Vision acuity : 20/30
Color vision fully intact

84
12.4 Contd…
Psychosocial development
Sense of initiative v/s guilt
At 4 year – very independent
Tends to be selfish and impatient
Physically and verbally aggressive
Demonstrates strong attachment for parent of sex
Jealousy of siblings may be evident
At 5 year – independent and trustworthy
Looks for parenteral encouragement and support
Very industrious
Engages in cooperative play

85
12.5 Contd…

At 6 year – bossy
Insist on being first in everything
Jealous of siblings
Long active and group play
Psychosexual development
Phallic stage {3-6 year} - attraction with opposite sex parents.
Spiritual development
Intuitive-projective faith {early childhood} – imagination, perception and
feelings are the mechanism by which the child explore and learn about the
world at large.

86
12.6 Contd…
Psychosocial development
Pre operational thought – substage – ii : {4-7 years} ; classifies object
according to one characteristic
Highly imaginative
Obeys commands because of parents fear and not because of understanding
between right and wrong
Classifies objects according to relationship that are similar
Aware of cultural differences
Very curious
Moral development
Morality stage – ii {4-7 year} : you do it for me ; I will do it for you

87
12.7 Contd…

at 4 year
Receptive language – understand directives {on, under, in back, and in front}
Expressive language – using 4-6 words sentence
Knows nursery rhymes and simple songs
Have a vocabulary of 1500 words
At 5 year
Receptive language – carries out instruction with three suggested tasks. Ex –
wash, dry, and sit down

88
12.8 Contd…

Expressive language – describes pictures with much comments and

description
Names primary colors and ask meaning of words
Has a vocabulary of 2100 words
At 6 year
Receptive language – counts numbers easily
recognizes shapes
Expressive language – uses all forms of sentences
Enjoy telling jokes

89
 13. STAGE OF GROWTH AND
DEVELOPMENT OF NORMAL
SCHOOL-AGE CHILD
•school-age period is between the age of 6 to 12 years. The child's growth and
development is characterized by gradual growth.
•Physical growth
•Weight - School–age child gains about 3.8kg/year.
•Boys tend to gain slightly more weight through 12 years.
•Weight Formula for 7 - 12 years
= (age in year x 7 )– 5
2
•Height - The child gains about 5cm/year.
•Body proportion during this period - Both boys and girls are long - legged.
90
13.1 Contd…

Dentition
•Permanent teeth erupt during school-age period, starting from 6 years, usually
in the same order in which primary teeth are lost.
•The child acquires permanent molars, medial and lateral incisors.

Physiological growth
•Pulse: 90+15 beats/min (75 to 105).
•Respiration: 21+3 breath/min (18–24).
•Blood Pressure: 100/60+16/10.

91
13.2 Contd…

Motor Development
•At 6 – 8 years
•Gross motor – rides bicycle without training wheels
•Runs, jumps, climbs and hopes. Constantly in motion
•Clumsy and awkward movement
•Fine motor – has improved hand – eye coordination
•Prints word ; learns cursive writing
•at 6 years, likes to eat with fingers, stuffs food into mouth, talkative while
eating
•At 7 years, improved table manners, less talking
•Needs to be remined to wash hands
•Can brush and comb hair

92
13.3 Contd…

•At 8–10 years

•Gross motor – performs tricks on bicycles; races
•Throws balls skillfully, overhead
•begins to participate in organized sports like basketball, soccer
•Fine motor – Uses both hands independently.
•Handles eating utensils (spoon, fork, knife) skillfully.
•dresses self completely; enjoys selecting own clothes
•Unaware of dirty clothes
•Needs to be reminded to brush teeth

93
13.4 Contd…

•At 10–12 years

•Gross motor :
• Enjoy all physical activities.
•Balances on one legs with eyes closed
•Catches tennis ball with one hand
•Fine motor :
• coordination continues to improve
•Dressing and grooming skill develop
•Bathes frequently prefers shower
•Movements are more graceful

94
13.5 Contd…

•Sensory development - visual acuity : 20/20 {adult value}

•Psychosocial development
•At 6 – 8 years : sense of industry v/s inferiority {6 – 12 years}
•has an “know it all” attitude craves attention
•Insists on being first in everything
•Return of temper tantrums – may use verbal physical attack
•Wants other children to play with
•Jealous of siblings
•At 8 – 10 years : curious about everything
•Concerned about relationships with others

95
13.6 Contd…

•Becoming peer – oriented

•Begins hero worship
•Considers peer opinions more important than parents
•Relationships with siblings improved
•Have reasonable fears
•Aware of appropriate sexual role
•At 10 – 12 years : has a greater self control
•Respects parents and their roles
•Able to control anger
•Still fears the dark

96
13.7 Contd…
•Psychosexual development
•Latency stage {6 – 12} : children engage with their same age and sex peer
groups.
•Spiritual development
•Mythic – literal faith : child stories or beliefs become the gateway to learning
about life.
•Intellectual development
•At 6 – 8 years : Pre-operational thought - substage – ii {4-7 years} : Attention
span increased
•Can describe objects in picture, knows their use
•Can see differences more than similarties

97
13.8 Contd…

•Can tell time and knows date, month also

•Follow rules to avoid punishment
•At 8 – 10 years : learns to understand and use abstract symbols and carries out
mental operations
•Shows interest in causal relationships
•Ashamed failures
•Interested in schoolwork
•Memory spans increasing
•Time usually punctual
•Rebels against authority may complain or wthdraw

98
13.9 Contd…

•At 10 – 12 years
•Develops abstract and deductive reasoning
•Uses problem – solving method
•Interested in the “why” and “how”
•Collects facts for future use
•Preoccupied with right and wrong
•Moral development
•Conventional morality stage 3 {7-9 years} : am I good person
•Stage 4 {10-12 years} : we need law and order

99
13.10 Contd…

•Language development
•At 6 – 8 years
•Receptive language – follow series of 3 commands. Response is dependent of
mood
•Responds to praise and recognition
•Expressive language – can repeats sentences of 10 to 12 words
•Uses all forms of sentence structure
•Develops a sense of humor; enjoys tells jokes

100
13.11 Contd…
•At 8 – 10 years
•Receptive language – follows suggestion better than commands
•Expressive language – is gregarious
•Begins to use shorter and more compact sentences
•At 10 – 12 years
•Receptive language – follows suggestions better than requests ; is obedient
•Expressive language – oral vocabulary of 7200 words, reading vocabulary of
50,000 words
•Uses parts of speech correctly
•Able to give precise dictionary definitions of words
•Uses numbers beyond 100 with meaning or Enjoy riddles

101
 14. STAGE OF GROWTH AND
DEVELOPMENT OF ADOLESCENT

•Adolescence is a transition period from childhood to adulthood. Its is based on

childhood experience 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:
•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.

102
14.1 Contd…

Height: By the age of 13, the adolescent triples his birth length.
•Males gains 10 to 30 cm in height.
•Females gains less height than males as they gain 5 to 20 cm.
•Growth in height ceases at 16 or 17 years in females and 18 to 20 in males
▪Physiological growth:
•Pulse : Reaches adult value 60–80 beats/min.
•Respiration : 16–20 breath/minute.
•NB : The sebaceous glands of face, neck and chest become more active .
When their secretion accumulates under the skin in face, acne will appear.

103
14.2 Contd…

•B.P. - 120/80 + 20/10 mm hg

•Dentition - It acquires cuspids, first and second premolars {12 – 13 years}
•Eruption of third molars { wisdom teeth }
•Motor development
•at 12 – 13 years
•gross motor – enjoy all physical activities
•Fine motor – coordination continues to improve
•Enjoys wearing current style of clothes
•Motor functions comparable to adults.

104
14.3 Contd…

•At 14 – 16 years / at 17 – 21 years

•Motor development - motor function comparable to that of adult
•Eye – hand coordination at adult level processes manual dexterity
•Sensory development
•Visual acuity : 20/20 {adult value}
•Psychosocial development
•At 12 – 13 years : sense of identity {6-12 years} – has intense loyalty to peer
group

105
14.4 Contd…

•Has short burst of anger {10 years}. Able to control anger {12 years}
•Hero worships of adults continues
•Knows about sexual intercourse starts masturbation
•At 14 – 16 years : sense of identity {13- 18 years} – “who am I” negative
counter : self diffusion
•Egocentric diminishes
•Separation from parents continues
•Heterosexual relationship and interest’s common
•Verbally attacks parent’s beliefs and values

106
14.5 Contd…

•At 17 – 21 years
•Sense of intimacy
•Establishes interdependent relationship with parents
•Have fewer but close friends
•Heterosexual relationship are the rule
•Psychosexual development
•Latency stage {6 – 12 years} – children from close relationships with others
from same age & sex
•Genital sex {14 – 16 / 17 – 21 years} – secondary sexual characteristics
appears from both sexes and enter to heterosexual relations

107
14.6 Contd…

•Intellectual development
•At 12 – 13 years : formal operational thought ; generates operational
thoughts
•Uses the scientific method for problem solving
•At 14 – 16 years : express concern for education v/s vocational choice
•At 17 – 21 years : purses further education or enters the job market
•Spiritual development
•Synthetic-conventional faith {adolescent stage} ; thoughts begins to
extends beyond the family
•Cognitive abilities will markedly develop

108
14.7 Contd…
•Moral development
•At 12 – 13 years : post conventional stage 5 {13 + years} – “the individuals
conform to maintains other’s respect
•At 14 – 16 years : fixed rules in moral decisions
•Obligation to do no harm and to do duty
•At 17 – 21 years : social contracts understood and formulated
•Correct actions depend on standards and individual rights
•“universal ethical principle”
•Language development
•Uses slang within and outside peer group
•Uses distinct meanings for words

109
14.8 Contd…
▪Appearance of secondary sex characteristics

▪Secondary sex characteristics in girls:

•8 – 9 years : sex hormones begin to release
•9 – 10 years
•hips start rounding out
•Breasts nipples start growing
•10 – 11 years
• Development of the breasts.
•Hair appear on labia
•Growth spurt begins

110
14.9 Contd…
•11 – 12 years : internal and external genitalia grows
•Pubic hair become darker and coarser
•12 – 13 years
•Underarm hair growth appears
•Onset of menstruation
•13 – 14 years
•At times underpants are wet with clear mucus especially during ovulation and
sexual arousal
•14 – 15 years
•Growth spurt complete
•Pregnancy is possible

111
14.10 Contd…
▪ Secondary sex characteristics in boys:
•9 – 10 years : sex hormones begin to release
•10 – 11 years : Testes become larger
•Scrotal skin becomes dark in color in texture
•11 – 12 years : Prostate begins to function
•Penis begins to lengthen
•12 – 13 years : pubic hair growth
•May experience wet dreams, spontaneous erection, ejaculations
•Growth spurt begins
•13 – 14 years : rapid growth of penis occurring about 1 year after testes begins
to grow

112
14.11 Contd…
•Testes color deepens
•two – third of boys may experience slight growth of breast tissue which
generally subsides within 1 year
•14 – 15 years : underarm hair appears
•Moustache begins as fine hair starting at outside lip edges about 2 years after
pubic hair appears
•Voice change begins
•15 – 16 years : sperm matures and can cause pregnancy
•Majority of growth spurt is complete
•16 – 17 years : chest and shoulders fill out
•Facial and body hair becomes heavier
•Acne occurs

113
114