1. بسم الله الرحمن الرحيم

2. Growth &Development

3. Fetal Growth & Devloment
Pregnancy is actually 280 days, or 40 weeks measured from the first day of the last menstrual period,, divided into three trimesters.
The fetus develops over many months’ time, but the first few months are the most critical.
All baby’s major organs begin forming in the early weeks of pregnancy, some even before realizing pregnancy.
Therefore, mother's health, nutrition, and avoidance of harmful substances are important even before pregnancy begins.
Anything mothers eat, drink, breathe, or touch can affect baby’s development, especially in the very sensitive period beginning at conception.

4. Growth & Development -Growth & Development are two terms refer to
continuous, dynamic processes occurring from
conception to maturity and follow certain dynamic
sequences.
-They are parallel to each other in normal child
-They are consistent, predictable and sequential

5. Growth
It is an increase of physical size of the whole body or organs of different parts of the body.
It is an increase of the number and the size of each individual cell (Quantitative changes)
The measuring scales are related to:
weight which is measured by Kg., gm or pound, Ounce.
Height Which is measured by Cm, Feet.

6. Normal Growth of young children
Regular measurements of child's height, weight and head circumference and plotting them on a growth chart are a good way to see if the child is growing normally.
Although many parents are preoccupied by where their child is on the growth charts and often worry if their child is small or near the bottom of the growth chart.
It is child's rate of growth that is the most important factor to consider when evaluating if child is growing and developing normally.
If child is following his growth curve, then he is likely growing normally

7. Growth charts

9. Also keep in mind that some children can normally move up or down on their growth curves when they are 6-18 months old.
As long as they are not actually losing weight, and they have no other symptoms, such as persistent diarrhea, vomiting, poor appetite or having frequent infections, then it may be normal to move down on growth percentiles.
Older children should stick to their growth curves fairly closely though.

10. General guidlines
for younger child
growth rates

11. Weight from just 2.6 to 3.8 kilos.
The majority of babies born full-term ,
i.e. 40 weeks (280 days),
Weight from just 2.6 to 3.8 kilos.
Height between cm long.
Head circumference is between 34 – 40 cm.
Infants born before the completion of 37 weeks of gestation are called premature baby.

12. continue. Weight 2 weeks - regains birth weight and then gains
about 1 1/2 - 2 pounds a month
3 months - gains about 1 pound a month
5 months - doubles birth weight
1 year triples birth weight and then gains
about 1/2 pound a month
2 years quadruples birth weight and then gains
about 4-5 pounds a year
9-10 years - increased weight gain as puberty
approaches, often about 10 pounds a year

13. 0-12 months - grows about 10 inches (25 cm).
Height
0-12 months - grows about 10 inches (25 cm).
1-2 years grows about 5 inches (13 cm).
2-3 years grows about 2 1/2 inches( 8 cm) a year.
Most children will double their birth height by 3-4
years of age.
3 years to puberty - grows about 2 inches (5cm) a year

14. Head Circumference 0→3 Months - ↑ 2 centimeters a month
6→12 Months - ↑ 1/2 centimeter a month
1→ 2 Years ↑ 2 centimeters a year

15. Remember
that these are general guidelines though that the child may grow a little more or a little less than this each year.

16. Factors Affecting Growth
Mother‘s health during pregnancy.
Period of pregnancy.
Multiplication of labor.
Gender.
Nutritional factors.
Health status of the baby.

17. Development
It is a progressive increase in skill and capacity of function.
i.e. increase of functional activity, indicates development of
millstones. (The ability to achieve specific function at certain
age) (Qualitative changes)
It is measured by specific scales that determines the different
age to achieve certain function.
e.g.:
The Denver Development Screening Test,
Test form with 105 items
Bruininks – Oseretesky. Form for eight subtests.
Test of Motor Proficiency

18. The Denver Development Screening Test (DDST)
It includes 4 areas of development :
1.Personal – social : the child ability to get along with people
and to take care of himself .
2. Fine – motor adaptive : the child ability to see and use his
hands to pick up objects and to draw .
3. Language : the child ability to hear , to follow directions and
to speak .
4. Gross – motor : the child ability to sit , walk and jump .

19. It was performed on children from birth to 6 years.
It has 105 items and the scoring is as follow :
P = pass , F = failure , R = refusal ,
N.O. = no opportunity .

20. Bruininks – Oseretesky Test of Motor Proficiency (BOT)
It is designed to assess gross and fine motor functions in children from 4.5 – 14.5 years .
It included 8 subtests comprised of 46
separate items .

21. The subtests are: Running speed & agility, Balance,
Bilateral co-ordination,
Strength (gross – motor skills),
Limb co-ordination (gross and fine motor skills ),
Response speed,
Visual motor control,
Upper limb speed and dexterity ( fine motor skills) .

22. Development depends on the maturation of the C.N.S.
Mylination of C.N.S. Is complete by the end of the first year of age.
Mylination without skills→→ Retardation
Skills without mylination →→no function

23. Patterns of growth and development
1st pattern of development
A cephalocaudal direction
or from head to tail. The head of the fetus initially forms more completely than the body and limbs. Then the trunk and limbs of the fetus develop. In following this pattern after birth, the infant develops beginning head control before learning to control the trunk or limbs functionally. Development moves downward with the child learning to control the upper trunk before the lower and using the eyes to engage the environment before learning the skills to use the hands to grasp and manipulate.

24. 2nd pattern of development.
From the center outward,
or proximal to distal.
The fetus develops the spinal cord and trunk , as limb buds are barely formed. As the fetus develops, the limb buds continue to grow into fully formed limbs and the peripheral nerves form to provide sensory data to the central nervous system, the brain.
The infant follows the same pattern of proximal to distal development, with the brain grows fast in the first few years of life when the development of more fine control of limbs is still emerging. As the child grows, the movements of the limbs become more refined and the child develops specific skills, such as throwing, writing. And dancing

25. 3rd Pattern of development
From general to the specific,
or from simple to more complex.
As the fetus grows, undifferentiated cells migrate to specific location in the fetus and take on specific roles (brain cells, skin, blood). In the developing child, this pattern is also strong. The child learns general skills first; for example, the child will cry to communicate. General communication strategies are refined to specific language over time. Limb movements start out as gross patterns that are directed by reflexes, and mature into reactions then skilled patterns of movements that are functional for life and safety such as running, jumping and climbing.

26. Stages of growth and develpment

27. Stages of growth and develpment
Prenatal Stage:
About 40 weeks (280 days), from conception to
birth . Infants born before the completion of 37
weeks of gestation are called premature infants.
Embryonic Stage : The 1st 10 weeks of gestation
Fetal Stage : After 10 weeks of gestation to birth.
Postnatal Stage
Neonatal Stage : From birth to 4 weeks of age.
Infant Stage : 4 weeks through 12 months of age
Toddler : 13th months through 2 years of age
Early childhood : From 2 years Through 6 years of age
Middle childhood : From 6 years Through 12 years of age
Adolescence : From 12 years of age up to 18 years.

28. Prenatal Stage

29. Intra Uterine growth and development
Prenatal Stage

30. The first trimester
From conception through 12 weeks
The first trimester is a highly sensitive period in the development of the baby.
This is the critical period of time when all of the major organs and structures are forming.
Harmful substances that are ingested can affect the normal growth and development of the fetus.
Conception through the 10th week is referred to as the embryonic period.

31. From conception through 12 weeks
At 5th week:
The embryo is :
About one-half inch long
Weighs less than an ounce.
Its brain, heart, lungs, eyes, ears, arms, and legs are forming.
At 8th week:
The fingers are distinct
The beginnings of all essential external and internal structures are present.
At 10th week:
the embryo is known as a fetus.
The face has a human profile and all of the major organs have formed.
It is now about 4 inches long and weighs about one ounce.
The heartbeat can now be heard with a Doppler stethoscope and can also be easily
seen on ultrasound examination.
The kidneys have begun to secrete urine, which partly makes up the amniotic fluid
around the baby.
Teeth buds are present in the gums.

32. The second trimester
From 13 weeks through 28 weeks.
The second trimester is a period of rapid growth for the fetus Sexual differentiation is beginning to show. By the 16th week: It is about 6 inches long Weighs about 5 ounces It moves about, swallows amniotic fluid, and has periods of sleep and wakefulness.

33. The final trimester marks the period of final growth.
From 29 weeks until delivery.
The final trimester marks the period of final growth.
During the last month of pregnancy, the baby can gain as
much as half a pound a week.
The average baby will weigh about 7 ½ pounds,
The range at full term from 5 ½ pounds up to over 9 pounds.
Fetal movement during this period of time is a good indicator
of fetal well being.

34. Virginia Apgar‘s method of evaluating newborn infant
Virginia Apgar‘s method of evaluating newborn infant is now in standard use to evaluate the newborn one minute after birth.
It is useful to make serial Apgar score, the longer the score remains low the worse the prognosis with regard to mortality or neurological sequel.
Total score:
8 – Good
Fair
0 – Poor condition
Score
Heart rate
Respiratory effort
Reflex irritability
Muscle tone
Color 2
Normal cry
Good
Pink 1
100
Irregular and shallow
Moderately depressed
Fair
Pale
No heart beat observed
Apnea for more than 60 sec.
Absent
Flaccid
Cyanotic

35. Parameters of development
Biological development is related to enzyme systems that stimulate complex metabolic changes.
Psychological development refers to cognitive and effective ( emotional)
Social development provides child to live in community.
All the parameters of development affect one another.
Parameter of
devepoment

36. Normal new born baby Characters of full term baby:
Should be delivered at or near term (after 40 weeks of pregnancy)
Free from any congenital defects or obstetrical changes.
Healthy pink color.
His or her heart rate is beats / min.
Breaths spontaneously and cries lustily
Position in prone lying, with head turned one side and arms, legs are flexed. (Flexion attitude).

37. 7. On ventral suspension, no head control (head lag)
8. Has a skeletal muscle tone.
↑flexor muscle tone in both upper and lower extremities due to unmylination of the pyramidal tract.
9. The fist of the hands are clenched and the thumb inside the palm