In the context of childhood development, growth is defined as an irreversible constant increase in size, and development is defined as growth in psychomotor capacity. Both processes are highly dependent on genetic, nutritional, and environmental factors. Development refers to functional or behavioral changes. Growth is biological. Development is social, emotional, cognitive, moral, and other domains of function.Human development is a lifelong process of physical, behavioral, cognitive, and emotional growth and change. In the early stages of life—from babyhood to childhood, childhood to adolescence, and adolescence to adulthood—enormous changes take place. Throughout the process, each person develops attitudes and values that guide choices, relationships, and understanding. Sexuality is also a lifelong process. Infants, children, teens, and adults are sexual beings. Just as it is important to enhance a child’s physical, emotional, and cognitive growth, so it is important to lay the foundation for a child’s sexual growth. Adults have a responsibility to help young people understand and accept their evolving sexuality. Growth and development includes not only the physical changes that occur from infancy to adolescence, but also some of the changes in emotions, personality, behavior, thinking and speech that children develop as they begin to understand and interact with the world around them. Skills such as taking a first step or smiling for the first time are called developmental milestones.

1. ASSISTING
INDIVIDUALS & GROUPS
TO PROMOTE AND MAINTAIN
HEALTH
PREPARED BY,
ARATHI ITTIEL
ASST. LECTURER
INSeR , MCC

2. GROWTH
AND
DEVELOPMENT

6. 1. Cephalocaudal direction:
The process of
cephalocaudal direction is 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.

8. 3. General to Specific:
• Children use their cognitive and language skills
to reason and solve problems.
• Children at first are able hold the big things by
using both arms, In the next part able to hold
things in a single hand, then only able to pick
small objects like peas, cereals etc.

9. • Children when able to hold pencil, first
starts draw circles then squares then
only letters after that the words.
• Development proceeds from general to
specific responses.

10. Factor influencing Growth and Development:
1.GENETIC FACTORS
1.PRENATAL FACTORS
2.POSTNATAL FACTORS

11. 1.GENETIC FACTORS :
• GENETIC PREDISPOSITION
• SEX
• RACE & NATIONALITY
2. PRENATAL FACTORS
• MATERNAL
MALNUTRITION
INFECTION
SUBSTANCE ABUSE
ILLNESS
HORMONES

12. • GROWTH POTENTIAL
• NUTRITION
• CHILDHOOD ILLNESS
• PHYSICAL ENVIRONMENT
• PSYCHOLOGICAL ENVIRONMENT
• CULTURAL INFLUENCE
• SOCIO ECONOMIC STATUS
• CLIMATE & SEASON
• PLAY & EXERCISE
• BIRTH ORDER OF THE CHILD
• INTELLIGENCE
• HORMONAL INFLUENZE

13. 1. INFANCY :
 NEONATE : BIRTH TO ONE MONTH
 INFANCY : ONE MONTH TO ONE YEAR

14. 2. EARLY CHILDHOOD :
TODDLER : 1 TO 3 YEARS
PRESCHOOLER : 3 TO 6 YEARS

15. 3. MIDDLE CHILDHOOD :
 SCHOOL AGE : 6 TO 12 YEARS

16. 4. LATE CHILDHOOD :
ADOLESCENTS : 13 YEARS
TO
APPROXIMATELY 8 YEARS

18. 1.ASSESSMENT OF GROWTH
a) WEIGHT :
☻ Weight is one of the best criteria for assessment of
growth and a good indicator of health and nutritional
status of child.
☻ Among Indian children, weight of the full terms
neonate at birth is approximately 2.5 kg to 3.5kg.

19. ☻ there is about 10% loss of weight first week of life, which
regains by 10 days of age .
☻ Then, weight gain is about 25- 30 gm per day for 1st 3
month and 400gm/month till one year of age.
☻ The infants double weight gain their birth weight by 5month of
age, trebled by one year, fourth time by two years, five times by
three year, six times by five year, seven times by seven year and ten
times by ten year.
☻ Then weight increases rapidly during puberty followed by
weight increase to adult size.

20. b) LENGTH AND HEIGHT :
☻ Increase in height indicates skeletal growth. Yearly
increments in height gradually diminished from birth to
maturity.
☻ At birth average length of a healthy Indian newborn baby is
50 cm.
☻ it increases to 60 cm at 3 months, 70 cm of 9 month and 75
cm at one year of age.

21. ☻ In second year, there is 12 cm increase, third
year it is 9 cm, fourth year it is 7 cm and in fifth
year it is 6 cm.
☻ so the child double the birth by 4 to 4.5 years
of age afterwards there is about 5 cm increase in
every year till onset of puberty.

22. c) BODY MASS INDEX (BMI)
☻ It is an important criteria which helps to assess
the normal growth or its deviations. (i.e. malnutrition
or obesity.)
BMI =Weight in Kg/(Height in meter) 2

23. ☻ BMI remains content up to the age of 5 years.
If the BMI is more than 30 kg/m2, it indicates
obesity and if it is less then 15Kg/m2 , it indicates
malnutrition .
☻ BMI Categories:
Underweight = <18.5
Normal weight = 18.5–24.9
Overweight = 25–29.9
Obesity = BMI of 30 or greater 30

24. d) HEAD CIRCUMFERENCE :
☻ It is related to brain growth and development of intracranial
volume. Average head circumference measured about 35 cm at
birth.
☻ At 3 months it is about 40 cm, at 6 month 43 cm, at one year
45cm, at 2 years 48 cm, at 7 year 50 cm and at 12 years of age
it is about 52 cm, almost same a adult .

25. ☻ Head circumference is measured by ordinal tap, placing
it over the occipital protuberance at the back, above the
ear on the side and just over the supraorbital ridges in
front . Taking the biggest measurement of three times.
☻ If head circumference increase more than 1 cm in two
weeks during the first 3 month of age then hydrocephalus
should be suspected.

26. e) FONTANELLE CLOSURE :
☻ At birth, anterior and posterior
fontanelle are usually present. Posterior
fontanelle closes early few weeks (6-8week)
of age.
☻ The anterior fontanelle normally closes
by 12- 18 months of age. Early closure of
fontanelle indicates craniostenosis due to
premature closure of skull sutures.

27. f) CHEST CIRCUMFERENCE :
☻ chest circumference or thoracic diameters is an importance
parameter of assessment of growth and nutrition status.
☻ At birth it is 2-3cm less than head circumference. At 6 to 12
months of age both become equal.
☻ After 1 year of age, chest circumference is greater than head
circumference by 2.5 cm and by the age of 5 year, it is about
5 cm larger than head circumference.

28. ☻ Chest circumference is measured by placing the
tape measure around the chest at level by placing the
tape measure around the chest at the level of the
nipple .

29. g) MID UPPER ARM CIRCUMFERENCE (MUAC):
☻ This measurement helps to assess the nutritional status of
younger children.
☻ The average MUAC :
• at birth is 11 to 12 cm
• at 1year of age it is 12 to 16 cm
• at 1 to 5 years it is 16 to 17 cm
• at 12 years it is 17 to 18 cm and
• at 15 years it is 20 to 21cm .

30. H) ERUPTION OF TEETH:
☻ There is a variation for the time of eruption of teeth. First teeth commonly
may appear in 6 to 7 months of age. Can be delayed even up to 15 months. So,
dentition is not dependable parameters of growth.

31. I. OSSEOUS GROWTH:
☻ Bony growth follows a definite pattern and time
schedule from birth to maturation.
☻ It is calculated by the appearance of ossification
center (area of bone to start ossifying) by X – ray study.
☻ Skeletal maturation or bone growth is an
indicator of physiological development and continue
up to 25 years of age.

32. GROWTH MONITORING :
☻ Assessment of growth may be done by longitudinal & cross sectional
studies. The common parameters used for growth monitoring include,
head circumference, chest circumference, upper segment/lower segment
ratio. The following are the 3 measures used for comparisons:
Use of mean/median values.
Use of percentile
Use of indices as weight for height & weight for age.
Common reference values: WHO reference value & Indian standards
Indian standards: ICMR under took a national wide cross sectional study
during the year 1956- 1965. this tool is widely used in India as the reference
value to assess growth.

33. Normal development is a complex process & has a multitude
of facets. However, it is convenient to understand & assess
development under the following domains :
A.GROSS MOTOR DEVELOPMENT
B.FINE MOTOR DEVELOPMENT
C.PERSONAL & SOCIAL DEVELOPMENT
D.LANGUAGE DEVELOPMENT

34. GROSS MOTOR DEVELOPMENT
Motor development progress in an orderly sequence to ultimate
attainment of locomotion & more complex motor tasks thereafter. In an
infant it is assessed & observed as follows :

35. FINE MOTOR DEVLOPMENT
Fine motor development upon neural tract maturation. Fine
motor development promotes adaptive actives with fine
sensorimotor adjustments and include eye coordination, hand
eye coordination, hand to mouth coordination, hand skill as
finger thumb opposition, grasping, dressing etc.

37. PERSONAL & SOCIAL DEVELOPMENT
Personal and social development includes personal
reactions to his own social and cultural situations with
neuromotor maturity and environment stimulation. It
is related to interpersonal and social skill as social
smile, recognition of mother, use of toys.

39. LANGUAGE DEVELOPMENT

40. Assessment of Development:
Healthy development, in all forms, particularly
social/emotional, communication, and behavior, should be
monitored by parents and physicians through screenings at each
well visit
1. The Denver Developmental screening test :
Developmental originally by Franken –
burg and dodds(1967), this simple, economic and useful test screens for
developmental delays during infancy and the preschool period. On the test,
the age division are monthly until 2 years of age , and half yearly from 2 to 6
years of age .

41. 2. Baroda Screening test: It was developed by Dr. Promila phatak
with 25 test items primarily for psychological aspects. The test
is relevant for age 0 to 30 months. Gross motor, fine motor and
cognitive aspects are evaluated in 10 mints mainly by the
psychologist.
3. Trivandrum development screening test: It is simplified version
of Baroda DST that can be used by the health worker, nurses
and pediatricians/ physicians. It has17 test items relevant for 0 to 2
years of age. The children are evaluated in three domains
(gross motor, fine motor and cognitive for 5 minutes only)

42. BREAST SELF EXAMINATION

43. Step 1: Begin by looking at your breasts in the mirror with your
shoulders straight and your arms on your hips.
Here's what you should look for:

44. Step 2:
Now, raise your arms and look for the same changes.

45. Step 3:
• Next, feel your breasts while lying down, using your right hand to feel
your left breast and then your left hand to feel your right breast.
• Use a firm, smooth touch with the first few finger pads of your hand,
keeping the fingers flat and together.

46. STEP 4
• Cover the entire breast from top to bottom, side to side — from your
collarbone to the top of your abdomen, and from your armpit to your
cleavage.
• Follow a pattern to be sure that you cover the whole breast. You can begin at
the nipple, moving in larger and larger circles until you reach the outer edge
of the breast. You can also move your fingers up and down vertically and from
outer to inner.

47. • Be sure to feel all the tissue from the front to the back of your
breasts: for the skin and tissue just beneath, use light
pressure; use medium pressure for tissue in the middle
of your breasts; use firm pressure for the deep tissue in the
back. When you've reached the deep tissue, you should be
able to feel down to your ribcage.
• Continue palpating using 3 pressure levels :

48. Step 5:
Finally, feel your breasts while you are standing or
sitting. Many women find that the easiest way to feel
their breasts is when their skin is wet and slippery, so
they like to do this step in the shower. Cover your
entire breast, using the same hand movements
described in step 4.

49. EXAMINATION OF TESTICLES
• Self-examination of the testes is important for early detection of
testicular cancer.
• The most common method of early detection is performing a monthly
exam. Since Testicular Cancer is usually isolated to a single testicle,
comparison of your testicle with the other can be helpful.
• It is normal for one testicle to be slightly larger than the other.
• Your focus should be noticing any changes from the previous month.
• Upon reaching puberty, all men should conduct a monthly testicular
self-exam and ask your doctor during your yearly physical to perform one.
as well It is best to carry out testicular self-examination after a warm
bath or shower. Warmth relaxes your scrotum, making it easier to feel
anything abnormal.

50. STEPS :
Stand in front of a mirror
check for any external swelling on the skin
Examine each testicle with both hands. Place your index and
middle fingers under your testicle with your thumbs placed on
top. Roll each testicle gently between your thumbs and
fingers. You should not feel any pain when doing this. Do
not be alarmed if your testicles are not exactly the same size.

51. Find the epididymis, a soft tube-like structure behind the testicle that
collects and carries sperm. If you are familiar with this structure,
you will not mistake it for a suspicious lump. Cancerous lumps are
usually found on the sides or in front of the testicle.

52. What other abnormalities may be important?
any enlargement of a testicle
significant loss of size in one of the testicles
feeling of heaviness in the scrotum
dull ache in the lower abdomen or in the groin
sudden collection of fluid in the scrotum
pain or discomfort in a testicle or in the scrotum

53. ARTICLES REQUIRED:
Container for specimen
Benedict solution
Acetic acid
Test tubes & holder.
Kidney tray
Paper bag
Spirit lamp with spirit
Newspaper
Matchbox
Cotton balls in bowl
URINE FOR SUGAR AND ALBUMIN TEST

54. PROCEDURE : -
Select a proper place.
Spread the newspaper.
Unbutton the bag.
Take out the kidney tray and specimen bottle
Give the specimen bottle to the client for collecting urine.
Take out hand washing articles and wash the hands
Take the articles required for the test

55. Test for sugar : -
Pour 5 ml of benedict’s solution in the test tube.
Boil it to find out the color change, if no change that shows the
purity of benedict’s solution.
Add 8 drops of urine into solution and reheat it; allow it to cool.
Observe the color change which indicates the sugar level.
Blue : 0%
Green : 1%
Yellow : 2 %
Orange : 3 %
Brick red : 5%

56. • Fill the test tube 3/4th with urine
• Boil the top portion. If there is cloudy appearance it
indicates albumin/phosphate.
• Add 5 drops of acetic acid & reheat.
• If cloud still presents it indicates albumin presence
and if it disappears it shows phosphate presence .
Test for albumin:-

57. Termination of articles:-
• After the procedure it is essential to terminate the articles in a proper
manner.
• After the result, recording & reporting, dispose the urine sample, as well
as the liquid from the used test tube.
• Take the articles to the hand washing area.
• Wash each article clearly.
• Put the articles on newspaper for drying up.
• Wash your hands
• Give health education
• Wipe all the articles with spirit swab before placing them into the bag
• Replace all the articles
• Close the bag
• Fold the newspaper and place it in the outer pocket.

58. ESTIMATION
OF
BLOOD PRESSURE
 WHAT IS BLOOD PRESSURE?

59. Blood pressure (BP) is a measure of the force that
the circulating blood exerts against the arterial wall.
SYSTOLIC PRESSURE:
• Systolic pressure is the maximum pressure exerted by the
blood against the arterial walls.
• It results when the ventricles contract ( systole )
DIASTOLIC PRESSURE:
• Diastolic Pressure is the lowest pressure in the artery.
• It result when the ventricles are relaxed (diastole )

60. Time of measurement:
• Use multiple readings at different times during the waking hours
of the patient.
• For patient taking antihypertensive medications monitoring of
blood pressure should be done before taking the scheduled dose.
Patient position:
• BP should be measured in sitting position. Patient should sit
for 5 minutes before measuring BP.
• In elderly, supine and standing position can be used to detect
postural hypotension.

61. Where to listen for blood pressure sounds:
1. Locate the antecubital fossa of the patient’s arm and
palpate the brachial artery. This location is the point over
which the stethoscope is placed to listen for Korotkoff sounds
later.
2. Wrap the cuff approximately 2.5 inch above the antecubital
fossa.

62. RECOMMENDED BLOOD PRESSURE MEASUREMENT
TECHNIQUE:
The patient should be relaxed and the arm must be supported
Ensure no tight clothing constricts the arm
The cuff must be level with heart.
If arm circumference exceeds 33 cm, a large cuff must be used.
Place stethoscope diaphragm over brachial artery
The column of mercury must be vertical
Inflate to occlude the pulse
Deflate at 2 to 3 mm/s. Measure systolic (first sound) and
diastolic (disappearance) to nearest 2 mm Hg .

63. 1. First, set out your glucometer, a test strip, a lancet and alcohol
swab.
2. Wash your hands to prevent infection.
3. Decide where you are going to obtain the blood from, usually
fingers.
4. Sometimes it helps to warm your hands first to make the blood
flow easier. You can rub your hands together briskly or run them
under warm water.
BLOOD SUGAR ESTIMATION WITH GLUCOMETER
Time Required: 10 to 15 minutes
STEPS:

64. 5. Turn on the glucometer and place a test strip in the machine when the
machine is ready. Watch the indicator for placing the blood to the strip
6. Make sure your hand is dry and wipe the area you've selected with an
alcohol pad and wait until the alcohol evaporates.
7. Pierce your finger tip on the soft, fleshy pad and obtain a drop of blood. The
type of drop of blood is determined by the type of strip you are using (some
use a "hanging drop" of blood versus a small drop for strips that draw blood
in with a capillary action)
8. Place the drop of blood on or at the side of the strip.
9. The glucometer will take a few moments to calculate the blood sugar
reading. Follow your doctors order for whatever blood sugar reading you get.

65. 10. You may use the alcohol pad to blot the site where you
drew the blood if it is still bleeding.
11. Write down your results. Keeping a record makes it
easier for you and your doctor to establish a good
treatment plan. Some glucometers can store your results in a
memory, for easier record keeping.

83. GERIATRIC ASSESSMENT
Definition:
“A Multidimensional interdisciplinary diagnostic process
focused on determining a frail older person’s medical,
psychological and functional capability in order to develop a
coordinated and integrated plan for treatment and long term
follow up.”

84. Uses:
Develop treatment and long-term follow-up plans,
Arrange for primary care and rehabilitative services
Organize and facilitate the very complicate process of case
management,
Determine long-term care requirements
Make the best use of health care resources

85. Implications of Geriatric Assessment:
Improve the assessment of the medical and the
psychological Problems
To provide Therapy and Rehabilitation services
To determine optimal post therapy placement for
an independent functioning
To provide healthcare both by Healthcare
Professionals and care takers

86. Geriatric Assessment – Why it is important?
Focuses on elderly individuals with complex problems,
Emphasizes functional status and quality of life, and
Frequently takes advantage of an interdisciplinary team of providers.
Effectively addresses The "Five I's of Geriatrics” i.e.,
1. intellectual impairment,
2. immobility,
3. instability,
4. incontinence and
5. iatrogenic disorders (due to therapy or drug )

87. 1. Medical History :
1. Demographic details
2. Chief complaints
3. Present Illness
4. Past history
5. Social History
6. Family History
Comprehensive Geriatric Assessment
2. Medical Examination:
1. Visual Impairment/ complaints
2. Locomotive disorders, joints, muscles
3. Neurological complaints
4. Cardiovascular disease
5. Respiratory disorders
6. Weight Changes
7. Gastro-intestinal/ Abdominal disorder
8. Psychiatric problem
9. Hearing loss
10. Genitourinary disorder

88. Periodic Geriatric Assessment:
Detailed health assessment once they are 45-50 years
Once in 5 years till 65 years of age
Thereafter every year or at least once in 2 years

89. Geriatric Assessment Tools
1.Visual Impairment - Snellen Test
2.Falls/Gait Disturbance - Fall Screening Test, Balance
Assessment Tools
3. Neurological Complaints:
Mini Mental State Examination
Abbreviated mental status test
Clock drawing
Mini-cog
Montreal Cognitive Assessment

91. 4. Hearing Loss : Watch tick test
5. Genitourinary : 2-item questionnaire, Single question and The 3IQ
questionnaire
6. Psychiatric Problems :
Geriatric Depression Scale
Hospital Anxiety and Depression Scale, and
Patient Health Questionnaire.
7. Weight Changes :
Nutritional Health Checklist, Detailed Dietary Assessment using 24-hour
recall, Physical Examination – over-consumption or inadequate nutrition .

92. 8. Functional Assessment Tools:
1. An overall impact of health conditions in the context of
a patient’s environment and social support system .
2. This can be assessed at 3 levels:
a. Basic activities of daily living (BADLs),
b. Instrumental activities of daily living (IADLs), and
c. Advanced activities of daily living (AADLs).

93. 9. Social Assessment:
There is a great deal of interdependency between patients’
social situations and their functional status.
Living arrangements, financial security, transportation access to
medical services
Psychosocial/ interpersonal relations
A variety of private and public resources
Home assessments.