Assessment of Growth and Development

A  Sudhakar

Assessment of Growth and Development1

DEFINITION

Growth

It refers to an increase in physical size of the whole or any of its parts and can be measured in inches or centimeters and in pounds or kilograms.

—Marlow

Development

It refers to a progressive increase in skill and capacity to function. It causes a qualitative change in the child's functioning. Maturation produces an increase in competence, an ability to function at a higher level depending on the child's heredity.

—Marlow

Growth and Development

Growth is the progressive increase in the size or parts of a child.

Development is progressive acquisition of various skills (abilities) such as head support, speaking, learning, expressing the feelings and relating with other people. Growth and development go together but at different rates.

STAGES

Table 1.1 Stages development

S.No	Stage	Time period
Prenatal period
1.	Ovum	0–14 days (after conception)
2.	Embryo	14 days to 8 weeks
3.	Fetus	8 weeks to birth (8–40 weeks)
Postnatal period
1.	New born	Birth to 28 days
2.	Infant	1–12 months
3.	Toddler	1–3 years
4.	Preschooler	3–5 years
5.	School-aged child	6–12 years
6	Adolescent Early adolescent Middle adolescent Late adolescent	13–18 years 13–14 years 15–16 years 17–18 years

PARAMETERS

Physical/biological development
Motor development
- Fine motor development
- Gross motor development
Sensory development
Psychosocial development
Psychosexual development
Spiritual development
Intellectual/cognitive development
Moral development
Language development
Play stimulation.

PRINCIPLES

Cephalocaudal Direction

The process of cephalocaudal direction from head down to tail. This means that improvement in structure and function come first in the head region, then in the trunk, and last in the leg region.

Figs 1.1A and B: Cephalocaudal direction

Proximodistal Direction

The process in proximodistal from center or midline to periphery direction. Development proceeds from near to far, outward from central axis of the body towards the extremities.

Fig. 1.2: Proximodistal direction

Piaget develops four important stages of cognitive development:

Sensorimotor stage (Birth to age 2 years)
Preoperational stage (Age 2–7 years)
Concrete operational stage (Age 7–12 years)
Formal operational stage (Age 11–12 years).

3Erikson's eight stages consist of the following:

Trust versus mistrust (infant)
Autonomy versus shame (toddlerhood)
Initiative versus guilt (preschooler)
Industry versus inferiority (young adolescent)
Identity versus role confusion (adolescent)
Intimacy versus isolation (young adulthood)
Generativity versus stagnation (middle adulthood)
Ego integrity versus despair (old age).

Table 1.2 Stages of psychosocial, psychosexual, intellectual and moral development.

Stage	Age	Tasks	Erikson's Psychosocial stages negative counterpart	Freud's psychosexual stages	Significant persons
Infancy	0–12 months	Sense of trust	Mistrust	Oral	Maternal person or substitute
Toddler	1–3 years	Sense of autonomy	Shame and doubt	Anal	Parental persons
Preschooler	3–6 years	Sense of initiative	Guilt	Phallic	Basic family
School going children	6–12 years	Sense of industry	Inferiority	Latency	Neighborhood and school
Early adolescence	Above 12 years	Sense of identity	Identity diffusion	Puberty	Peer groups and out groups, and models of leadership
Late adolescence and young adult	16–18 years	Sense of intimacy and solidarity	Isolation	Geniality	Partners in friendship, sex, competition and cooperation.

DEVELOPMENTAL WARNING SIGNS

At any age	Maternal concern Regression in previously acquired skills
At 10 weeks	No smiling
At 6 months	Persistent primitive reflexes Persistent squint Hand preference Little interest in people, toys and noises
At 10–12 months	No sitting No double syllable babble No pincer grasp
At 18 months	Not walking independently Less than 6 words Persistent mouthing and drooling
At 2¹/₂ years	Two to three word sentences
At 4 years	Unintelligible speech

MILESTONES THAT ARE ESSENTIAL TO REMEMBER

Age	Milestone
4–6 weeks 6–7 months 9 months 10 months 12 months 18 months 24 months	Smiles responsively Sits unsupported Gets to a sitting position Pincer grasp Walks unsupported Two or three words Tower of three or four cubes Two to three word sentences

GROWTH

Accurate measurement of growth is a vital part of the assessment of children. In order to interptet a childs growth, measurements must be potted on a growth chart. If there is concern about growth, the rate of growth must be assessed by measuring the child on two occasions at least 4–6 months apart.

Height

Use a properly calibrated standing frame.

The child should be measured barefoot with knees straight and feet flat on the floor stretch the child gently and read the measurement.

Weight

Scales must be calibrated accurately.
Babies should be weighted naked (no nappy).
Older children should be weighted in underwear only.

Length

The child should be measured lying down until 2 years of age. Measuring the length of infants requires skill.

Use proper equipment and two people to hold the child.

Head Circumference

Use flexible non-stretchable tape.
Obtain three successive measurements and take the largest to be the occipitofrontal circumference (OFC).

FINE MOTOR DEVELOPMENT

Grasping and Reaching

Prone position

Pull to sit

Sitting

Pull to sit

Standing and Walking

Building Bricks

Manipulation

Pencill Skills

SPEECH AND LANGUAGE DEVELOPMENT

SOCIAL DEVELOPMENT

PUBERTY

Puberty is evaluated by clinical examination of the genitalia, breasts and secondary sexual characteristics. The scale used known as Tanner staging.

Boys

Girls

Principles of Puberty

The first signs of puberty are usually testicular enlargement in boys and breast budding in girls.
Puberty is precocious if it starts before the age of 8.5 years in girls and 9.5 years in boys.
Puberty is delayed if onset is after 13 years in girls and 14 years in boys.
A growth spurt occurs early in puberty for girls, but at the end of puberty in boys.

Chapter Notes

Assessment of Growth and Development1