CHILD GROWTH
&DEVELOPMENT
HU Yan
Department of Primary Child Care
Children’s Hospital
1,To master growth patterns of
common used growth parameters.
2,To understand how to assess
growth and development.
3,To know the important regularities
of growth and development.
Aim
?Definition
?Patterns of physical growth
?Other indices of growth
?Regularities of growth and development
?Growth assessment
Growth,
defined as an increase in size of
body,biological growth of an organism
takes place through cell multiplication,
this morphological growth can be
measured clinically.
Development,
is the association process of
differentiation of the organism,in
which growing tissues and organs
take on increased complexity of
function(physiological,motor,
cognitive,affective).
Thus,since both processes are part
of one whole,the combined terms
growth and development form an
unitary concept that indicates the
quatitative and qualitative of
maturational changes of an organism.
Physical growth can be assessed
by various anthropometric
measurements,
? is composed of tissues,
organs,systems and fluid,etc.
? is a common and sensitive
measurement of physical growth,
especially for evaluating present
nutrient state.
Weight
Increment
(kg/y )
Increment
（ kg）Weight (kg)Age
>2y ~Puberty 2kg /y 2
3m 6±
9±12m
12±24m
3At birth
3
3 6
33
1,The first growth spurt occurs in the first
year of life (the increment is about 6kg).
Patterns of Weight Increment
2,Growth is not at the same rate in different
age, The increment of weight during the
first 3 months is equal to that of the
following 9 months.
3, Yearly increments increase slowly until the
onset of puberty.
?About formulae:
3~12months,weight(kg)=(age month+9)/2
These formulae are used only for
calculating dosage of drug and fluid in
clinic,Because the growth is not at the
same rate in different age,especially in
infant; and the growth is affected by many
factors,such as gene,environment and
individual variation.
Attention
?Weight loss:
Loss of 3%~ 9% of birth weight in
the first few days of life is considered
normal and is common for most
newborns,
Length/Stature
--- Stature
--- Length< 3y
≥3y Stand
Supine
Linear growth is a measurement of the
vertical distance from the highest point
on the head to the heel.
Increment
(cm/y )
Increment
（ cm）L/S (cm)Age
>2y~Puberty 5~7cm /y 5~7
3m 61~62±
75±12m
85±24m
50At birth
11~12
12~13 25
1010
1,The first growth spurt occurs in the first
year of life (the increment is about 25cm).
2,Growth is not at the same rate in different
age, The increment of weight during the
first 3 months is equal to that of the
following 9 months.
3, Yearly increments increase slowly until the
onset of puberty.
Patterns of Length Increment
Crown-rump/Sitting height
- Crown-rump
length
- Sitting
height
<3y
Sit
Supine
≥3y
They give a measure of the length of the head and
trunk,It is a measurement of the distance from the
highest point on the head to the base sitting surface,
During the first year of life,spinal increase
is faster than extremities,Later on,the
extremities grow at a faster rate than the
trunk,which is contribute to the body length
and leading to a gradually change in relative
proportions,
The ratio of sitting height/total height
0.50
0.55
0.60
0.65
0.70
0.75
0.80
3m 12m 2y 6y
Boys Girls
Puberty
Defining the
classification of short
stature
Abnormal(Disproportionate) →
A syndrome with short limbs
（ Achondroplasia,hypothyroidism,etc）
Disproportionate
Proportionate
Head Circumference
HC is a
measurement of
perimeter of head,from
eyebrows to occipital
prominence,The
change of the HC is
related with the growth
of brain and skull,
Age HC(cm) Increment(cm)
At birth 34
3m 40 6
12m 46 6
24m 48 2
5y 50 2
15y 53~54 3~4
1,The first growth spurt occurs in the first
year of life (the increment is about 12cm).
2,The increment of HC during the first 3
months is equal to that of the following 9
months.
Patterns of HC Increment
3, Rapid,decelerating growth of HC, (At
birth,the head is ? of the neonate’s body,By
adulthood,it is only 1/8th the size of the body,)
4, The shape of head and circumference
are affected by not only diseases,but
also heredity.
Small HC ——
HC increase too fast——
Cerebral dysplasia,
Microcephaly
Hydrocephalus
Abnormal of HC
Growth on Puberty
Physical developments in height &
weight:
?occur very rapidly in infancy
?continue at a relatively steady
pace throughout childhood
?slow down towards puberty
? At puberty,there is a marked growth
spurt(The second peak of height
velocity,PHV),that is,a very rapid
increase in size and weight.
? Girls usually showing their pubertal
growth spurt around age 9~11.
? For boys the same process begins at
apx,age 11~13,
? According to Tanner (1990),girls finish
pubertal growth by about age 16
whereas boys continue to grow until
approximately 18 years of age.
Sexual Precocity,Secondary sexual
characteristics appear
before puberty.
Girls<8y,Boys<10y
Delayed sexual maturity,Secondary sexual
characteristics do not appear
after puberty
Girls>14y,Boys>16y
Skeleton
development
Dentition
development
Cranium,Fontanel
Cranial suture
Spinal development
Bone development
Cranial development
Closure time of fontanel/suture
Fontanel/suture At birth Time of closure
Anterior
fontanel 1.5-2cm ≦ 18m
Posterior
fontanel 0.5-0.7 1-2m
Cranial
suture Smallest 3-4m
How to measure the size
of anterior fontanel
Small size or
early closure：
Large size or
delayed closure：
Abnormality of anterior fontanel
Microcephaly
Hydrocephalus,
Cretinism
Intracranial
hypertension( Encephalitis,
Meningitis)
Dehydration
Abnormality of anterior fontanel
Bulging fontanel：
Sunken fontanel,
Spinal development
Age Movement Muscles Curvature
3m Lift head Cervical Cervical（ anterior）
6m Sit alone Lumbar Thoracic（ posterior）
12m Walk alone Lower extremities Lumbar（ anterior）
posterior
curvature of
thoracic
vertebra
sit by himself
at 6 months
stand and walk
by one year old
anterior curvature
of lumbar vertebra
posterior
curvature of
sacral vertebra
anterior curvature
of cervical vertebra
hold head up by 3months
Osteite (center of ossification),
which is located near ends of long
bones (epiphyses),with growth
plates,It is very important for
bone’s growth in length.
Bone development
The sequence of appearance of secondary centers
Bone age
Bone age is that the age should be
according to the osteite number for
normal child,The most commonly
used standards are those of Gruelich
and Pyle,which require radiographs
of the left hand and wrist; knee films
are sometimes added for younger
children(usually less than 1 year old),
Abnormality of Bone Age
Hypothyoidism,Hypopituism
Precocity
of BA：
Adrenogenital syndrome,
Precocity
Retardation
of BA：
Dentition
Primary teeth:
?Primary teeth are 20 totally,
?The first eruption is at about 6
months(4~10 months),
?The timing of tooth eruption is more
variable than other developmental
parameters
?Delayed eruption is usually
considered when there are no
teeth by approximately 12 months
of age.
?The last eruption of primary teeth
is at 2~2.5 years of age,
Primary teeth
Permanent teeth
6y,First molar
7～ 8y,primary
teeth are
exfoliated
instead by
permanent teeth
according to the
eruption order.
12y,Second molar
>18y,Third molar
Totally,32
Delayed eruption–
Hypothyroidism,idiopathic
Disorder – Hypothyroidism,Brain dysplasia
Failing to erupt –
Ectodermal dysplasia,Mechanical
blockage
Abnormality of dental enamel –
Ectodermal dysplasia
Abnormality of Dentition
?Growth and development are a
continuous,series of distinct stages
process.
Girls
Boys
?Imbalance development of different
systems and organs.
?Individual variation
Child has rather big variation
individually in growth and
development,even if the identical
twins,owing to some factors such
as heredity,sex,environment and
education etc,
An important part of well-child
care is the assessment of a child's
growth,that is to make sure that
children are growing normally,
Why do growth assessment
?Principles
?Representation of results
?Contents of growth assessment
?Reliable and accurate data
?Single Value and series investigation
?Reference and standard
Principles
Measurement error
40
45
50
55
60
65
70
75
80
85
90
95
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
97
50
3
cm
Length,girls
Choosing reference
R eference,based on a North
American population by NCHS,USA,
is recommended by the WHO as the
international standard of growth.
Choosing reference
Besides,there are many local or
national references,for example,
physical growth indices of 9 cities
in China,
+2SD-2SD
P3
P50
P97
Statistics review
Growth curve
Methods of assessment
?Reference table
?Growth curve
Example1,（ Weight of girls）
P3 P25 P50 P75 P97
1y～ 7.49 8.54 9.18 9.91 11.37
2y～
ny～
-2SD -1SD +1SD +2SD
1y～ 7.18 8.21 9.24 10.27 11.30
2y～
ny～
X
Example2：（ Height of boys）
50
60
70
80
90
100
110
120
130
140
150
160
170
180
190
Boys:height
2 4 6 8 10 12 14 16 18
-2SD
Age ( year )
+2SDP 97
P 3
P 50
?Growth level
?Growth velocity
?Proportion of body
Growth level
Every single measurement can
be plotted on a growth curve
which illustrates the amount of
growth in children within
different age group,
Results：
<P3
P3-P97
>P97
Example,（ Weight of girls）
P3 P25 P50 P75 P97
1y～ 7.49 8.54 9.18 9.91 11.37 (kg)
-2SD -1SD +1SD +2SD
1y～ 7.18 8.21 9.24 10.27 11.30 (kg)
The weight of a one year old girl is 8.2 kg.
Growth level：
X
X
W/A P3-P25
W/A -（ 1SD～ 2SD）
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
97
50
3
kg
Weight,Girls
eg,An infant at the 3rd
percentile of weight
for age
?Failing to grow
?Growing normally
?Recovering form growth failure
Attention 1
For premature infants:
we should minimize the effect of
gestation by subtracting the weeks
of prematurity (40 weeks is
considered as full term)from the
postnatal age,
Attention 2
Height:≤40m
Weight,≤ 24m
Head circumference,≤ 18m
Time for correction
Example:
A girl,20m old.Weight 8.8kg,Length 79cm，
HC 47.6cm.
Gestational age:32Weeks.
Correcting:18m
W,P3-P10
L,P20-P30
Assessment:20m
W,<P3
L,P10-P20
HC,-（ 1SD-2SD）X
Growth velocity can show the
process of growth,Growth velocity
is measured in terms of how much
a child grows within a specified
period of time,
Growth velocity
Serial height
50
60
70
80
90
100
110
120
130
140
150
160
170
180
190 Boys:height
2 4 6 8 10 12 14 16 18
-2SD
Age ( year )
+2SDP 97
P 3
P 50
Normal
Result representation
Normal
Descending
Accelerated
No gains
Slowed
The birth weight of a girl is
2.3Kg.When she is 3 months old,the
weight is 5.4Kg （ Growth level,< P3 ）
Growth velocity：
The increment of weight,3.1kg≈
Reference:3.08Kg/0-3m
Normal
Example
proportion of body
Weight to stature
Trunk-leg ratio
Weight for
length,W/L
Body mass
index,BMI
<P3
P3-P97
>P97
W/L,It indicates the range of
weight for definite length,
The weight of a 2 years old
boy is 14kg,the length is 76cm.
Reference table,W/L—— >P97
Example
BMI=W(kg)/H2(m)
Example,if an 8 year old boy
weighs 26.8 kg (50-75th percentile
for age) and is 130.4 cm tall,his
BMI would be calculated as follows,
26.8/(1.304)(1.304) = 15.8,
Trunk-leg ratio
It is the most common index of
shape and is a measure of the relative
length of the trunks and legs,Usually,
the ratio of sitting height/total
height(SH/TH) can reflect trunk-leg
ratio.
Result representation(Claculating)
Ratio of SH/TH≤Reference Normal
（ Proportionate）
Ratio of SH/TH ＞ Reference Abnormal
（ Disproportinate）
A 2 years old boy,his length is 65cm，
crown-rump length is 42cm。
crown-rump length/ length（ 42÷ 65= 0.65）
0.65>0.59（ Reference） Abnormal
Hypothyroidism
Example
Review
?Patterns of physical growth;
?Skeleton and dental development ;
?4 regularities of growth;
?3 indices of growth assessment.
&DEVELOPMENT
HU Yan
Department of Primary Child Care
Children’s Hospital
1,To master growth patterns of
common used growth parameters.
2,To understand how to assess
growth and development.
3,To know the important regularities
of growth and development.
Aim
?Definition
?Patterns of physical growth
?Other indices of growth
?Regularities of growth and development
?Growth assessment
Growth,
defined as an increase in size of
body,biological growth of an organism
takes place through cell multiplication,
this morphological growth can be
measured clinically.
Development,
is the association process of
differentiation of the organism,in
which growing tissues and organs
take on increased complexity of
function(physiological,motor,
cognitive,affective).
Thus,since both processes are part
of one whole,the combined terms
growth and development form an
unitary concept that indicates the
quatitative and qualitative of
maturational changes of an organism.
Physical growth can be assessed
by various anthropometric
measurements,
? is composed of tissues,
organs,systems and fluid,etc.
? is a common and sensitive
measurement of physical growth,
especially for evaluating present
nutrient state.
Weight
Increment
(kg/y )
Increment
（ kg）Weight (kg)Age
>2y ~Puberty 2kg /y 2
3m 6±
9±12m
12±24m
3At birth
3
3 6
33
1,The first growth spurt occurs in the first
year of life (the increment is about 6kg).
Patterns of Weight Increment
2,Growth is not at the same rate in different
age, The increment of weight during the
first 3 months is equal to that of the
following 9 months.
3, Yearly increments increase slowly until the
onset of puberty.
?About formulae:
3~12months,weight(kg)=(age month+9)/2
These formulae are used only for
calculating dosage of drug and fluid in
clinic,Because the growth is not at the
same rate in different age,especially in
infant; and the growth is affected by many
factors,such as gene,environment and
individual variation.
Attention
?Weight loss:
Loss of 3%~ 9% of birth weight in
the first few days of life is considered
normal and is common for most
newborns,
Length/Stature
--- Stature
--- Length< 3y
≥3y Stand
Supine
Linear growth is a measurement of the
vertical distance from the highest point
on the head to the heel.
Increment
(cm/y )
Increment
（ cm）L/S (cm)Age
>2y~Puberty 5~7cm /y 5~7
3m 61~62±
75±12m
85±24m
50At birth
11~12
12~13 25
1010
1,The first growth spurt occurs in the first
year of life (the increment is about 25cm).
2,Growth is not at the same rate in different
age, The increment of weight during the
first 3 months is equal to that of the
following 9 months.
3, Yearly increments increase slowly until the
onset of puberty.
Patterns of Length Increment
Crown-rump/Sitting height
- Crown-rump
length
- Sitting
height
<3y
Sit
Supine
≥3y
They give a measure of the length of the head and
trunk,It is a measurement of the distance from the
highest point on the head to the base sitting surface,
During the first year of life,spinal increase
is faster than extremities,Later on,the
extremities grow at a faster rate than the
trunk,which is contribute to the body length
and leading to a gradually change in relative
proportions,
The ratio of sitting height/total height
0.50
0.55
0.60
0.65
0.70
0.75
0.80
3m 12m 2y 6y
Boys Girls
Puberty
Defining the
classification of short
stature
Abnormal(Disproportionate) →
A syndrome with short limbs
（ Achondroplasia,hypothyroidism,etc）
Disproportionate
Proportionate
Head Circumference
HC is a
measurement of
perimeter of head,from
eyebrows to occipital
prominence,The
change of the HC is
related with the growth
of brain and skull,
Age HC(cm) Increment(cm)
At birth 34
3m 40 6
12m 46 6
24m 48 2
5y 50 2
15y 53~54 3~4
1,The first growth spurt occurs in the first
year of life (the increment is about 12cm).
2,The increment of HC during the first 3
months is equal to that of the following 9
months.
Patterns of HC Increment
3, Rapid,decelerating growth of HC, (At
birth,the head is ? of the neonate’s body,By
adulthood,it is only 1/8th the size of the body,)
4, The shape of head and circumference
are affected by not only diseases,but
also heredity.
Small HC ——
HC increase too fast——
Cerebral dysplasia,
Microcephaly
Hydrocephalus
Abnormal of HC
Growth on Puberty
Physical developments in height &
weight:
?occur very rapidly in infancy
?continue at a relatively steady
pace throughout childhood
?slow down towards puberty
? At puberty,there is a marked growth
spurt(The second peak of height
velocity,PHV),that is,a very rapid
increase in size and weight.
? Girls usually showing their pubertal
growth spurt around age 9~11.
? For boys the same process begins at
apx,age 11~13,
? According to Tanner (1990),girls finish
pubertal growth by about age 16
whereas boys continue to grow until
approximately 18 years of age.
Sexual Precocity,Secondary sexual
characteristics appear
before puberty.
Girls<8y,Boys<10y
Delayed sexual maturity,Secondary sexual
characteristics do not appear
after puberty
Girls>14y,Boys>16y
Skeleton
development
Dentition
development
Cranium,Fontanel
Cranial suture
Spinal development
Bone development
Cranial development
Closure time of fontanel/suture
Fontanel/suture At birth Time of closure
Anterior
fontanel 1.5-2cm ≦ 18m
Posterior
fontanel 0.5-0.7 1-2m
Cranial
suture Smallest 3-4m
How to measure the size
of anterior fontanel
Small size or
early closure：
Large size or
delayed closure：
Abnormality of anterior fontanel
Microcephaly
Hydrocephalus,
Cretinism
Intracranial
hypertension( Encephalitis,
Meningitis)
Dehydration
Abnormality of anterior fontanel
Bulging fontanel：
Sunken fontanel,
Spinal development
Age Movement Muscles Curvature
3m Lift head Cervical Cervical（ anterior）
6m Sit alone Lumbar Thoracic（ posterior）
12m Walk alone Lower extremities Lumbar（ anterior）
posterior
curvature of
thoracic
vertebra
sit by himself
at 6 months
stand and walk
by one year old
anterior curvature
of lumbar vertebra
posterior
curvature of
sacral vertebra
anterior curvature
of cervical vertebra
hold head up by 3months
Osteite (center of ossification),
which is located near ends of long
bones (epiphyses),with growth
plates,It is very important for
bone’s growth in length.
Bone development
The sequence of appearance of secondary centers
Bone age
Bone age is that the age should be
according to the osteite number for
normal child,The most commonly
used standards are those of Gruelich
and Pyle,which require radiographs
of the left hand and wrist; knee films
are sometimes added for younger
children(usually less than 1 year old),
Abnormality of Bone Age
Hypothyoidism,Hypopituism
Precocity
of BA：
Adrenogenital syndrome,
Precocity
Retardation
of BA：
Dentition
Primary teeth:
?Primary teeth are 20 totally,
?The first eruption is at about 6
months(4~10 months),
?The timing of tooth eruption is more
variable than other developmental
parameters
?Delayed eruption is usually
considered when there are no
teeth by approximately 12 months
of age.
?The last eruption of primary teeth
is at 2~2.5 years of age,
Primary teeth
Permanent teeth
6y,First molar
7～ 8y,primary
teeth are
exfoliated
instead by
permanent teeth
according to the
eruption order.
12y,Second molar
>18y,Third molar
Totally,32
Delayed eruption–
Hypothyroidism,idiopathic
Disorder – Hypothyroidism,Brain dysplasia
Failing to erupt –
Ectodermal dysplasia,Mechanical
blockage
Abnormality of dental enamel –
Ectodermal dysplasia
Abnormality of Dentition
?Growth and development are a
continuous,series of distinct stages
process.
Girls
Boys
?Imbalance development of different
systems and organs.
?Individual variation
Child has rather big variation
individually in growth and
development,even if the identical
twins,owing to some factors such
as heredity,sex,environment and
education etc,
An important part of well-child
care is the assessment of a child's
growth,that is to make sure that
children are growing normally,
Why do growth assessment
?Principles
?Representation of results
?Contents of growth assessment
?Reliable and accurate data
?Single Value and series investigation
?Reference and standard
Principles
Measurement error
40
45
50
55
60
65
70
75
80
85
90
95
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
97
50
3
cm
Length,girls
Choosing reference
R eference,based on a North
American population by NCHS,USA,
is recommended by the WHO as the
international standard of growth.
Choosing reference
Besides,there are many local or
national references,for example,
physical growth indices of 9 cities
in China,
+2SD-2SD
P3
P50
P97
Statistics review
Growth curve
Methods of assessment
?Reference table
?Growth curve
Example1,（ Weight of girls）
P3 P25 P50 P75 P97
1y～ 7.49 8.54 9.18 9.91 11.37
2y～
ny～
-2SD -1SD +1SD +2SD
1y～ 7.18 8.21 9.24 10.27 11.30
2y～
ny～
X
Example2：（ Height of boys）
50
60
70
80
90
100
110
120
130
140
150
160
170
180
190
Boys:height
2 4 6 8 10 12 14 16 18
-2SD
Age ( year )
+2SDP 97
P 3
P 50
?Growth level
?Growth velocity
?Proportion of body
Growth level
Every single measurement can
be plotted on a growth curve
which illustrates the amount of
growth in children within
different age group,
Results：
<P3
P3-P97
>P97
Example,（ Weight of girls）
P3 P25 P50 P75 P97
1y～ 7.49 8.54 9.18 9.91 11.37 (kg)
-2SD -1SD +1SD +2SD
1y～ 7.18 8.21 9.24 10.27 11.30 (kg)
The weight of a one year old girl is 8.2 kg.
Growth level：
X
X
W/A P3-P25
W/A -（ 1SD～ 2SD）
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
97
50
3
kg
Weight,Girls
eg,An infant at the 3rd
percentile of weight
for age
?Failing to grow
?Growing normally
?Recovering form growth failure
Attention 1
For premature infants:
we should minimize the effect of
gestation by subtracting the weeks
of prematurity (40 weeks is
considered as full term)from the
postnatal age,
Attention 2
Height:≤40m
Weight,≤ 24m
Head circumference,≤ 18m
Time for correction
Example:
A girl,20m old.Weight 8.8kg,Length 79cm，
HC 47.6cm.
Gestational age:32Weeks.
Correcting:18m
W,P3-P10
L,P20-P30
Assessment:20m
W,<P3
L,P10-P20
HC,-（ 1SD-2SD）X
Growth velocity can show the
process of growth,Growth velocity
is measured in terms of how much
a child grows within a specified
period of time,
Growth velocity
Serial height
50
60
70
80
90
100
110
120
130
140
150
160
170
180
190 Boys:height
2 4 6 8 10 12 14 16 18
-2SD
Age ( year )
+2SDP 97
P 3
P 50
Normal
Result representation
Normal
Descending
Accelerated
No gains
Slowed
The birth weight of a girl is
2.3Kg.When she is 3 months old,the
weight is 5.4Kg （ Growth level,< P3 ）
Growth velocity：
The increment of weight,3.1kg≈
Reference:3.08Kg/0-3m
Normal
Example
proportion of body
Weight to stature
Trunk-leg ratio
Weight for
length,W/L
Body mass
index,BMI
<P3
P3-P97
>P97
W/L,It indicates the range of
weight for definite length,
The weight of a 2 years old
boy is 14kg,the length is 76cm.
Reference table,W/L—— >P97
Example
BMI=W(kg)/H2(m)
Example,if an 8 year old boy
weighs 26.8 kg (50-75th percentile
for age) and is 130.4 cm tall,his
BMI would be calculated as follows,
26.8/(1.304)(1.304) = 15.8,
Trunk-leg ratio
It is the most common index of
shape and is a measure of the relative
length of the trunks and legs,Usually,
the ratio of sitting height/total
height(SH/TH) can reflect trunk-leg
ratio.
Result representation(Claculating)
Ratio of SH/TH≤Reference Normal
（ Proportionate）
Ratio of SH/TH ＞ Reference Abnormal
（ Disproportinate）
A 2 years old boy,his length is 65cm，
crown-rump length is 42cm。
crown-rump length/ length（ 42÷ 65= 0.65）
0.65>0.59（ Reference） Abnormal
Hypothyroidism
Example
Review
?Patterns of physical growth;
?Skeleton and dental development ;
?4 regularities of growth;
?3 indices of growth assessment.
