2  Growth and Development

Author

xxx

Published

June 6, 2025

2.1 Introduction

Growth and development are fundamental indicators of a child’s overall health and well-being. As medical students in Ghana, it is crucial to comprehend the physiological processes of growth and development, their milestones, and how socio-economic and environmental factors specific to Ghana impact these processes.

Growth refers to an increase in physical size (height, weight, head circumference). In contrast, development refers to the acquisition of skills and functions such as motor abilities, language, cognition, and social behaviour. Both occur simultaneously and are influenced by genetic, nutritional, hormonal, environmental, and psychosocial factors.

2.2 Principles of Growth and Development

  1. Cephalocaudal progression: Development proceeds from head to toe. For example, infants gain head control before they can sit or walk.
  2. Proximodistal progression: Development proceeds from the center of the body outwards. Gross motor skills develop before fine motor skills.
  3. Sequential and Predictable: Milestones follow a predictable pattern, although the pace may vary.
  4. Critical periods: There are periods when the child is especially sensitive to environmental stimuli.
  5. Individual variability: Normal children may achieve milestones at slightly different ages.

2.3 Stages of Growth and Development

1. Neonatal Period (Birth – 28 Days)

Growth:

  • Weight: Average birth weight is 2.5–4.0 kg. Infants may lose up to 10% of their birth weight in the first week but regain it by day 10.
  • Length: ~50 cm at birth.
  • Head circumference: ~35 cm at birth.

Development:

  • Primitive reflexes: Rooting, sucking, Moro, palmar grasp, stepping reflex.
  • Sensory abilities: Can see up to 20–30 cm, prefer human faces, respond to loud sounds.
  • Motor: Moves all limbs symmetrically, exhibits flexed posture.

2. Infancy (1 month – 1 year)

Growth:

  • Weight doubles by 5–6 months and triples by 1 year.
  • Length increases by 50% in the first year.
  • Head circumference increases ~1 cm/month in the first 6 months.

Development:

  • Gross motor:

    • 3 months: Head control.
    • 6 months: Rolls over.
    • 9 months: Sits without support, crawls.
    • 12 months: Stands, may begin walking

  • Fine motor

    • 4–6 months: Reaches for objects.
    • 9 months: Pincer grasp begins
    • 12 months: Transfers objects between hands, bangs objects together.

  • Language:

    • 2 months: Coos.
    • 6 months: Babbles.
    • 9–12 months: Says “mama,” “dada” (non-specific), understands “no.”

  • Social:

    • 2 months: Social smile.
    • 6 months: Stranger anxiety.
    • 12 months: Waves “bye-bye,” enjoys peek-a-boo.

3. Toddler (1 – 3 years)

Growth:

  • Gains 2–3 kg per year.
  • Height increases by ~12 cm per year.
  • Head growth slows; the anterior fontanelle closes by 18 months.

Development:

  • Gross motor:

    • 15 months: Walks independently.
    • 18 months: Climbs stairs with help.
    • 2 years: Runs, kicks a ball.
    • 3 years: Rides tricycle, climbs stairs alternating feet.

  • Fine motor:

    • Builds tower of 3 (18 months) to 9 (3 years) cubes.
    • Can feed themselves with a spoon.
    • Begins to draw lines and circles.

  • Language:

    • 18 months: 10–20 words.
    • 2 years: 2-word phrases, ~50 words.
    • 3 years: Sentences of 3–4 words.

  • Social:

    • Parallel play.
    • Temper tantrums, strong desire for independence.
    • Recognizes self in mirror.

4. Preschool (3 – 5 years)

Growth:

  • Gains 2 kg/year.
  • Height increases ~6–8 cm/year.

Development:

  • Gross motor: Hops on one foot, skips, throws, and catches a ball.
  • Fine motor: Copies shapes, uses scissors, dresses self with help.
  • Language: Clear speech, tells stories, knows names, age, and gender.
  • Cognitive: Magical thinking, learns numbers, colours.
  • Social: Cooperative play starts forming friendships.

5. School-Age (6 – 12 years)

Growth:

  • Steady growth of ~5–7 cm/year and 2–3 kg/year.
  • Permanent teeth begin to erupt around age 6.

Development:

  • Gross motor: Coordination improves, participates in sports.
  • Fine motor: Writes well, does crafts, and is independent in dressing and eating.
  • Cognitive: Concrete operational stage (Piaget) – can think logically about tangible objects.
  • Social: Peer relationships become central; starts forming moral values.
  • Emotional: Develops self-esteem; compares self to others.

6. Adolescence (13 – 18 years)

Divided into early (10–13), middle (14–16), and late (17–19) adolescence.

Growth:

  • Pubertal growth spurt:
    • Girls: Peak at 11–12 years.
    • Boys: Peak at 13–14 years.
  • Growth completes by 18–20 years.
  • Sexual maturation: Tanner staging is used to assess the progression of puberty.

Tanner Staging Overview:

  • Stage 1: Prepubertal.
  • Stage 2: Breast bud (girls); testicular enlargement (boys).
  • Stage 3–5: Progressive pubic hair growth, breast and genital development.

Development:

  • Cognitive: Formal operational stage – abstract thinking.
  • Psychosocial (Erikson): Identity vs. Role Confusion.
  • Emotional: Self-awareness, mood swings, peer pressure.
  • Social: Increased independence, interest in opposite sex, development of personal values.

2.4 Factors Influencing Growth and Development in Ghana

1. Nutrition

  • Malnutrition remains a significant cause of stunting and wasting in Ghana.
  • Exclusive breastfeeding for 6 months followed by appropriate complementary feeding is critical.
  • Micronutrient deficiencies (iron, vitamin A, iodine) are common.

2. Health and Disease

  • Frequent infections (malaria, diarrheal disease, respiratory infections) affect growth.
  • Helminthic infestations (e.g., Ascaris, hookworm) can cause anemia and malabsorption.
  • HIV and chronic illnesses impact weight gain and development.

3. Immunization

  • Vaccines under Ghana’s EPI (Expanded Programme on Immunization) protect against major childhood illnesses.
  • Delays in vaccination can predispose children to infections that impair growth.

4. Socioeconomic Status

  • Poverty, poor housing, and low parental education levels contribute to undernutrition and developmental delays.
  • Urban-rural disparities exist, with rural children at higher risk of poor outcomes.

5. Environmental Factors

  • Poor sanitation increases the risk of repeated infections.
  • Environmental toxins (e.g., lead exposure in certain mining communities) can cause neurodevelopmental issues.

6. Parental Care and Stimulation

  • Emotional support, play, and verbal interaction are key for early brain development.
  • Neglect, abuse, and trauma can lead to delayed speech and cognitive skills

2.5 Clinical Assessment of Growth and Development

Anthropometric Measurements

  • Weight: Measured at every visit. Weight-for-age is a good screening tool.
  • Height/Length: Height-for-age assesses linear growth; used to detect stunting.
  • Head circumference: Measured in children under 2 years; useful in assessing brain growth.
  • Mid-upper arm circumference (MUAC): Used in children aged 6–59 months to screen for acute malnutrition.

Growth Charts

  • WHO growth standards are used in Ghana.
  • Plotted regularly to monitor trends over time.
  • Red flags: crossing percentiles downward, weight loss, or faltering height.

2.6 Red Flags in Growth and Development

Medical students should be alert to signs that may indicate problems:

  • No head control by 4 months.
  • No sitting by 9 months of age.
  • No walking by 18 months.
  • No single words by 15 months.
  • Regression of previously attained milestones.
  • Persistent failure to thrive despite nutritional intervention.
  • Rapid head growth or microcephaly.
  • Poor school performance in school-aged children.

2.7 Role of the Health Worker

In Ghana, health workers play a vital role in promoting optimal growth and development:

  1. Growth monitoring and promotion: Routine weighing and charting in Child Welfare Clinics (CWC).
  2. Nutrition counseling: Promote exclusive breastfeeding, weaning practices, and dietary diversity.
  3. Immunization: Ensuring timely vaccination.
  4. Early identification and referral: Recognizing signs of developmental delay and making timely referrals.
  5. Parental education: Encouraging stimulation, responsive parenting, and early learning.
  6. School health services: Routine screening in schools for hearing, vision, and dental problems.

2.8 Conclusion

Understanding child growth and development is critical in paediatrics and preventive health care. In Ghana, many preventable factors influence a child’s trajectory. As future medical practitioners, students must recognize normal patterns, use appropriate tools for assessment, and intervene early where deviations exist. Knowledge of cultural, nutritional, and environmental influences is essential for context-specific care. By prioritizing growth and development, we lay the foundation for healthier futures in Ghana’s children.