Normal child development and normal growth of a child

It is fascinating to study the topic of normal child development. It is extremely difficult to define a normal human being as there are wide variations.

There are many factors-genetic, racial and environmental affecting growth and development of a child.

The word growth is used to denote increase is the size of the body whereas development refers to functional maturity and acquisition of skills.

Growth from a single cell in the womb to the full term baby continues after birth till the end of adolescence. The rate of growth varies during different stages.

The normal baby weighs between 2.5 and 4 kg at birth. This range covers the majority of newborn babies. However slight deviations are occasionally seen without any abnormality.

After birth it is normal for a baby to lose up to 10% of body weight. The birth weight is regained by about the 10th day. Thereafter the weight goes on increasing. The rate of weight gain also varies among babies.

During the first six months the weight increases by approximately 600g/month and for the next six month by about 300g/month. The birth weight doubles between 5 and 6 months and triples by 1 year and quadruples by 2 years.

After the first year the rate of weight gain decreases. Any acute illness can cause temporary weight loss which is regained once the child recovers.

It is essential to check a child’s weight every month for the first six months. This can be combined with vaccination.

If everything is normal monthly check-up is not needed after 6 months. Further assessment can be done when the child is brought for vaccination at nine months, fifteen months and eighteen months.

Due to wide variations in normal growth it is not easy to comment on one value. When in doubt it is better to compare the weight of the child with a standard chart.

The length at birth varies between 45 and 50 cms. It increases to about 75 by one year and 100 cms by the end of 4 years.

Thereafter it increases by about 5 cms per year till adolescence when a spurt in linear growth occurs due to hormonal changes.

Linear growth is complete by about 16 years is girls and by about 18 years is boys.

Due to relatively greater increase is weight compared to length babies tend to have a plump appearance till about 2 years. Afterwards they look leaner.

There is wide variation in linear growth also. It depends on multiple factors- racial and genetic. Many parents are curious to know how tall their son or daughter would be. We can give an approximate idea using the following formula.

Mid-parental height for boys= Mean parental height + 7 cms

Mid-parental height for girls= Mean parental height - 7 cms

Mean parental height= (Father’s height in cms + Mother’s height in cms)/2

As with weight we cannot comment on a single value. Linear growth is not affected by acute illness. However chronic diseases can affect it. When in doubt serial measurements have to be taken and the values compared with a standard chart.

Normal child development is a complex issue and there are two ways of describing it. One is to take each area of development (speech, motor skills etc.) and describe the various stages attained at different ages.

The other is to mention the various milestones which are attained at particular ages. The latter is easier for people to understand as it tells them what their child should be doing at a particular age.

The following description applies to development of a full term baby. Development of premature babies will be delayed depending on the degree of prematurity at birth.

Once again it is very important to remember that normal child development varies widely and no two children are alike. Isolated delay in one area of development is less significant than delay in all areas of development.

Parents often worry when relatives or friends ask them whether the child has started walking or saying a few words. It is not wise to attach too much of importance to such comments but seek professional opinion.

They can compare the development of their child with the following description but should not get panicky about some variation. When in doubt professional consultation should be sought.

Normal child development newborn baby to two months

Precise developmental assessment is not possible at birth. If the baby cries vigorously, moves all limbs, shows startle response when there is a loud sound and is feeding well we can be reasonably sure that there is no serious problem.

We can assess the function of a particular part of brain only when it is mature. As most of the brain functions are not developed at birth correct assessment is not possible. A baby starts smiling spontaneously between four to six weeks but does not look at the mother.

By the end of two months a baby looks at the mother making eye to eye contact and smiles. He is also able to follow light through 180 degrees from side to side. Any baby who does not smile by the end of two months should be shown to a Pediatrician.

If a newborn baby is gently lifted by holding the hands the head completely lags behind and if the baby is made to sit the head falls on the chest. Development proceeds from the head to lower limbs and control over the neck muscles is attained earlier than control of upper limbs.

Normal child development three months

By three months a baby is able to hold the neck straight though slight bobbing is common. He also makes a few cooing sounds.

Normal child development four months

A four month old baby can reach for and grasp objects. This marks the beginning of eye hand co-ordination. However the grasp is immature. He cannot approximate the thumb and a finger to grasp a small object (pincer grip).

Normal child development five months

At five months he can hold his head steady when made to sit with support. But he cannot sit without support. The back is curved when held in sitting position.

Normal child development six to seven months

After completion of six months developmental assessment can be quite accurate. But for Learning Disorders, we can assess the status of the nervous system correctly. When placed on his abdomen he can lift his head and most of his chest while supporting his weight on his upper limbs.

He can transfer objects from one hand to the other between six and seven months. If some sound is produced outside the field of his vision, he turns towards the source of sound. He starts uttering monosyllables like ma or da but without attaching any meaning to the syllables.

Normal child development eight months

He can sit without support. The back is straight while sitting.

Normal child development nine months

He is able to bear weight for some time if held in standing position. He starts to crawl on his abdomen. He can hold a small object by approximating the thumb and fore finger (pincer grip). He can utter bi-syllables like mama and dada.

Normal child development ten months

Starts creeping on his hands and knees taking his abdomen off the ground. You can encourage him to move forward by placing some toys in front of his at some distance.

Some babies do not crawl but start walking directly. He can also pull himself to stand holding onto furniture.

Normal child development one year to eighteen months

By the age of one year a child can stand without any support and take a few steps with some support. He says about two words with meaning. At 13 months he can walk without any support.

He can turn two or three pages of a book at a time at 13 months. At about 15 months a toddler can take a few steps sideways or even backwards. He can feed himself with a spoon.

Normal child development one and a half to two years

At one a half years a child can run a short distance. He can also feed himself with a cup at this age. He can climb up stairs by the age of two years. But he brings both feet to a step before climbing the next and cannot alternate.

By two years he can turn the pages of a book one by one. He can copy and draw a horizontal or vertical line by two years. He can build a tower of 3 to 4 cubes by one and a half years and a tower of 6 to 7 cubes by two years.

A one and a half year old child has a vocabulary of 4 to 20 words. At two years he can verbalize toilet needs, speak short phrases of two to three words and point to a few named objects or pictures.

Normal child development two to three years

After two years he can jump off the floor with both feet. By the age of two and a half years he can walk backwards and begins to hop on one foot. At two and a half years he can copy a crude circle and holds crayon in fist. He refers to self as I and can point to objects described by use.

Normal child development three to four years

Can hold crayon with fingers. He can dress or undress completely but needs help with buttoning. He can climb up stairs in a coordinated manner keeping one foot per step.

At three years he can ride a tricycle. He can build a tower of 9 to 10 cubes. He copies circle and imitates a three cubes bridge.

He is able to give full name. He draws a circle when asked to draw a person. He has a vocabulary of 250 words and can withhold and postpone bowel movement for a short period.

Normal child development four to five years

He can run and turn without losing balance and can stand on one leg for about ten seconds. He is able to button his clothes. He can count to four.

If asked to draw a person draws a circle with two appendages. He knows the days of the week. He can imitate and copy a + after seeing someone draw it. Later he can copy one already drawn.

Normal child development five to six years

He can skip and catch a ball thrown at him. He knows right and left hand. At six years he has a vocabulary of about 2500 words and can speak six to seven word sentences. He can draw a person with eight details.

By the time a child completes six years we can be sure about the status of development. Any Learning disability would have manifested itself by this time.

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