Growth and development

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1 : GROWTH AND DEVELOPMENT Dr. Iqbal Hossain Assistant Professor of Pediatrics Faridpur Medical College, Bangladesh
2 : Growth and development begins at conception and end at maturation. Growth is defined as the increase in the size of an individual due to increase in number and size of the cells. Development is the maturation of function and acquisition of variety of skills for functioning optimally in a society.
3 : Stages of Growth and Development Middle Childhood School age 6 to 12 years Late Childhood Adolescent 13 years to approximately 18 years Infancy Neonate Birth to 1 month Infancy 1 month to 1 year Early Childhood Toddler 1-3 years Preschool 3-6 years
4 : Principles of Growth and Development Growth is an orderly process, occurring in systematic fashion. Rates and patterns of growth are specific to certain parts of the body. Wide individual differences exist in growth rates. Growth and development are influences by are influences by a multiple factors.
5 : Factor influencing growth and development Genetic Nutritional Socio-economic Environmental: physical surrounding, psychological, social, cultural factor Chronic disease Emotional and cultural like unstable family, insecurity, loss of parents inadequate schooling have negative effect on growth and development Intrauterine growth retardation and maternal infection adversely affect the fetus and thereby newborn
6 : Growth Patterns The child’s pattern of growth is in a head-to-toe direction, or cephalocaudal, and in an inward to outward pattern called proximodistal.
7 : Growth Pattern
8 : Why developmental assessment? Early detection of deviation in child’s pattern of development Simple and time efficient mechanism to ensure adequate surveillance of developmental progress Domains assessed: cognitive, motor, language, social / behavioral and adaptive
9 : Growth in Embryonic Period By 6 days postconceptual age, the embryo consists of a spherical mass of cells with a central cavity (the blastocyst) By 2 wk, implantation is complete and the uteroplacental circulation has begun; the embryo has two distinct layers, endoderm and ectoderm, and the amnion has begun to form By 3 wk, the third primary germ layer (mesoderm) has appeared, along with primitive neural tube and blood vessels. Paired heart tubes have begun to pump. During wk 4–8, lateral folding of the embryologic plate, followed by growth at the cranial and caudal ends and the budding of arms and legs, produces a human-like shape By the end of wk 8, as the embryonic period closes, the rudiments of all major organ systems have developed; the average embryo weighs 9 g and has a crown-rump length of 5 cm.
10 : Growth in Fetal Period From the 9th wk on fetal somatic changes consist of increases in cell number and size and structural remodeling of several organ systems By 10 wk, the face is recognizably human. . By 12 wk, the gender of the external genitals becomes clearly distinguishable. Lung development proceeds with the budding of bronchi, bronchioles, and successively smaller division By 20–24 wk, primitive alveoli have formed and surfactant production has begun During the 3rd trimester, weight triples and length doubles as body stores of protein, fat, iron, and calcium increase
11 : Growth from birth to puberty New born infant loses 10% of body weight and regains the weight by 10 days. Then gains 25-30 gm/day during 1st 3 months of life 20 gm/day between 3-6 months 15 gm/day during 6-9 months 12 gm/day during 9-12 months Birth weight double at 5 months, triple at 1 yrs, quadruples at 2 years and 5 times at 3 years Length: 50 cm at birth, 60 cm at 3 months, 70 cm at 9 months, 75 at 1 yr, 85 at 2 yrs and 100 cm at 4 yrs. Then 5 cm every year till the age of 10 years Head circumference: At birth 35 cm. 3 months- 45 cm, 2yrs – 48cm
12 : Formula for average weight and height of normal children: Weight 3to 12 months: age(m) +9 2 1 to 6 years= age (yrs)X2+8 7 to 12 yrs= age(yrs)X7.5 2 Height: At birth50 cm At 1 year 75 cm 2 to 12 years= age(yrs)X6+77
13 : Gross Motor Skills The acquisition of gross motor skill precedes the development of fine motor skills. Both processes occur in a cephalocaudal fashion Head control preceding arm and hand control Followed by leg and foot control.
14 : Gross Motor Development Newborn: barely able to lift head 6 months: easily lifts head, chest and upper abdomen and can bear weight on arms
15 : Head Control Newborn Age 6 months
16 : Sitting up 2months old: needs assistance 6 months old: can sit alone in the tripod position 8 months old: can sit without support and engage in play
17 : Sitting up 2 Months age
18 : Sitting Up Age 2 months Age 8 months
19 : Development The Denver Development Screening test (DDST) is used to assesses the child development. The test consist of 4 separate segment Gross motor Fine motor and adaptive Personal social Language function
20 : Ambulation 9 month old: crawl 1 year: stand independently from a crawl position 13 month old: walk and toddle quickly 15 month old: can run
21 : Ambulation 13 month old Nine to 12-months
22 : Fine Motor - Infant Newborn has very little control. Objects will be involuntarily grasped and dropped without notice. 6 month old: palmar grasp – uses entire hand to pick up an object 9 month old: pincer grasp – can grasp small objects using thumb and forefinger
23 : Speech Milestones 1-2 months: coos 2-6 months: laughs and squeals 8-9 months babbles: mama/dada as sounds 10-12 months: “mama/dada specific 18-20 months: 20 to 30 words – 50% understood by strangers 22-24 months: two word sentences, >50 words, 75% understood by strangers 30-36 months: almost all speech understood by strangers
24 : Hearing BAER hearing test done at birth Ability to hear correlates with ability enunciate words properly Always ask about history of otitis media – ear infection, placement of PET – tubes in ear Early referral to MD to assess for possible fluid in ears (effusion) Repeat hearing screening test Speech therapist as needed
25 : Fine Motor Development 6-month-old 12-month-old
26 : Red Flags in infant development Unable to sit alone by age 9 months Unable to transfer objects from hand to hand by age 1 year Abnormal pincer grip or grasp by age 15 months Unable to walk alone by 18 months Failure to speak recognizable words by 2 years.
27 : Fine Motor - toddler 1 year old: transfer objects from hand to hand 2 year old: can hold a crayon and color vertical strokes Turn the page of a book Build a tower of six blocks
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33 : Fine Motor – Older Toddler 3 year old: copy a circle and a cross – build using small blocks 4 year old: use scissors, color within the borders 5 year old: write some letters and draw a person with body parts
34 : Toddler Adele Piliterri, Child Health Nursing, Lippincott
35 : Toddler Safety becomes a problem as the toddler becomes more mobile. Pilliterri, Lippincott
36 : Toddlers
37 : Issues in parenting - toddlers Stranger anxiety – should dissipate by age 2 ½ to 3 years Temper tantrums: occur weekly in 50 to 80% of children – peak incidence 18 months – most disappear by age 3 Sibling rivalry: aggressive behavior towards new infant: peak between 1 to 2 years but may be prolonged indefinitely Thumb sucking Toilet Training
38 : Pre-School
39 : Fine motor and cognitive abilities Buttoning clothing Holding a crayon / pencil Building with small blocks Using scissors Playing a board game Have child draw picture of himself Pre-school tasks
40 : Red flags: preschool Inability to perform self-care tasks, hand washing simple dressing, daytime toileting Lack of socialization Unable to play with other children Able to follow directions during exam Performance evaluation of pre-school teacher for kindergarten readiness
41 : Pool Safety
42 : School-Age
43 : School Years: fine motor Writing skills improve Fine motor is refined Fine motor with more focus Building: models – legos Sewing Musical instrument Painting Typing skills Technology: computers
44 : School performance Ask about favorite subject How they are doing in school Do they like school By parent report: any learning difficulties, attention problems, homework Parental expectations
45 : Red flags: school age School failure Lack of friends Social isolation Aggressive behavior: fights, fire setting, animal abuse
46 : School Age: gross motor 8 to 10 years: team sports Age ten: match sport to the physical and emotional development
47 : School Age
48 : School Age: cognitive Greater ability to concentrate and participate in self-initiating quiet activities that challenge cognitive skills, such as reading, playing computer and board games.
49 : 13 to 18 Year Old
50 : Adolescent As teenagers gain independence they begin to challenge values Critical of adult authority Relies on peer relationship Mood swings especially in early adolescents
51 : Adolescent behavioral problems Anorexia Attention deficit Anger issues Suicide
52 : Adolescents


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