Growth & development
一,Definition
? Growth,volume increasing of body & organs
? Development,tissues & organs functional maturation,
that is the concept of ongoing change and maturation
– Child development encompasses all aspects of pediatrics,
– It applies to somatic,psychological,and cognitive growth and to
behavior
二,Growth and development patterns
? Continuity and phase process
– Continuous process
– Varies in different phase (two peak),at infancy; at puberty
? Imbalance
– Brain growth,rapid in the first 6 years of life
– Lymphoid tissue,increases rapidly before puberty and then declines
– The reproductive organs,remains slow until puberty
? General developmental pattern
– From top to bottom
– From near to far
– From crude to fine
– From unadvanced to advanced
– From simple to complex
? Individual variations
Fig,Postnatal growth curves of four major organ systems,All
values are calculated in terms of size attained at 20 years.
Body ratio change
Development rules:
From top to bottom
From near to far
nearby to
peripheral
三,Determinants of growth and development
? Heredity,the most important factors
? Environmental factors
can be improved potentially
– Nutrition,important factors at childhood,the smaller the
children’s age,the more important
– Diseases,factor that can not be neglected
– Seasonality,growth rate varied during the four seasons
? Hormone,a complex system
四,Physical growth
? Index in common use
Weight
Length/Height
Sitting height
Head circumference
Chest circumference
Upper arm circumference
(一） Weight,basic index
?Defined as the summed weight of body’s parts,including
skeleton,muscle,organs,bowel,fat,and water etc.
? Measurement,The child was weighed undressed on a
calibrated balance scale to the nearest 0.01 kg.
? Typical patterns of WT gain
3 -12 mo,[age (mo) + 9]/2 (kg)
1 - 6 yrs,age (yr)× 2 + 8 (kg)
7 -12 yrs,[age(yr)× 7 -5]/2
（二） Height,genetic index
? Defined as the vertical length from calvaria to vola
? Measurement:
< 3 years,Supine length is measured using a fixed headboard,
> 3 years,Erect height was measured in millimeters using
a stadiometer fixed to the wall.
? Typical patterns of HT gain
12 mo,75 cm
2 – 12 (yrs),age (yrs) ?7 ＋ 77
(四） Head circumference and fontanel
? Related to intracranial volume
? Measured with a flexible tape marked in millimeters as the
maximum circumference between the supra-orbital ridge
and occiput,
birth,32-34cm; 6 mo,42-44cm; 1 yr,46cm;
2 yrs,48cm 6 yrs,49-50cm; 15 yrs,54-58cm;
? Anterior fontanel,about 1.5-2cm at birth,gradually
ossification after 6 months,and close at 12 to 18 month.
? Posterior fontanel,closed at birth in about ? babies,for
most babies,it close postnatal 6-8 weeks.
Metopic
suture
Coronal
suture
parietal
boneSagittal
suture
Lambdoid
suture
Frontal
bone
Anterior
Fontanelle
Posterior
Fontanelle
Occipital
bone
Fontanelles and suture
五,Skeletal and Dental development
? carpal ossification centers,There are 2-3 carpal
ossification centers at 1 years; 4 carpal ossification centers
at 3 years,7 at 6 years,9 at 8 years,and 10 at 10 years,The
numbers of carpal ossification centers is defined as years
plus 1 before 8 years of age,
? Bone age,defined as the normal age of ossification center
appeared.
? Primary teeth,total 20,teeth erupt from 6 months,
normal range at 4-10 months,finished at 2-2.5 years,
number of primary teeth=months-(4 or 6)
? permanent teeth,total 32,teeth erupt from 6 yrs of age.
Low
er
Cen
tral
inciso
r
9 6 8 3 2 2 3 8 6 9
10 5 7 4 1 1 4 7 5 10
Normal sequence of eruption of primary teeth
Upp
er
Cen
tral
inciso
r
Low
er
Cen
tral
inciso
r
Upp
er
Cen
tral
inciso
r
Low
er
Cus
pid
in
cis
or
Low
er
cus
pid i
ncisor
Low
er
lat
eral
inciso
r
Low
er
lat
eral
inciso
r
Low
er
Fir
st mo
lar
Low
er
Sec
ond
mo
lar
Low
er
Fir
st mo
lar
Upp
er
Sec
ond
mo
lar
Low
er
Sec
ond m
olar
Upp
er
Sec
ond mo
lar
Upp
er
Fir
st mo
lar
Upp
er
Fir
st
mol
ar
Upp
er
Cus
pid
in
cis
or
Upp
er
Cus
pid i
ncisor
Upp
er
lat
eral
inciso
r
Upp
er
lat
eral
inciso
r
Eruption ages (months) for primary teeth
5 - 9 MONTHS
Two lower incisors
8 - 12 MONTHS
Four upper incisors
9 - 14 MONTHS
Two lower
incisors
12 - 18 MONTHS
First molars
18 - 24 MONTHS
Canines (eye teeth) 24 - 30 MONTHSSecond molars
Teething follows a predictable sequence,but
the timing is unpredictable.
The evaluation index of children physical growth
index/age neonatal 6months 1years 2years
Weight (kg) 3 6# 9 12
Height (cm) 50 65 75 85
Head
circumference (cm) 34 42 46 48
Chest
circumference (cm) 32 CC=HC CC>HC
Teeth 0 To start eruption Months-6 20*
#4-5 months *may last to 30 months
Estimate methods
Referenced standard:
? Used to estimate children’s growth and developmental
status,and young children’s nutritional status,
? Need to establish the different age’s standards
? Referenced standard is made by using health population’s
cross section investigation information in a area or a country
methods
(1) Deviation method
Mean,standard difference for age and gender
Normal school
Mean+1SD=68% range
Mean+2SD=95% range (normal range)
Mean+3SD=99.7% range
(2) Percentile
P50 is similar to mean
P3 is similar to mean - 2SD
P97 is similar to mean + 2SD
P3- P97 include 94% population (similar normal range)
Might be applied for data of normal distribution &
nonnormal distribution（ physical growth data）
(3) Z score
The Z score is defined as the difference between a
subject’s measurement and the mean measurement for
the normal reference standard divided by the standard
deviation for the normal reference standard
? Z score are calculated using the below equation:
actual measurement – reference standard mean (WHO)
Z score＝－－－－－－－－－－－－－－－－－－－－
standard deviation for reference standard (WHO)
六,The development of brain
Average brain weights at different times of development,
AGE BRAIN WEIGHT (grams)
20 weeks of gestation 100
Birth 400
18 months old 800
3 years old 1100
Adult 1300-1400
1 mo hearing 3 mo Holds head erectand lifts head
4 mo Lifts head
Support by breast 6 mo tries to sit
7 mo Rolls from back
to stomach
8 mo creep
5 mo Grasp
2 mo watch
Activities development charts
9 mo Stands
with help
10 mo Walks
with help
12 mo Stands
alone
1 mo Crying 3 mo Smiles when spoken to
4 mo Babbling
sounds
6 mo Babbling
sounds,ma ma”
7 mo Imitates
sounds
8 mo Imitates
sounds 9 mo understanding
12 mo Be able to call mama
dada or other people
5 mo Babbling
sounds
2 mo Silence
Language development sequence
neurologic and psychologic development
age Activities to be observed Activities related by parent
1-2
mo
Holds head erect and lifts head
Turns from side to back
Regards faces and follows objects through visual field.
Drops toys
Becomes alert in response to voice.
Recognizes parent
Engages in vocalizations
Smiles spontaneously
3-5
mo
Grasps cube—first ulnar then later thumb opposition
Reaches for and brings objects to month
Makes ―raspberry‖ sound.
Sits with support.
Laughs.
Anticipates food on sight.
Turns from back to side.
6-8
mo
Sits alone for a short period.
Reaches with one hand.
First scoops up a pellet then grasps it using thumb opposition.
Imitates ―bye-bye‖.
Passes object from hand to hand in midline.
Babbles.
Rolls from back to stomach.
Is inhibited by the word no.
neurologic and psychologic development
age Activities to be observed,Activities related by
parent:
9-11 mo Stands alone.Imitates pat-a-cack and peek-a-boo.
Uses thumb and index finger to pick up pellet.
Walks by supporting self on furniture.
Follows one – step verbal commands,
eg,―Come here,‖ ―Give it to me.‖
1 y Walks independently.Says ―mama‖ and ―dada‖ with meaning.
Can use a neat pincer grasp to pick up a pellet.
Releases cube into cup after demonstration.
Gives toys on request
Tries to build a tower of a 2 cubes.
Points to desired objects.
Says 1 or 2 other words,
一,Definition
? Growth,volume increasing of body & organs
? Development,tissues & organs functional maturation,
that is the concept of ongoing change and maturation
– Child development encompasses all aspects of pediatrics,
– It applies to somatic,psychological,and cognitive growth and to
behavior
二,Growth and development patterns
? Continuity and phase process
– Continuous process
– Varies in different phase (two peak),at infancy; at puberty
? Imbalance
– Brain growth,rapid in the first 6 years of life
– Lymphoid tissue,increases rapidly before puberty and then declines
– The reproductive organs,remains slow until puberty
? General developmental pattern
– From top to bottom
– From near to far
– From crude to fine
– From unadvanced to advanced
– From simple to complex
? Individual variations
Fig,Postnatal growth curves of four major organ systems,All
values are calculated in terms of size attained at 20 years.
Body ratio change
Development rules:
From top to bottom
From near to far
nearby to
peripheral
三,Determinants of growth and development
? Heredity,the most important factors
? Environmental factors
can be improved potentially
– Nutrition,important factors at childhood,the smaller the
children’s age,the more important
– Diseases,factor that can not be neglected
– Seasonality,growth rate varied during the four seasons
? Hormone,a complex system
四,Physical growth
? Index in common use
Weight
Length/Height
Sitting height
Head circumference
Chest circumference
Upper arm circumference
(一） Weight,basic index
?Defined as the summed weight of body’s parts,including
skeleton,muscle,organs,bowel,fat,and water etc.
? Measurement,The child was weighed undressed on a
calibrated balance scale to the nearest 0.01 kg.
? Typical patterns of WT gain
3 -12 mo,[age (mo) + 9]/2 (kg)
1 - 6 yrs,age (yr)× 2 + 8 (kg)
7 -12 yrs,[age(yr)× 7 -5]/2
（二） Height,genetic index
? Defined as the vertical length from calvaria to vola
? Measurement:
< 3 years,Supine length is measured using a fixed headboard,
> 3 years,Erect height was measured in millimeters using
a stadiometer fixed to the wall.
? Typical patterns of HT gain
12 mo,75 cm
2 – 12 (yrs),age (yrs) ?7 ＋ 77
(四） Head circumference and fontanel
? Related to intracranial volume
? Measured with a flexible tape marked in millimeters as the
maximum circumference between the supra-orbital ridge
and occiput,
birth,32-34cm; 6 mo,42-44cm; 1 yr,46cm;
2 yrs,48cm 6 yrs,49-50cm; 15 yrs,54-58cm;
? Anterior fontanel,about 1.5-2cm at birth,gradually
ossification after 6 months,and close at 12 to 18 month.
? Posterior fontanel,closed at birth in about ? babies,for
most babies,it close postnatal 6-8 weeks.
Metopic
suture
Coronal
suture
parietal
boneSagittal
suture
Lambdoid
suture
Frontal
bone
Anterior
Fontanelle
Posterior
Fontanelle
Occipital
bone
Fontanelles and suture
五,Skeletal and Dental development
? carpal ossification centers,There are 2-3 carpal
ossification centers at 1 years; 4 carpal ossification centers
at 3 years,7 at 6 years,9 at 8 years,and 10 at 10 years,The
numbers of carpal ossification centers is defined as years
plus 1 before 8 years of age,
? Bone age,defined as the normal age of ossification center
appeared.
? Primary teeth,total 20,teeth erupt from 6 months,
normal range at 4-10 months,finished at 2-2.5 years,
number of primary teeth=months-(4 or 6)
? permanent teeth,total 32,teeth erupt from 6 yrs of age.
Low
er
Cen
tral
inciso
r
9 6 8 3 2 2 3 8 6 9
10 5 7 4 1 1 4 7 5 10
Normal sequence of eruption of primary teeth
Upp
er
Cen
tral
inciso
r
Low
er
Cen
tral
inciso
r
Upp
er
Cen
tral
inciso
r
Low
er
Cus
pid
in
cis
or
Low
er
cus
pid i
ncisor
Low
er
lat
eral
inciso
r
Low
er
lat
eral
inciso
r
Low
er
Fir
st mo
lar
Low
er
Sec
ond
mo
lar
Low
er
Fir
st mo
lar
Upp
er
Sec
ond
mo
lar
Low
er
Sec
ond m
olar
Upp
er
Sec
ond mo
lar
Upp
er
Fir
st mo
lar
Upp
er
Fir
st
mol
ar
Upp
er
Cus
pid
in
cis
or
Upp
er
Cus
pid i
ncisor
Upp
er
lat
eral
inciso
r
Upp
er
lat
eral
inciso
r
Eruption ages (months) for primary teeth
5 - 9 MONTHS
Two lower incisors
8 - 12 MONTHS
Four upper incisors
9 - 14 MONTHS
Two lower
incisors
12 - 18 MONTHS
First molars
18 - 24 MONTHS
Canines (eye teeth) 24 - 30 MONTHSSecond molars
Teething follows a predictable sequence,but
the timing is unpredictable.
The evaluation index of children physical growth
index/age neonatal 6months 1years 2years
Weight (kg) 3 6# 9 12
Height (cm) 50 65 75 85
Head
circumference (cm) 34 42 46 48
Chest
circumference (cm) 32 CC=HC CC>HC
Teeth 0 To start eruption Months-6 20*
#4-5 months *may last to 30 months
Estimate methods
Referenced standard:
? Used to estimate children’s growth and developmental
status,and young children’s nutritional status,
? Need to establish the different age’s standards
? Referenced standard is made by using health population’s
cross section investigation information in a area or a country
methods
(1) Deviation method
Mean,standard difference for age and gender
Normal school
Mean+1SD=68% range
Mean+2SD=95% range (normal range)
Mean+3SD=99.7% range
(2) Percentile
P50 is similar to mean
P3 is similar to mean - 2SD
P97 is similar to mean + 2SD
P3- P97 include 94% population (similar normal range)
Might be applied for data of normal distribution &
nonnormal distribution（ physical growth data）
(3) Z score
The Z score is defined as the difference between a
subject’s measurement and the mean measurement for
the normal reference standard divided by the standard
deviation for the normal reference standard
? Z score are calculated using the below equation:
actual measurement – reference standard mean (WHO)
Z score＝－－－－－－－－－－－－－－－－－－－－
standard deviation for reference standard (WHO)
六,The development of brain
Average brain weights at different times of development,
AGE BRAIN WEIGHT (grams)
20 weeks of gestation 100
Birth 400
18 months old 800
3 years old 1100
Adult 1300-1400
1 mo hearing 3 mo Holds head erectand lifts head
4 mo Lifts head
Support by breast 6 mo tries to sit
7 mo Rolls from back
to stomach
8 mo creep
5 mo Grasp
2 mo watch
Activities development charts
9 mo Stands
with help
10 mo Walks
with help
12 mo Stands
alone
1 mo Crying 3 mo Smiles when spoken to
4 mo Babbling
sounds
6 mo Babbling
sounds,ma ma”
7 mo Imitates
sounds
8 mo Imitates
sounds 9 mo understanding
12 mo Be able to call mama
dada or other people
5 mo Babbling
sounds
2 mo Silence
Language development sequence
neurologic and psychologic development
age Activities to be observed Activities related by parent
1-2
mo
Holds head erect and lifts head
Turns from side to back
Regards faces and follows objects through visual field.
Drops toys
Becomes alert in response to voice.
Recognizes parent
Engages in vocalizations
Smiles spontaneously
3-5
mo
Grasps cube—first ulnar then later thumb opposition
Reaches for and brings objects to month
Makes ―raspberry‖ sound.
Sits with support.
Laughs.
Anticipates food on sight.
Turns from back to side.
6-8
mo
Sits alone for a short period.
Reaches with one hand.
First scoops up a pellet then grasps it using thumb opposition.
Imitates ―bye-bye‖.
Passes object from hand to hand in midline.
Babbles.
Rolls from back to stomach.
Is inhibited by the word no.
neurologic and psychologic development
age Activities to be observed,Activities related by
parent:
9-11 mo Stands alone.Imitates pat-a-cack and peek-a-boo.
Uses thumb and index finger to pick up pellet.
Walks by supporting self on furniture.
Follows one – step verbal commands,
eg,―Come here,‖ ―Give it to me.‖
1 y Walks independently.Says ―mama‖ and ―dada‖ with meaning.
Can use a neat pincer grasp to pick up a pellet.
Releases cube into cup after demonstration.
Gives toys on request
Tries to build a tower of a 2 cubes.
Points to desired objects.
Says 1 or 2 other words,
