G&DThe process of growth & development start before the baby born that is from the conception in the mother’s womb. The period extends through out the life cycle. But the principle changes occurs from the conception to the end of adolescence.

GROWTH:- It is process of physical maturation resulting an increase in size of the body & various organs. It occurs by multiplication of cells & an increase in intracellular substance. It in quantitative changes of the body which can be measured in inches/c.m./kg. etc. It is measurable & progressive phenomenon.

DEVELOPMENT:- It is the process of functional & physiological maturation of the individual. It is progressive increase in skill & capacity of function. It include psychological emotional & social changes. It is qualitative aspects of maturation & difficult to measure.

1.) G & D is continuous & orderly process with individual difference & is unique to each child.
2.) It proceed by stages & its sequence is predictable & same in all children but there may be different in time of achievement.
3.) There is co-ordination between increase in size and maturation.
4.) They proceed in cephalocaudal (i.e from head to tail ) & proximodistal (i.e from centre or midline to periphery) direction.
5.) Initial mass activities and movement are replaced by specific response and action by the complex process of individualized changes.
6.) Rate of growth & development is interrelated to rapid in infancy & in puberty but slow in preschool and school age.
7.) G & D depends on combination of many interdependent factor especially by heredity and environment.

They influence directly or indirectly by promoting or hindering the process. The determinant can be grouped as heredity & environment. Heredity determines the extent of G & D that is possible, but environment determines the degree of which the potential is achieved.

1.) Genetic Factor :- Different characteristics i.e height, body structure, color of skin, eyes & hair depends on inherited gene from parent.
Abnormal gene from ancestors may produce different familiar disease which usually hinders G&D. Eg. Thalassemia etc. G&D also affect chromosomal abnormalities i.e Down’s syndrome.
Sex of children influence their physical attributes & pattern of growth. It is determine at conception. At birth male babies are heavier & longer than female.

2.) Prenatal factors:- Various condition influence the fetal growth in utero:-
• Maternal malnutrition:- Dietary insufficiency & anemia lead to intra uterine growth retardation. LBW & preterm have poor growth potentials.
• Maternal infections:- Different intra uterine infection like HIV, HBV, TORCH etc. may transmit to the fetus via placenta & affect the fetal growth.
• Maternal substance abuse:- Intake of teratogenic drugs(thalidomide, phenytoin etc.) by the pregnant women in the first trimester affect the organogenesis hinder fetal growth . Maternal tobacoo intake ( smoking & chewing) & alcohol abuse also produce fetal growth restriction.
• Maternal illness:- Pregnancy Induced HTN, anemia, heart disease, DM, hypothyroidism have adverse effect on fetal growth.
• Hormones:- like thyroxine, & insulin influence fetal growth. Thyroxine deficiency retards the skeletal maturation of the fetus.

• Miscellaneous :- Various condition like uterine malformation (septed uterus, bicornuate uterus) malposition of fetus, polyhydramnios, inadequate prenatal care etc. influence fetal growth.

3.) Post-Natal Factors :-
• Growth potentials – It indicated by the child’s size at birth. The smaller the child at the birth, the smaller he is likely to be in subsequent years. LBW babies have various complication in later life which retard child’s growth.

• Nutrition – Balanced amount of nutrient have great role in G&D of child. Both qualitative & quantitative supply of nutrition (i.e protein, fat, CHO, vitamin and minerals in the daily diet are necessary for promotion of G&D. It help the child in body building energy production & protection from infections.

• Childhood illness :- Chronic diseases of heart (CHD, rheumatic heart disease), chest (TB, asthma), kidney (nephrotic syndrome, liver (cirrhosis) malabsorption syndrome etc. lead to growth impairement.
Accidental injury,prolong hospitalization have adverse effect on G&D.

• Physical event:- Housing, living condition safety measures, enviornment sanitation ventilation, fresh air, hygiene, water supply etc. having direct influence on child’s growth & development.

• Psychological event:- Good parent-child relationship & healthy interaction with other family member, neighbours, friend peers & teacher are important factors for promoting emotional, social & intellectual development. Broken family, lack of love affection, lead to emotional & personality development disorder.

• Cultural influence:- The child learn standard of honesty, discipline, intellectual inquiry, manners, aggression from family & society. The childrearing practice, food habit, traditional belief, social taboos, attitude towards health, standard of living also influence G&D.

• Socio- economic status:- Poor socio economic group may have less favorable environment for G&D than the middle & upper groups.

• Climate & season:- weight gain is greatest in late summer rainy reason autumn. Max height gain among children in spring,these influence the activity level.

• Play & Exercise:- It promote physiological activity & stimulate muscular development social, moral, intellectual, emotional development are enhanced by play & exercise.

• Birth order of Child :- The 1st born child gets free attention until the 2nd child born. They learn from adult & 2nd born learns from elder one. Middle born gets less attention.

• Intelligence :- It influence mental and social development. A child with higher intelligence adjust with environment promptly & fulfill own needs & demands whereas a child with low level of intelligence fail to do.

• Hormonal influence :- Hormones are the important aspects of internal environment. Which have vital role in G&D. All hormones in body affect growth in some manner. The important 3 are:- somatotrophic hormone, thyroid hormone, adrenocorticotrophic hormone stimulate to secrete gonadotrophic hormone. Other that less directly influence the process of G&D include insulin, cortisol, calcitonin etc.