Knowledge of normal growth and

development of children

Is essential

for preventing and detecting disease by

recognizing overt deviations from normal
pattern

GROWTH AND DEVELOPMENT

Many people use the terms growth

and development interchangeably
In reality they are different, though they
inseparable, neither take place alone

GROWTH
Growth refers to quantitative changes

Increases in size and structure

Not only does the child become larger
physically, but the size and structure of the
internal organs and the brain increase
As result of the growth of the brain, the child
has a greater capacity of learning, for
remembering, and for reasoning
The child grows mentally as well as physically

Development refers
to quantitative and
DEVELOPMENT
qualitative changes
It may defined as a progressive series of orderly,
coherent changes
Progressive signifies that the changes are
directional, that they lead forward rather than
backward
Orderly and coherent suggest that there is a
definite relationship between the changes taking
place and those that preceded or will follow them

Fig 1 . The interacting of development

Physical, intellectual, and psychosocial developments should
not be viewed as separate entities because they operate
interdependently, each strongly influencing the others

PRINCIPLES OF DEVELOPMENT

Development involves changes

Early development is more critical than
later development
Development is the product of maturation
and learning
The developmental pattern is predictable
The developmental pattern has
predictable characteristics

There are individual differences

in development
There are periods in the developmental
pattern
There are social expectations for every
developmental period
Every area of development has
potential hazards

Hurlock EB. Child Development. Auckland : McGraw-Hill International

Book Co, 1978. P.22-47.

DEVELOPMENT INVOLVES CHANGES

Changes in size
Physical : height, weight, circumference,
internal organ
Mental : memory, reasoning, perception,
creative imagination
Changes in proportion
Physical : see Fig. 3
Mental : imaginative capacity is better
developed than reasoning
capacity;
while the reverse is
true in adults

1/2

1/3

2 mo (fetal) 5 mo

1/4

Newborn

1/5

1/6

1/7

1/8

2 yr

6 yr

12 yr

25 yr

Fig 2. Changes in body proportions from the 2nd fetal mo to

adulthood. (From Robbins WJ, Brody S, Hogan AG, et al:
Growth New Haven, Yale University Press, 1928)

Disappearance of old features

Physical : thymus gland, baby hair and
teeth
Mental : babyish locomotion and speech
Acquisition of new features
Physical : second teeth, primary and
secondary sex characteristics
Mental : interest in sex, moral standards,
religious beliefs

EARLY DEVELOPMENT IS MORE

CRITICAL THAN LATER
Conditions affecting early foundations

a. Favorable interpersonal relationship

b. Emotional states
c. Child - training methods
d. Early role - playing
e. Childhood family structure
f. Environmental stimulation

Fig 3. UNIVERSAL FACIAL EXPRESSIONS

Infants show these types of facial
expressions relating to basic emotions, regardless of the culture in which

DEVELOPMENT IS THE PRODUCT OF

MATURATION AND LEARNING
MATURATION

Intrinsic maturation.The unfolding of

characteristics potentially present in the
individuals genetic endowment
Phylogenetic functions
Functions common to the race, such as
creeping, crawling, sitting and walking.
Development comes from maturation
Ontogenetic functions. Functions specific to
the individual, such as swimming, ball
throwing, riding bicycle, writing. Training is
essential

Fig 4.
MILESTONES
OF MOTOR
DEVELOPMENT

.development is the product of maturation and learning

LEARNING

Learning is development that comes from

exercise and effort.
Through learning, children acquire
competence in using theirs hereditary
resources. They must have opportunity to
learn
Some learning comes from practice or the
mere repetition of an act

THE DEVELOPMENT PATTERN IS

PREDICTABLE
Developmental direction
Cephalocaudal - proximodistal law (fig.5)
Specific areas of development likewise
follow predictable patterns
Motor development, emotional behavior,
speech, social behavior, concept
development, goals, interests, and
identification with others

TWO PRINCIPLES OF
DEVELOPMENTAL DIRECTION
Cephalocaudal principle

Fig 5

Principle that development proceeds in a headto - tail direction : the upper body parts
develop before the lower parts
Proximodistal principle
Principle that development proceeds in a nearto-far manner : the parts of body near its center
(spinal cord) develop before the extremities

Fig 5. The laws of developmental direction

THE DEVELOPMENT PATTERN HAS

PREDICTABLE CHARACTERISTICS
Similarity in developmental patterns
All children follow a similar developmental
pattern with one stage leading to the next
General pattern is not altered by individual
variations in the speed of development
Development proceeds from general to
specific responses
In mental as well as in motor responses, general
activity always precedes specific activity
In emotional behavior babies first response to
strange and usual objects with general fear

.the development pattern has predictable characteristics

Development is continuos
Development is continuous from the moment
of conception to death but it occurs at
different rates, sometimes slowly and
sometimes rapidly
Developmental changes donot always go
forward in straight line but, in the end, the
changes lead forward

.the development pattern has predictable characteristics

Different areas develop at different rates

Fig 6. shows the pattern of development for four
different parts of the body (Brain and head,
General, Lymphoid, Reproduction)
There is correlation in development
When physical development is rapid, so in
mental development

200
LYMPHOID TYPE

180

PERCENTAGE

160
140
120
NEURALTYPE

100
80
GENERAL TYPE

60
40

GENITAL TYPE

20
0

12

16

20

AGE IN YEARS
Fig 6. Main types of postnatal growth of the various parts and organs of the
body. (After Scammon: The measurement of the body in childhood. In:
Harris B et al (eds): The Measurement of Man. Minneapolis, University of
Minnesota Press, 1930)

THERE ARE INDIVIDUAL DIFFERENCES IN

DEVELOPMENT
Although the pattern of development
is similar for all children
all children follow the predictable pattern
in their own way and at their own rate
all children do not reach the same point
of development at the same age

there are individual differences in development

Causes of differences

Every person is indeed biologically and

genetically different from every other
No two people have identical environmental
influences, even identical twins
Individual differences are caused by both
internal and external conditions

THERE ARE PERIODS IN

THE DEVELOPMENTAL PATTERN

There are five major developmental

periods in childhood (See Table 1)
Although eachperiod has its own
characteristic events and issues, the
ages given for each
time span are only approximate and
somewhat arbitrary

Table 1

The Chronological Phases of Childhood and

Their Major Characteristics

PHASE

TIME SPAN

CHARACTERISTICS

Prenatal
period

Conception to
birth

Infancy

Birth to 18
months
(up to 24
months)

Changes in brain functioning result

from an increased number of
neural connections, leading to a
period of intense development of
motor abilities, language
acquisition, and socialization

Early
childhood

18 months to 6
years

Through exploration, play, and the

development of self-sufficiency,
children become increasingly
willful and independent

Child begins as a single cell and

emerges 9 months later as a
multimillion-cell functioning
person

PHASE

TIME SPAN

CHARACTERISTICS

Middle
childhood

6 to 11 years

Emphasis is on learning the

fundamental skills of reading,
writing, and mathematics; more
complex thinking and reasoning
abilities become evident, and
children become capable of logical
thought and of seeing the world
from the point of view of others

Adolescence

11 to 18 years

Dramatic physical and

psychological changes occur; key
issues are separation,
independence, and peer
relationships

Tabel 2. Tahap-tahap Tumbuh Kembang Anak

1. Masa pranatal (Prenatal period)
a. Masa zigot / mudigah: konsepsi 2 minggu
b. Masa embrio: 2 minggu 8 / 12 minggu
c. Masa janin / fetus: 9 / 12 minggu lahir
- Masa fetus dini: 9 minggu trimester ke-2
- Masa fetus lanjut: trimester akhir kehamilan
2. Masa bayi (Infancy) : usia 0 1 tahun
a. Masa neonatal: usia 0 28 hari
- Masa neonatal dini: 0 7 hari
- Masa neonatal lanjut: 8 28 hari
b. Masa pasca neonatal: 29 hari 12 / 15 bulan
3. Masa anak dini (Early childhood)
a. Toddlerhood: usia 1 3 tahun
b. Masa pra sekolah (Preschool period): usia 3 6 tahun
4. Masa sekolah (School period): usia 6 18 / 20 tahun
a. Masa pra remaja (Middle and late childhood): usia 6 11 tahun
b. Masa remaja (Adolescence):
1. Masa remaja dini (Early adolescence): 11 - 13 tahun
2. Masa remaja pertengahan (Middle adolescence): 14 17 tahun
3. Masa remaja lanjut (Late adolescence): 17 20 tahun

THERE ARE SOCIAL EXPECTATIONS

FOR EVERY DEVELOPMENTAL PERIOD
Social expectations are known as
developmental task
Factors influencing mastery of developmental
tasks
Aids to mastery
Accelerated physical development
Strength and energy above average to age
Above average intelligence
An environment that offers opportunities for
learning
Guidance from parents and teachers in learning
A strong motivation to learn
Creativity accompanied by a willingness to be
different

.there are social expectations for every developmental period

Obstacles to mastery
Retardation of developmental level
(physical or mental) Poor health
A handicapping physical defect
Lack of opportunity to learn
Lack guidance in learning
Lack motivation to learn
Fear of beeing different

EVERY AREA OF DEVELOPMENT

HAS POTENTIAL HAZARD

Even when developmental pattern is

progressing normally, there are likely to be, at
every age, hazards in some areas of
development that interfere with this normal
pattern
Individual hazards arising from the childs
genetic endowment or environment
Forewarning of potential hazards associated
with different areas of development is
important

BIOLOGI

FISIK
MASYARAKAT

KELUARGA

INDIVIDU

SOSIAL DAN BUDAYA

EKONOMI DAN POLITIK

Fig 7. The influence of environment on child growth and

development

Fig 8. Bronfenbrenners Chronosystem

The pattern of developmental can be

interfered with either temporarily or
permanently, by environmental or physical
conditions

This interference may take the form of

delaying or accelerating the speed or it may
alter the pattern

FURTHER READING

1. Soetjiningsih,Tumbuh Kembang Anak,

1995
2. Nelson Text book of Pediatrics, 2004
3. Rudolphs Pediatrics, 2003
4. Soetjiningsih, Tumbuh Kembang Remaja
dan Permasalahannya, 2004
5. Hurlock EB, child Development, 1978