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GROWTH
£
^ rowth an extremely regular process, refers to the continuous addition in body
dimensions o f an organism over a period of time (Kaul and Nyamongo 1990).
It denotes a net increase in the size or mass of tissues, It is largely attributed to
multiplication o f cells and increase in the intracellular substance. Hypertrophy or
expansion of cell size contributes to a lesser extent to the process of Growth (Ghai
1993). Since growth signifies an increase in the size of the body and its different
organs, it can be measured in terms of centimeters or inches and kilograms or pounds
(Park and Park 1983).
The growth of a child is the outward expression of the interaction between its
genetic potential and environment. The various stages of the growth process, i.e.
embryonic, foetal, neonatal, infancy, childhood, and the adolescence merge smoothly
with each other to provide, under normal conditions, a smooth continuum from
conception to adulthood. Although growth progresses in a smooth and harmonious
fashion, it is not uniform across the various stages (Srivastava 1998).
M ost people equate growth with an increase in height and weight. 1 hese are, of
course, the most obvious signs, but there are also less apparent kinds of growth in
infants. Increases in weight and height are only a rough index of total growth because
different parts o f the body mature at different rates (Ambron 1975).
11
I:
The C ourse o f Physical G row th
At an early age and tliioughout life a c h ild ’s image o f his body and its
properties are im portant features o f the conception o f h im se lf A yonng child is
especially rem inded o f his body size and his physical strength. Being small has much
the sam e m eaning as being older and having m ore know ledge and sell' directive
(Sharm a 1995).
I .l:
C h a n g es in B ody Size
The m ost obvious signs o f physical growth are changes in the size o f the
child’s body as a w hole. D uring infancy, these changes are faster than they will be at
any tim e after birth. By the end o f the first year, the infants height is 50 per cent
greater than it w as at birth; and by 2 years, it is 75 per cent greater. W eight shows
sim ilar dram atic gains. By 5 m onths, birth w eight has doubled; at 1 year, it has tripled;
and 2 years, it has quadrupled. Infact, if children kept grow ing at the rate they do
during the early m onths o f life, by age
1 0
they w ould be
10
feet tall and w eigh
2 0 0
pounds. Fortunately, grow th slow s in early and m iddle childhood.
Tw o types o f grow th curves are used to track changes in height and weight.
D istance curve and velocity curve. D istance curve plots the average height and weight
o f a sam ple o f children at each age. T he group averages are referred to as growth
norm s. V elocity curve plots the average am ount o f grow th at each early interval (Berk
1994).
Since the overall grow th trends are derived from group averages, they are
deceiving in one respect. R esearchers who have carefully tracked height changes o f
individual children repoit that rather than steady gains, little grow th spurts occur
throughout infancy and childhood. In one investigation, infants w ere follow ed over the
first 21 m onths o f life - T hey w ent for period o f 7 to 63 days w ith no growtii and then
added as m uch as a half-inch in a 24 hour period. A hiiost alw ays, parents described
their babies as irritable, restless, and very hungry on the day before the spurt (Lainpl,
Veldhvis and Johnson, 1992). A study o f Scottish children, w ho were follow ed
between the ages 3 and 10, revealed sim ilar but m ore widely spaced spuits in height.
Girls tended to forge ahead at ages four and a h a lf six and a half, eight and a h a lf and
ten, boys slightly later at four and a half, seven, nine and ten and a h a lf hi between
these spurts were lulls in w hich grow th was slow er (Butler, M ckie and R atC liff 1990).
1. 2:
C h a n g e s in B ody P ro p o rtio n s
A s the c h ild ’s overall size increases, different parts o f body grow at different
rates. The head develops first from the prim itive em bryonic disk, follow ed by the
lower portion o f the body. D uring infancy, the head and chest continue to have a
grow th advantage, but the trunk and legs gradually pick up speed. Physical growth
during infancy and childliood follow s proxim odistal trend. It begins at the center o f the
body and m oves outw ards, w ith the upper arm s grow ing before the low er arms, w hich
grow before the hands. A lthough body proportions o f girls and boys are sim ilar in
infancy and childhood, m ajor difference that are typical o f young adults appear during
adolescence. These differences arc caused by the action o f sex horm ones on skeletal
grow ths. B oys end up m uch larger than girls and their legs are longer in relation to the
rest o f the body. The m ajor reason is that boys benefit from tw o extra years o f
preadolescent grow th, w hen the legs are grow ing the fastest (T anner 1990).
1.3:
C hanges in B ody C om position
M ajor changes in the body’s m uscle fat m ake up take place w ith age. Body fat
begins to increase in the last few w eeks o f prenatal life and continues to do so after
birth, reaching a peak at about 9 m onths o f age. T his very early rise in “ baby fat” helps
the sm all infant to keep constant body tem perature. T hen, begim iing in tiie second year
13
o f life, cliildreii becoinc more slender, a liend lhat continues into m iddle childhood. At
birth, girls have slightly m ore body fat than boys, a difference that becom es greater
over the course o f childhood. A round age
8
, girls start to add m ore fat than boys on
their arms, legs and trunk, and they do so throughout puberty. In contrast, the arm and
leg fat o f adolescent boys decreases (T anner and W hitehouse 1975).
M uscle grow s according to a different pattern than fat, accum ulating very
slowly throughout infancy and childhood. Then it rises dram atically at adolescence.
Although both sexes gain in m uscle at puberty. The increase is m uch greater for boys,
who develop larger skeletal m uscles and hearts and a great lung capacity. Also, the
num ber o f red blood cells, and therefore the ability to carry oxygen from the lungs to
the m uscles, increases in boys but not in girls (K atchadourian 1977).
1.4:
S k e leta l G ro w th
T he skeletal system is m ade up o f bones and teeth. M ost people think o f
skeletal in term s o f changes in height and w eight and the appearance o f teeth (D ecker
1988). Since children o f the sam e age differ m arkedly in the rates o f growth,
researchers have devised m ethods for m easuring progress tow ards physical m aturity.
These techniques are useful for studying the causes and consequences o f individual
differences in physical growth. T hey also provide rough estim ates o f children’s
chronological age in areas o f the w orld w here bir1 h dates are not recorded (Berk 1994).
The best w ay o f estim ating a c h ild ’s physical m aturity is to use skeletal age, a m easure
o f developm ent o f the bones o f the body. Skeletal age can be estim ated by X -raying
the bones o f the body and seeing how m any epiphyses there are and the extent to
w hich they are fused. In the absence o f X -rays, dental developm ent is likely to be
advanced in physical m aturity (M ott; Jam es and Sperhac 1990).
14
W hen the skeletal ages o f infonts and children are exam ined, girls are
considerably ahead o f boys. At birth, the difference betw een the sexes am ounts to
about 4 to
6
w eeks a gap that w idens over infancy and childhood and is responsible for
the fact that girls reach their full body size several years before boys. Girls are
advanced in developm ent o f other organs as well. Girls also experience fever
developm ental problem s, and infant and childhood m ortality for girls is also lower
(Tanner 1990).
II:
N ature and Phenom ena o f G rowth
The individual is ever changing in term s o f grow th and m orphogenesis. The
nature and the phenom ena o f grow th are considered here in relation to the eras o f
m ajor change or difference in grow th rate, nam ely intrauterine life, infancy, childhood,
adolescence, and adulthood (Sm ith 1976).
II.1:
Intrauterine Life
The M ajor E ra o f M aternal Influences on G row th: The size o f a full-term infant
does not correlate w ell w ith the size o f the father; it correlates inore w ith the size o f
the m other (M orton 1955; C aw ley et al 1954). Thom son has em phasized that large
m others have larger babies: The offspring o f a 170 cm, 75 kg w om an was 0.75 kg
larger than the new born o f a 150 cm, 40 kg w om an. The practical application o f this
know ledge has been stressed by M ata. His studies in a G uatem alan rural village
dem onstrated that sm aller w om en have sm aller babies, w ho have higher rates o f
m orbidity and m ortality from infectious disease, rem ain sm aller and do not perform as
w ell as babies born o f larger w om en (Sm ith 1976). Placenta and sex o f the baby has a
role to play in the deceleration o f late fetal grow th. The m ale fetus grow s faster than
the fem ale, predom inantly after 32 w eeks gestation. Thus, the new born boy averages
9cm longer, is 150 gm heavier, and has a greater head circum ference at full term than
15
the female (Babson, Belirmaii and Lessel 1970). Male new bom babies are slightly
more m uscular and less obese than fem ale new born babies (T anner 1974).
II.2:
Infancy
fh e lira o f C hanging G row th Rate: 1he faster late fetal growth rate o f the male
as com pared to that o f the fem ale in length, w eight, and head growth continues for
three to six m onths after birth (Sm ith et al 1976). T hereafter, there is no appreciable
sex difference in grow th rate until the advent o f adolescence.
A fter birth, the infant shifts from a grow th rate that is predom inantly
determ ined by m aternal factors to one that is increasingly related to his own genetic
background, as reflected by m id-parental size. As a consequence, for about tw o thirds
o f norma! infants, the linear growth rate shifts during the first 12 to 18 months. Tlie
num ber shifting upw ard and the num ber shifting dow nw ard in grow th rate are about
equal (Sm ith, T ruog el al
1976). Infants who are relatively sm all at birth but whose
genetic background indicates larger size begin their acceleration tow ards the new
growth rate soon after birth, and they have achieved a new channel o f grow th by
4
to
18 m onths (Sm ith et a l 1976).
T hus, new bom s w ho are sm all for gestational age but have the genetic
capacity to catch up to the norm al range generally show accelerated grow th w ithin the
first six m onths after birth. In contrast, m ost sm all-for-date babies w ho do not show
catch-up grow th during the first
6
m onths continue to grow at a slow rate into
childhood and are generally destined to be o f sm all structure (Fitzhardine and Steven
1972).
D uring infancy, the infant is generally obese and by 1 year is m ore than 50 per
cent longer than at birth and about three tim es as iieavy. T ow ards the latter part o f the
first year, there is a gradual dim inution in grow th rate, accom panied by a reduction in
16
the degree o f adiposity (G am et al 1983), By 18 montlis to 2 years, the older infant has
achieved the m ore consistent grow th rate o f childhood.
11.3:
C hildhood
The Era o f Stable G rowth: By the age o f 18 m onths to 2 years the m ajor shilts
in infantile grow th rate are over, and the child grows at a fairly consistent rate o f 5 to
7.5 cm yearly. There is gradual deceleration o f linear grow th rate and an acceleration
o f w eight gain in the period betw een infancy and adolescence. The m ajor period o f
brain grow th is then over, and lym phoid tissue has achieved its greatest size in
proportion to the individual. A diposity is relatively less in m id-childhood but often
increases in the few years before adolescence (Sm ith 1976).
II.4:
A dolesccncc
The Era o f Sex H orm one - induced Shifting Growth: The acceleration o f linear
growth gradually increases, with a peak grow th velocity about tw o to three years after
the advent o f adolescence. The fem ale m atures m ore rapidly than the m ale throughout
childhood and begins adolescence tw o years earlier, at the average age o f
1 0
years
(Sm ith 1976).
Ill:
Prin ciples o f Physical G row th
III.l:
T he P rinciple o f D evelopm ental D irection
G row th, both in physical structure and in functioning, tends to proceed along
head-to-feet (C ephalocaudal) and centre-to-periphery (Proxim odistal) gradients. Thus,
the head reaches adult size first, the legs last, and internal organs like the heait reach
full capacity to function before the extrem ities do.
17
111.2: The Principle o f C ontinuity
Bodily growth proceeds in a continuous fashion. It is not reversible and never
stops except w hen a child is affected w ith disease or severe m alnutrition. However,
somatic (bodily) grow th does not always proceed at the sam e rate; it m ay spurt or slow
down for e.g., typically the periods from birth to
2
years and from II to 15 years are
tim es o f very rapid growth; the years from 3 through 10 and from 16 tlirough 18 show
relatively slow growth.
111.3: T lic P rincipal o f U evclopniental Sequence
A s a general rule, steps o f physical grow th follow one another in a som ew hat
uniform and predictable order. T hat is, alm ost all children lose certain baby teeth first,
certain other last; alm ost all reach puberty before they attain physical stature.
N ot all children operate according to the sam e tim e table, but the sequence o f
events tends to be predictable.
111.4: T he P rinciple o f M aturation or R eadiness
M ost accom plishm ents o f a child require a certain level o f skeletal-m uscularneurological developm ent. W hen this level o f d evelopm ent has been reached, we say
that a child biologically is “ready” to perform a certain task. A lthough he m ay not
perform it even w hen he is ready, he cannot perform it before that tim e. Thus, a child
of
6
m onths appears to be unable to control his bladder, no m atter how he m ay try. N or
can a child o f 6 m onths learn to walk.
1II.5: T h e P rinciple o f Individual G row th Patterns
A lthough developm ental direction and sequence are roughly the sam e for all
children, individual children differ greatly w ith respect to th eir ow n tim e schedules.
One baby is able to pick up a ball m uch sooner than another; one child loses his first
incisors earlier than another. Furtherm ore, the old beliefs that a “ slow grow er” will
18
catch up by spurting later on and that a given child will grow faster in som e respects
than in others seem highly questionable. A ciiild who grow s fast in one physical
featiue is likely to grow fast in all features, and he is likely to continue growing fast
imtil his full growth is reached. The converse is true for a slow grower (N anda 1998).
IV:
Factors Influencing G row th
G row th results from the continuous and com plex interplay betw een heredity
and environm ent (Berk 1994). Som e o f the factors w hich influence growth are as
follows:
IV .l:
H e re d ity
O ur genetic heritage is individual as well as species-specific. In addition to
being program m ed for the basic developm ental sequences, each o f us also receives
genetic instructions for unique grow th tendencies. Both size and body shape seem to
be heavily influenced by specific inheritance (Bee 1989). The genes we inherit have
the biggest say in m oulding our basic body - w hether w e w ill be tall and thin, short and
stocky or ju st in betw een (M ittler 1971). T all parents tend to have tall children; short
parents tend to have short children (G ain 1980). The size o f the head is m ore closely
related to that o f parents than are the size and shape o f hands and feet (Ghai 1993).
G row th potential o f children o f different racial groups is variable (G hai 1993).
Racial differences are largely the consequence o f m ultiple gene differences. It is not
surprising that there should be differences in size and in pace o f m aturation am ong
som e racial groups (Sm ith 1976). T he bones o f black children harden earlier than
those o f w hite children, and their perm anent teeth appear sooner. B lack children
m ature earlier than w hite children, and they tend to be larger (A A P 1973).
19
Rate or tem po o f grow th seem s to be an inherited pattern as well. Parents who
were them selves early developers, as m easured by such things as bone ossification or
age o f m enarche, tend to have children w ho are fast developers too (Garn 1980).
Since identical tw ins are m uch more alike in body size than are fraternal twins,
we know that heredity is an im portant factor in growth. How ever, this resem blance
depends on w hen infant tw ins are m easured. At birth, the differences in lengths and
weights o f identical tw ins are actually greater than those o f fraternal twins. The reason
is that identical tw ins share the sam e placenta, and one baby usually m anages to get
m ore nourishm ent. A s long as negative environm ental factors are not severe, the
sm aller baby recovers and sw ings back to her genetically determ ined path o f growth
within a few m onths (W ilson 1976). T his tendency is called catch-up growth, and it
persists throughout childhood and adolescence.
G enes control grow th by inlluencing the body’s production o f and sensitivity to
horm ones. Som etim es m utations disrupt this process, leading to deviations in physical
size. O ccasionally, a m utation becom es w idespread in a population. C onsider the Efe
o f Zaire, an A frican people w ho typically grow to an adult height o f less than 5 feet.
D uring early childhood, the grow th o f E fe children tapers o ff to a greater extent than
that o f other pre-scholars because their bodies are less responsive to grow th H arm one
(GH). By age 5, the average Efe child is shorter than are 97 per cent o f 5 year - olds in
the U nited States (B ailey 1990).
W hen environm ental conditions are adequate, height and rate o f piiysical
m aturity (as m easured by skeletal age and tim ing o f m enarche) are strongly influenced
by heredity. For exam ple, identical tw ins generally reach m enarche w ith a m onth or
tw o o f each other, w hereas fraternal tw ins differ by about 12 m onths (T anner 1990).
Body w eight is also affected by hereditary m ake up, since the w eights o f adopted
A llam a
20
1-ibrat?
i b c sis
^
No.
children correlate m ore strongly w ith those o f their biological than adoptive parents
(Stunkard et al 1986). N evertheless, reaching genetic potential in any aspect o f
physical grow th depends on appropriate environm ental support, and good nutrition is
essential.
IV .2:
N u tritio n
N utrition is im portant at any tim e during grow th period, but it is especially
critical during infancy because o f rapid brain and body growth. A young baby's energy
needs are tw ice as great as those o f an adult. This is because 25 per cent o f tlie infant's
total caloric intake is devoted to growth, and extra calories are needed to keep rapidly
developing organs o f the body functioning property (Pipes 1989).
Babies do not ju st need enough food. T hey need the right kind o f food, hi early
infancy, breast-feeding is especially suited to their needs. B ecause o f the benefits o f
breast feeding, breast-fed babies in poverty-stricken regions o f the w orld are m uch less
likely to be m alnourished and
6
to 14 tim es m ore likely to survive the first year o f life
(Grant 1992).
Breast m ilk has been term ed as the “ U ltim ate health food” (O lds and Eiger
1973) because it offers so m any benefits to babies. Breast-fed children are protected in
varying degrees against diarrhea, respiratory infections, allergy, colds, bronchitis,
pneum onia, G erm an m easles, scarlet fever, and polio (Jelliffe and Jelliffe 1971). They
are m ore likely to have healthy teeth and less likely to be obese or to suffer from
prem ature atherosclerosis (T ank 1960).
H ow ever, breast-feeding is not for everyone. Som e m others sim ply do not like
it, or they are em barrassed by it. O ccasionally, m edical reasons prevent a m other from
nursing. If she has a serious viral or bacterial disease, such as AID S or tuberculosis,
she runs the risk o f infecting h er baby (Seltzer and B enjam in 1990).
21
By
6
m onths o f age, infants require the nutritional diversity o f solid foods and
around 1 year, their diets should include all the basic food groups (M ott, Janies and
Sperhac 1990). A t about age 2, there is often a dram atic change in the quantity and
variety o f foods that children will eat. M any who as toddlers tried anything and
everything becom e picky eaters. This decline in appetite is norm al. U occurs because
growth has slow ed. A nd preschoolers’ w ariness o f new food m ay be adaptive. Young
children are still learning which item s are safe to eat and w hich are not. By sticking to
fam iliar foods they are less likely to sw allow dangerous substances when adults are not
around to protect them (R ozin 1990.)
A lthough the A m erican A ssociation Pediatrics (A A P) recom m ends w aiting to
start solid foods until 4 to
6
m onths o f age, m any infants begin getting solids-usually
cereal or strained fruits by the age o f 3-4 m onths. Som e nutritionists condem n early
feeding o f solids as a form o f “ forced feeding” (I'om on el al 1979), because babies
who cannot sit w ithout support or control their heads and necks cannot effectively
com m unicate w hen they have had enough.
O f course, children need a good diet beyond infancy. C hildren w ho do not get
sufficient and proper food due to either poverty or ignorance are m alnourished and do
not grow properly (A rya 1996). M alnutrition in the early years m ay have a perm anent
effect on som e p aits o f the brain and nervous System (Bee 1989).
I'lio period o f m axim um brain growlh is the first 2 lo 3 years alter birth
(particularly the first
6
m onths after birth). Severe m alnutrition during that tim e, even
if the child later has an adequate diet, m ay still cause a lasting slow rate o f physical
and m otor developm ent (M alina 1982). In developing countries w here food resources
are lim ited m alnutrition is w idespread. Recent evidence indicates that 40 to 60 per cent
o f the w o rld ’s children do not get enough to eat (L o zo ff 1989). A m ong the 4 to 7 per
22
cent w ho are severely all'ected, m alnutrition leads to tw o dietary diseases: M arasm us
and Kw ashiorker. K w ashiorkor (Protein m alnutrition) - this nam e m eans the diseaseof-the-child-w ho-is-w eaned-w hen the new child is born. It is very com m on in those
parts o f the w orld w here the diet is m ainly carbohydrate. M arasm us refers to the
severely m alnourished child who prim arily lacks calories and who is less then 60 per
cent o f the expected weiglit for age and has no odem a (Rendle 1970).
Children w ho m anage to survive these extrem e form s o f m alnutrition grow to
be sm aller in all body dim ensions (C aller, Ram sey and Solim ana 1985). in addition,
their brains are seriously affected. One long term study at M arasum ic children revealed
that an im proved diet lead to som e catch-up grow th in height, but the children failed to
catch up in head size (Stoch et al 1982).
The effects o f m ilder m alnutrition, or subnutrition, are harder to detect and
have not been w idely studied. We really d o n ’t know how poorly the child m ust be
nourished before w e see the effects in grow th rate or m otor coordination. It does
appear, how ever, that chronic sub-nutrition affects the c h ild ’s level o f energy, w hich in
turn can affect the nature o f the interactions the child has w ith both the objects and the
people around him (B arrett et al 1982). M alnutrition low ers childrens resistance to
disease. T hey are less able to resist viruses, bacteria and fungi then other children
(E delm an 1977, E delm an et al, 1973).
IV.3:
Illness
A m ong w ell-nourished youngsters, ordinary childhood illnesses have no effect
on physical grow th. B ut w hen children are poorly fed, disease interacts w ith
m alnutrition in a vicious spiral, and the consequences can be severe.
In developing nations w here a large proportion o f the population live in
poverty, illnesses such as m easles and chicken pox occur in infancy and take the form
23
o f severe illnesses. Poor diet depresses the body’s im m une system , m aking children far
more susceptible to disease (Eveleth and Tanner 1990). D iseases in turn, is a m ajor
cause o f m alnutrition and, through, it affect growth.
Due to the high prevalence o f infections disease. N ot only does growth stop, as
a rule, during the period o f disease, but the sick child gets even less food while ill and
convalescing, partly because his appetite is poor and partly as a result o f a traditional
witliliolding o f certain foods during illness. There is thus a vicious circle; infection
aggravates m alnutrition and m alnutrition renders the child m ore prone to infection
(W allgrens and R obinson 1973).
IV.4:
E m otional Stress
Severe em otional stress is another factor that affects c hildren’s growth.
U nloving care or extrem e neglect can cause a child to stop grow ing, even if the child is
fed adequately (Stew art and Friedm an 1987).
hiorganic failure to thrive is usually
present by 18 m onths o f age. Lifants w ho have it show all the signs o f m arasm us.
H ow ever, no organic (or biological) cause for the baby’s w asted appearance can be
found. E nough food is offered, and the infant does not have a serious illness. The
behaviour o f babies w ith failure to thrive provides a strong clue to its diagnosis. In
addition to apathy and w ithdraw al, these infants keep their eyes on nearby adults,
anxiously w atching their every m ove. T hey rarely sm ile w hen the m other com es near
or cuddle w hen picked up (Leonard et al 1986; O ates 1985). Em otional deprivation as
in broken hom es or orphanages also interfere w ith the optim al grow th o f a child.
A nxiety and lack o f security and love can affect the horm onal regulation o f growth
(Arya 1996).
24
Deprivation dw arfism appears later than failure to thrive, usually betw een 2
and 15 years. Its m ost striking features are substantially below average stature,
decreased GH secretion and im m ature skeletal age. Researchers believe that severe
emotional deprivation results in stunted growlh. W hen such children are removed from
their em otionally inadequate environm ent their GH levels quickly return to norm al and
they grow rapidly. But if treatm ent is delayed until later, the dw arfism can be
perm anent (O ates et al 1985).
Care giving problem s associated w ith these grow th disorders are often
grounded in poverty and family disorganization, w hich place parents under severe
stress. H ow ever, failure to thrive and deprivation dw arfism do not occur ju st am ong
the poor. T hey som etim es appear in econom ically advantaged fam ilies w hen m arital
conflict or other pressures cause parents to behave insensitively and destructively
tow ards their children (G agan 1984).
The study o f grow th disorders highlights im portant influences on physical
grow th that are not readily apparent, w hen w e observe the healthy, norm ally
developing child. In the case o f failure to thrive and deprivation dw arfism , w e becom e
consciously aw are o f the close connection betw een sensitive, loving care and liow
children grow (B erk 1994).
IV .5:C lim ate and A ltitude
U nless the physical clim ate, hot or cold, is linked to a difference in nutrition,
tem perature seem s to have little effect on c hildren’s physical grow th. C ontrary to som e
popular beliefs, children living in hotter clim ates do not m ature earlier than those
living in m ore tem perate zones (T anner 1970). A ltitude appears to slow up grow th, but
people in m ountainous areas also tend to be undernourished. H igh altitude does induce
larger chest circum ference and bigger lungs, as proved by a study com paring coastal
25
and m ountain children in Peru (Tanner 1978). Sim ilar adaptations eons ago are
probably responsible for the different body types o f A fricans, A sians, and Caucasians.
IV.6:
Sex D ifferences
A particular kinti i>l gciictic inlhicncc over giow lh show s up iu the tlillcicnccs
between m ales and females, fro m early on in prenatal developm ent, there are physical
differences betw een boys and girls. N ew born g irl’s skeletal system s are several weeks
m ore m ature than new born boys. W hatever the inborn differences betw een them , boys
and girls differ in the am ounts o f experience they have with particular physical
activities. These experiences m ay influence inborn differences — but not always.
D ifferences in group averages do not tell about the skills o f individual girls and
individual boys. E ven the group differences in abilities betw een boys and girls tend to
be quite sm all. A study by M ilne et al (1976) show ed that averages for the boys were
slightly ahead o f those for the girls, in each class there were som e girls who could run
faster and ju m p farther than m ost o f the boys in the class.
IV.7:
E ndocrine D isorder
The endocrine disorder in children can be a cause o f grow th disorder. The
children having endocrine disorders appear norm al in height and w eight at birth. The
delay in grow th is observed usually after one year. G row th is regular but slow. They
gain less than 4cm height per year (Sharm a 1995).
Several other factors w hich affect grow th arc birth order, parental size, birth
w eight, socio-econom ic condition, bii1 h-spacing, single and m ultiple pregnancies,
education o f parents.
In the final analysis, the environm ent seem s to produce its effect m ainly by the
presence (or absence) o f infective illness and the plane o f nutrition (Patton et al 1963).
R ecent findings also indicate the im portant role played by psychological factors in
26
affecting health and consequently growth and even survival (Frank and Zeisal 1988
and W HO 1988). H ow ever, o f the environm ental influences, nutrition has been found
to have a greater im pact on growth (Jelliffe 1966), and is m ore critical during the
periods o f rapid child developm ent. Although grovvtli is iullucnccd by biological and
environm ental factors at all the stages o f developm ent, certain specific changcs takes
place at each stage.
V:
G row th P aram eters
V .l:
W eight
B ecause it sum s up all the increases in body size, w eight is an im portant
indicator o f growth. C hildren grow fast during the fu st tw o or three years o f their lives
than they ever w ill again. A tw o year old weighs about one-fifth o f w hat he will
probably w eigh at eighteen (A m bron 1975).
Parents and pediatricians have devised several rules o f thum b for calculating
w hat a baby’s average w eight gain should be. One form ula states that an infant
generally doubles his w eight during the first five m onths, triples it by the end o f the
first year, and quadruples it by tw o and a half. A nother m ethod o f calculation says that
the average baby gains tw o pounds per m onth for the first three m onths and about one
pound per m onth by the tim e he is six m onths old, then tapers o ff to tw o-thirds o f a
pound per m onth during the second year o f life (A m bron 1975). M ales double their
birth w eight sooner than do heavier infants (Pipes 1993).
In the w estern countries new borns w eigh on an average 3.4 kg. Infants
w eighing m ider 2.5 kg at birth are classed as prem ature infants in those countries
(K um ar 1988). In different parts o f India the average birth w eight is about 2,700 to
2,900 gm s. B abies born in hom es w ith a higher socio-econom ic status w eigh m ore
than those belonging to poor socio-econom ic groups. A lm ost all babies lose w eight
during the first three to four days after birth and regain it by seven to ten days. A lter
that, the w eight increases by 25 to 30 g a day for the first three m onths, and thereafter
less rapidly (G hosh 1992).
I
he c h ild ’s rale ol weight increases is delerjnined not only by his hcicdily but
also by w hat and how m uch he eats. To achieve their growtli potential, babies and
small children should be given a nutritionally sound diet and be allow ed to eat more or
less as m uch they like. Poor nutrition in early childhood can have devastating and long
lasting som etim es even perm anent effects on all aspects o f a ch ild ’s developm ent, not
ju st on his w eight (A m bron 1975).
Several studies in India have show n that the w eight curves o f m any children
are excellent for the first 4 to 5 m onths o f life, w ith the birth w eight doubling by this
age. Thereafter, how ever, the curves tend to flatten, because by this tim e the breast
m ilk dim inishes and insufficient or no food is given to supplem ent it. M any wellnourished m others, how ever, can produce enough breast m ilk to sustain a baby’s
grow th for about six m onths on breast m ilk alone (G hosh 1992).
G row th Velocity
A.
B.
0-4 m onths
1.0 kg/nioiith (30g/day)
5-8 m onths
0.75 kg/m onth (20g/day)
9-12 m onths
0.50 kg/m onth (lO g/day)
1-2 years
3.0 kg/year
3-12 years
2.0 kg/year
12-18 years
5.0-6.0 kg/year (0.5 kg/m onth)
W eight at 4-5 m onths
2 x birth w eight
W eight at 1 year
3 x birth w eight
W eight at 2 years
4 x birth w eight
W eight at 7 years
7 x birth w eight
W eight in kg = (A ge in years + 3 x 2 ) (Singh 1996).
28
V.2:
L engtli o r H eight
H eight like weiglit increases at a rapid but decelerating rate until adolescence
when the adolescent growth spurt occurs. Infants usually increase their lengths by 50%
by 1 year o f age, double them by 4 years o f age, and triple them by 13 years o f age
(Pipes 1993). Y ou cannot m ake your child grow taller than he is destined to be, and
this depends partly on how tall, his parents are. A dult size is not directly related to size
at biilh. H ow ever, after the first year o f life it is possible to predict a ch ild 's adult
height from his c u n e n t height and age, using height and w eight charts. This is because
most children follow their ow n particular growth line (Hull 1988).
The average length at birth is about 20 inches. M ost babies grow nine or ten
inches in
their first year and are betw een thirty-tw o and their-seven inches tall at the
age o f tw o. As w ith w eight, how ever, the rate o f increase is m uch m ore im portant than
the num ber o f inches in determ ining noim ality. A m ore significant w ay o f calculating
height increases during the first tw o years o f life, therefore, is by percentages. In the
first 3 m onths a child increases his overall length about 20% nearly 50% by one year
and alm ost 75% by age tw o (A m bron 1975).
H eig h t Velocity
A.
A t birth
20 inches (50 cm)
G ain during 1st year
10 inches (25 cm)
Gain during 2nd year
5 inches (12.5 cm)
Gain during 3rd year
3-4 inches (7.5-10 cm)
Gain during 3 - 1 2 years
A dolescence
2-3 inches/year (5.0-75 cm)
8
cm / year girls
1 0
cm / year boys.
B.
Length or height (inches) = A ge in years x 2.5 + 30
C.
P redicdon o f adult height.
A dult height can be predicted by tlie follow ing form ulae:
a)
T anner’s Form ulae
A dult height =
height at 2 years x
2
A dult height = - height at 3 years x
1.87.
29
b)
W cccli’s I'om iiilae
A dult height in inches
Boys = 0.545 II 3 I 0.544 A + 14.84
Girls = 0.545 H 3 + 0.544 A + 10-09
W here H 3 is the height o f the child at 3 years and
A refers to m ean height o f parents (Singh 1996)
V.3:
Head C ircuinferciice
The brain grow th is very rapid during infancy and it is unaffected by m ild to
moderate degrees o f under nutrition. The m arasm ic children are seen to have relatively
large head for their body size. D uring states o f under nutrition o f varying severity,
weight (Subcutaneous fat and m uscles), linear grow th (height) and brain growth are
affected in that order (Singh 1996). The head circum ference is likely to be sm aller than
usual i f the grow th o f the brain has been defective (Illingw orth 1996).
M easurem ent o f head circum ference is an im portant param eter to assess the
growth o f an infant. The circunircrence o f the head in hidian infants at birth is on an
average 13.8 inches or 35 cm.
Head C ircu m feren ce G ro w th V elo city
T ill 3 m onths
3 m onths - 1year
2 cm /m onth
2 cm /3m onths (1/3 o f initial velocity)
1-3 years
1 c m / 6 m onths (1/12 o f initial velocity)
3-5 years
1 cm /year (1/24 o f initial velocity)
D uring, first year three is 12 cm increase in head circum ference, w hile betw een
1-5 years age, only 5 cm gain occurs in head size. A dult head size is achieved betw een
5 to
V.4:
6
years (Singh 1996).
C h est C ircum ference
A t birth head circum ference is larger by upto 3 cm as com pared to chest
circum ference. T he head circum ference is larger by m ore than 3 cm as com pared to
A lla m n I q M I j b r t r ?
•1
Ac>i N o
30
chest circum ference at birth in pre-term , smail-for-ciate and liydroccphahc infants. Tlie
chest circum ference equals head circum ference around 9 montlis to 1 year o f age but
thereafter chest grow s m ore rapidly as com pared to the brain, hi pre-term babies, chest
circum ference m ay exceed head circum ference betw een 6 to 9 m onths o f age. In
m alnourished children, chest size may be significantly sm aller tlian the head
circum ference because growth o f the brain is less affected by under nutrition.
Therefore, there w ill be considerable delay before chest circum ference overtakes head
circum ference (Singh 1996).
V.5:
M id-A rm C ircum ference
N orm ally, the arm circum ference increases rapidly from birth to 1 year, from
about 11 to 16 cm. B etw een the first and fifth birthdays, it rem ains fairly constant at
about 16 to 17 cm am ong w ell-nourished children and can be used as an ageindependent m ethod. D uring this tim e, the fat o f early infancy is replaced by m uscle. A
m easurem ent below 80 per cent o f norm al, i.e., 12.5 cm, indicates severe m alnutrition
and betw een 12.5 cm and 13.5 cm indicates m oderate m alnutrition (G hosh 1992).
Arm C ircum feren ce fo r D ifferen t H eights
M id-arm circuiiiferencc (cm)
16.50
16.00
15.50
15.00
14.75
14.50
14.25
14.00
13.75
13.50
13.25
13.00
12.75
12.50
H eight (cm)
133.00
129.00
125.00
121.00
118.00
116.00
113.50
110.00
106.50
103.50
97.50
90.00
80.00
70.00
(S in g h 1996)
31
VI:
M easu rem en t o f G rowth
V arious A nthropom etric m easurenients helps in m onitoring growth o f a child.
It shows individual is underw eight, too thin or in case o f a child has not been growing
at the norm al rate (D avidson et al 1975). A nthropom etric m easurem ents are taken
daily aroim d the world. T hey are used to m easure growth and nutritionally related
disease that effect it, evaluate degrees o f m alnutrition or to prom ote child survival
m onitoring projects. Learning to these m easurem ents accurately requires skill and
much practice. N ow a training tool has been developed that health care trainees and
non professional field w orkers can use. The tool is not equipm ent, but a statistical
control m ethod that m onitors the errors anthropom etry students m akes and helps to
im prove their m easurem ent skills (Zerfas
1986). A nthropom etry has its own
advantages and disadvantages. These are listed below:
A d va n ta g es o f A n th ro p o m e try
•
It is reasonably good for evaluating changes in protein energy m alnutrition in
grow ing children (Salvey, N ancy and Philip 1981).
•
It has been used in surveys prim arily to identify grow th retardation and obesity
both o f w hich m ay be related to diet.
•
It provides an additional check for the reliability o f the diet surveys (Lakshm i
1981).
•
A nthropom etry, pailicularly the m easurem ents o f heights, w eight is the single
m ost valuable nutrition assessm ent tool, particularly in young children but also
in certain adult population (Salvey, N ancy and Philip 1981).
D isadvantui’es o f A n th ro p o m e try
•
T he disadvantages o f anthropom etry as a nutritional assessm ent tool in
developing countries is the lack o f inform ation regarding the relationship o f
anthropom etric stature to the prevalence and incidence o f m orbidity and
m ortality.
•
It is m uch less successful in detecting m odest changes in nutritional status in
adults and have little value for evaluating changes in the m ost m icro nutrient
levels.
32
•
C e r t a i n a n t h r o p o i i i c l r i c ii ic a s u r c n ie iU s c a n n o t be t a k e n u n ti l a g e is n o t k n o w n
(Salvey, N ancy and Philips 1981).
The various anthropom eric m easurem ents inckide m easuring.
V l.l:
W eight
The w eight can be recorded on a beam type w eighing scale (D etecto Scale with
accuracy o f n 20 g). The scale should be frequently checked w ith standard weights and
zero error m ust be adjusted before weighing. The bathroom type o f scale is very
unreliable for children and should not be used, hi field conditions Salter spring and
Bar scale are quite satisfactory because they are convenient to carry (Singh 1996).
VI.1.1: S a lte r yVeighing S ca le
The Salter w eighing scale is a reliable, light and portable scale, w hich can
weigh children up to 25 kg. The Salter scale is round in shape, w ith a needle in the
centre. W eights are m arked in kilogratns around the dial. T here are tw o variations o f
the Salter scale. One kind has 500 gm m arkings betw een kilogram s, and tlie other has
100 gm m arking betw een kilogram s. The scale has a screw on top to m ake the zero
adjustm ent so that the needle points to zero before the child is weighed.
The scale has tw o hooks. One is on top and is used w ith a rope to hang the
scale on a beam or branch o f a tree. The other one is below th dial and is used to hang
the sling or pants in w hich the child is placed for w eighing. W hile w eighing the child
it is necessary that the child feet should not touch the ground. N o one should touch the
child w hile w eight is being read. W eight should be taken w hen the needle stops
m oving. W eight should be read exactly opposite the scale. It should never be read
from the side (N IPC C D 1988).
33
VI. 1.2: B a r Weij^hini; S calc
It is a light m etal scale. It is reliable, sensitive and portable and can weigh
children up to 20 kgs. It has 2 hooks. H old the scale so the num bers are right side up.
The upper hook is used to hang the scale from a beam or a branch o f a tree, and the
lower hook is used to hang a basket or sling in w hich the child is placed for weighing.
The Bar scale is graduated from 0-10 kgs. There are tw o types o f Bar scale. In one type
o f scale, each kilogram is divided into 100 gm divisions. In other type, each kilogram
is divided into 50 gm division. T w o w eights are used with the Bar Scale. The big red
w eight is alw ays used w hen w eighing children and is attached to the m ovable slider.
The sm all blue w eight is only used for children who w eigh m ore than 10 kgs. It is
attached to the fixed bracket on the right side o f the scale. A t the left end o f the scale is
a counterw eight w ith a screw in the centre. This is used for balancing the scale if the
scale is not horizontal w hen the basket or sling is on the low er hook, and the slider is
at zero. W hen you are w eighing the child see that the scale does not touch a wall or
doorw ay and the scale should be at the w orkers eye level. W eight should be read to the
nearest 100 gm s (N IPC C D 1988).
The other types o f w eighing m achines are lever type and now adays m ostly
electronic w eighing m achines are used.
VI.2:
Length or H eight
Up to 2 years o f age, height or rather length is best m easured by the
inlantonicler, w ith the infant lying supine. A ssistant is asked to keep the vertex snugly
touching the fixed vertical plank. The legs are fully extended by pressing over the
knees, and feet are kept vertical at 90 degree, the m ovable pedal plank o f infantom eter
is snuggly opposed against the soles and length is read from the scale (Singh 1996).
34
In older children who can stand, height can be m easured by the rod attached to
the lever-type m achine or sim ply m aking the child stand against a wall on which a
m easuring scale is inscribed. The child should stand witli bare feet on a Hat floor
against a wall w ith feet parallel and with heels, buttocks, shoulders and occiput
touching the wall. The head should be held erect with eyes aligned horizontally and
ears vertically w ithout tilt. W ith the help o f a w ooden spatula or plastic ruler, the
topm ost point o f the veilex is identified on the wall (Singh 1996).
V1.3;
M id -a rm C ircu in fci eiice
M id-arm circum ferencc is m easured with a fiberglass or steal tape at the
m idpoint betw een acrom ian and olecranon. The tailors tape is not accurate and should
not be used. If the circum ference o f the arm is less than 12.5 cm, it is suggestive o f
m oderate to severe m alnutrition.
B angle test can be used for quick assessm ent o f arm circum ference. A
fiberglass ring o f internal diam eter o f 4 cm is slipped up the arm. I f it passes above the
elbow , it suggests that upper arm is less than 12.5 cm and the child is m alnourished
(Singh 1996).
H ealth w orkers can use tapes w ith green, yellow and red colors to indicate
norm al, m oderate and severe m alnutrition, respectively. This is a useful m ethod for
illiterate w orkers but should be used m ainly as a screening procedure for severe
m alnutrition (G hosh 1992).
Qvac S tic k
It is developed on the principle that acute starvation severely affects m id-arm
circum ference w hile height is unaffected. T he child appears tali, tiiin and w asted. The
Quae Stick is a m eter rod w ith tw o sets o f m arkings. T he expected height o f the child
against various sizes o f m id-arm circum ference is inscribed on the rod. The
35
m alnouiislied cliild w ould be taller than the anticipated height derived ironi the midaim circum ference (Singh 1996).
VI.4:
Chest C ircum ference
Ihc chcst circuuirercnce is m easured at the level o f the nipples, midway
between inspiration and expiration, w hile the child is in recum bent position. It can be
m easured with a non-stretehable plastic tape. The reading can be recorded to the
nearest 0.1 cm (Ghai 1993).
VI.5:
H ead C ircum ference
G row th o f the head can be judged by m easurem ent o f the circum ference, using
a non-stretch tape m easure going around the head from frontal to occipital region,
recording the m axim um circum ference.
VII:
A s se ssm en t o f Nutritional Status
G row th assessm ent is an essential com ponent o f pediatric health surveillance
because alm ost any problein w ithin the physiologic, interpersonal, and social dom ains
can adversely affect grow th fN elson 1996). The process o f norm al grow th and
developm ent
is
dependent
on
an
adequate
and
tim ely
supply
o f nutrients.
U ndernutrition is reflected in im pairm ent o f grow th, and therefore an useful indicator
o f nutritional status. G row th retardation is an im poilant quantifiable m anifestation o f
under nutrition (G opalan and Cliatterjee 1985). A s m easurem ent o f grow th has always
been considered a valuable, m ost convenient and practical tool for the assessm ent o f
nutritional status o f children, anthropom etry has an im portant place o f nutrition
surveys o f populations.
N utritional status refers to the state o f nurture o f an individual or a specific
group. The term m ay refer to a specific nutrient (e.g. Z ink) or to a class o f nutrients (as
in the assessm ent o f PEM ) and m ay apply to cither nutritional d edciency or excess
36
(Jelliffe and Jelliffe 1979 and Sim opoulas 1982). N utritional status may be assessed in
a laboratory, using precise instrum entation or in a field utilising other appropriate
methods.
Uiological anthropologists have
most
Irequcntly
uscti
liekl m ethods
in
assessing nutritional status. The m ethods tend to focus either upon the evaluation o f
dietary intake or upon the m easurem ent o f grow th and body com position (i.e.
nutritional anthropom etry). [Kaul and N yam ongo 1990).
Nutritional anthropom etry is recognised w idely as an elfective m eans o f
assessing nutritional status. The m easurem ents taken are used to assess either physical
growth or body com position (Frisancho 1974). G row th assessed by anthropom etric
m easurem ents is one o f the m ost sensitive indicators o f the nutritional status o f child
(Devi and G eervani 1998).
H eight and w eight evaluated against age are m ost often used to indicate
nutritional status. D eviations froin the reference value are usually expressed in one o f
the three ways: (a) as a percentage o f the m ean; (b) as a Z -score (i.e., a standard score);
or (c) as a pcrcentile, according to IlU SS -A shm orc and .lohnston (198,''), the most
useful descriptive statistics for the children o f developing countries is Z-scores.
A nthropom etric m easurem ents have becom e an indispensable approach for
evaluation o f nutritional status o f children (Frisancho 1984; and V ijayaraghavan
1987). M any m easures are currently being used to determ ine the nutritional status
am ong children (M ishra 1993) A m ong the m ost studies are w eight, height, arm
circum ference, skin-fold thickness, chest circum ference head circum ference (Devi and
G eervani 1998 and M ishra 1993). Perhaps the sim plest and m ost com m only used o f
these m easures are height and w eight (E xpert C om m ittee on M edical A ssessm ent
1996). Som e investigators have used the ratio o f head circum ference to chcst
37
circumference in assessing nutritional status (Jelliffe 1966). How ever, in a study o f
Ladino G uatem alan children, (M artorell el al 1975) found this ratio “to have no power
to discrim inate either populations or individuals w ho are well nourished or m oderately
m alnourished”.
H eight is a m easure o f growth and poor or inadequate nutritioii m ight be
indicated by failure to increase height appropriately (M ishra 1995). Height does not
change so rapidly as weight. Therefore, w eight can be considered “sensitive” indicator
o f nutritional status, responsive to acute nutritional deficiency o f short duration, while
height deficit m ay be considered to be indicative o f chronic nutritional deprivation
(Devi and G eervani 1998).
W hen related for age, w eight and heiglit provide the m eans to study a child
over a period o f tim e. W eight for height and arm circum ference provides ageindependent m easure and so is useful when age is difficult to estim ate or known.
C om binations o f these m easurem ents have been suggested, to distinguished “types o f a
m alnutrition (Seoane and L atham 1971).W aterlow et al (1973) has em phasized that
w eight and height m easurem ents together are useful to understand the dynam ics o f
m alnutrition, distinguishing betw een current and chronic m alnutrition. V isw esw ara
Rao et al (1979) has argued persuasively that w eight and height m easures are adequate
for assessing nutritional status and that not m ucii is gained by additional form s o f
m easurem ent.
Fom an (1977) suggested that w eight for height or w eight for age interpreted in
relation to height for age can be useful indicators o f excess body w eight and if above
the 95th percentile, m ay be used as indicators o f obesity.
A n investigation by Stine et al (1967) attem pted to derive an index o f health
from body m easures. He com pared the m eans o f various m easures In a coefficient o f
38
correlation and found that height and w eight were tlie m ost correlated o f the m easures.
Also correlated were height and age and weight and age. He conchidcd that one
m easurem ent alone is not a sufficient index o f health.
A w eight for height ratio (relative body w eight) has been used by some
investigators as an age independent index o f body-build w ith the suggestion o f a bodymass index o f w eight/height w hich attem pts to estim ate body-m ass. The index is
highly co n elated w ith w eight and relatively independent o f height. Jensen (1973) has
suggested the use o f chest/head circum ference ratio as an indicator o f nutritional
status. H ow ever, there is controversy on the use o f this index (M claren 1972).
D ugdale’s nutritional index (1971) offers the advantages o f being relatively
easy to m easure and is age-independent. 7 h is index is based on a pow er relationship
betw een w eight (in kilogram s) and height (in centim eters). The index betw een height
and w eight are calculated by the equation;
W eight (kg)
H eight (cm )' ^
C hildren are classified as m alnourished i f their nutritional index value is 88 or
below (corresponds w ith third percentile o f Stuart-Stevensen Series). A nutritional
index o f 110 or above w ould signify obesity (corresponds w ith ninety seventh
percentile in Stuart-Stevenson Series).
V II.1: W eight as an Indicator o f N utritional Status
For an individual child a single w eight m easurem ent, in the absence o f m arked
clinical signs, is o f lim ited use. Field w orkers have noticed that children w ho by
w eight for age w ould be considered m oderately or even severely m alnourished were
“the picture o f health its e lf’ w ith a good deposit o f subcutaneous fat.
39
They were sim ply sm all cliildien w hose w eight at birth had been low. either
because they had suffered from intrauterine m alnutrition, or because they were born
prematurely, or because they w ere children o f sm all parents (Devi and Geervani 1998).
The size o f the child at birth dcjiends m ainly on the nutritional status o f the
m other (B ergner and Susse 1970; and Lechtig et al 1975) her age and num ber o f
pregnancies she has had (Selvin and Garfuikel 1972). It is also related to the size o f the
m other (G urney and T hom pson 1970; Russel 1976). T h e 's iz e o f the child at birth
seems to determ ine, to som e extent the developm ent o f the child during the fust few
years o f life (Tam ier and Thom pson 1970; Babson 1970 and C ruise 1973).
Ill som e cases, the children m ay be sm all because they had previously suffered
a period o f under nutrition and had failed to catch upon growth. H ence, the im portance
o f differentiating betw een acute and chronic m alnutrition has been stressed repeatedly
(Dawn 1964; Seonc and Latham 1971; W ater low 1973, W ater low 1974).
M alnutrition o f acute onset is thought to pose m ore severe threat to life either
directly or by rendering the child m ore susceptible to the effect o f various infections.
A chronically m alnourished child in thought to adopt to the condition (unless it is
severe) partly by reducing its need for nutrients through grow th failure. M ore serious
than either as an acute exacerbation o f chronic condition. (D evi and G eervani 1998).
T o differentiate betw een acute and chronic m alnutrition a single w eight alone
is not enough. A n acute episode o f m alnutrition w ill reduce the w eight o f the child, but
obviously it w ill not reduce the height that the child has already achieved; there is
therefore a deficit in w eight for height.
40
VIII:
C lassification of M alnutrition
V lll.l:S c o a n c a n d L athiiiii C lassillcatio ii (1971)
This classification talces into account tlie weiglit as well as the height o f the
child. Childicn are classifieci into follow ing groups
•
N o rm a l C h ild re n ; with norm al height for age, norm al w eight for
age and norm al w eight for height.
•
C u r r e n t A cute S h o rt-D u ra tio n M a ln u tritio n : C hildren with
norm al height for age, low w eight for age and low w eight for height.
•
P a s t C h ro n ic M a ln u tritio n : This category includes children with
low height for age, low w eight for age but norm al w eight for height.
•
C u r r e n t Lon(; D u ra tio n M a ln u trilio n : It includes children with
low height for age, low w eight for age and low w eight for height.
This classification is show n to be very useful to assess the type and duration o f
under nutrition.
V III.2 :W a te r L ow C lassificatio n
T his classification is also based on deficit in w eight and height. W ater low
(1972) has grouped children in follow ing categories:
•
N o rm a l C h ild re n : Children with noiinal height for age and norm al
w eight for height.
•
S tu n te d : C hildren w ith low height for age and norm al w eight for
height.
•
W a s te d : C hildren w ith norm al height for age and low w eight for
height.
•
S tu n te d a n d W a ste d C h ild re n : C hildren w ith low height for age
and low w eight for height.
W asting is considered as current acute under nutrition and stunting w ithout
w asting as past chronic under nutrition. B oth stunting and w asting is an evidence to
41
show that the child has both past and current undernutrition. This classification has
also received w ide recognition and is being used by m any scientists.
V lI1.3:F ollow ing C lassificatio n has been |)i oposed by In d ia n A cadem y of
P e d ia tric s. (As p e r w eight fo r age).
A ge
G ra d e I
G ra d e II
G ra d e III
G ra d e IV
Birth
2A -2.1
2.1-2.3
1.7-2.0
1.6 or less
3 m onths
4.0-4.5
3.5-3.9
2.9-3.4
2.8 or less
6 m onths
5.4-6.1
4.6-5.3
3.9-4.5
3.8 or less
9 m onths
6.5-7.3
5.5-6.4
4.6-5.4
4,5 or less
12 m onths
7.2-8.1
6.2-7.1
5.1-6.1
5.0 or less
15 m onths
7.6-8.6
6.5-7.5
5.4-6.4
5.3 or less
18 m onths
8.1-9.1
6.9-8.0
5.8-6.8
5.7 or less
24 m onths
9.5-10.7
S.2-9.4
6.8-8.1
6.7 or less
(S in g h 1996)
IX;
R eferen ce S tan d ard s
A ch ild ’s grow th data is usually com pared w ith that o f a ‘reference’ population
to facilitate evaluation o f his nutritional status. T hese are usually obtained by
m easuring a statistically adequate sam ple o f a healthy, w ell nourished segm ent o f the
population with known accurate ages. I he observation that w ell-nourished children in
developing countries grow in m uch the sam e w ay as their counterparts in the
developed w orld, has lent support to the use o f a single international grow th standard
for all (S tephenson et a l 1983). T he underlying assum ption is that all children have the
sam e genetic potential especially in the early years o f life and their grow th is m ore
strongly influenced by environm ental factors such as nutrition than by heredity
(H abiclit et al 1974).
T he m ost frequently used reference standards are derived from studies o f
grow th in healthy children from the US and the UK. The H arvard standards obtained
42
from B oston children in 1930s have been used extensively throughout the world.
Reference data collected on British children (Tanner et at 1966) have been used in
developm ent o f the “R oad-to-health” card.
The National C enlrc I'or Ilcallli Statistics (NCI IS), USA has collcctcd data on a
large, econom ically and ethnically heterogeneous US child population. The NCMS
reference data are being recom m ended for use by W HO (Devi and Geevani 1998).
M ost developing countries lack suitable standards for com paring and m onitoring
growth o f their children. The data collected under the auspices o f the Indian Council o f
M edical R esearch (IC M R
1972) in different parts o f India provide valuable
inform ation on heights and w eights o f children. These are com m unity averages and
can be used as reference standards.
The anthropom etric data to be used in the developm ent o f a reference
population should fulfill the follow ing criteria (W atcrlow el at 1977):
•
M easurem ent should relate to a w ell-nourished population;
•
The sam ple should be statistically adequate;
•
T he sam ple should be cross-sectional, since the com parisons
are o f a cross-sectional nature; and ,
•
M easurem ents should be carefully m ade and recorded by
observers trained in anthropom etric valuables using equipm ent
o f w ell tested design and calibrated at frequent intervals.
A nthropom etric data on w ell-to-do young children from D elhi and Hyderabad
have been collected by G hosh et al (1977) and R ao et al (1976). These studies
highlight th at given proper environm ent, particularly good nutrition, the growth
potential o f Indian children, at least upto adolescence, is com parable to that o f children
o f the w est. H ow ever, data on w ell-fed Indian adults is m eagre. Rao and Sastry (1977)
have reported anthropom etric data o f young m ale adults by m easuring students
attending Indian Institutes o f T echnology w ho had attended Public School in their
43
childhood. The above data obtained on w ell-to-do children may be used to indicate the
optimal grow th pattern o f hidian children. There is how ever, a need to collect
reference data on the lines o f N C H S standards (H am ill et al 1979) to be used as
standards o f reference.
X:
C hanging G row th P atterns in the Past 100-200 Years “The S ecu lar T ren d ”
D uring the past 100 to 200 years, there has been a profound change in the pace
o f m aturation and to a lesser extent in the ultim ate size o f individuals in so-called
“developed” countries. 'Ih is faster m aturation has resulted in greater increm ents o f
growth and in larger size for age during childhood, and in an earlier advent o f
adolescence and o f final height attainm ent. W hereas a century ago the average male
did not reach final height until 23 years, he now reaches it by 17 years. The age o f
m enarche in the fem ale has dropped from approxim ately 17 years to approxim ately 13
years. Thus today itiaturation occurs about 25 per ccnt faster. W hether this acceleration
o f general body m aturation is accom panied by acceleration in brain developm ent and
in level o f perform ance during childhood is an interesting question. Studies in
Scotland have show n a rising intelligence quotient in 11 years old (Boyne 1960).
This accelerated m aturation has also given rise to a profound difference in
stature during childhood and adolescence. For exam ple, the average 14 year old boy o f
today is often at the sam e m aturational level and size as the 18 to 19 year old m ale o f
100 years ago. Since the period o f linear grow th is shooter, the im pact on final height
attainm ent is only m odest. Som e o f the estim ate o f the increase in stature during the
past century have been excessive because they com pared the stature o f form er recruits
w ho had not yet ceased grow ing to the stature o f recent recruits o f the sam e age who
had reached their final height. (Sm ith 1976).
F or exam ple, O ppers conpaied the statiue o f 19 and 25 year old recruits in Holland
in tlie era o f 1819 to 1902 to tliat recorded in tlie 1960’s. Tliere was increase o f 16 cm in tlie
44
heiglit o f tlie 19 year olds, whereas tliere was ojily a 6 cm increase in tlie staliire o f 25 year old
recruits. Tlius in tlie late 1800s, tlie average recruit grew 10 cm more from 19 to 25 years
because he w as a relatively slow m aturer.
The cause or causes for this dramatic change aie not known, llie most popular
hypotliesis is tliat it is tlie consequence o f a decrease in growtli inhibiting factors, such as poor
cliildliood nutrition and chronic childliood disease possibly combined with more genetic out
breeding in recent times. W hatever tlie causes, tlie concomitant epidemiological data on
populations that have luidergone this shill show to date only beneficial coirelates such as a
falling infant moilality rate, wliich paiallels tlie increase in statuie. Some biologists believe
improved nutiition and health aie laigely responsible for tliese secular gain .Tobias (1975)
reported tliat secular gains are not so great among low-income children, who have poorer
diets and are more likely to suffer fiom growtli stiuiting illnesses. And in countries witli
widespread poverty and diseases a secular decrease in body size has occuned.
Tliere are now some indications tliat tlie trend is leveling off. For example,
Wieringten observed no increase in tlie size o f the offspring o f well-to-do, large paients, and
tlie Metropolitan Life Insiuance Company’s statistics also show no significant increase in
stature in the United States from 1954 to 1970.
Htunmis cannot keep growing laiger and matuiing eailier indefinitely, since we
cannot exceed the genetic limitations o f our species. Secular gains have slowed or stopped
entirely in some developed counties such as England, Sweden, N o w ay , Japan and tlie
United States (Chin Rona and Price 1989; Roche 1979). Consequently modem children
raised under good nutritional and social conditions are likely to resemble tlieir parents in
physical growth more than at any time dui ing the previous 130 years.
45
GROWTH
STUDIES
I.
G row th Studies
I.l:
Norm al values, and standards
Rao et al (1959) found that retardation in growth was obvious w hen com pared
to the percentiles in U .S.A. The low est percentiles o f U.S.A. w ere considerably higher
than the average curvcs oblaincd in the present study. 'I he degree o f retardaliun in
growth o f the hidian infants was, however, not so great in the early periods o f infancy.
As a rule in all the area surveyed, boys were found to be slightly taller and heavier then
girlds o f the sam e age.
U dani (1963) com pared the w eight o f children in different socio-econom ic
groups w ith the children in USA. The study concluded that the physical grow th o f
upper class children com pared well w ith that o f A m erican children o f various groups
in USA percentile standard.
The evaluation o f grow th and developm ental o f 1000 children in six urban
slum s o f K anpur w as done in the age group o f 0-15 years by G upta et al (1985). The
grow th standard w as found to be low er than the standard laid dow n by ICM R. A high
incidence o f different grades o f protein energy m al-nutrition (71% ) w as recorded.
T hese findings are in agreem ent w ith those o f other w orkers. Factors responsible for
low er standard o f health status w ere also discussed.
Prasad et a l (1994) found that m ean birth w eight w as less than that o f average
birth w eight o f A m erican and E uropean infants. H ow ever it w as com parable to studies
conducted by ICM R. T he difference in m ean biitli w eiglit o f m ales and fem ales was
found to be statistically significant.
46
M atllur et al (1994) have reported that average vveiglit o f both boys and girls
was ahiiost equivalent to the 25th percentile o f N C llS standards up to 30 m onths but
fell below these standards there after. The average length in both boys and girls was
between 25th and 50th percentile o f NCI IS data. I he average w eight, length, head
and chest circum ference in both boys and girls were com parable to ICM R standards.
The observations indicates that exclusive breast feeding should be prom oted for
adequate grow th o f infants during first six m onths o f life.
A study w as conducted by N ational N utrition M onitoring bureau (NN M B),
Hyderabad to evaluate a possible bias in Indian well to do standard w eight values. It
was reported that am ong pre-school age children, girls often fared better com pared to
boys w ith regard to body weight. A nalysis suggested that there exists a bias and the
values quoted for girls in H yderabad well to-do standard are certainly on the lower
side. H ence, as recom m ended by W H O there is a need to adopt N CH S standard values
in assessm ent o f the nutritional status o f pre-school children instead o f local standards.
Form an et al (1995) reported that after 10 years o f urban settlem ent 680
Bedouin A rab children, who had anthropom etric assessm ent from birth (1981-82)
through early childhood, were reassessed in 1991-92 to com pare the rates o f stunting
in early and later childhood as w ell as to describe the factors influencing current
height-for-age. B ased on m ultiple linear regression analysis height in early childhood
and m aternal height w ere statistically significantly and positively associated w ith
current m ean height-for-age in both cohorts. Li the 1982 cohort socio-econom ic status
in early childhood w as positively and current fainily size w as negatively and
significantly associated w ith current m ean height-for-age. Thus, conditions that were
present in early childhood had the largest influence on current height. In 1992, 10%
and 6% o f the infant siblings o f the 1981 and 1982 cohorts, respectively w ere stunted
47
com pared w ith 17% and 1% o f the siblings aged 1-2 years o f the respective coiiorts.
Therefore, the high rates o f early childhood stunting in 1981-1982 appeared to be a
birth cohort specific phenom enon.
Pratiba e( a! (1985) coiidiicled study on 139 healthy fiill-teiin single Infants for
daily growth. N o statistically significant sex related difference was found in the
absolute m easurem ents. On an average infants lost w eight over first 3.0 days
am ounting to about 3.9% o f the birth weight. This was follow ed by a positive weight
growth and the w eight equaled the birth weight by 5.3 days. A significant num ber o f
normal infants show ed an initial actual reduction in the head size. M ultiple stepwise
regression analysis show ed a significant positive influence o f breast feeding on first
weeks w eight gain, accounting for about 6.5% variation.
D atta B anik (1982) conducted a sem i-longitudinal study to find the height and
w eight o f tw o groups o f children betw een birth to 14 years o f age. The results indicate
that w ith better socio-econom ic status, it is possible to have the grow th potential
sim ilar to those o f A m ericans. The m ean o f heiglit and w eight o f children o f both
sexes belonging to low incom e group correspond with 25th percentile and 10th
percentile o f A m erican standards respectively. The literature available suggests that
retardation o f grow th o f children belonging to low er socio-econom ic groups is due to
environm ental factors inclusive o f nutrition.
Datta Banik el al (1967) in their study on birth w eight o f Indian infants and its
relationship to sex, period o f G estation, M aternal age, parity and socio-econom ic class
found tiiat m ean birth w eight o f m ale infants w as higher than that o f the females.
There w as a tendency for the birth w eight to increase w ith parity upto 3rd order in
m ales and upto 4th order in fem ales. T he study further show ed that m ean birth w eight
increased w ith socio-econom ic classes.
48
Dalta Banik et a! (1970) found that Boys were heavier tliein females at all ages.
The birth w eight doubled at 4th m onths, tripled by one and a h a lf years and quadrupled
by 3 years, by the end o f one and a h alf years the infant had increased his birth length
by 50% and about doubled at one and a h a lf years o f age.
C hildren from relatively higher socio-econom ic status were heavier and taller
from birth upto 5 years. A dverse socio-econom ic status had m ore ellect on weight than
on height.
Shinde et al (1980) conducted a study to exam ine the grow th and developm ent
o f pres-school children betw een one to six years o f age. The m ean w eights o f children
in the study at the age o f 1 year com pared well w ith H arvard figures, but beyond this
age the m ean w eight in both the sexes were uniform ly low. C om parison o f selected
w eight percentiles also show ed that children in the present study com pared well with
Harvard children at 1 year o f age. Beyond this age H arvard children exceeded their
Indian counterparts, so that around the age o f 3 years the 10th H arvard percentile
coincided w ith the 50th percentile o f the study. The m ean heights o f children
com pared w ell w ith H arvard series up to age 2 years, beyond w hich m ean values were
persistently low.
B irth w eight seem s to influence the subsequent grow th and developm ent o f the
child up to 5 or 6 years. The effect o f low birth w eight on later grow th and
developm ent has been studied by a num ber o f researchers in India (O hai 1980; Iyer
1987). Tliese studies show ed that the m ean grow th velocity o f such infants w as fairly
close to that o f norm al infants.
Agai-wal and A garw al (1994) in their study on physical grow th o f L id ian y
affluent children have reported that data show ed values low er than European and
NCH S (A m erican) standards. C entre w ise com parison show ed that Ludhiana children
approached the latter. The differences in growth seem to be possibly due to lower
velocity in Indian children o f present study in the first 18 m onths as com pared to
Am erican Children.
A cross sectional anthropom etric
study o f children age 0-84 montlis was
perform ed by Bangenholm et al (1988). A high overall prevalence o f w asting and
stunting w as found am ong the children. How ever, rural children exhibited a
satisfactoi 7 w eight-for-height during the first 6 m onths o f life com pared with both the
references o f the urban and slum children. Slum children had a high prevalence o f
w asting during the first 18 m onths o f life. For the younger age groups, rural children
were shorter than urban children but at 7 years o f age all the children were sim ilar,
w ith a m ean height-for-age corresponding to -1.7 standard deviations o f that for the
reference population.
M alcl el al (1984) conducted a retrospcctivc study o f infants m ortality from
death registers in St L ucia and St V incent. In both islands post neonatal deaths by
month w ere found to be evenly distributed throughout the first year although the total
infant m ortality rates differed widely. The grow th o f a coliort o f children from three St
Lucian villages w as studied. T heir w eight curve show ed faltering at 3 m onths.
Therefore it is concluded that there is no necessary association betw een this pattern o f
infant grow th and infant m ortality rate, nor betw een the distribution o f w eight velocity
and the distribution o f deaths in first year.
C o nnor’s et al (1999) found that low w eight percentile at age 2 years
w as
related to adverse developm ental outcom e in ELBW infants at high perinatal risk or
w ith
neuroiogical
im pairm ent
though
m inim al
neurologically norm al infants at low perinatal risk.
[1 3
association
w as
present
for
B ortolus et a! (1988) in their study to assess tlie relationship between birth
weight o f the c h ild ’s developm ent at 18th m onths o f age found that children with
height and w eight less than 10th percentile at 18 m onths were significantly more
frequent in the low birth w eight group. M otor problem s were about 6 lim es more
common in children w ith birth w eight less than 2500g than in those with birth weight
> or = 2500g. This study confirm s the differences in grow th and developm ent
for
children in low and norm al birth weight.
K aira et al (1983) conducted a longitudinal study o f the growth and
developm ent param eters o f low birth w eight babies. O bservations o f developm ental
m ilestones revealed that SFD infants had advantage over pre term infants so far as
attaim iient o f m otor m ilestones are concerned. Both the groups were, how ever,
generally retarded as com pared to the control in attaining all the m ilestones. Higher
birth w eight infants had advantage over very low birth infants throughout the first one
year o f life. A s regarding Grow th the LBW babies w hen com pared to norm al w eight
infants retained the handicaps o f weight, length, head and chcst circum ference with
w hich they were born and rem ained sm aller throughout the first year o f life. SFD
babies m aintained their advantage o f grow th param eters except in w eight throughout
the one year p eriod as com pared to pre term infants.
K ennedy et a l (1999) found that significant catch up grow th occured as length
increased from 0.87 at 4 m onths o f age to 0.45 at 18 m onths. A regression model
predicting head circum fercnce at age 18th m onths w as developed that included
nutrilion aiul growth variables such as head circum rcrciice at 9tli m onlhs, type
of
parenteral am ino acids adm inistered in the hospital, score w eight at 4 m onths, adjusted
age and the tim e o f 1st enternal feeding.
51
NIN (1983) conducted a study to determ ine the efl'ect on growth o f rural
infants during the first year. The data from the study suggests tliat low birth weight
infants catch up w ith those who were born with a higher birth weight.
1.2:
Feeding
R eports exam ining data on grow th in relation to exclusive breast feeding show
differing results for e.g A hn et o/(1980) observed satisfactory growth w ithout
supplem entation during m ajor part o f the first year o f life. On the contrary Sidhu et al
(1981) and K um ari et al (1981) have reported that adequate growth occurs only for 7
and 3 m onths respectively am ong Indian com m unities. T hey recom m ended that in
breast fed children w eaning should not be delayed beyond 7th m onth.
Several studies have indicated clearly that breast fed children are less likely to
be m alnourished and have better w eight and height, less chances o f infection than
bottle fed children (W hiten et al 1969; Rafiqual 1984 and V ictora et al 1986).
N um erous studies also indicated that infants w holly or partly breast fed had a
m uch low er incidence o f m orbidity and m ortality than, those given anim al m ilk. It is
also clear from several studies that the protective effect o f breast feeding declines with
age (C lavano 1982).
C onveney (1985) expressing his view w hether B reast M ilk is the best food for
all infants, said that not all infants w ill benefit from being breast fed. H um an m ilk m ay
be unsuitable for infants with som e m etabolic conditions, or those w hose m others are
undergoing certain drug therapies. The com position o f breast m ilk is influenced by the
m aternal
diet
and
enviroiunental
pollution.
O ccasional
repo:1s
o f nutritional
deficiencies in breast fed infants em phasis the unpredictability o f hum an m ilk. These
reports although rare, serve as rem inders that hum an m ilk is neither a perfect nor a
52
complete food. H ealth workers need to be m ade aware o f the shortcom ings o f breast
milk as well as its undoubted benefits.
Intake and growth were com pared betw een m atched cohorts o f infants either
breast-fed (B f ) or fornuila fe d ( f f ) by lleining ct a / (1993). D ilfercnces in energy and
protein intakes w ere significant at 3,6, and 9 m onths. Gains in w eight and lean body
m ass were low er in BF than in FF infants from 3 to 9 m onths. BF infants gained more
w eight and lean body m ass per gram protein intake but not per m ega joule intake.
A lthough grow th differences betw een groups were related to differences in intake,
there is no evidence o f any functional advantage to the m ore rapid growth o f FF
infants.
G rum m er and Laurence (1993) reported that several studies that found a
relationship betw een prolonged breast feeding and m alnutrition are reviewed. M any
studies have show n a negative association betw een prolonged breast-feeding and
growth, but there is little reason to expect the association to be casual.
B ohler et al (1995) conducted a prospective study o f 113 children in rural
Bhutan, m orbidity, nutritional status and feeding practices wore recorded m onthly over
a period o f 32 m onths. T his inform ation was related to seasonal variations in rainfall.
D iarrhoea had a negative im pact on grow th, as m easured in m onthly intervals, during
the second and third years o f life, reducing daily w eight gain by 4.4 + 2.0 g. This
im pact w as largest during the m onsoon period. For respiratory tract infections the
value w as 2.6-1- 1.7g. G row th in w eight w as low est during the m onsoon period.
C ontinued breast feeding was associated w ith an odds ratio for diarrhoea o f 0.51, and
for respiratory tract infections o f 0.63. G row th in w eight w as less reduced during the
m onsoon season for children w ho w ere breast fed than for those not breast fed. It was
concluded that breast feeding is o f particular im portance tlirougliout the warm and
rainy season.
Prentice (1994) exam ined children living in an econom ically disadvantaged
rural area o l'lln b c i province to determ ine llie rehuionsliip belw een diiralion ill bieasl
feeding and growth. It was concluded that m others in developing countries should be
encouraged to breast-feed their children for the first tw o years o f life.
N iels et al (1998) found no significant difference betw een breast fed and
form ula-fed infants w ith respect to w eight, length and head circum ference. How ever,
when girls were analyzed separately, BF girls differed in grow th status and body
com position at 4 and 8 m onths o f age, as a result o f low er w eight gain betw een 2 and 4
m onths o f age. A t 2 - 4 m onths o f age, FF girls had higher w eight gains. A lthough this
effect w as sm all and the physiological significance m ay be questionable.
K arkal (1968) carried out a study on feeding patterns in Bom bay. It w as found
that iiigh proportion o f m others stated breast feeding on third day o f their deliveries.
The infants w ere com pletely dependent on m others m ilk for an average o f 17-19
weeks. O ver l/4 th o f m others started w eaning (breast m ilk supplem ented w ith outside
food-either liquids or solid) w ithin a m onth, h a lf by 3 m onths and three-fourth by 9
m onths. By a year, only a few m others had not begun w eaning. M ilk w as the m ain
supplem entary food introduced (98% cases). T he analysis show ed that the sex o f the
baby did not m ake difference as to w hen the m others started supplem enting breast
milk.
D evdas et a l (1973) conducted study to locate the nutrient gaps in the diets o f
50 children below 30 m onths o f age. It w as found that out o f 45 children w ithin 12
m onths o f age, 32 w ere breast-fed fully up to 8th m onths, after w hich period they were
partly bottle-fed and partly breast fed. T he heights and w eights o f the children were
\
M
\
com parable to ICM R up to 1 year o f age. Thereafter, the heights and weights were
below IC M R standards. The growth retardation around 12-24 m onths is reflected in
the undulating body w eights and other anthropom etric values. The head and chest
circum ference were sim ilar for the target children to those reported by the ICMR.
NIN (1983) conducted a study to find the growth o f breast fed infants in the
slum population. The study indicates that till 5th m onth grow th o f breast fed infant is
satisfactory and parallel to that o f Hai-vard infants. A fler 5th m onth, faltering in weight
starts. The study also indicates that to prevent the faltering o f growth after 5 months,
supplem entation
should
be
introduced
betw een
4-6m onths,
sim ultaneously
encoouraging breast feeding as long as possible.
K han (1984) conducted a study on 223 children in rural area o f Bangladesh.
A nthropom etric m easurem ents w ere obtained every m onth up to 12 m onths and then
every 3 m onths. The history o f feeding was recorded. The m others were visited weekly
to record inform ation on diarrhoel illness. The average w eight o f exclusively breast fed
children w as not significantly different from that o f those w ho w ere breast fed with
supplem ents. The average w eight paralleled the H arvard standard up to the 4th m onth,
and the increase in height show ed the som e pattern. D uring the first year the
incidences and duration o f diarrhoeal attacks w ere higher in the exclusively breast fed
children than in the supplem ented groups. O n average there w as 3.2 attacks o f
diarrhoea per child per year and the average duration w as 15.9 days per child per year
during the first 2 years.
NIN (1984-85) conducted a study to see the G row th and developm ent o f breast
fed infants in urban slum s. The results suggest that the breast m ilk is satisfactory for
70% o f the infants only up to 3 m onths o f age. A fter 4th m onth, the percentage o f
infants having poor grow th velocity increased significantly indicating that i f the
55
supplem ents are not iiilrociLiced at tlie appropriate time, a high |)ercentagc may sulfer
from m oderate to severe m ahuitrition by 7th or 8th m onths itself.
M athur el al (1994) has reported that breast feeding should be prom oted for
adequate grow th o f infants during first six m onths o f life.
K um ar et al (1999) observe that exclusively breast fed pre term babies regained
birth w eight at 2 w eeks and then gained
338 g in next two w eeks which is near
intrauterine growth rate. The m ean weight o f group 1, ie E13F group was significantly
higher from 2nd m onth onw ard till the o f follow up period. Group 1 babies also had
greater head and chest circum ferences than group II babies. It is postulated that babies
around 33-34 w eeks o f gestational age can be w ell m anaged on exclusive breast feeds
but the sam e may not be true for extrem ely pre term babies. It was further observed
that sickness episodes were significantly lower in EBF pre term babies. Diarrhea, URl,
Pneum onia and hospitalization all were low er in EBF group.
1.3:
W eaning
Several investigators have repoiled that introduction o f supplem entary food
before the age o f 4 m onths does not have any significant benefit (V cnkatachalam el al
1976). In a study o f W HO on breast feeding, it w as observed that w eight gain was
usually low in infants w ho did not receive any food supplem ents until after 6
m onths(W H O and UN ICEF, 1989).
T he general slow ing in the rate o f grow th am ong the children investigated after
the age 6 m onths w as attributed to lack o f early supplem entation w ith protein and
calorie rich food (Sw aininathan el al 1964; M aya and Rao 1983; Rafiqual 1984) use
o f cow s m ilk as supplem entary food w as associated w ith good nutritional status.
56
Diisseldorp et a! (1996) conducted a longitudinal study to see the relationship
between diet and growth in
a Dutch population
consum ing a m acrobiotic diet.
Anthropom etric m easurem ent were taken in 1985, 1987 and in 1993. Analysis
indicated significant catch-up in height and arm circum ference. In 1993, both girls and
boys were still significantly below the relerence for height and sum o f 4 skin foids for
age, and girls w ere below reference for w cight-for-height and arm circum lcrcncc for
age. In girls m ultiple regression analysis show ed a significant positive effect o f the
consiunption lici|ucncy o f dairy pioducts on catch-up growth in height, weight and
arm circum ference, afler adjustm ent for m enarche age and baseline height, w eight and
arm circum ference. The addition o f m oderate am ounts o f dairy products, to a
vegetarian type o f diet im proved grow th o f children especially girls.
Pollitt et al (1997) conducted a study to determ ine w hether shot1 term
supplem entary feeding during infancy and childhood have long lasting effccts. In
1986, children age 6-60 m onths participated in a 3 m onth random ized trial to test the
effects o f dietary supplem ent. A gain these children were enrolled in 1994. The
subjects w ho had received the supplem ent before the age o f 18 m onths perfonned
better than control group on the Sternberg test o f w orking m em ory. It was concluded
that the supplem entation during infancy w as responsible for the difference. This
findings show s that supplem entation can have long-lasting effects on a specific
dom ain i f the child receives it at the appropriate age o f developm ent.
G rew al et al (1973) in their study in M adhya Pradesh, hidia also found that the
age at w hich supplem entary foods are introduced into the diet w as consistently related
to nutritional status. A ccording to them top m ilk, sem isolids and adult diet are started
about 3-6 m onths later in the fam ilies o f m oderate/severely m alnourished children,
com pared to fam ilies o f norm al children.
57
In rm al Bangladesli, a coiiimuiiity based w eaning iiUei vcnlion used volunteers
to teach com plem entary feeding to families o f 62 breast-fed infants 15 aged 6-12
months. Over 5 m onths
treatm ent children gained an overage 0.46 SD more in
weight-for-age than the 55 control subjects and were 0.5 kg heavier at the llnal
ineasure. The differences were statistically significant (D<O.OOI). The findings
suggests that
educational interventions teaching fam ilies to feed hygienic,
sim ple,
cheap, energy-enriched com plem entary foods to breast fed infants after 5-6 m onths can
improve child growth, even under im poverished conditions (Brown el al 1992).
1.4:
Feeding and W eaning
To determ ine w hether growth faltering during early infancy w as attributable to
inadequate intake o f hum an milk, the nutrient intakes, 30 Otonii infants were studied
at 4 or 6 m onths o f age by Butte et al (1992). The observations revealed that Grow th
velocities w ere not significantly
correlated w ith nutrient intakes. G row th faltering
am ong O tom i infants despite energy intakes com parable to those o f breast-fed infants
in m ore protected environm ents m ay have resulted from an increase in the need for
nutrients or fiom a grow th-lim iting nutrient, other than energy in their diet.
A study w as conducted by C ohen et al (1994) to evaluate w hether there are any
advantages o f com plem entaiy feeding o f breast -fed infants prior to six m onths. Low
incom e prim iparous m others w ho had exclusively breast fed for 4 m onths were studied
in H onduras, and results indicate that breast fed infants self-regulate their total energy
intake w hen other foods are introduced.
H anderson el al (1994) have reported that the current references on infants
growth and developm ent by the W HO are inadequate and have caused alarm am ong
health care professionals w hen infants fall below the range. The introduction o f
supplem entary foods in breast-fed children
58
can be life-threatening, especially in
developing countries
w here w ater and food sanitation is poor and can cause fatal
infections.
M arquis et al (1977) conducted a study on 107 breast fed and weaned children
to determ ine w hether breast m ilk contributed to im proved liner growth between 12
and 15 m onths o f age. The results revealed that com plem entary foods, anim al-product
foods, and breast m ilk all prom oted toddlers linear growth, hi subjects with low
intakes o f anim al product foods, breast-feeding was positively associated with linear
growth. Linear grow th was also positively associated with intake o f anim al-product
foods in children w ith low intakes o f com plem entary foods. W hen the fam ily’s diet is
low in quality, breast m ilk is an especially im portant source o f energy, protein and
accom panying m icro nutrients in young children. Thus, continued breast-feeding after
1 year o f age, in conjunction w ith feeding o f com plem entary foods, should be
encouraged in toddlers living in poor circum stances.
D ew ey
et al
(1999)
conducted
a
study
on
A ge
o f introduction
of
com plem entary foods and grow th o f term Low -B irth-W eight, breast fed infants. It was
concluded that there was no grow th advantage o f com plem entary feeding o f sm all-forgestational- age, breast fed infants betw een 4 and 6 m onths o f age.
C hild feeding practice and the dietary pattern upto 3 years o f age in relation to
econom ic background and m aternal literacy has been studied by N alw a (1981). I h e
type o f pre lacteal feed used and the tim e lag in initiating breast feeding varied am ong
the different econom ic and educational strata, the association being m ore significant
with incom e. H ow ever, m ean ages o f introduction o f Top feeds, senii-solids, solids as
well as com pletion o f w eaning w ere associated m ore significantly w ith education. The
dietary pattern, in general, was far from satisfactory in
am ong the low er strata.
59
all categories and m ore so
N IN ( 1 9 8 1 ) c o n d u c te d a s tu d y to i d e n tif y th e a p p r o p r i a te a g e for
i n tr o d u c tio n
o f s u p p le m e n ts
fo r
in f a n ts .
The
G ro w th s t a tu s o f s o le ly b r e a s t fe d in f a n ts w a s
r e s u l ts
i n d ic a te
th a t
m o re o r le s s sa m e as th a t
o f H a rv a r d i n f a n t s up to th e a g e o f a b o u t 5 -6 m o n th s , b u t w a s im p a ir e d
th e r e a f te r . I n c r e m e n ts o f h e ig h t a n d w e ig h t w e re r e d u c e d a n d p r e v a le n c e
o f v a r io u s fo rm s o f m a l n u t r it i o n
i n c r e a s e d b e y o n d th e a g e o f 6 m o n th s .
T he m e a n a g e a t w h ic h g r o w th r a te s s t a r ti n g d e c l i n in g w a s a r o u n d 5
m o n th s w ith
95%
c o n f id e n c e
lim its
o f 4 .0 - 5 .7 5
m o n th s .
The s tu d y
c o n c lu d e d th a t it is d e s i r a b l e to p r o v id e s u p p l e m e n t s to th e b r e a s t fe d
in f a n ts b e tw e e n th e a g e s o f 4 a n d 6 m o n th s to p r e v e n t g ro w th f a lt e r i n g .
S in h a
and
K um ar
(1 9 9 1 )
re p o rt
th a t
th e r e
w as
u n s a t is f a c to r y
g r o w th p e r f o r m a n c e o f e v e n th o s e w h o r e c e iv e d o th e r f o o d s a lo n g w ith
b r e a s t m ilk w h ic h is i n d ic a ti v e o f th e f a c t th a t th e q u a li t y a n d q u a n tity
o f s u p p l e m e n t a r y f o o d s ( a lo n g w ith o th e r f a c t o r s ) w e re n o t s u f f i c i e n t to
p r o m o te n o r m a l g r o w th .
R a o a n d R aj P a th a k ( 1 9 9 2 ) c o n d u c t e d a s tu d y o n b r e a s t f e e d in g
a n d w e a n in g p r a c t ic e s in r e la ti o n to n u t r i t i o n a l s t a t u s o f I n f a n ts . T h e
r e s u l ts r e v e a le d th a t a lm o s t a ll a r t i f i c i a l l y fe d i n f a n t s in lo w e r s o c i o ­
e c o n o m ic c la s s w e re m a l n o u r i s h e d w h ile th is w a s n o t so in th e h ig h e r
s o c io - e c o n o m i c c la s s . H o w e v e r , th e p r o p o r t io n o f m a l n o u r i s h e d c h il d r e n
in th e lo w e r s o c i o - e c o n o m i c f o r p a r t i a l l y b r e a s t fe d (B F + A F ) g ro u p w a s
c o m p a r a b le w ith e x c l u s i v e l y b r e a s t fe d ( B F ) g r o u p a n d w a s s i g n i f ic a n tl y
lo w e r (P < 0 .0 1 ) th a n A r t i f i c i a l F e d g r o u p i n d i c a t i n g p r o t e c ti v e e f f e c t o f
p a r ti a l
b r e a s t f e e d in g a g a i n s t r i s k s o f c o n ta m in a ti o n a s s o c i a t e d w ith
w e a n in g fo o d s in s u c h c o m m u n i ti e s . T h e r e a l b o t t l e n e c k th u s
be th e la c k
o f k n o w le d g e
o f h a n d li n g
a d e q u a te q u a n t i t i e s .
60
and
g i v in g
w e a n in g
a p p e a r s to
fo o d s
in
Phatak (1993) lias reported that the breast fed babies were observed to be
leaner by the currently accepted
‘S tandards’ which have been established m ostly on
formula fed babies. The growth pattern o f the breast fed babies cannot be interpreted
as i'alterijig' since their m olor-m ental dcvelopnienl was iioinia! and they were thriving
well.
Bavdekar et al (1994) conducted a study on infant feeding practices in Bom bay
slums. R esults reveal that 96% infants below the age o f 4 m onths received breast milk,
though
exclusive
breast feeding
was
practised
only
in
37%
infants.
Tim ely
com plem entary feeding rate was only 0.48. 23% o f m others used bottle for
adm inistration o f supplem entary food or water. Only
15.7% o f m others used
com m ercial m ilk form ula and 8.5% used com m ercial w eaning foods.
1.5:
Factors Affecting G row th
1.5.1:
Socio-E conom ic Status
The results o f the study by T aylor et al (1978) in 6 villages near M anila
revealed no association betw een socio-econom ic status o f fam ily and growth o f
children, under certain social conditions. Despite large differences in incom e, there
was no significant relationship betw een total incom e and nutritional status o f children.
They considered m aternal care and feeding habits to be independent
o f socio­
econom ic status.
A study w as conducted by A shw orth et al (1997) to m onitor grow th, m orbidity
and feeding patterns o f low birth w eight infants from poor fam ilies and to investigate
the relative contributions o f a num ber o f socio-econom ic m aternal and infant variables
to post natal grow th. It w as concluded that the early differential grow th patterns are set
in utero and are indirectly affected by socio econom ic status.
61
Suiya Prakasli cl a! (1973) carried a study on m itritioiial. status o f rural
children. The results show ed m ean weight and height o f these children am ong low
socio-econom ic status were equivalent to 5th percentile o f the data obtained from
children belonging to higher socio-econom ic group.
T heophilus and Usha (1985) conducted a study to find the growth pattern of
healthy infants belonging to low socio-econom ic group. The results revealed that the
healthy infants w hose m others m ade the best use o f facilities in the well baby clinic in
particular and the hospital for children in general, show ed a fairly satisfactory growth
pattern as indicated in all the physical m easurem ents m onitored from birth to first year
o f life, even though the m easurem ents were low er than those reported for norm al
infants except the crow n-heal length. The authors have suggested that intensive
nutrition education given to m others o f infant, belonging to low socio-econom ic group
with suitable dem onstration geared to local conditions for the feeding and care o f
infants w ill help to im prove their health and well being in order to give them a better
start in life.
D eshm ukli et al (1998) conducted a study to find out the prevalence o f low
birth w eight (LBW ) and its association w ith m aternal factors. On m ultivariate analyses
the m aternal factors significantly associated w ith LBW w ere anem ia, low scioeconom ic status, short birth interval, height, m aternal age and prim iparity. The study
concluded that above m entioned factors are significantly risk factors for LBW.
L5.2:
In co m e
In m ost o f the studies from South E ast A sia (G ans 1963; C utting and C utting
1972; G upta e t al 1973; D evdas 1974; M aya and Rao 1983). Poverty and low
econom ic status w as found to be one o f the m ajor causes o f m alnutrition. In these
studies a dow nw ard trend in the proportion o f m alnourished children w ith increasing
62
socio-economic status was reported. All the variables which measures household
wealth or which are considered as proxies for income showed a definite pattern of
positive relationship with children’s nutritional status in most of these studies.
Levinson (1974) studied rural Indian children age 6-24 uioiUhs. i le found a low
order relationship between income and nutritional status. Cultural piactices. diarrhocal
infection, caste, sex and age were found to be major determinants of nutritional status.
Achar and Yankaver ( 1062) condiictcd sludics on birlli weiglil ofSoulh iiuliaii
infants. It was found that the average birth weight for the poor and lower middle class
was found to be 6.031bs and 6.51bs for middle and upper class. An increase in birth
weight with parity was found, the effect being more in low income groups. There w'as
diiect relationship between the average birth weight and the socio-economic status of
the families. The effect of income was most apparent in the case of primipara than
women with high parities.
Arora et al (1963) conducted a study to find birth weight of infants in low
income groups. The analysis showed that the maximum number of babies had weight
less than 4 lbs. The study showed direct relationship between the weight of babies and
parity o f the mother up to 5th parity. After that the study showed an inverse
relationship. It was concluded that the weight o f newborns increased with the age of
the mother.
However, in few studies, positive relation between income and growth of pre­
school children was not observed. Swaminathan et al (1964) studied three socio­
economic groups o f a rural community in India with family income ranging from
Rs. 100-400 per annum. No relationship was observed between the economic groups
and the weight status at biilh or at subsequent periods. This was explained by the fact
63
that the environm ental conditions, habits and custom s were more or less the same in
the entire group o f population.
Poverty is defined as a lack o f incom e and resources. It is frequently associated
with poor physical growth o fc h ik h c n aiul mal nulrilion. Several studies indicated that
income is the m ost im pt factor that determ ines the nutritional status (Desai et al 1970 ;
Cutting and C utting 1972, D evdas 1974).
Desai et al (1970) observed growth and incom e to be associated in their study
on pre-school children in Jam aica, inspite o f the relatively lim ited range o f socio
econom ic status in their study area.
H arish C handra et al (1971) in his study to find the effect o f parity on birth
w eight in the different econom ic groups show ed that at each parity the m ean birth
w eight show ed appropriate fall from the highest incom e group to the lowest, clearly
indicating that the m ost im poilant single factor that had influenced birth w eight was
the socio-econom ic status o f the family.
Phodke and K ulkarni (1971) observed that there w as no m arked difference in
the m ean birth w eight o f m ale and fem ale babies in any o f the incom e group. No
differences in birth w eights w ere in any way related to m aternal age. H ow ever, the
econom ic status o f the fam ily w as considered as the m ost im portant single factor
influencing birth weight.
M ushtari (1997) conducted a study on pre-school children to assess the im pact
o f additional incom e from dairy on som atic status o f children. It w as concluded that
additional incom e either independently or jo in tly did not influence height for age,
w eight for age and w eight for height for age o f the child.
64
Bhat and Dahiya (1985) revealed that the relationship o f age with height,
weight head and chest circunifereiices was positive and significant in both sexes. The
boys and girls in the high incom e group were the tallest and the heaviest than those in
low and m iddle incom e groups. There was a positive and significant correlation
between incom e and height and w eight o f the subjects.
1.5.3:
Literacy o f Parents
A m other is the principle provider o f the prim ary care that the child needs
during the 1'' 6 years o f life. I he type o l'ca re she provides depends to a large extent
on her know ledge and understanding o f som e aspects o f basic nutrition and health
care. D uring the past decade, evidence
has accum ulated from several studies tliat
m aternal education is an im portant determ inant o f infant and child m ortality (Caldw ell
1981; C hen 1986) and also nutritional status o f children (G aise 1969; Bhuiya et al
1986 and V ictora et al 1986).
A iling and E lequin (1976) noted that as the level o f education o f m other
increased, a corresponding decrease in the incidence o f 2nd and 3rd degree
m alnutrition am ong their pre-school children could be expected.
Study conducted by Christian et al (1988) in G ujarat state o f htdia revealed,
that children’s m ean daily intake o f nutrients increased w ith the increase in the
m other’s educational level. In this study, the difference in the w eight and height o f
children o f literate and illiterate m other’s was clear.
Puri et a l (1976) in their study found that on an average, solids w ere introduced
at a later age w hen the m other was illiterate. W ith an im provem ent in the educational
status o f the m other, the solids w ere added at an earlier age.
65
Maya and Rao (1983) and later Victoria (1986) found ;i marked correlation
between the prevalence o f m alnutrition in children and the imniber o f years o f
schooling o f tlieir parents. Stunting and underw eight were nearly twice as comm on
among children w hose parents had no education than am ong those whose parents had
1-3 years o f schooling.
But in contrast, father's education appears to have very little effect on
nutritional w ell being o f pre-schoolar’s (Grewal et al 1973). Rafiqual (1984) also
observed that, given the sam e am ount o f education, the m others education will have a
more positive effect than the fathers education on the dietary intake o f infants.
1.5.4:
W orking Status o f M others
The study conducted by Pachauri e? a / (1971 a) revealed no trends, betw een the
m others nature o f w ork and the birth weight. How ever, definitive trend w as observed
betw een the m aternal w eight o f the birth w eight and betw een the per capita incom e
and birth weight.
Pachauri et al (1971 b) found that c h ild ’s w eight varied positively with
m other’s w eight and father’s weight. The study found that m other’s w eight was
relatively m ore im portant factor so far as its effect on birth w eight was concerned and
w as follow ed by the father’s height and w eight. It further show ed that socio-econom ic
and envirom nental factors such as m alnutrition, overw ork, inadequate educational
status adversely affected the health and efficiency o f m others. It show ed
positive
coiTelation o f birth w eight both w ith m other’s and father’s occupation.
E vidence from a num ber o f other studies (G rew al et al, 1973) in hidia,
(R aw son and V alverde, (1976) in C osta Rica (C hutikul and Sirilaksana, 1986) in rural
Thailand associated w om en w ho w ork outside the hom e w ith low er nutritional status
for their children. This is often so because the m other’s jo b seriously
66 I
affected the
amount o f tim e she is able to devote to child care and young children are often left
under the supervision o f older siblings.
R abiee et al (1980) studied the role o f m aternal work on nutritional status o f
children in Gilaii, Iran. I hey concluded that m aternal work can have a negative clTcct
on child’s nutritional status
through non-financial m echanism s that affect
food
consum ption and health.
M others w orking status had significant effect on the height for age o f children.
Children o f m others who w ent to w ork were significantly longer than those who stayed
at hom e (C hristian et al 1988). This w as attributed to increase in incom e o f fam ilies o f
w orking m others in the study at Baroda, India.
1.5.5:
Birth O rder
C hild rank in the family w ould affect his nutritional status. A higher birth order
num ber im plies a large num ber o f children already present in the family. Prevalence o f
PEM increases w ith birth ranks, m uch as it docs with family size (W ray and Aguirre,
1969).
1.5.6:
M aternal Factors
R elationship betw een m aternal age and birth w eight o f children has been
confirm ed in several studies (R am an K utty et al 1983 and Oni 1986). hi a study at
B ogota, C hristiansen et al, (1975) found the age o f m others to be related to height but
not to w eight o f child. M others aged over 30 years had a higher percentage o f children
o f norm al height. It has been concluded that m aternal age and parity failed to exert
any effect on the height and w eight o f infants.
N IN (1984-85) conducted another study to identify factors influencing the
growth velocity o f the slum infants. The results revealed that m aternal w eight gain and
67
birth w eight are closely associated, 60% o f low birth weights (<2.5kg) occurred
in
mothers w ho gained less than 6 kg. Poor w eight gain o f infants appears to be related to
low w eight gain during pregnancy.
C hristian et al (1989) found m aternal height, m onths o f lactation and weight
for height o f m other to have significant relationship with weight for age o f ini'ants.
M others height and w orking status were found to have significant relation with height
for age o f infants. T he author concludes that not a single factor but m ultiple factors are
related to child nutrition which seem to vary under various circum stances o f living.
A study w as conducted by Fawzi et al (1997) to find the relations between
m aternal anthropom etric status during pregnancy and infant feeding practices and
growth from birth through the first 6 m onths o f life. M ean m aternal w eight at the first
prenatal visit at 6 and 9 m onths o f pregnancy were positively associated w ith birth
length and w ith linear grow th betw een birth and 1,3 and 6 m onths o f age. M aternal
height, w eight and skin fold thickness at 6 and 9 m onths o f pregnancy were positively
associated w ith m ean birth w eight. Infants breast-fed exclusively had greater attained
weight and w eight gain in (he first 3 m onths com pared w ith infants w ho were bottlefed exclusively. These findings underscore the need for program s that im prove the
nutritional status o f w om en before,
during, and after pregnancy and encourage
exclusive breast-feeding o f infants for at least the first 3 m onths o f life.
*1.5.7:
O ther Factors
Several studies have suggested an association betw een grow th failure and the
em otional and social environm ent o f the child. Psychosocial factors w ithin the fam ily
as a possible cause o f grow th failure w as also revealed by various studies (C olem an
and Provence 1957; T albot 1963).
68
hi m ost traditional societies, male childien are prelTered over female eliildren.
This is outw ardly expressed in term s o f the quality o f m aternal care given and very
often m anifests in slow er growth rates in female children (Taylor el a! 1972).
Studies all over the world indicated that m alnutrition is com m only seen
amongst girls than boys (Grewal 1973; Tripp 1981; Rafiqual 1984).
The findings o f Rafiqual (1984) in Bangladesh did not support the hypothesis
that m ale children are favoured over fenialc childien in the iiitia fam iliar distribulioii
o f food, hi this study contrary to expectations dietary adequacy ratios
were
consistently higher for fem ales than m ales, in the age group o f 0-4 years, Bhuiya el cl
(1986) also reported that there was little difference am ong m ale and female in the
proportion o f m alnourished at the lowest socio-econom ic levels.
hi a study by Pande (1965) an association was found betw een the econom ic
status o f fam ily and w eight gained by children and the study show ed that boys were
heavier then girls (5-12 yrs age group), w here as in other studies girls were found to be
heavier than boys in the sam e age.
John and Joseph (1970) in their study conducted on infants born in Bom bay
hospital found that average birth weiglit o f m ales w as significantly higlier than that o f
fem ale. Parity o f the m other o f bitih w eight o f child w ere also found to be positively
correlated. It further show ed a positive co-relation betw een the birth w eight and the
birth order o f the child.
Phadke and Limaye (1973) in their study on infant grow th in rural and urban
M aharashtra has reported that in all age groups boys w ere taller than girls. Increase in
w eight, length and head circum ference w as observed to the m axim um during the early
m onths o f life and m ore so during the first m onth, hi general urban infants w ere found
69
to be belter built than n.iral infants. In uiban groups, tlic heiglit and weight increased
with im provem ent in the socio-econom ic status o f their family.
The study conducted by Phatak (1975) revealed that there was significant sex
and area dilTcrenccs. lioy.s were I'ounil to be superior to girls and urban to luial
in
most aspects o f growth. G row th increased with increase in socio-econom ic level. Birth
order as well as m others age show ed a significant interaction in contributing to weight.
Fam ily size w as not found to be a significant factor by itself, but had a significant
interaction w ith the m others age. The m ixed longitudinal approach to the sam ple o f
600 children show ed alm ost the sam e trend o f grow th as the cross-sectional study.
Physical param eters including birth w eight, crow n-heal length, crow n-rum p
length, head circum ference
and chest circum ference were studied by C hopdar and
N abarro (1981) in villages o f W estern Orissa. It w as found that the birth w eight and
all other
nieasurem enls
were greater in m ales than Icjnales. P value for all
m easurem ents w as less than 0.001.
L ongitudinal study on 300 infants in rural areas o f St. V incent by A ntrobus
(1971) revealed that those children, who lived in houses w here there were a total o f
less than 2 children under 5 years o f age w ere consistently heavier upto 2 years o f age
than those w ho belonged to hom es w ith m ore than 2 under-fives.
C hristiansen et al (1975) in their study on poor pre-school children at Bogota,
has concluded that sm aller fam ilies had a higher percentage o f children witli norm al
w eight and height. In their study the percent children w ith norm al w eight and height
dropped considerably, in fam ilies w ith 6 or m ore children.
H ow ever, G rewal el al (1973) in their study at M .P, India
size and birth order show ed no association w ith m alnutrition.
70
reported that fam ily
M ost o f the studies on detcm iinaiils o f nutiitioiial status have considered
family size and type. W ith social change, more num ber o f nuclear families have
em erged w hich has affected the life style o f fam ilies both in rural and urban sector.
Grewal el at (1973) study in M adhya I’radcsh on pre-school children revealed that a
large percentage o f poorly nourished children belonged to nuclear families. How ever
Victora et a! (1986) found no association betw een nutritional status and type o f family
(nuclear or extended) in Brazil.
R am an K utty et a! (1979) revealed that the influence o f a com paratively large
family size (average 6-7) is on o f the probable factors affecting height and w eight
since height and w eight o f children have been show n to be inversely associated w ith
fam ily size.
G hosth (1991) reveals that m ultiple factors like low incom e, wide spread
prevalence o f infection, large laniilies, overcrow ding, poor sanitation, em otional
factors and custom s and traditions o f harm ful nature operate in grow th failure.
Study o f C hristiansen et al (1975) in Bogota, C olom bia indicated that physical
grovrth w as positively associated with expenditure on food, sanitary conditions in the
hom e, m others age, birth interval betw een the survived children, level o f parental news
paper reading, aspirations for children and socio-econom ic status. Physical grow th was
negatively associated w ith crow ded living conditions and fam ily size. M others age,
family size, spacing o f birth and sanitary conditions w ere related to w eight and height
o f children independent o f socio-econom ic status.
H orner ef a / (1981) investigated the factors affecting the grow th in N icaragua.
Factors associated w ith 2nd and 3rd degree m alnutrition w ere high birth order, early
infancy, large household, higli incidence o f disease and physical handicaps.
71
Socio-econom ic and eiivironincnlal indicatois on nulrilioiial status oF rural
Brazil children described by Victora et al (1986) were family incom e, fathers
education level, m others education level, em ploym ent status o f head o f the family,
luinibcr o f siblings, family ethnic backgrdiincl, type o f housing, dcgiee o f crowding
and type o f sew age disposal.
M ukerjee and Biswas (1959) conducted a study to investigate the probable
relationship betw een the birth weight and gestation period and som e other variables.
The study show ed that m ost o f the births took place betw een 39 w eeks and 41 weeks
o f gestation and the m odal birth w eight was in the range o f 6-7 lbs. I he average birth
w eight for m ales w as foiuid to be 6.01 lbs and for fem ales 5.91 lbs. There was a
tendency for the birth w eight to increase w ith parity up to the 4th para. W hen birth
weight was cross-tabulated w ith age o f m other, it show ed a positive correlation up to
the age o f 25, but afler that it show ed a tendency for the birth w eight to decrease,
with advancing age. hi the case o f prim ipara, the birth w eight increased upto the age
o f 30 years and afler that it started dim inishing. B irth w eight w as found higher in the
econom ically better group.
V ijay K um ar (1992) in his study concluded that the increase in birth w eight to
w hich birth spacing contributes brings in a higher quality o f child life. This ensures
m aternal and child sui^ival and decrease m orbidity.
M athai (1996) et al reported that factors w hich influence birth w eight are
gestation at birth, sex o f infant, birth order and m aternal height. T hey concluded that
birth w eight percentiles for gestation w hen used should be adjusted for birth order,
sex o f infant and m aternal height.
Ballw eg (1972) stated that proportion o f children under 2 years o f age, who
were severely m alnourished is nearly 4 tim es greater than the proportion o f five years
j
D
olds, so characterized. Even in India, G hosh (1989) and several others reported that
prevalence o f m alnutrition is highest betw een the age o f 6 m onths and 2 years. NNM B
data (1975-1989) also clearly show ed that stunting increase w ith age, in pre-school
children.
A study w as conducted by B agenholm ei al (1988) to assess the growth and
m alnutrition am ong preschool children in D em ocratic Yem en. A high overall
prevalence o f w asting (8.7% ) and Stunting (35.2% ) w as found am ong the children.
However, rural children exhibited a satisfactory w eight-for-height during the first 6
m onths o f life com pared w ith
both the reference and the urban and slum children.
Slum children had a high prevalence o f w asting during the first 18 m onths o f life. For
the yoim ger age groups, rural children were shorter than urban children, but at 7 years
o f age all the children w ere sim ilar, w ith a m ean height for-age corresponding to -1.7
standard deviations o f that for the reference population.
The synergism betw een nutritional status and hospital adm ission due to
diarrhea and pneum onia w as studied by V ictora et al (1990) in a population based
birth cohort o f > 5000 children in southern Brazil. C hildren w ere identified soon after
birth in 1982 and data on nutrition status (w eight and length) and hospital adm issions
were collected in 1984 and in 1986. D iarrhea adm issions w ere stronger predictors o f
m alnutrition w as a m ore im portant risk factor for pneum onia than for diarrhea. All
associations w ere stronger
in the first 2 years o f life, although the early effect o f
severe diarrhea and pneum onia on nutrition status could still be detected ifi the 4th
year o f life.
T o assess the nutritional status o f children below 5 years, 350 children were
random ly selected by V andana Sen et al (1980). 20.3% o f the children w ere up to 12
m onths o f age. 22.9% , 21.7% and 14.3% w ere in 25-36 m onths, 37-48 m onths and 49-
73
60 m onths o f age groups respectively. A ccording to w eight for age m ethod 68.6% o f
the children had vaiying degree PCM . The W eight/H eight ratio over diagnosed 20.0%
o f the children w hile m issed 16.7% o f the children. The results obtained by this index
were 83.3% sensitive
and 80.0% specific. So the W eight/H eiglit ratio 0.0015 was
found to be nearly equally valid in com parison to w eight for age m ethod in detecting
P.C.M and also it is the m ost useful age independent index.
A cross sectional study w as conducted by Ray et al (1990) in a Predom inantly
M uslim C om m unity to find out the nutritional status o f the under-5 children and the
factors responsible for it. The study show ed that the overall prevalence o f m alnutrition
was 57.9% . T he factors identified for under nutrition include sex o f the child being
m ore in fem ales, parental illiteracy, large fam ily size and com m on infections.
M ehta et al (1998) conducted clinical assessm ent o f nutritional status o f
neonate using CA N score and com pared w ith other m ethods. CAN score <25
separated 60% o f the babies as w ell nourished and 40% as m alnourished-W eight for
age and Ponderal Index classified 70- 75% o f babies as w ell nourished (A G A ) and 2530% as m alnourished. A lso M A C /H C classified nearly h a lf the babies as well
nourished and h a lf as m alnourished. In conclusion CAN score m ay be a sim ple clinical
index for identifying fetal m alnutrition and for prediction o f neonatal m orbidity
associated w ith it, w ithout the aid o f any sophisticated equipm ent.
W alker et al (1992) conducted a study on stunted children o f Jam aica. The
children w ere assigned to supplem entation. W eekly m orbidity histories w ere take-for 2
years. Separate m ultiple regressions on each sym ptom for w eight or length gain w ith
coughing, apathy, anorexia and fever. A pathy and diarrhea reduced gains in length.
Significant reductions in linear grow th w ith low er respiratory-tract infections occurred
only in non supplem ented
children. G row th over 4-m onth intervals w as reduced if
74
diarrhea occurred in tlie first 2 montiis o f the interval but there was no long-term
effects o f apathy, fever or anorexia. Some o f the effects o f m orbidity on growth was
therefore transient and m orbidity is unlikely to be a m ajor cause o f growth retardation
in this population.
W aterlow (1994) has critiqued various studies that exam ined the relationship
o f gain in height to gain in w eight for children in developing countries. He reports that
it is difficult to determ ine the relationship because o f the physical difficulty o f
m easuring gains in height, w hich are small over short periods o f time.
D ayal (1980) reported that w ith increasing severity o f m alnutrition there w as a
highly significant fall in the perform ance o f tlie intelligence scale and it also show ed
that the difference w as m uch m ore m arked in young children (1-6 yrs). A lso, it was
found that there w as a m arked im provem ent in intelligence after nutritional
rehabilitation.
In order to assess the grow th faltering and developm ental delay in children
w ith PEM , a study w as conducted by Sathy et al (1991). It w as observed that
A nthropom etric m easurem ents. Som atic Q uotient (SQ ), D evelopm ent Q uotient (DQ),
M otor Q uotient (M O Q ) and M ental Q uotient (M E Q ) in 136 children in the age group
1-24 m onths w ith varying degrees o f
protein energy m alnutrition (PE M ) were
com pared w ith an equal num ber o f com parable w ell nourished children. There w as a
progressive reduction in SQ, D Q , M O Q and M EQ as the degree o f PE M advanced.
There w as a direct linear correlation betw een SQ and D Q and betw een height and DQ
in 4 degrees PE M . H ow ever, tiiere w as no direct correlation betw een head
circum ferertce and either DQ or M EQ.
U padhyay el al (1992) assessed the m orbidity, physical grow th and behaviour
developm ent o f inl'anls. The study revealed that children having G rades 11 and 111 m al­
75
nutrition show ed poor developm ent in all the areas o f behaviour i.e., m otor, adaptive,
language and personal social. Besides m aliuilrition environm ental factors like m others
involvem ent in teaching, encouraging the child, talking to him or being w ithin the
visual range, the parental education, their caste and the c h ild 's birth order contributed
significantly to the developm ent o f the child during infancy.
V azir et al (1998) obsei-ved that m alnourished children attained developm ental
m ilestones at a later age. D evelopm ental delay am ong the m alnourished w as especially
observed in areas like vision and fine m otor, language and com prehension and
personal social. The delay was to the extent o f 7-11 mojiths in these areas in dilfereiit
age groups. Paternal involvem ent w ith child care especially father spending
tim e,
telling stories taking child for outing was found to be im portant for positive
psychosocial developm ent. O ther factors included parents teaching child, sm all family
size and paternal occupation, child’s appetite, observe o f health problem s, parental age
and fam ily having ow n have and electricity w ere the factors significantly related to
better nutritional status o f children.
Jesudasen et al (1978) dem onstrated that in infants under nutrition was
associated w ith low m ental age and m otor age. Further m aternal under nutrition
affected c h ild ’s nutritional status,
C havez and M artinez (1982) using G essell Schedule show ed clear difference in
m otor developm ent by 4 m onths, language 8 m onths, consistently poor adaptive and
personal social behaviour in m alnourished infants.
Pow ell and G ranthan (1985) in preschool children developm ental studies
show ed th at housing, m aternal education, w orking status contributed significantly to
the variance in nutritional status but not in developm ent.
76
Dagan et al (1983) conducted a study in the Negev Desert, Israel to assess tlie
Growtli and nutritional status o f B edouin infants-Grovvth and feeding practices o f 353
Bedouin infants w ere com pared to tliose o f 302 Jew ish infants from the sam e area and
to Am erican standards. These tw o populations differed in their
cultures and
educational back grounds. The feeding practices o f Bedouin infants were markedly
different from those o f their controls. The Bedouin infants show a progressive
decrease in w eight, length and head circum ference, w hile the Jew s were com parable
to A m erican. D ata show ed m arked stunting in the presence o f only m ild m alnutrition.
This observation argues against the general belief that m arked stunting is the result o f
prolonged severe m alnutrition. D ifferences in cultural and genetic backgrounds, as
well as different feeding practices and increased m orbidity, could contribute to this
phenom enon.
G ersh o ff et al (1988) conducted a study to determ ine the effects o f providing
high-calorie and vitam in-niineral supplem ent to preschool village children retarded In
growth and developm ent. The children w ere divided into 5 control and intervention
groups. The interventions consisted o f a village health program , high-calorie snacks
and vitam in-m ineral supplem ents. Tlie supplem ents w hen used w ere provided in day
care centres for p reschool children. The health and nutrition interventions used did not
significantly affect grow th during the study period. M onthly changes in length and
w eight observed in this study indicate that grow th patterns in Thai children are
different from those seen in industrialized societies. Factors otlier than lack o f
nutrients and infection m ay be responsible for the inadequate grow th often reported in
developing countries.
Sm ith (1990) has reported that som e o f the nutritional deficiencies affect
children’s concurrent m ental functions.
DEVELOPMENT
I:
Early Scientific Beginning
H istorically, attitudes towards childhood and child learning have varied widely.
In the M iddle Ages, for exam ple, European adults largely ignored the period of
childhood. They view ed children as infants until age 6 or 7; they considered older
children to be small adults and treated them to adult conversation, jokes, music, food
and other entertainm ent, hi the sixteenth century, a revised image o f childhood sprang
from the religious m ovem ent that gave birth to Protestantism - in particular, from the
Puritan belief in original sin. A ccording to Puritan doctrine, the child was a fragile
creature o f God who needed to be reform ed (B erkl994). The seventieth-century
Enlightenm ent brought new philosophies o f reason and fostered ideals o f human
dignity and respect. Conceptions o f childhood appeared that were more hum an than
those o f centuries past (Berk 1994). In the eighteenth century, babies were no longer
Swaddled, children were dressed more comfortably, and corporal punishm ent
declined. A new theoiy o f childhood was introduced by the French philosopher o f the
Enlightenm ent, Jean-Jacques Rousseau (1712-1778). He view ed children as naturally
endowed w ith an innate plan for orderly, healthy growth.
Scientific child study evolved quickly during the early part o f the twentieth
century. Scientists selected a child o f their own or o f a close relative for observation.
Then, begum ing in early infancy, they jotted down
day-by-day descriptions and
im pressions o f the Y ongster’s behaviour. These were called baby biographies (Berk
1994). One o f the m ost fam ous w as Charles D arw in’s about his son and perhaps the
m ost influential were those o f Jean Piaget, whose theories about how children learn,
were based on observations o f his ow n three children (Papalia 1994).
78
The baby biographies were clearly a step in the right direction. Preyer, set high
standards for m aking observations. He recorded what he saw im m ediately, as
com pletely as possible, and at regular intervals. He also tried not to inilLience the
child’s behaviour or to let his own interests and interpretations tiistort whnl he saw.
And he checked the accuracy o f his own notes against those o f a second observer.
These are the sam e
high standards that m odern researchers use when m aking
observations o f children. As a result o f the biographers pioneering efforts, in
succeeding dccades llie child becam e a com m on subject o f scientilic research. (Uerk
1994)
G.
Stanley
Hall
(1844-1924)
one
o f the
psychologists o f the early 20th century is generally
m ost
influential
A m erican
regarded as the founder o f the
child study m ovem ent (D ixon and L em er 1992). bispired by D arw ins w ork, H all and
his w ell-know n student A rnold Gesell (1880-1901) developed theories based on
evolutionary ideas. T hese early leaders regarded child developm ent as a genetically
determ ined series o f events that unfolds autom atically, m uch like a bloom ing flower.
Gesell devoted a m ajor part o f his career to collecting detailed norm ative inform ation
on (he l)ehaviour o f infants and children. Ilis .schctlules ol inlant developm ent were
particularly com plete, and revised versions continue to be used today. Gesell was also
am ong the first to m ake know ledge about child developm ent m eaningful to parents.
H e provided them w ith descriptions o f m otor achievem ent, social behaviours, and
personality characteristics (G esell and Illg, 1949) G esell hoped to relieve parents
anxieties by inform ing them o f w hat to except at each age. If, as he believed, the
tim etable o f developm ent is the product o f m illions o f years o f evolution, then children
are naturally know ledgeable about their needs (B erk 1994).
79
A lthough Hall and G esells w ork offered a large body o f descriptive facts about
children o f different ages it provided little inform ation on the how and why ot
developm ent. Yet the child’s developm ent has to be described before it could be
understood.
D evelopm ent can be defined as the changes in the structure, thouglit or
behaviour o f a person that occur as a function o f both biological and environm ental
influences. U sually these changes are progressive and cum ulative. They result in
increased size o f the person, increased com plexity o f activity and
integration o f
organization and function. (Craig 1979).
D evelopm ent o f the child can be defined as the em ergence and expansion o f
his capacities to provide great facility in functioning. This developm ent is achieved
through the process o f growth, m aturation and learning, w hich has tw o aspects o f
changc quantity and quality. D evelopm ent is m ore than a concept w hich can be easily
observed and apprised. D evelopm ent follow s a pattern w hich is continuous, orderly,
progressive and predictable. It is not lim ited to grow ing big. (Sharm a 1995) It is
concerned w ith changes that occur in children. It includes the way the children’s
bodies grow and develop. C hild developm ent is concerned w ith the way the children
think and learn, the w ay they feel about them selves and the w ay they interact w ith each
other (D ecker 1988)
D evelopm ent refers to functional or non-organic changes and is usually
qualitative in nature. D evelopm ent refers to the process through w hich an individual
grows up. A s regards child developm ent, the follow ing statem ents define the field
m ore precisely.
•
C hild developm ent is an individual process.
•
C hild developm ent depends on the heredity o f individuals, the
environm ental factors and the interaction am ong them .
80 I
II:
•
C hild developm ent is the study
change over time.
o f developm ent
and not merely
•
D evelopm ent is the result o f the confluence o f orgasm ic and contextual
variables (Srivastava 1998)
•
D evelopm ent is not m erely change in physical size or proportions o f
adding inches or ability to ability. Instead, developm ent is a complex
process o f integrating m any structures and functions (Goel 1985).
Principles o f Developm ent
D evelopm ent is a continuous process from conception to m aturity (Illingworth
1996, Singh 1996).
The total period o f developm ent can be divided into the follow ing stages.
•
Pre-natal period-from conception to birth.
•
N eo-natal stage-from birth to tw o weeks.
•
Infancy-from tw o w eeks to one year.
•
B aby hood- from one year to tw o years.
•
C hild — hood: from tw o to 12 years.
•
A dolescence-from 13 years onw ard (Sharm a 1995).
T he sequence o f developm ent is identical in all children but the rate o f
developm ent varies from child to child. I'or exam ple, a child has to learn to sit before
he can w alk, but the age at w hich children learn to sit and w alk varies considerably
(Illingw orth 1996, Singh 1996).
D evelopm ent depends on the m aturation and m yelination o f the nervous
system. U ntil that has occurred no am ount o f practice can m ake
a child learn the
relevant skill. W hen practice is denied, the ability to perform the skill lies dorm ant,
but the skill is rapidly learnt as soon as opportunity is given (Illingw orth 1996 and
Singh 1996).
81
The direction o f developm ent is cephalocaudal
head control follow ed
the infant initially develops
by ability to grasp, sitting) craw ling, standing, w alking etc.
(Illingworth 1996, Singh 1996 and Goel 1985).
In all the phases, o f developm ent, w hether m otor or
responses are o f a general nature
observation
m ental the child’s
before becom ing specific. It is a comm on
that w hen show n a bright object, an infant
show s w ild excitem ent by
m oving trunk, arm s, legs and babbling while an older child m erely sm iles and reaches
for objects (Illingw orth 1996, Singh 1996 and Goel 1985).
The developm ent is orderly and proceeds in an unchanging sequence. Every
child “ Sits before he stands ... babbles before he talks ... draw s a circle before he draws
a square ... is dependent on others before he achieves dependence on s e l f ’ - (Goel
1985).
It is observed that the rate o f developm ent for each child is constant. It
is
possible to predict at an early age the range w ithin w hich the m ature developm ent o f
the child is likely to fall (Sharm a 1995).
E ach stage o f developm ent has som e trait characteristic o f its own. Som e traits
develop m ore rapidly and m ore conspicuously than others. E ach phase is distinguished
by a dom inant feature a leading characteristic w hich gives the period its coherence
and unity upto the age o f 2 years for exam ple, the baby concentrates on his
environm ent, grow ing control over his body and learning to speak. A djustm ent to
physical and m ental decline, to changed patterns o f living o f w ork and social life
dom inate the latter years o f life span (B ronson 1962).
82
Ill;
Factors Influencing D evelopm ent
The rate and pattern o f developm ent can be m odified by external and internal
conditions o f the body. Som e o f the follow ing factors, w hose relative im portance we
shall not attem pt to determ ine, influence developm ent:
n i.l:
Sex
Sex plays an im portant role in the physical and m ental developm ent o f the
child. D ifferences
in the rate o f physical growth are especially apparent. Sex is
indirectly influencial on developm ent in that the cultural pressures force the child to
conform to the culturally approved pattern for his sex (D inkm eyer 1967 and Sharm a
1995).
III.2: G lands o f Internal Secretion
These glands affect developm ent in both prenatal and postnatal stages o f
growth. D eficicncy in the activity o f the sex glands delays the onset
o f puberty.
D eficiency o f parathyroid m ay result in defective bone grow th and hyper excitability
o f the m uscles. T hyroxin produced by the tiiyroid gland is essential to physical and
m ental growth.
111.3: N utrition
A t every age, but especially in the early years
o f life, feeding is o f great
im portance for the developm ent o f the child. N ot only is the am ount o f food eaten
im portant; the quality o f the food is vital.
I1I.4: C ulture
T he characteristics o f infancy are universal. C ulture begins to take its effect in
the early training process
and overlays or m odifies a m ore basic substratum
behaviour.
83
of
111.5: P osition in th e Finnily
The position o f tiie child wiliiin the t'ainily
may iiilliiciice his devclopinciit
through eiivirom nental Factors. I'he second or third cliild within the family develops
more quickly than the first born, not because o f any pronounced intellectual
difference, but because o f the fact that the younger children may learn from imitating
an older brother or sister.
III.6 :
L ife S ty le-S elf co ncept
'I he individual view o f life and his evaluation o f his w orld and his place in that
world are factors in his developm ent (D inkm eyer 1967)
111.7: E stim a tio n o f the P a r t P layed by E n v iro n m e n t
The environm ent can greatly lower or raise the IQ score, and som e feel that a
really bad hom e can cause m ental sub norm ality (Stott 1962). The Clarkes, discussing
environm ental
factors in m ental sub norm ality concluded on the basis o f m easured
recovery being equivalent to the degree o f organic psychological dam age, that cruelty
and neglect m ay retard intellectual developm ent by at least 17 points. In tw in studies
they calculated that the environm ent m ight have an even bigger effect on the IQ.
K nobloch and Pasam anick (1962) studied the developm ent o f w hite and N egro
children and found that w hereas m otor developm ent rem ained com parable in the two
groups, those aspects o f developm ent
m ost subject to social influences show ed
considerable differences w ith increasing age. The adaptive behaviour quotient rose
from 105.4 to 110.9 for w hite children and fell from 104.5 to 97.4 for the N egroes.
L anguage ability likew ise
im proved in the w hite children and decreased
in the
N egroes. Studies reveal that environm ent m akes a significant difference in the activity
level, and in the social, language, em otional and intellectual grow th o f children. The
84
environm ent is im portant not only to the normal ciiild, but to the liandicapped child
also (Illingw orth 1987).
IV:
Types o f Developm ent
M otor Developm ent
Language D evelopm ent
Social Dcvclopmciil
Personality D evelopm ent
Em otional Developm ent
Cognitive D evelopm ent
I V .l:
M o to r D evelopm ent
M otor developm ent is the developm ent o f control over bodily m ovem ents
through the coordinated activity o f the nerve centres, the nerves and the m uscles. This
control com es from the developm ent o f the reflexes and m ass activity present at birth.
Until this developm ent occurs, the child will rem ain helpless (H urlock 1978). M otor
developm ent is differentiated into gross-m otor and fine m otor areas in w hich skills
involving large areas o f the body (for exam ple
grasping, w riting etc) are acquired
(V azir and R eddy 1998).
M otor developm ent begins w ith the control o f undirected body m ovem ents in
general and proceeds to the control o f the w hole body. It follow s the cephalocaudal
developm ent. The child first gains control over his head, then sits and finally achieves
the erect posture and coordinated control over body m ovem ents. T his enables him to
get the characteristic erect posture and gait (Phatak 1990).
T here are three m ain patterns in the infants m otor developm ent:
•
M ovem ents are slow because babies m ust think as they m ove.
•
A t first babies show general reactions to things in their w orld. Later
in the first year, babies give m ore specific reactions to things they
[8 5
see or hear. I'or iiislaiice, il'babies are show n soiiielliing tlicy want,
young infants wiggle all over, but older infants sm ile and reach for
the object.
•
IV.1.1:
M otor developm ent occurs in tw o directions head to foot and centre
to extrem ities (trunk outw ard) (D ecker 1988).
P rinciples o f M otor Ucvelopiiieiit
In num erous longitudinal studies, group o f babies and young children have
been tested and observed over a period o f tim e to see w hen certain form s o f m otor
behaviour appear and to discover w hether these form s are sim ilar for other children o f
the same age. Extensive studies show that various m otor perform ances involving the
arms, w rists and fingers, such as reaching, grasping and thum b opposition develop in
a predictable sequence (Bayley 1965, K ravitz 1971, Rlieingold et al 1962)
M any other studies have concentrated on m otor perform ances involving the
feet, legs and w hole body, such as w alking, jum ping, running and hopping, hi addition
a few studies have been m ade o f the age and sequence o f developm ent o f specific
skills such as those involved in self-feeding and se lf dressing,
and throw ing and
catching balls (Scrutton and R obson 1984; Solom ons el al 1968). From these studies
some im portant principles o f m otor developm ent have em erged. T hey are as follows.
M otor D evelopm ent D epeiuls on N e u ra l a n d M u sc u la r M atu ra tio n
D evelopm ent o f tiio different form s o f m otor activity parallels the developm ent
o f different areas o f the nervous system . Skilled m ovem ents cannot be m astered until
the m uscular m echanism o f the child m atures.
L e a rn in g o f S k ills C a n n o t O ccur U ntil th e C h ild is M a tu ra tio n a lly R eady
T rying to teach the child skilled m ovem ents before the nervous system and
m uscles are w ell developed w ill be w asted effort. Such training m ay produce
tem porary gain but the long term effects w ill be insignificant or nil.
86
M otor D evclopuicnt F ollow s n Prcdictubic I’lilleni
M otor developm ent follow s the laws o f developm ental
direction.
The
predictable patterns o f m otor developm ent is evident in the change from m ass to
specific activities. T hat m otor developm ent is predictable is show n by evidence that
the age at w hich babies start to w alk
is consistent with the rate o f tlieir total
developm ent. A baby w ho sits early, for exam ple, walks earlier than babies who sit
later. Because o f this consistency in rate o f developm ent, it is possible to predict with
a fair degree o f accuracy when a baby will start to walk on the basis o f evidence o f
the rate o f developm ent in other m otor coordination.
It is P ossible to E stablish N o rm s f o r M o to r D evelopm ent
B ecause early m otor developm ent follow s a predictable pattern, it is possible
to establish norm s, based on m ean ages, for different form s o f m otor activity. These
norm s can be used as guidelines to enable parents and others to know w hat to except
and at w hat ages to expect it o f their children. T hey can also be used to assess the
norm alness o f a child's developm ent.
There are In d iv id u a l D iffe re n ce s in th e R a te o f M o to r D evelopm ent
Even though m otor developm ent follow s a pattern that is sim ilar for all in its
broader aspects, individual differences occur in the detail o f the pattern. These affect
the ages at w hich different individuals reach different stages. Som e o f these conditions
speed up the rate o f m otor developm ent w hile others retard it (H urlock 1978).
IV.1.2: Sequ en ce o f M otor D evelopm ent
E xperim ental studies o f m otor developm ent have revealed
that there is a
norm al pattern o f achieving m uscle control and have indicated the ages at w hich the
average child is able to control different parts o f the body.
87
Hurlocks has given follow ing sequence o f M ctoi' Developm ent.
Head region
Ocular pursuit movements-4 weeks
Social smiles - 3 months
Eye Coordination- 4 montiis
In a prone p o s ilic ii-1 nionlh
In a sitting position -4 montlis
Trunk region
Turning
From side to back -2 monlhs
From back to side - 4 months
Complete - 6 months
Sitting
Pulls to sitting position - 4 months
With support - 5 months
Without support - 9 months
Organs o f elimination
Bowel control - 2 years
Bladder Control - 2-4 years.
Arms and Hands
Defensive movements - 2 years
Thumb-sucking -1 months
Reach and grasp - 4 months
Grasp and hold - 5 months
Picking up object with opposed thumb -8 months
Legs and Feet
Hitching (backward movement in sitting position) - 6 months
Crawling - 7 months
Creeping
On hands and knees - 9 months
on all fours -1 0 months
Standing
With support - 8 months
W ithout support - 11 months
Walking
With s u p p o rt-1 1 months
W ithout support -1 2 -1 4 months
88
Bayley (1969) has given follow ing M ileslones for Clioss and Fine M otor
Development in the first tw o years.
M o to r skill
A verage age A chieved
Age ra n g e in w hich 9 0%
o fiiita n ts achieve the skill
W hen held upright
head erect and steady
6 weeks
3 w eeks- 4 m onths
W hen prone, lifts se lf
by arm s
2 m onths
3 w eeks- 4 m onths
Rolls from side to back
2 m onths
3 weeks-5 m onths
4.
R eadies I'or dangling ring
3 monllis
1-5 m onths
5.
Grasps cube
3 m onths, 3 weeks
2-7 m onths
6.
Rolls from back to side
4 ‘/2 m onths
2-7 m onths
7.
Sits alone
7 m onths
5-9 m onths
8.
Crawls
7 m onths
5-11 m onths
9.
Pulls to stand
8 m onths
5-12 m onths
10. Plays pat-a-cake
9 m onths, 3 w eeks
7-15 m onths
11. Stands alone
11 m onths
9-16 m onths
12. W alks alone
11 m onths, 3 w eeks
9-17 m onths
13. Builds tow er o f 2 cubes
13 m onths, 3 w eeks
10-19 m onths
14. Scribbles vigorously
14 m onths
10-21 m onlhs
15. W alks upstairs with help
16 inuiiths
12-23 m onlhs
16. Jum ps in place
23 m onths, 2 w eeks
17-30 m onths
1.
2.
3.
By looking at the above table w e can see that there is organization and
direction to the infants m otor achievem ents. First, m otor control o f the head com es
before control o f the arm s and trunk, and control o f the arm s and trunk is achieved
before control o f the legs (C ephalo-caudal trends) Second, m otor developm ent
proceeds from the center o f the body outw ard, in that head, trunk and arm control is
m astered before coordination o f the hands and fingers (Proxim o-distal trend) (Berk
1994).
89
Follow ing average m iles stores have been given by w ood (1974) in respcct of
m otor developm ent.
Age in M o n th s
M ilestone
1
1leaderect for few seconds
2
Head up w hen prone (Chin clear)
3
Kicks well
4
Lifts head and chest prone
5
Holds head erect with no lag
6
Rises on to wrists
7
Rolls from front to back
8
Sils w ithout suppoit
9
I'urns around on floor
10
Stands w hen held up
11
Pulls up to stand
12
W alks or side-steps around pen
13
Stands alone
14
W alks alone
15
Clim bs up stairs
16
Pushes pram , toy horse etc.
17
Picks up toy from floor w ithout falling
18
C lim bs on to chair.
19
C lim bs stairs up and down.
20
Jum ps
21
Runs
22
W alks up stairs
23
Seats se lf at table
24
W alks up and dow n stairs (Papalia 1979)
IV.1.4: F actors C ontrolling M otor D evelopm ent
Physical Status; M otor developm ent to a great extent is controlled by physical
status o f the child. It is generally observed that the child w ith sound physical health
has better m otor coordination com pared to the one having poor physical
health
(Sharm a 1995) W eech and Cam pbell (1941) found a significant correlation between
w eight gain over a fifty-day period and sitting, creeping and walking.
90
W right (1960) has presented an excellent analysis
o f the m any ways that
physical disabilities m ay influence the hum an personality wliich may in turn determine
the m otor skills that a child will attem pt to acquire.
S ex
D uring infancy no sex difference are seen in activity level. But as the child
enter social play age, these differences can be seen. The girls are seen playing passive
games as com pared to boys w ho indulge in blocks building etc. Phatak (1990) found
stable sex differences in m otor scores are conspicuously observed in the urban upper
Socio Econom ic group but not in tiie lower Socio E conom ic group and in the rural
group.
C ulture
M any studies show that culture plays an im portant role in the developm ent o f
m otor skills. E ach parent has its ow n concept o f bringing up he child.
The hunter trains the child to w alk first (Sharm a 1995). W hat is norm al and
typical for children in one culture m ay not be so in another. The A rapesh in N ew
Guinea, for exam ple, hold their babies a great deal, “ ollen in a standing position so
that they can push w ith their feet against the arm s or legs o f the person w ho holds
them . A s a result infants can stand, steadied by their tw o hands, before they can sit
alone”(M ead 1953).
A pparent differences in m otor developm ent have been dem onstrated betw een
black and w hite A m erican children (Bayley 1965); betw een A frican, European and
Indian C hildren (G eber and D ean 1957).
R obert M aiina (1980) review ing the findings o f a num ber o f studies involving
babies from E urope and the United States, found that the m edian age for the onset o f
91
walking was 11.4 and 14.5 moiillis.
1liis range is rem arkably narrow given the
complexity o f w alking activity. Super (1976) however, observed several cultures in
East A frica in w hich infants began w alking about a month earlier than those in most
western societies. Care givers in these
babies
cultures believed it was important to teach
to walk, and infants continued to exhibit the steeping
retlex until walking
began.
In still other cultures, w alking begins surprisingly late. A m ong the Ache o f
Eastern Paraguay, children are significantly delayed in acquiring a host o f m otor skills,
but the disparity is best illustrated by walking, reported not to begin until twenty one to
twenty three
m onths o f age (Kaplan and D ove 1987). T his sm all band o f people,
engaged in hunting and gathering, do not encourage the acquisition o f m otor skills in
the infants.
Iiilc'llii’c'iice
hitelligence plays an im poilant role in the developm ent o f m otor activities
specially during the first year o f life. The dull children or less intelligent take longer
tim e to sit, stand or w alk (Sharnia 1995). In Bayley’s study, the correlation between
intelligence and m otor developm ent w as approxim ately. 50 at nileen m onths o f age. A
num ber o f studies
have show n that intellectually retarded children
as a group are
som ew hat retarded in m otor developm ent. Studies o f intellectually gifted children as a
group also reveal these children as som e w hat accelerated in m otor growth.
(T hom pson 1979)
In d iv id u a l D iffe re n ce s
The m aturity rate o f each child is different w hich creates individuality in m otor
developm ent. M ost o f the children crawl before they walk, how ever, som e walk before
they crawl (Sharnia 1995). A lthough the order o f m otor m ilestones is sim ilar across
92
children, there are large individual dilTerences in the rate at w hich m otor developm ent
proceeds. Each new skill is a m atter o f developing increasingly com plex system o f
action.
Besides
m aturation,
m otor
developm ent
is
affected
by
movem ent
opportunities, infant rearing practices and a generally stim ulating environm ent. (Berk
1994)
IV .1.5: E n v iro n m e n ta l In flu en ces O n M o to r D evelopm ent
The environm ent plays an im portant role in m otor developm ent, even though
in m ost cases it is rather limited. I here are two basic enviroiunental variables that
appear to be m ost clo.scly related to m otor developm ent: opportunity for practice and
m otive-incentive conditions. The research literature leaves little doubt that the
developm ent o f som e m otor skills is highly influenced by specific practice and
form alized instruction. A lthough there are a num ber o f basic m otor skills in infancy
which seem to be little affected by practice, m any o f the m otor skills o f early
childhood appear to be seriously lim ited by the paucity and psychological restrictions
o f opportunities to experim ent with, tryout, and consolidate developing m otor abilities
(Thom pson 1979). The role o f the environm ent is usually quite lim ited, although early
experience can affecl m aturation rales in som e areas, like vision (l.ipsill 1986). In
general, w hen children are well fed and w ell cared-for, and have physical freedom and
the chance to practice m otor skills, their m otor developm ent will be norm al (ClarkeStew art 1973).
W hen
the environm ent is grossly deficient in any o f these areas,
developm ent can suffer as in a classic study
o f three orphanages
in Iran (Dennis
I960). Fortunately, such severe environm ental deprivation is rare. B ut it is clear that
the environm ent can play a part in m otor developm ent, and that the m ore restricted a
child’s environm ent is the greater its effect will be.
93
I V . 1.6: S U i n u l i i l i i i g M o l o r U c v e l o p i i i e i i t
In order to see whetlier m otor developm ent can be speeded up, a num ber of
researchers have tried to train children to walk, clim b stairs, and control the bladder
and bowels earlier than usual.
In a classic experim ent, Gesell (1929) studied a pair o f identical twins. He
trained tw in T, but not tw in C, in clim bing stairs, building with blocks, and hand
coordination. W ith age, how ever, tw in C became ju st as expert as tw in 1'; Gesell
llierclbrc, acknow ledged the povverltil inlhiences ol'm aluralion on inliinls; behaviour.
Even though this study was conductcd m ore (han 70 years ago- and on only two
infants- G esell’s conclusion still stands (I'apalia and Sally 1994).
hi a study o f another pair o f tw ins M cG raw (1940) m easured the effects o f very
early toilet training. She put one tw in on the toilet every hour o f every day starting at 2
m onths o f age, the other tw in was not put on the toilet until 23 m onths o f age. 1he first
twin did not begin to show som e control until about 20 m onths and did not achieve
consistent success until about 23 m onths; and the other tw in quickly caught up. This
shows that m aturation has to occur before training can be effective.
W hile it is usually not advisable to attem pt to speed up m otor developm ent for
an individual child,
developm ental ages for certain skills do, appear
to vary
som ew hat from one culture to another (Papalia and Sally 1994).
IV.1.7: R ole o f N ature and N urture
D espite its im portance, researchers have often over estim ated nature’s
contribution to the em ergence o f m otor skills (Parm elee and Sigm an 1983). The lack
o f opportunity to engage in m otor activities can seriously interfere w ith their
acquisition. Evidence that m otor skills do not sim ply follow a m aturational course
com es from observations o f blind children. Even though blind infants achieve m any
94
m ilestones at ages sim ilar to the sighted, reaching for objects and crawling and
walking are substantially delayed. These findings have led researches to design special
programs to encourage blind infants to acquire self-initiated m ovem ent at an earlier
age (Fraiberg 1977). I hus, a com plete theory o f m otor skill developm ent needs to give
recognition to the contribution o f both nature and nurture.
IV.2: L a n g u a g e D evelopm ent
One o f the m ost im pressive developm ents in infancy and one that clearly
reveals individual differences am ong children is the beginning o f language (Stewart
and Friedm an 1987),
R oger Brow n has defined language as an arbitrary system o f sym bols, which
taken together m ake it possible for a creature with lim ited pow ers o f discrim ination
and a lim ited m em ory to transm it and understand an infinite variety o f m essages and to
do this inspite o f noise and distraction (Brow n 1973 b).
T he critical elem ent in this definition is the phrase infinite variety o f messages.
Language is not ju st a collection o f sounds. Very young babies m ake several different
sounds, but we do not consider that they are using language. They do not appear to use
those sounds to refer to things or events and they do not com bine individual sounds
into different orders to create varying m eaning. So far as we know , for exam ple, it
does not m atter w hether a 6 m onth-old says “K akiki bababa” or bababa kikiki”(llclcn Bee 1989).
Language developm ent refers to the developm ent o f phonology, syntax,
sem antics and pragm atics. G enerally a distinction is m ade betw een language and
speech (H arris 1983). B ut this distinction is m ore clear cut in theory than in practice.
The Fuzzy boundary betw een these term s has prom pted som e researches to use them
interchangeably.
95
IV.2.1: I’lioiiological U evclopiiieiit
Phonological developm ent refers to the developm ent o f the sound system.
Researchers in w est have identified the follow ing stages in developm ent:
0-3 m o n th s : In this stage vocalizations began to be apparent.
Language is used to express various em otions like pain,
discom fort and hunger. Back vowels like /u/and /o/are
vocalized in this stage.
3-6 m o n th s:
Front vow els like/i/e/and m id-vow els like/a/are produced
in com bination with consonants like/m /n/p/t/and /d/in
this stage.
6-12 m o n th s; 1his period is lull o f babbling activity. I his is ollen
referred to as the pre language stage, because m ost o f the
consonants and stress patterns through babbling, fro m
the seventh inonth onw ards the child repeats or echoes
sequences o f sounds. The first w ord also begins to
emerge.
This sequence o f developm ent is said to be invariant across languages.
Jackboson (1968) in his law o f universal sequence claim s that the phonem es com m on
to all languages are acquired first. Phonem es specific to particular languages are
acquired later (Srivasti and Devaki 1998).
IV .2.2: vSyntactic D evelopm ent
I'he developm ent o f syntax refers to how children com bine w ords to make
sentences. Syntactic grow th is m easured in tw o ways. One m ethod is to adm inister
tests and plo t the course o f developm ent. T his is usually done in an experim ental
situation. A nother and a m ore frequently used m ethod is collecting data from
observation in the natural setting, hi general, researches have identified the follow ing
stages in syntactic growth.
S ta g e I: Tw o W ord U tterance
T his stage is noticed around 18 m onths o f age. The ch ild 's language consists
o f sentences that are o f tw o w ords length. This stage has been variously called the
96
telegraphic speech (Brown and Fiaser 1963). Pivot graniiiier (Braiiie 1963) and Openclose (G lietnian and W anner 1982).
II: D cvcliipnient ()IMiiri)lii)lii};y
M orphology consists o f two aspects, inllcctions anti derivations. 1lie child
begins to actiuire inllections from the age o f 2 years, and derivations much later.
Brown (1973 a) after an extensive study lias provided an order o f de\elopnient of
m orphology with present progressives (verbs with 'in g ' as the m arker as in going,
eating etc.) com ing first. This order has received stipport from other studies (J.G.de
Villiers and P.A de Villicrs 1973: Dcvaki 1992)
Slage I I I : D evelopm ent o f N egatives anil Q uestions
A fter the developm ent o f m orphology, children begin to acquire
sentences.
The developm ent o f negatives has been studied in Telugu. The findings o f Telugu
show three developm ental stages nam ely (a)N egatives show ing non-existence develop
first (b) N egatives show ing denial develops next, and (c) N egatives show ing rejection
develops
last. These
findings are slightly different
from those
reported
by
Vaidyanathan (1984) in 1aniil aiul by Bloom (1970) in fjiglish. Vaiilyanathan reports
that rejection develops first followed by non existence and prohibition
and denial.
Bloom , how ever, reports that non-existence develops first, follow ed by rejection and
denial( Srivastava 1998).
IV.2.3: Sem antic D evelopm ent
It deals
with tlie
issues
o f how
children
acquire
m eaning.
Sem antic
developm ent takes place with extraordinary speed as preschoolers foot m ap thousands
o f w ords into their vocabularies. A lthough individual differences exist, object words
are em phasized first, action and state w ords, increase later. Errors o f under extension
and over extension gradually decline as preschoolers enlarge and refine their
97
vocabularies. D uring m iddle cliildliood, understanding o f word meanings become
more flexible and precise. A dolescents acquire many abstract words and grasp subtle
non literal w'ord m eanings. Adult feedback assists witli word learning, but a m ajor role
is played by the c h ild ’s cognitive processing (Berk 1994).
IV.2.4: Pragm atic D evelopm ent
The developinent o f pragm atics refers to the use o f language in every day
interaction.
Besides phonology, vocabulary, and gram m ar, children m ust learn to use
language effectively in social contexts. For a conversation to go well, participants must
take turns, stay on the sam e topic, state their m essages clearly, and conform to cultural
rules that govern how individuals are supposed to interact. During the preschool years,
children m ake considerable headw ay in m astering the pragm atics o f language. (Berk
1994)
Pragm atic developm ent has been dealt with diversely by w estern researchers. It
is seen either as a part o f sem antic
developm ent by Pease and Berko (1985) Lee
(1980) as a pail o f .socio-lingiiistic tlcvcliipm enl by D estelano (1978) and Kuc/aJ
(1984) referred it to as discourse developm ent and as com ponents o f inter and intra­
personal com m unication skills by Dickson (1981) (Srivastava 1998).
Several scholars have presented
a developm ental
perspective o f pragm atic
developm ent. T hese m ay be sum m ed up in term s o f the follow ing 3 stages (Ingram
1989)
S tage I:
This stage applies to the earliest m onths w herein the child
responds to a d u lt’s acts by som e acts or sounds.
S ta g e II :
This stage occurs at the end o f the first year and the child
responds to adults speech by som e acts and to adults act by
speech.
98
Stage 111:
lliis slage begins IVom 1.6 years onw ards and the cliild
responds to adults speech by speech.
IV.2.5: Stages in Language D evelopm ent
ST A G E S IN LA N G U A G E DEV ELO PM EN T
Follow m g are the language m ilestones from birth to 2 years.
Age________________________ ____________
Birth
1
‘/2
D e v e l o p m e n t _____________________
Baby can perceive speech, cry, m ake som e response to sound
to 3 m onths
Coos and laughs
3 m onths
Plays with speech sounds
5-6 m onths
M akes consonant sounds, trying to m atch w hat she or he hears.
6-10 m onths
Babies to understand w ords (usually “no” and baby’s own
nam e), im itates sounds.
9 m onths
Uses gestures to com m unicate and plays gesture games.
10 m onths
Loses ability to discrim inate sounds not in ow n languages.
10-14 m onths
Says first w ord (usually a label for som ething) im itates sounds.
13 m onths
U nderstands sym bolic function o f nam ing
14 m onths
Uses sym bolic gesturing
16-24 m onths
Learns m any new w ords, expanding, vocabulary rapidly, going
from about 50 w ords to up to 400; uses verbs and adjectives;
speaks 2 w ords sentences.
18-24 m onths
Says llrst sentences.
20 m onths
Uses few er gestures, nam es m ore things.
24 m onths___________ U ses m any 2-w ord phrases, no longer babbles, w ants to talk.
S o u rc e o f M ilestones:
Bates, O ’Connell, and Shore 1987; C apute, Shapiro and
Palm er 1987
T he stages o f language developm ent are pre speech, the first w ords, the first
sentences and the early syntax.
P re speech
T he w ords infant is based on the latin-for “w ithout speech” . Before Stefan said
“D ada” or A nna said “H i” , both like all norm al infants, m ade a variety o f sounds that
99
progressed
in a fairly set sequence from crying to cooing and babbling, accidental
imitation, and then deliberate initiation. These
sounds are known as pre-linguistic
speech (Papalia and Olds 1994).
Babies can distinguish between sounds long before they can utter anything but
a cry. In the first m onths o f life, they can tell apart sim ilar sounds like bah and pah
(liiinas al id 1971). Ihis ability to differentiate sounds seem s to be an inborn capacity
tliat people love as they hear the language spoken around them . Babies seem to lose
this ability at about 9 or 10 m onths o f age, w hen they begin to understand m eaningful
speech, but before they are physically m ature enough to produce their own.
A t anyw here from 6 w eeks to 3 m onths o f age, babies stail to laugh and coo
when they are happy, m aking squeals, gurgles and vow el sounds like ah. A kind o f
“vocal tem iis” begins at about 3 m onths, w hen they begin to play w ith speech sounds,
producing a variety o f sounds that sccni to m atch the ones they hear from the people
around them (Bates ef a / 1987).
C ross-cultural studies- like one that looked at babies grow ing up in French-,
Chinese, and A rabic-speaking fam ilies-found that babies do not, as w as once believed,
“try out” all speech sounds in all hum an languages, but instead m ove in the direction
o f their own language (Boysson et al 1984).
B abbling-repeating consonant-vow el strings like m am a-nia-m a-occurs rather
suddenly betw een 6 and 10 m onths o f age, and these strings are often m istaken for a
baby’s first w ord. E arly babbling is not real language, since it does not seem to have
m eaning for the baby, but it becom es m ore w ord like, leading into early speech (Dore
1975).
100
A t first babies accidentally imitate soimds tliey hear. 'I'lieii tiiey imitate
them selves m aking these sounds. At about 9 to 10 m onths o f age they deliberately
imitate other sounds, w ithout understanding them. Once they have this basic repertoire
o f sounds, they string them together, in patterns that sound like language but seem to
have no m eaning (Lenneberg 1967).
T his pre linguistic speech can be rich in em otional expression starting at about
2 m onths, when infants cooing begins to express contentm ent, the range o f emotional
tone inciease steadily. Long bclbre cliildien can express any ideas in words, parents
becom e attuned to their babies feelings through the sounds they m ake ( fonkovaYom poli 1973).
Babies understand m any w ords before they can say them . The first words m ost
babies understand are either own nam es or the w ord no. They also pick up other words
with special m eaning for them , and parents som etim es have to start spelling w ords in
front o f 14- m onths old if it is not tim e yet to give them their b-a-n-a-n-a (Papala and
Old 1984).
I!y the end o f Iho lirst year (he baby has som e .sense o f intentional
com m unication, a prim itive idea o f reference, and a set o f signals that serve to
com m unicate w ith the baby’s fam iliar caregivers (Bates et al 1987). The linguistic
stage is now set for speech.
F irst W ords
The average baby says
his or her first w ord som e-tim e betw een 10 and 14
m onths, initiating linguistic speech - the use o f spoken language to convey m eaning.
Before long the baby will use m any w ords and will also show som e understanding o f
gram m ar, pronunciation, intonation, and rhythm (Papalia and Old 1984).
101
Typically by 15 m onths o f age a child o f either sex has spoken 10 dif ferent
words or nam es (N elson 1973) Vocabulary continues to grow throughout the single­
word stage (w hich tends to last until the age o f about 18 m onths). The sounds and
ihytiiins o f spccch
g lo w
inoic chilioralc, anti
even
if much o f Ihc cliiUfs spccch is slill
babbling it does seem quite expressive.
In studying the Hrst 50 words spoken by a group o f 1-and 2 year-olds, Nelson
(1973, 1981) found the m ost com m on were nam es o f things, either in the general sense
(“o o f-o o f’ for dog) or the speciHc
(“ U nga”) for one particular dog). Others were
action w ords (“bye-bye” ), m odifiers (“ hot”), w ords that
express
feelings or
relationships (the ever-popular “no”), and a few gram m atical w ords (“ for”).
By 13 m onths m ost children seem to understand the sym bolic function o f
naming; that is, they realize that a w ord stands for a specific thing or event. They add
words slow ly to their vocabulary until a “nam ing explosion” occurs som ewhere
betw een 16 and 24 m onths, and the baby goes from saying about 50 w ords to saying
about 400 w ithin a few w eeks (Bates et al 1987).
F in I S e n te n c e s
The age at w hich children begin com bining w ords varies, although the range is
sim ilar for children w ho learn spoken language and children o f d e af parents who learn
sign language. G enerally they put w ords together betw een 18 and 24 m onths o f age,
about 8 to 12 m onths after the first word, but this is very variable. A lthough pre
linguistic speech is fairly closely tied to chronological age, linguistic speech is not.
K now ing a c h ild ’s age tells us very
little about his or her language developm ent,
according to R oger Brow n (1973 a) w ho has studied this phase o f language
acquisition.
102
Early S y n ta x
Som etim es betw een tlie ages o f 20 and 30 months, children acquire the
fiindaments o f syntax. They begin to use articles (a, tlie), prepositions (in, on), plurals,
verb ending and form s o f tlie verb to be (am, are, is). By 3 years o f age, their speech
becom es longer and m ore com plex, although they om it many parts o f speech, they get
their m eaning across, and they are fluent speakers (Brow n 1973a, 1973b). Language
continues to develop, o f course, and by late childhood, children arc fully com petent in
gramm ar, although they continue to enlarge there vocabulary and improve their style.
IV.2.6; In d iv id u a l D ifl'crciiccs in L an g u a g e D evelopm ent
T he rate o f developm ent differs considerably from one child to the next. The
first word usually is heard when the child is som ew here around one year old. Yet it is
not at all uncom m on for the first w ord to be delayed until 14 or 16 months.
S e x D ifference
In early research the results show ed that girls were considerably superior in
language developm ent in the first few years o f life. But this definitely does not m ean
that every female is beller (han every male.
S o cia l C lass D ifferen ce
T he usual assum ption is that poor children have less good language. The poor
children seem to know few er w ords. The clear reason for this is that m iddle or rich
class children get to talk m ore from the earlier days o f life and are exposed to m any
m ore w ords. Low er-class m others, use a restricted language code, talking to their
children in short, sim ple and easily understood sentences. Social contacts and
relationship o f the child have an im portant influence on speech developm ent (H urlock
1965).
I 103
Early Verbal E xchau);e
In conversation initiated by adults, two year olds otten sim ply repeat what the
adult says. Me Carthy (1950) cites research evidence w hich indicates that children who
associate with adults show greater linguistic acceleration than those wlio associate
with other children.
Intelligence
The intellectually gifted child usually speaks earlier and more efficiently.
While the m entally dcl'cclive child speaks later and articulates poorly. M ost
psychologists
agree
that
intelligence
advances
are
fundam ental
for
language
developm ent.
H earing
Babbling sound w hich is product at about five to six m onths is to an extent
determ ined by
m aturation. The continuation o f babbling, depends
on feed-back
children hearing them selves and on social stim ulation(hearing others and responding
to them).
lleaUh
The severe and prolonged illness during the first tw o years o f life delays the
beginning o f speech and the use o f sentences. M ost o f the needs are readily fulfilled by
the adults around him thus he has little incentive to talk. H urlock cites evidence to
show that physical condition has a im portant influence on the developm ent o f speech.
P ersonality
A shy w ithdraw n, who avoids com m unication w ith others speaks less than the
one w ho is a m ixing kind and prom otes com m unication w ith everyone around him.
(Sharm a 1995)
104
I V . 2 .7: T h e l i i n u c i i c e O T I lie lO ii v ii 'o in ii ti il O n L : i i i n u ; i ^ e l)cvcl<i|)iiieii(
Early theories : Imitation and Reinforcement
The earliest attem pts to explain language developm ent were prim arily based on
learning theory approaches and on the com m on sense idea that learning a language
was a fairly straight forw'ard process o f im itation or reinforcem ent.
Im itation
It obviously has to play som e part, since the child does learn, the language he is
hearing and tloesn't invciil Ills own. Cliiklicn do imilalc senleiiccs they hear ; they tlo
repeat the nam e o f som e new object w hen they hear it (Leonard et al 1983); they do
learn to speak w ith the
accent o f those they are listening to.
I'liere is even some
evidence froiii research by Elizabeth Bates (Bates et al 1982) that those babies who
show the m ost im itation o f actions and gestures in the first year o f life are also the
ones, who later learn language m ore quickly, thus, the tendency to im itate may be an
im portant ingredient in the language- learning process.
R ein fo rc em e n t
A m ore form al theory o f language developm ent based on learning theory was
proposed by Skinner. 1le argued that children arc directly taught language by their
parents or others aroim d them , the adults, he thought, shape the c h ild ’s first sounds
into w ords and then w ords into sentences by selectively reinforcing those that are
understandable or “correct” . If your child says “coo” w hile reaching for a cookie and
you say “ No say cookie” and w ithhold the cookic until she says som ething closer,
you are shaping the c h ild ’s language (Bee 1989).
N ew er E n v iro n m e n t T heories: T a lkin g to th e C h ild a n d O ther In p u t Theories
The children w ho hear a lot o f language develop vocabulary a little faster in the
early years than do those w ho are talked less (Engel et a l 1975). B ut it m ay not be
105
sheer quantity that is critical liere; rather, it seems that tliose infants wliose parents use
language responsively- who talk to the inlant when the baby m akes some noise or in
response to som e other behaviour o f the child later are slightly faster in language
developm ent (Clarke - Stewart 1973; Olson el a/ 1986).
M otherese
A dults typically speak to young children in a special, sim plified way called
motherese. M otherese consists o f short, sim ple sentences that may be repeated in
dilTerent forms lor ejnphasis (Stew art and l iictlm an 1987) Sincc this dislinclivcly
sim pler language is m ost often heard from m others to their youngsters, it has acquired
the nam e m otherese (Snow and Ferguson 1977; Schachter and Strage 1982).
M otherese h a s several k ey fe a tu re s:
•
It is spoken in a higher-pitched voice and at a slow er pace than is
spoken to adults, with clear pauses at the ends o f sentences
(Jacobson et al 1983).
•
The sentences are short and nearly alw ays gram m atical.
•
The sentences are gram m atically sim ple, w ith relatively few
m odifers and few clauses.
•
It is highly repetitive.
•
T he vocabulary is concrete, nearly alw ays referring to objects or
people that are im m ediately present.
•
A s the child's sentences becom e longer and m ore com plex, the
adults language m oves ahead slowly in length and com plexity,
alw ays a notch or tw o ahead o f the child (Bee 1989).
Today, som e researchers question the value o f m otherese, arguing that com plex
rather than restricted speech by parents leads to fast, accurate language developm ent
by children. T hese investigators contend that it is w hat children select from w hat they
hear, rather than w hat adults pre select for them , that is m ost im portant in learning
language (G lcitnian, N ew port and G leitm an 1984).
106
O ther researchers, however, still find positive correlation's between use o f
motlierese and the rate o f 2 years o ld ’s language growth (H off-G insbery 1985)
IV.3:
Social D evelopiiiciit
Social developm ent is acquisition o f the ability to behave in accordance with
social expectations (H urlock 1978). The social developm ent o f the child is associated
with other features o f his growth. The child as he grows up not only develops in
physical, m ental, em otional and attitudinal behaviour but, side by side with his social
behaviour also.
liach child develops within a spccillc social setting the nature o f the specific
life space has an
influence upon his learning experiences and how he feels about
them. Each culture, and to an extent, each group
furnish
a set o f expectations and
relationship
to w hich the individual belongs,
w hich
influence the
eventual
developm ent o f social skills, behaviours and attitudes. Social contact is necessary for
normal developm ent. The child develops through the stim ulation w hich he receives
from other people. Hum an behaviour is learned in the daily interactions with parents
siblings and eventually significant others (D inkm eyer 1965)
IV.3.1: U cvclupniciilnl I'rciuls in Social G row di
W e know that as children grow older the am ount o f social play increases
betw een them and that they m ake m ore friends as they grow from infancy to kinder
garden age (R ubin 1977). T hey also increasingly tend to select friends w ho are o f the
sam e sex (H agm an 1933). Role taking increases as child becom es older (Flavew l
1966).
In the past decade the influence that peer groups have on the social
developm ent o f their m em bers has draw n increasing attention
(lla rtu p 1983). It is
evident that the attitudes o f their peers becom e o f grow ing im portance to the child
107
during llicse early years as these groups
make it clear to tlieir
iiiciiibers tiuit they
favour positive, friendly behaviour and dislike aggression and selfishness (Hartiip et
al 1967). Such groups rate socially com petent children highly and these attitudes,
which are often frankly expressed, help shape the behaviour o f the children in the
group. Then too, as children becom e 4 or 5 years old they turn to their peers more
frequently for help than they turn to adults for it (Stith and C onnor 1962) and this aid
seeking prom otes m ore opportunities for positive social interactions.
Follow ing are the progress indicators o f social developm ent for 1st 2 years."
B e h a v io u r item s
A ee exDCctcd (w eeks)
1. R esponds to sm iling and talking
2.
Know s m other
6
12
3.
Show s m arked interest in father
14
4.
Is sober with strangers
16
5.
W ithdraw s lioni strangers
32
6. R esponds to bye-bye
40
7. R esponds to inhibitory w ords
52
8. Plays pat-a-cake
52
52
9. W aves “bye-bye”
Y e ars, m o n th s
10. Is no longer shy tow ards strangers
1-3
11. F.njoys imitation o f adiilt activities (sm oking etc)
1-3
12 Is interested in and treats another child like
1-6
an object rather than a person
13. Plays alone
1-6
14. B rings things (Slippers etc) to adult
1-6
15. Show s begning o f concept o f private ow nership
1-9
16. W ishes to participate in household activities
1-9
17. H as m uch interest in and w atches other children
2
18. B egins parallel play
2
19. Is dependent and passive in relation to adults
2
A bridged from the longitudinal study o f Individual D evelopm ent, by L.H.
Stott, Detroit: The M errill-Palm er Institute. Copyright 1955 by the MerillPalm er histitute. I'lie ages should be regarded as approxim ate.
108
IV.3.2: Socialization in Early Years o f Life
Socialization is the process by w hich children learn the standards, vahies and
expected behaviour for their culture or society. Socialization occurs through parents
serving
as m odels o f behaviour, expressing,
acceptance and warm th, providing
restrictions or freedom , and punishing unacceptable
behaviour. This process starts
from the day the child is born. As he grows his social needs increase, his peer group
full fills som e o f his essential needs. Mere observations becom es one mean o f
socialization.
The attachm ent relationship that begins in the first year forms an important
basis o f socialization in the later years. H om e environm ent is very im portant for
socialization process. A ll the fam ily m em bers and their relationship w ith the child
favour the developm ent o f good social attitudes and help the child to becom e a social
person. The w ay the parents rear a child, also has an influence. If the child’s need in
his child hood are not taken care o f or not full filled, he is likely to acquire certain anti­
social behaviours (Sharnia 1995).
A lthough opinion rem ains divided about how children becom e socialized
(M accoby and M artin, 1983), it appears children learn to becom e like other people and
to gel along w ith them as a result o f identifying with and im itating them and also by
being reinforced for desirable social behaviours.
C onsiderable evidence indicates that children learn by observing grow n-ups
and other children and that, particularly i f the person is nurturing and pow erful, they
will seek to be like the m odel and im itate his behaviour (B andura 1977; B andura and
Huston 1961; M ischel and G rusec 1966).
109
Research indicates that children also learn socially acceptable responses as a
result o f reinforcem ent either by adults (Allen el al-, 1964; Horow itz 1967) or by peers
(Fiiniian and M asters 1980). The quality o f emotional attaclim ent between m other and
child is an additional im portant influence on socialization. Children who are closely
attached to their m others tend to be m ore com pliant, that is, conform more readily to
the wishes and instructions o f their families as well as better liked and accepted by
their peers (Sroufe 1983).
IV.3.3: Infant Coniniiiniciitiun
Infants com m unicate with those around them w ith their appealing baby ness,
gazes, vocalization,
sm iles,
laughter and
cries. T hey com m unicate
by facial
expressions and bodily gestures. M others interpret babies expression and gestures as
com niunications
even w hen the baby is not intentionally sending
Eventually, the infant does learn to
m essages.
com nnniicatc and bcconies a truly interactive
partner in these social exchanges (Stew art and Fried m an 1987)
B aby n ess
H um an babies, like puppies, kittens, calves, and colts, have a special appeal.
This cute baby ness equips infants w ith a pow erful m eans o f attracting the nurturance
they need. Ethologists m aintain that baby ness helps to ensure the infants survival
(Bowlby 1969; L orenz 1971). It keeps adults near by and interested in feeding,
.sheltering and slim iilating (heir offspring.
G azing
B abies also com m unicate w ith the people around them by gazing. W hen
infants are held close, they can see their parents face and hair or a proffered hand or
toy. D uring feeding and play, parents hold their infants at a distance that is well w ithin
the infants visual w indow . That interesting face, as M om or Dad talks to and looks at
110
the infant, turns feeding and playtime into excellent opportunities for form ing social
and em otional ties (Stew art and Friedman 1987).
W hen infants are about 6 weeks old, their visual and m otor system s have
m atured enough so that they can focus on their m others eyes, w ith their own bright
eyes wide open. W hen they are about 3 m onths old, infants becom e able to m aintain
eye contact w ith their m others to gaze into their eyes for several seconds, and the
mothers feelings o f atlnclim ent to the infant deepen. The infants intent gaze not only
affects how the m other feels but it also com niunicates a useful m essage about how the
infant is feeling. G azing is an effective m eans by w hich the infants com nuinicate with
parents (Stew art and Freidm an 1987).
Vocalizing
Vocalizing is another m eans by w hich the infant com m unicates. For the first
few m onths, the infants vocal sounds are coos and gurgles. By about 4 m onths, infants
utter relaxed consonant and vowel sounds w hen they hear their parents voices or see
their faces approaching. They string these sounds together ‘bababababa’ ‘dahdahdah’
in sentence-like patterns. T his babbling is vocal play, not a deliberate attem pt to say
som ething. Infants vocalize in this w ay even w hen there is no one around to listen. But
although infants do not intend these sounds to convey m eaning, parents react to them.
W hile the infant is vocalizing or right after, the m other is likely to speak (Jones and
M oss 1971). T he infants vocalization is a m eans o f com m unicating w ith parents who
are w illing to listen.
S m ilin g A n d L a u g h in g
Sm iles and laughter are arguably the infants m ost irresistible m eans o f
com m unicating. D uring the first tw o w eeks o f life, infants ordinarily sm ile w hen they
111
are drowsy or sleeping liglitly rather Hum wlien tliey are awake. In the second two
weeks o f life, sm iles can be coaxed from infant by gentle stim ulation while they are
awake. These early sm iles look like later sm iles, and like later sm iles they arise from
arousal and relaxation. But it will be another few weeks until the infant is sm iling with
real pleastire. W hen infants are about 1 month old, they begin to smile exogenous
sm iles that are responses to events in the outside world. The 15 m onth old sm iles after
he has done som ething like more a ball aiul then show s his mastery by m oving it again.
His sm iles how that in his earliest m onths o f life, he already takes pleasure from
learning and doing (Stew art and I'riedm an 1987).
Laughter is another sign o f joy. Laughter is also a reaction to arousal and a fine
means o f com m unication, like sm iling, bifants begin laughing w hen they are 3 or 4
months old. 5 m onths old laugh when they are jiggled and tickled under the chin and
also w hen M om or D ad plays peekaboo. Laughing, like sm iling, happens first in direct
response to an event and later in response to the infants interpreting expecting or
participating in the event (Sroufe 1979).
M a k in g F a ces a n d G estures
A nother m eans by w hich infants com m unicate w ith others is by the gestures o f
their arm s and legs and the expressions on their faces- their frow ns and furrows, glares
and grim aces. E ven young infants faces show expressions that in adults indicate
pleasure and dlspleasuie, anger and fear, joy, surprise, sorrow , disgust (C harlesw orth
and K eutzer 1973). Parent inteipret babies facial expressions and gestures as
com m unication. In interactions, infants learn that others will react in particular ways to
their expression and gestures. Parents also learn to interpret the infants signals
accurately (Stew art and Friedm an 1987).
n i '2 ~ l
IV.3.4: Social M ilestones d u rin g the 1st y e a r o f life by N ew son, 1977
B irth To 3 M o n th s: The D ance Beginss.
•
Fixes eyes on parents eyes and hold gaze.
•
Sm iles at a nodding head or high voice.
•
Sm iles at parents face (the first social sm ile)
•
Cries w hen parents does not interact as usual
•
D iscrim inates betw een sight o f parents and others.
3 To 6 M o n t h s : E m o tio n s A ppear
•
Laughs
•
M ay act wary with strangers
•
A cts differently tow ards parents and other people
6 To 12 M o n th s: F o cu sed R ela tio n sh ip s Develop
•
Laughs at incongruity
•
A cts fearfiil w ith strangers in threatening situations.
•
A cts as a real partner in social interactions
•
D eliberately seeks out and stays near parents.
IV.3.5: Influences o f C ulture and Econom ic Status on Social B ehaviour
C hildren differ in their social behaviour at any stage o f their developm ent on
account o f great inlliieiice which is cxcrcised on them by the culture or custom s in
w hich they are born or live. The effect o f custom s is also visible quite clearly in the
activities o f children. C hildren bom in poor fam ilies, play m ore or less such w hich are
relative to the custom s prevailing in their fam ilies. The econom ic status o f the fam ily
is also m ore often responsible in developing the varying social behaviour patterns in
children. A child b o m in a low fam ily m ay not be able to adjust h im self socially well,
Social developm ent takes place in each and every child but individual
differences are there w hich can be noticed from the very infancy am ong children. The
reasons for these individual differences are quite com plex to com prehend clearly. But
113 I
they may be on account ot the training and education o f the children or on account of'
the environm ent.
IV .4.1:P ersonality Developm ent
The term personality is one o f the shpperiest in all o f psychology-personality
describes a broader range o f individual characteristics, m ostly having to do with the
typical ways each o f us interacts w ith tlie people and the w orld around us. Concept o f
personality is not reduced to num bers like an IQ score. C hildren do not have an
amount o f personality; they have a kind or type o f personality, a style or pattern (Helen
Bee 1989).
A ccording to A llport (1961) personality is the dynam ic organization w ithin the
individual o f those psychophysical system s that determ ine the individuals unique
adjustm ents to the environm ent. (H urlock 1978)
P ersonality D evelopm ent In In fa n ts
R esearches concerning early influences on the developm ent o f personality and
character are a great deal to the stim ulation received from the pioneering w ork o f
Sigm und Freud (M ehta 1964). Frued believed that personality is decisively form ed in
the first few years o f life, as children deal w ith conflicts betw een their biological,
sexually related urges and the requirem ents o f society. Freud proposed that the
conflicts occur in a series o f psychosexual stages, each o f w hich centres on a particular
part o f the body and its needs. T w o o f these stages occur during the first 3 years o f life
(Papalia and Old)
IV.4.2: Som e Im portant P ersonality D eterm inants
Som e o f the determ inants o f personality have their greater effect on the core o f
the personality pattern. How m uch inlluence different factors will have on personality
114
developm ent w ill depend to a large extent upon childrens ability to understand the
significance o f the factors in relation to them selves.
E arly E xperiences
Unhappy childhood experiences has a lasting effect on personality by making
the individual feel insecure. Studies o f the effects o f early experiences have shown that
experiences and the m em ories o f them , even though Vague, are highly influential
because they leave an indelible im pression on the child’s se lf concept. The attitude and
em otional reactions o f parents, the total cultural context o f the environm ent in which
the child grows up, and other factors in the child’s total experience are o f great
im portance in determ ining the pattern o f personality (Baum rind 1967).
C ultural In flu e n c e s
The cultural group to w hich children’s; parents belong sets the m odel for the
approved personality pattern. Children learn to behave in a w ay that is socially
approved in their culture. Li m any cultures, children are trained to be fam ily oriented.
As a result they develop personality patterns, characterized by loyalty, cooperation,
self-sacrifice, and oflen-unrealistic concepts o f them selves and their roles in life. In
cultures that are m ore individual oriented becom e m ore egocentric, m ore anxious to
help them selves than others (H urlock 1978).
P hysique
Physique, or body build, influences personality both directly and indirectly.
Directly, it determ ines w hat children can and cannot do. Indirectly it determ ines how
children feel about their bodies. This in turn is influenced by how significant people in
their lives feel about them (L ester 1974).
C hildren w ho are m arkedly different from their age m akes in physique oflen
develop som e com pensalory behavior, .such as clow ning iuid show ing off. This leads
to non favourable social reactions that leinloLco tlic non I'avoLiiable social leactions to
tlieir physiques (H urlock 1974).
P hysical C ondition
There are tw o aspects o f children’s physical conditions that affect their
personalities-general health and physical defects. N ot only does good health enable
children to engage in the nonnal activities o f their age groups but it also has a
favourable effect on their personalities. C hildren w ho are delicate and sickly develop
feeling o f inferiority and m artyrdom because they cannot engage in the activities o f
their health age m ates (M attson 1972). The m ore different the defects m ake children
from their age m ates, the greater will be their beliefs to their inferiority, inadequacy
and m artyrdom .
A ttractiveness
It is assum ed that those w ho are attractive have m ore desirable personality
characteristic than those who are m iattractive. This reinforces favourable social
attitudes tow ards them (K lcck ei ul 1974). A t an early age, attractive children sense
favourable social-attitudes tow ards them and this influences their se lf concept
favourably. As a result, they arc m ore self-confident m ore relaxed, and m ore friendly
and gracious than are children w ho are less attractive (D ion et al 1972). Just because
attractiveness o f appearance leads to favourable personality characteristics it does not
m ean that the m ore attractive children are the m ore favourable their personalities will
be (H urlock 1978).
Intelligence
C hildren w hose m telligence is definitely below that o f other children o f the
same age usually find them selves as outsiders in the peer group. B ecause o f their
narrow social experiences, ow ing to lack o f social acceptance by peer, dull children
116
tend to have poor social insight. This fiirtheL- impairs their social adjustm ents and adds
to their social rejection. Fortunately, dullness does not damage the personality pattern
as m uch as one m ight anticipate. The reason for this is that m ost dull children lack the
social insight to realize how unfavourable social attitudes tow ards them are (Gottlieb
1975).
E m otions
Suppression o f em otional expressions results in m oodiness, which tends to
make the individual rude, uncooperative, and pre-occupied w ith self. H eightened
em otionality, tends to m ake one nervous and ill at ease; it is often accom panied by
specific m annerism s, such as nail biting giggling (H urlock 1978). W hen em otions are
so strong that behaviour becom es disorganized, they will adversely effect children’s
characteristic patterns o f adjustm ent. By doing so, they have a profound effect on their
personalities by leading to unfavourable self-concepts (A liand 1976).
N a m es
A nam e, per se, has little effect on the se lf concept. Its influence is felt only
when children realize how it affects significant people in their lives. If a child suspects
or have reason to believe that others react unfavourable to their nam es, it will have a
dam aging effect on their se lf concepts. N icknam es or pet nam es have a profound effect
on their personalities. A s children grow older and are called by fam ily nam es will
these nam es begin to have an effect on their personalities (H urlock 1978).
S u c ce ss a n d F a ilu re
Failure, not only dam ages the self-concept but it encourages the developm ent
o f patterns o f behaviour that are harm ful to personal and social adjustm ents. These
harmful effect com e from children’s realization o f the unfavourabe evaluation o f
others as well as from their own self-evaluations. By contrast, success leads to
117
favourable se lf concepts which in turn, lead to good personal adjustm ents and
favourable social evaluations. These contribute heavily to good future adjustm ents
(Hurlock 1978).
Social A cceptance
Social acceptance influences every childs desire to develop socially approved
personality traits and it affects the self-concept favourably. Social acceptance plays a
large role in the developm ent o f the se lf concept. Children who are friendly and selfconlidcnt, in turn, win more Iriends, as their popularity increases, their poise, self
assurance and leadership qualities also grow stronger. By contrast, unpopular children
feel inferior, they are envious o f their popular age m ates, they becom e sullen, irritable.
These reactions do not help them to develop the personality traits that w ill im prove
their acceptance (H urlock 1978)
O ther influences w hich can affect personality o f a child are status symbol,
school influences and above all fam ily influence. H ow great an influence the family
has on personality developm ent has been expressed in the follow ing
anonym ous writer:
If a child lives with criticism , he learns to condition.
I f he lives w ith hostility, he learns to fight.
I f he lives w ith fear, he learns to be apprehensive.
I f he lives w ith pity, he learns to feel sorry for hiinself.
I f he lives w ith tolerance, he learns to be patient.
If he lives w ith jealously, he learns to feel guilty.
I f he lives w ith ridicule, he learns to be shy.
If he lives w ith sham e, he learns to be asham ed o f him self.
I f he lives w ith encouragem ent, he learns to be confident.
I f he lives w ith praise, he learns to be appreciative.
I f he lives w ith acceptance, he leam to love.
118
way by an
1V.5:
•
II lie lives willi icciigiiltion, he lc;irns to luive a goal.If he lives with
honesty, he leam s to value truth.
•
If he lives with security he learns to have faith in him self and others
(H urlock 1978),
E m o tio n al D evelopm ent
E m otions involve feelings, im pulses tow ard action, and the subjective elem ent
o f perception that produces the feelings and im pulses (Jersild I960) for our purposes,
expressions o f feelings that exceed m ildness and becom e intense will be considered as
euiolions. lim otions play a signilicani role iji Ihe developinciit o f the chilil. Some
believe that em otion is prior to all experiences and is fundam ental to them to the
extent that all learning is acquired in em otional term s (D inkm eyer 1967).
From the begim iing o f life infants are social beings: Infants em otion’s are
central aspect o f early developm ent. The em otional state o f infants differ from those
o f adults. Partly because infants do not consciously evaluate there feelings the way
adults do (Sharm a 1995) B abies begin to express em otion during the first year o f life.
Em otions continue to be im portant throughout their lives (D ecker 1988). Very soon
after birth, babies show signs o f interest, distress, and disgust; and w ithin the next few
m onths these prim ary em otions differentiate into joy, anger, surprise, sadness and fear.
Self-conscious em otions like em pathy, jealously, sham e, guilt and pride com e latersome o f them not until the second year (Papalia and O ld 1994).
IV.5.1; G eneral T rends in Em otional D evelopm ent
W atson (1959) was a pioneer in initiating an experim ental approach o f the
study o f em otional
responses o f infants, lie presented various kinds o f stim uli to
neonates and recorded their reactions. His observation show ed that new -born exhibited
three kinds o f unlearnt em otional responses, nam ely, fear, rage and love. He postulated
119
that all em otional reactions experienced by older children and adults are the auto
growths o f these three prim ary em otions.
B ridges (1930) w ork is classic in the study o f em otions. She has made
extensive studies on babies ranging
in age from birth to two years in a roundling
home. She noted that the new born responds with an undifferentiated excitem ent to
any kind o f em otional situation. As a result o f m aturation and learning, differentiation
from the general excitem ent takes place by about 3 m onths o f age. Distress and delight
are the em otions to appear
first. D istress becom es differentiated into anger, disgust
and fear by the tim e the infant reaches 6 m onths o f age. Jealousy appears from distress
by about 18 m onths o f age and at this age affection is show n for children and adults
separately. Betw een the ages o f 18 and 24
m onths, the em otion joy, becom es
differentiated from elation and affection on the sight o f delight.
Irwin and W eiss (1934) studied the avert activity and incidence o f crying
among 50 new born
infants w hen they are clothed and unclothed. They found that
94% o f the infants were quieter w hen w earing clothing. These and sim ilar findings
have been rationalized by Dennis (1940) on the follow ing grounds. Restlessness and
crying can be clicitcd from ihc ncwboiri infant by any intense and ciuluiing Irom ol
stim ulation M ild form s o f restraint, such as is often induced by infant binding am ong
certain racial groups m ay lead to quiescence and sleep. T his negative reaction to
intense form s o f restraint m ay generalize to other less physical form s o f frustration
with increasing age. How ever, these later responses to frustration are not necessarily
accom panied by involvem ent o f the autonom ic nervous system .
A s a result o f his investigation, Sherm an (1928), proposed a genetic theory o f
em otional developm ent. He concluded that em otional behaviour in the new born infant
is not differentiated beyond the sim ple feelings o f “ pleasant” and “unpleasant” . The
infant m akes a positive approach response to “pleasant” stim ulation, and a negative
120
withdrawal response to “ unpleasant” or noxious situation. W ith increasing m aturation
and experience the infant learns to m ake those responses that are most likely to attract
and retain pleasant situations, and to avoid or resist unpleasant circum stances. Thus
we see that Sherm an’s theory starts with two primary em otional states and accounts
for the addition o f other em otions on the basis o f learning principles.
IV .5.2: R e sp o n d in g to E m otions
From on early age, infants respond to differences in other people’s emotional
expressions
if these arc rcllected in dirccl interaction with the infant. In one study,
researchers tested the responses o f 3-nionth-old babies to the em otional expression o f
their m others w hile interacting with the infants (Cohn and fronick, 1983). Some
m others w ere asked to act as they norm ally w ould, som e to act depressed- to slow
their speech, keep their face still and m inim ize touching their infant or m oving their
own body. The babies responded quite differently to norm al and depressed m otlieis.
Babies o f depressed m others spent h a lf the tim e protesting, reacting warily, or giving
fleeting sm iles. B abies o f norm al acting inothers show ed m uch m ore variety in their
play, protested or acted wary only rarely, and w hen they sm iled, did so for significant
periods o f tim e.
Y oung infants also respond to others em otional expressions i f the expressions
are clear and salient- like crying. Investigators have observed, for exam ple, that 6m ontli-olds are responsive to the distress o f other babies (Hay et al 1981). W hen
infants
w ere placed in a room w ith another infant w ho began to cry, nearly all o f
them (84% ) looked at the distressed infant for nearly the w hole tim e he or she cried.
Some infants also learned, gestured or touched the crying baby. M oreover, if there
were no toys present and the infant w ent on crying, the other infant w as likely to grow
distressed too. C learly infants respond to crying. Som e researchers have reported that 3
m onth-olds w ho saw a frow ning face cried m ore than infants w ho saw a sm iling face
(Barrera and M aurer 1979). M any studies show that a C aregivers em otional expression
121
(happy, angry, or fearlul) influences whether a 1 year-old will show wariness of
strangers, play w ith an nnl'ainiliar toy, or cross tlic deep side o f tlie visual cliff (Rosen
et al 1992; W alden and Organ 1988).
M others
and
fathers
serve
as
equally
effective
sources
o f emotional
information for babies. W hen parents are absent, infants and toddlers turn to other
familiar adults, especially those who interact with them in an em otionally expressive
way (Cam ras and Sachs 1991). In fact, a Caregivers em otional cues during m om ents o f
uncertainty m ay be a m ajor reason tliat she serves as a secure base for exploration. In
an unfam iliar playroom , babies show a strong desire to rem ain w ithin eyeshot o f their
mother. If she turns away they will leave an attractive set o f toys to relocate within her
usual field so they
can
retain access to her facial and vocal cues
(C a iT
et al 1975).
IV .5.3: M ilestones o f E m o tio n al D evelopm ent D u rin g 1*’ 2 y e ars o f life
Table: Milestones of Emotional Development During 1st 2 years of lifes
A rc
Em otional Expressiveness
F.niofional U nderstanding
Birth- 6 months
Signs o f almost all basic emotions are
present, cacli o f which becomes
recogniziible witii age
Resonance to the emotional cues of
others is present
Social smile emerges.
1.aughter appears.
Expressioiis o f happiiiess are greater
when interacting with familiar people.
7-12 months
A nger and f e a r increase
Ability to detect the meaning of
others emotional signals emerges.
Use o f caregiver as a secure base
emerges.
Social referencing develops.
Emotional self-regulation improves as
crawling and walking pennit approach
and retreat from stimulation
1-2 years
Self-conscious emotions appear but
depend on the presence o f others
Vocabulary o f words for talking about
feelings expand.
Empalhie responding appears.
N ote :
These mileslones rcpre.sent overall age Ircjids. Individual differences exist in the persons age at
which eacli inilc.sloiie is allaiiicd (llcrk l'W'1),
122
Following are som e o f llie em otions vvliicli develop duiing infancy.
Love
In the first few m onths, babies do not know that they depend on others to meet
their needs. They do get hungry, wet, soiled and lonely, and they cry. After their needs
are met, they feel clean and com forted. But it takes tim e for babies to know that other
people are m eeting these needs. A s babies com e to kiiow who helps them , they feel
close (attached) to them. In this way, love begins
around 6 m onths o f age. Not only
do babies show love to im portant adults, but to children who keep them com pany as
well (D ecker 1988). Love between a child and his m other is not only due to her being
a source o f food but also due to her being a source o f bodily contact e.g. Playing in her
lap, sucking her breast, sleeping w ith her. In the developm ent o f affectionate
relationship the sense o f bodily contact appears to take a special significance (Kum ar
1988).
F ear
A t birth, babies startle (Jerk or show the M oro reflex) w hen they hear loud
sounds or do not have support for their bodies, liy 4 or 5 m onths, babies begin to look
soberly at strange adults. They m ay even show fear o f known adults in new hairdos,
hats, or sunglasses. B abies do not seem to fear strange young children or unknown
adults w ho have their backs to them . Babies seem to fear only the strange adults face
or a change in a know n adults face. Fear as an em otion occurs around 6 months. Some
babies are m ore fearful than others. Fear affects m otor and m ental grow th because
fearful babies oRcn will not try new things (D ecker 1988). E m otional reaction o f the
fear can be m ost devastating and m ay prom ote the developm ent o f unhealthy
personality (K um ar 1988).
123
A iixiety
It is closely related to feat. It is tear o f a possible event. Anxiety is seen most
often betw een the tenth and tw elfth month. Anxiety shown by young babies is called
separation anxiety. Babies bcconic anxious when tliose adults vvlioni they love leave
them. Separation anxiety can be seen when the parent leaves an alm ost one-year-old
baby with a regular baby-sitter. M ost tw o-year-olds do not show as m uch separation
anxiety as younger babies do (D ecker 1988).
A n g er
A lm ost Irom birlh, babies seem lo be angry at tim es. Very young babies Hail
(swing arm s and legs in a thrashing m otion), turn red, and cry loudly. These actions are
like those used to throw a tantrum . A nger becom es m ore directed toward a certain
person or object by 8-10 m onths. B abies express anger in physical ways. They m ay try
to get aw ay from a person holding them , or they may grab, shake or hit an object.
Babies vary in their am ount and strength o f anger (D ecker 1988).
IV .5.4: In flu e n c e o f E n v iro n m e n t on E m o tio n al D evelopm ent
Environm ent
has a decisive role in shaping the destiny o f the child. I he
parents especially m other contributes m axim ally to the em otional developm ent o f a
child. Som e o f tlie influences o f parental environm ent are given in the follow ing
paragraphs (G hai 1980).
PurenUil R ejection
If birth o f a child coincides w ith a tragedy in the fam ily (e.g. death o f a family
m em ber, loss o f em ploym ent or financial loss to the parent) it m ay be considered as a
bad om en and m ay result in rejection o f the child. Birth o f an unw anted child, or a
child o f fem ale sex can lead to rejection.
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Parental D o m in a n ce
The parents try to impose their own value system, aspirations and philosophy
on the child. This may build up stresses in the child’s interaction with parent.
O verprotected C hild
Overprotection may prevent the child to develop his sense o f independence and
autonomy. The child resists such interference in his or her life. Such over solicitous
parents feel frustrated at the attitude o f overprotected child.
O ver-expectations
They m ay try to push him to achieve scholastic goals, which may be beyond his
level o f com petence. A conflict betw een the child s parents expectations increases the
stressful situation (Kagan and M oss 1962).
U ndue C riticism
Children are very sensitive to im plied criticism or com parisons with other
children. A ppreciation and recognition o f the achievem ent, o f your own child is
necessary. I f parents ignore him and appreciate other children he begins to resent the
parental attitude resulting in nialadjustnient.
Lack o f C onsistency
Som e parents are strict at one tim e but becom e lax in attitude at another time.
The child is confused. A consistent discipline is conductive to a balanced developm ent
(H erington 1975).
B roken H o m e
A broken hom e due to parental discord, disharm ony or separation is tragic for
the developm ent o f the child.
125
Another Birth-Too Soon
The child’s emotional need of affection and security may appear to be
threatened with the birtli of another child. 1 he older sibling may feel deprived and this
may initiate behavioural disturbances (Knniar 1988).
IV.6: Cognitive D evelopinent
Cognition refers to the inner processes and products of the mind that lead to
knowing. It includes all menial activity-remcmbci ing, symbolizing, calcgori/ing,
problem solving, creating, fantasizing and even dreaming (l lavell 1985). Cognition
gives meaning to perceptions, l luis, perception is important to cognition (Berk 1994).
Jean Piaget, the Swiss psychologist, described how humans learn. He believed
people learn by exploring their world. Because of inborn rellexes such as sucking and
grasping, people begin to explore the world from birth. As reflexes disappear,
voluntary movement and sense perception help infants explore (Decker, 1988). As a
cognitive theorist Piaget has embraced the concept of development in stages that are
sequential, iiTeversible and qualitatively different.
IV.6.1: Divisions O f D cvelopineiil
Piaget’s four major divisions of development are:
•
•
•
•
Sensori motor
Pre operational
Concrete operational, and
Formal operational.
Sensorimotor (Birth to 2 years)
The sensorimotor period is composed of six fairly discrete stages
encompassing the first 18 months o f life.
126
•
Practicing R eflexes (Birth - 1 inoiUli) I liis stage is prim arily devoted to excessing
the ready-m ade reflexive schem ata such as sucking. cr> ing and making lists.
•
Repeating N ew Learning ( 1 - 4 m onths) Babies begin to change some o f their
reflex skills. Before babies sucked and grasped only when stim ulated, hi this stage,
babies do such things as suck their thum bs or open and close their hands. These
actions are not planned, but they bring pleasure. Babies repeat the actions olten.
Piaget called the m ain learning in this stage primary circular reactions. Towards
the end o f this stage, babies are anticipating the future. In this way, routines help
m ental growth.
•
Begiim ing to control their W orld ( 4 - 8 m onths) : The num bers and types o f actions
increase at a rapid rate throughout this sub-stage. M any new actions - such as
kicking - do not have their roots in the reflexes. These new actions aid infants as
they explore their w orld. Piaget called these learning secondary circular reactions.
D uring this tim e, infants also begin looking for objects. This m eans that they
realize objects exist even w hen they cant see them.
•
A pplying Learning to Solve C om plex Problem s ( 8 - 1 2 m onths): In this sub stage,
babies begin to apply learning to solve com plex problem s. They try to discover an
o b je c t’s purpose. T hey exam ine an object and then experim ent w ith it. D uring this
stage babies com bine tw o or m ore actions to achieve a goal. Com bining actions
helps the baby to achieve m any m ore goals than w ould be possible if a new action
had to be learned for each goal.
•
D iscovering N ew W ays to Solve Problem s (12 - 18 m onths): This is characterized
by tertiary circular reactions. The child is busy exploring and m anipulating
different m eans to the sam e end, or investigating one particular activity for a
variety o f results.
127
•
Beginning o f Thought (18 m onths - 2 years): hi this stage cliild i nvents new means
unlike any slie has li ied pieviously. lor exam ple, svilhout any prior experience, she
ligtircs out liovv to open a box (D ecker I98fi).
Pre operational S tage (2 - 7years)
The highlights o f this stage are the new use o f sym bols, s> iiibolic play and
language. Sym bols and sym bolic play are c]ualitatively new because they m ark the
child's ability to think about som ething that is not im m ediately before him. Previously,
inlclligence was lim ited to the child’s im m ediate environm ent, this developm ent gives
the m ind greater flexibility.
The intuitive or transitional stage begins roughly at 5 years o f age. A child is
able to understand m ultiple points o f view and relational conccpts than the pre
conceptual child. Still, his thought is characterized m ore by w hat he does not know
than by w hat he does know. His com prehension o f arrangem ents by size, num ber and
spatial classifications is incom plete. He is unable to perform m ental operations or
transform ations o f perceptual reality (Criag 1979).
The C oncrete O perational Sta g e 7-/ / yea rs
Piaget view ed the concrete operational stage, w hich spans the years from 7 to
11, as a m ajor turning point in cognitive developm ent. W hen children attain it, their
thouglit m ore closely resem bles that o f adults than that o f the sensorim otor and pre
operational child. A ccording to Piaget, concrete operational reasoning is far more
logical, flexible and organized than cognition w as during the preschool period (Berk
1994). A child is increasingly able to think about things from points o f view other than
his own, although these thoughts do not rise to the level o f abstractions. He can
perform som e operations on specific events or objects, but he cannot operate on his
own operations (Phillips 1979; Inhekler and Piaget 1958).
128
F orm ul O perations ( I I y ea rs a n d older)
A ccording (o Piaget, llic capacily for abslract tliinkiiig begins aioinid age I I .
At the form al operational stage, tlie adolescent reasons mucli like a scientist searching
for solutions in the laboratory. Concrete operational children can only operate on
reality, but formal operational adolescents can operate on operations. In other words,
concrete things and events are no longer required as objects o f thought. Instead,
adolescents can com e up with new, more general logical rules through internal
rellcction (Berk I9 ‘M). fo jin al operations concludes llic most ilianiatic devclopuicnts
in cognition, although other forms o f growth continue throughout adulthood (Craig
1979).
IV.6.2: In fa n t C ogn itiv e D evelopm ent
B ow er (1976) tested babies on the Piagetian concept o f conservation, which
can be briefly sum m ed up as (he aw areness (hat m atter does not change in quantity if it
is rearranged. A ball o f clay, for exam ple, that is then rolled into the shape o f a sausage
still contains the sam e am ount o f clay and weighs the same.
Piaget and m ost other researchers have found (hat children do not grasp this
concept until about 9 years o f age. Bower, how ever, found that 18 m onth old babies
move their arm s in picking up the tw o different shapes o f clay in such a way that
show s that they know the w eight rem ains the saine. W hen he tested the same children
two years later, how ever, he found that they no longer acted as if they understood this
principle. T hey seem ed to reacquire it at the age o f 7 or 8, lose it again, and not have a
stable grasp o f it until they turn 13 or 14 years old.
B ow er also found evidence o f other concepts at an early age, such as object
perm anence and num ber conservation (when objects aie rearranged into different
patterns, the num ber o f item s rem ains constant). Postulating that children lose these
129
concepts because they d o n 't piactice them, Bovver provided practice — and got some
unexpected results.
Ciiildren who had attained num ber conservation before tiie age o f 2 and tiien
practiced tlie counting tasivs did more poorly at the age o f two or two and a half than
children w ithout practice. By the age o f 5, though, the practiced group had caught up.
In referring to a sim ilar situation with children who had received practice in a
task relating to objcct permanence. Bower siiggcsled that (oo nuich praclicc on one
task m ight prom ote acquisition o f a concept so specific that the children cannot apply
their discovers to other sim ilar situations. 1hey lose the relationship between the initial
problem and the new one. Says Bower, they m ust dredge the initial discovery from
their m em ory, erring until they do, and they will seem to repeat an earlier phase o f
their cognitive developm ent.
Phatak et al. (1990) conducted a study to find the pattern o f cognitive
developm ent o f norm al babies from birth to six weeks. They observed tliat Indian baby
at six w eeks is still a baby in arm s in need o f support, getting acquainted with the
environm ent through vi.sion and pa.ssive body m ovem enl. I he follow ing aspects o f
m ental developm ent have been credited w ith 100 per cent beyond a particular age and
give a trend.
•
•
Q uiet w hen picked up - 7 days
M om entary regard o f red ring - 14 days
•
R esponds to sounds o f bell facial expression - 1 4 days
•
R esponds to sound o f rattle facial expression -
•
Regards a person up to 5 seconds - 2 1 days
•
Free inspection - 21 days
14 days
T he cognitive developm ent o f children from one m onth to 30 m onths was
undertaken by Phalak (1969, 1970). It was ob.served that during 1st m onth all infants
130
can regard a person m om entarily and respond to voice. During 2nd montli they can
follow up m oving person, vocalize once or twice. In the 3rd nionlli children show
social sm ile. In 4th m onth infants search for sound with eyes, recognize the mother, hi
6th month approaches m irror image plays with paper and inspects own hand. In 7th
month pick one cube, lifts cup, discrim inate strangers, reaches for second cube and
retains 2 cubes. In 8th month sm iles at m irror image, hi 9th month retains 2 or 3 cubes
offered. 10th m onth infant can realize 4 different syllables, in 12th month adjust
towards and says da - da.
hi 15th m onth he can uncover a square box, turn pages, hi 18th month he can
adjust the round block in the hole o f the form board. In 19th m outh can say 2 w ord by
23rd m onth he can build a tow er o f 3 cubes. By 25th m onth he can point to parts o f
doll and use w ords to m ake wants known, hi 26th m onth he can nam e one object and
discrim inate betw een a cup and a plate.' By 3()th month he can m ake a train o f cubes
and form sentences w ith two words.
IV.6.3: C ognitive Stiinuliition
The role o f cognitive stim ulation has been considered very significant in the
context o f researches in the area o f deprivation and social advantage. In these attem pts
the m ajor em phasis has been on establishing the link ages betw een the level o f
stim ulation and cognitive attainm ent. The findings in general suggest a negative
relationship betw een deprivation condition and cognitive developm ent. It has been
observed that experiential deprivation associated w ith residential background, caste
status, ethnic differences and poverty have retarding effect on cognitive com petence,
intellective perform ance and scholastic achievem ent. (M ishra 1983; Siiilia 1982;
Tripathi 1988). T he im pact o f deprivation is com plicated by the non-inteliective
factors like m alnutrition, m otivational inadequacy and lack o f supportive clim ate. On
the w hole, the available evidence tends to suggest that the children from deprived
131
backgrounds display a cluster o f features vvliicli renders them ill-prepared to participate
in the m ain stream . The negative effects o f deprivation are o f cum ulative nature and,
therefore, the discrepancy in perform ance between deprived and non-deprived groups
increases with age and grade. This situation dem ands early and sustained intervention
so that the vicious circle o f poverty and deprivation may be broken. This kind o f
intei"vention needs structural change as well as psychological enrichment.
In recent years som e attem pts have been m ade to enrich the lives o f tliese
deprived children through various program s o f cognitive stim ulation. For instance
Dash and Rath (1984) have tested a short, term 8 w eek cognitive stim ulation program
on other cognitive test perform ance. The pretest-posttest design show ed that the
perform ance on visual perception and association and figure drawing improved
significantly and the im provem ent w as greater in the disadvantaged group.
R ath and Patnaik (1979) found cognitive training effects on verba! reasoning
test perform ance, conservation for volum e also increased. Positive transfer was found.
Sinlia and M ishra (1985) show ed that helplessness has greater effect on cognitive
perforrnance o f highlydeprived. M ohanty and C houdhary (1981) dem onstrated the
effect o f training with screening and self-transform ation was effective in inducing
conservation
am ong
non-conserve
children
betw een
5
and
7 years
o f age.
A nandlakshm y (1990) has reported an interesting study o f intervention into cognitive
developm ent through playing with infants betw een 9 - 1 5 m onths. W hile one month o f
play sessions appeared
insufficient to cause any appreciable
increase in the
developm ental indices o f infants; nevertheless, their m otivation to play increased. The
intervention w as successful in providing the needed experience w hich resulted in
exploratory orientation. The studies on envirom nental process/variables related to
cognitive developm ent (A nandlakshm y 1990, Bevli 1990, M ishra and Tiw ari 1990)
^32]
indicate that m others education regarding the significance o f play activities, teaching
practices, ethical discrim ination, parental allitudes, em phasis on positive concepts,
parental concern, clim ate o f hom e significantly contribute to cognitive outcomes.
I’rcschool experience has also been reported to be an im portant factor inlluencing
cognitive developm ent, the effect o f w hich is equally shaied by high as well low SliC
children (Jachuck and Chatterjee 1989). Recently D.Sinha (1990) has analyzed the
issue o f intervention in the context o f poverty and deprivation. He notes that
p.sychology has lim ited but significant role in coping with diveise problem s by helping
the poor and deprived in developing adequate coping strategies skill, attitude and
m otivation. This, however, should be backed up by relevant environm ental support.
V:
Developm ent A ssessm en t
Developm ent assessm ent serves different purposes at different ages, hi the
neonatal period, behavioral assessm ent can delect a range o f neurological impairm ents
and can sensitize parents to their infants individual characteristics. During infancy,
assessm ent serves to reassure parents and to identify sensory, m otor, cognitive and
emotional problem s early, w hen they m ay be m ost am enable to treatm ent. During
middle childhood, assessm ent may suggest solutions for academ ic and social
problem s. A ssessm ent includes both screening and diagnosis. Screening identifies
children w ho
m ay benefit from
further diagnostic
assessm ent;
developm ental
diagnosis involves identifying a specific delay or disability and understanding its
significance in the context o f the childs other biological psychological and social
strengths and vulnerabilities (N elson 1996).
A ssessm ent during infancy is based on the im portance o f early intervention for
developm ental and em otional problem s. Developm ental assessm ent is extrem ely
133
important to know about the child’s previous developm ent and to compare it with
future developm ent (Illingw orth 1991),
A ccording to G ood enough, liedem ann in Germ any (1789) was the lirst to
publish a detailed record o f the developm ent o f one child, but it was not until Charles
Darwin in 1877 published a detailed account o f the developm ent o f one o f his own 10
children that interest aroused. In 1893 Shinn published
one o f the
most complete
records o f a young babies developm ent . hi 1931 Shirley wrote an exlrcm ely full
account o f 25 childicn iji their fust 2 years (lllingwortli 1987).
VI:
The V alu e o f Developm ent A ssessm ent
Every parent w ants to know w hether his child is developing normally,
especially if in a previous pregnancy there had been a m iscarriage or still birth, or if
the child had proved to be m entally or physically handicapped. An elderly mother,
with no other children, who has lost her husband or is separated from him, is likely to
be unduly concerned about her c h ild ’s developm ent.
D evelopm ental assessm ents provide im portant inform ation to the obstetrician
with regard to the
safety o f special investigations, treatm ent and m anagem ent
in
pregnancy or labour. It provides vital inform ation for the neonatologist, who has to
face difficult ethical problem s with regard to the resuscitation o f very low birth weight
babies or o f the infant thought to have suffered serious perinatal brain dam age. The
pediatrician needs to be able to assess a babies mental developm ent when faced with
sucking and sw allow ing problem s
in the new born, backw ardness in any field
of
developm ent, or w ith a child o f unusual appearance or behaviour. By his full
developm ental exam ination he is able to m ake an early diagnosis o f defects o f vision
or hearing, bi order to m ake a decision about suitability for adoption, developm ental
assessm ent is essential. Developm ental assessm ent is frequently o f great im portance
134
lor m cdico-legal purposes. Num erous claim s arc made against doctor or hospitals, on
the grounds that child s mental or physical handicap was caused by brain damage
arising from negligence w hen he is
found to be m entally subnorm al
or to have
cerebral palsy; a p lainlilf may blame the obstetrician for causing at delivery or labour
(Illingworth 1987).
VII:
M ethods of A ssessm en t
For a long tim e the clinicians have been
using the age o f achieving certain
skills as a quick but crude index o f the child 's developm ent. Sucli age-bound indices
are called m ilestones (indicating the progress on the life-road). One cannot rely on a
single iteni for assessing the developm ent o f a child especially if the deviation from
normal is not gross. For careful assessm ent and follow -up, a battery o f tests m ust be
em ployed so as to cover the developm ent o f interm ediate steps and allied skills
(Nelson 1996).
A large num ber o f m ethods have been standardized to assess the developm ent
o f children. T hey dem and the availability o f skilled clinical psychologist and
specialized kits for reliable assessm ent, fiessci developm ent evaluates gross m otor ,
line m otor, social, adaptive and language behaviour. A m iel-'fison
m ethod o f
assessm ent pays special attention to inuscle tone (active and passive), neurosensory
responses (V isual and passive) and neurosensory responses (Visual and acoustic) and
neurobehavioural assessem ent. V ineland and R avals social m aturity scale assesses the
social and adaptive m ental developm ent. The other m ethods
o f neurom otor
assessm ent include Bayley scale o f infant developm ent (m otor and m ental), Brazelton
neonatal
behaviour
scale,
V oja
Technique
(postural
reactions
and
central
coordination) and Denver developm ental screening test (DD S T). A m ong these, Bayley
135
scales o f infant developm ent (BSID), is m ost popular and widely practiced . In the
community setting health workers can he trained to scieen developm ent o f children by
using P h a ta k ’s Baroda screening
(BDST).
Trivandrum
lest. Baroda Uevelopm ental
Developm ental
Screening
Chart (TD SC)
Screening lest
and
W oodside
Screening system T ests (W SST) (Singh 1996).
G esell’s D evelopinciit S c h ed u les
Gesell has devised two schedules - Developm ental Schedules for the age group
from birth to 18 m onths (Gessel 1969) and Developm ent Schedules for 15 m onths to
72 m onths (G esell, 1963). W ith these schedules it is possible to assess developm ent in
four areas (i) M otor,
(ii) A daptive
(iii) Language and
(iv) personal-social. The
results are expressed in term s o f developm ent quotient (DQ ). The schedules are useful
for developm ental diagnosis- the discrepancies in the 4 areas o f developm ent- indicate
the diagnosis e.g brain damage, lack o f environm ental stim ulation etc. Even though
attem pts have been m ade to standardize the schedules for Indian children, no suitable
norms are available (Nelson 1996).
The B ayley Sc a le s o f In fa n t D evelopm ent (B SID )
The scales m easure the developm ent o f an infant (up to the age o f 30 m onths).
U nder 2 headings- the m otor and the m ental. The m otor scales have 67 test-item s and
the m ental scale have 163. Li the m otor as well as the m ental scales, all the item s are
arranged in order o f difficulty or to put in other w ords, in the order o f increasing age
placem ent. Each item that the child passes is given one m ark. The total m otor and
mental perform ance scores are counted by adding the num ber o f item s passed on the
respective scales. T he age-placem ent o f the item w hose serial num ber corresponds to
the total score gives the developm ent age o f the child (Nelson 1996).
fl3 6 I
D enver D evelopm ental S c re en in g Test
It was first developed in 1967 . It was devised to provide a sim ple method of
screening for evidences o f slow developm ent in infants and preschool children. The
test covers four functions. Gross m otor, language, fine m otor- adaptive and personalsocial (franken
burg and
Dodd
1967 ) .
DDST
was subsequently
revised, re­
standardized and presented as the Denver 11 Test in January, 1992 . It contains 125
items. It surveys a broad range o f developm ental skill w hich are presented as age
norms, ju st like physical growth curves. Developers o f the Denver 11 em phasize that
the m odule does not quantitatively
ineasure
intelligence, m otor developm ent,
com m unication skill or social com petence. This is not a substitute for appraisal o f
intelligence or developm ental quotients.
A c h ild ’s developm ent is considered delayed if the child cannot perform an
item w hich 90 percent children o f his age can do. Caution is advocated if the child is
delayed in 2 or m ore
item s w hich can be done by 90 per cent o f children
of
com parable age. Three or m ore cautions are considered suspect (Ghai 1993).
T rivandrum D evelopm ental S c re en in g C hart
i'he T rivandrum Developm ental Screening C hart ( i'DSC) was designed and
developed at the child developm ent center, SA T H ospital,
M edical College,
Trivandrum . 17 test item s w ere chosen to include adequate m ental and m otor
developm ental m ilestones spread over the first tw o years o f life. The range for each
test item was taken from
the norm s given in Bayley Scales o f hifant D evelopm ent
(Baroda norm s) It w as validated both at the hospital and com m unity level against the
standard DD ST. TD SC had a sensitivity o f 66.7% and specificity o f 78.8% which
m akes it an acceptable sim ple screening tool even for the com m unity level worker
(N air et al 1991). It is suitable for developm ental screening o f children below 2 years
o f age.
I 137 I
Woodside S ca le D evelopm ent
The w oodside system
uses 4 charts for giaphic representation o f the
developm ental progress o f the child. These charts refer to (1) Social (ii) liearing and
language (iii) vision
and fine m otor, and
(iv) Gross m otor areas o f developm ent.
Developm ent is considered satisfactory if the m ark on the woodside chart lies above
the step. It is doubtful if the m ark lies between the step and the dotted (threshold) line
or the m ark lies on the bottom step for the child w hose age
falls betw een two
consccutive steps ((ihai
Baroda Oevelo]>inent S c re en in g Test (HOST)
To sim plify the Bayley scales o f infant developm ent. 22 m otor items and 31
mental item s
not requiring any standardized equipm ent have been retained. These
items w ere grouped age w ise, one m onthly in the first 12 m onths and 3 m onthly
thereafter till 30 m onths. The 50 percent and 97 percent age placem ent o f each item
have been plotted on a graph and joined to have tw o sm ooth curves. The total num ber
o f the item s passed by a child is plotted against his chronological age. W hen this point
falls below 97 percentile curve, the child is considered to have developm ental delay
and is subjected to detailed assessm ent (Singh 1996).
A screening tool for A ssessm ent o f the H om e Environm ent and Psychosocial
D evelopm ent o f Preschool children has been developed by Um a et al (1962). This tool
was developed on the basis o f the data collected on a sam ple o f 150 children in the age
range o f 2 years 10 m onths to 3 years 8 m onths. (0-relation analysis was used in
identifying hom e environm ent and psychosocial developm ent variables for the
developm ent o f the tool.
A m iilti centric cross-sectional collaborative study was undertaken in 3 centres
in India w ith the m ain aim o f developing sim ple and reliable indicators for the early
138 I
detection
o f developm ental disabilities in children
compare the
under 6 years o f age and to
age o f attainm ent o f developm ental milestones in children in the 3
regions. The study provided a sim ple low-cost and culture-appropriate psychosocial
developm ental screening test battery which can be used with ease by trained public
health grass-roots functionaries (V azir el al 1998 a).
C ulturally
appropriate
techniques
for
m onitoring
child
psychosocial
developm ent were prepared and tested in China, India and Thailand on a total o f 28,
139 children. R epresentative groups aged between birth and 6 years were exam ined
and the results were used to produce national developm ent standards separately for
rural and urban children in
C hina and India, and for all children
com bined in
Thailand. In each country, betw een 13 and 19 key m ilestones o f psychosocial
developm ent w ere selected for a sim plified developm ental screening operation and
these
have been incorporated on a hom e-based record o f a child’s growth and
developm ent (L ansdow n et a! 1996).
A culture-appropriate and sim ple test battery consisting o f 67 test item s was
developed and field tested in Hai-yana, India in 1987-89. Percentile age values were
constructed for various developm ental m ilestones included in the cultural-appropriate
test battery. T he locally relevant, sim ple and low cost developm ental tests and
reference values can be used for early detection o f developm ental
disabilities at
prim ary care level (K um ar et al 1995).
VIII:
C om m on Pitfalls o f D evelopm ent Screening
W hen considering the range o f developm ental problem s in children, there are
several com m on pitfalls into w hich an untrained practitioner is likely to fall. Before
using any screening clinicians m ust be aware o f both the strengths and w eaknesses o f
screening (M alhi and Singh 1999).
139
'I he m ost com m on pitfall revolves around the notion that children who are
mentally retarded, also look difl'erent (Illingworth 1987). Bvidence indicates that the
good
looking delayed child is typically identified late conversely, the child with
dimorphic Teatnres may (Lock cl iil 1986) not be necessarily inlellcclnally dcficicnt
(Blasco 1991).
A nother pitfall o f developm ental diagnosis which practitioners often fall prey
to is w hen a child w ith norm al or near norm al gross m otor developm ent is presum ed to
be o f norm al intelligence. Several authors have em phasized that m otor m ilestones are
not predictive o f intelligence. Studies reveal that m any children with m oderate and
severe m ental retardation do not dem onstrate gross m otor delay (M alhi and Singh
1999).
In addition, there is tendency am ong practitioners to ignore language delay
until about 2 years. It is im portant to rem em ber that language developm ent, which is
m easured in term s o f expressive and receptive capability, is one o f the best predictors
o f later intelligence, and no parent w ith a child with
language delay should be
reassured w ithout appropriate developm ental testing (M alhi and Singh 1999)
One o f the m ost serious pitfalls is w hen the results o f developm ent screening
tests are used for predicting later developm ental status or intelligence o f the child. In
the first tw o years o f life, scores on developm ent tests have lim ited predictive value
for future developm ent unless the scores are in the very retorted rang. Predictions
im prove as the child grows older but are still subject to serious error because a child
m ay undergo at least tw o types o f changes in developm ent after the adm inistration o f
an early screening test. One change in the developm ental status o f the child as he
grows older is due to the acquisition o f new skills w hich are qualitatively different
from earlier skills. D evelopm ental testing at different ages m eans different skills are
140
the focus o f testing w hile in infancy, developm ental testing is confined to testing o f
sensory m otor skills, at older ages screening necessarily involves testing o f higher
mental abilities (M alhi and Singh 1999).
i he second problem relates to the change in the child 's circum stances, bolh
physically as well as psychosocial over a period o f tim e thus altering a ch ild 's rate of
developm ent. Environm ental factors and psychosocial stresses such as death o f a
parent, may also delay developm ent. Keeping this in view, it is recom m ended that no
screening result should be used in isolation to m ake a defm ite statem ent o f diagnosis.
M oreover, a child who fails on a screening test should be periodically screened befoie
m aking a definitive diagnosis. In order to ensure accuracy it is recom m ended that only
trained persons adm inister a screening test (M alhi and Singh 1999).
IX.
P resent T ren d s and Future P erspectives In Child Developm ent
There has been upsurge o f interest in the area o f developm ental psychology
recently. Li the last decade, it has show n tlie happy trend o f extending its scope and
broadening its horizons across various aspects o f hum an developm ent. It focuses on
changes in behaviour and various abilities accursed as the child grows up as well as on
the process o f change. The present trend is tow ards an increasing sense
o f social
relevance and ecologically valid theorizing (Bevli 1990).
A t the very outset, how ever, it m ay be noted that w hile the trends do suggest
patterns o f developm ent
in diverse areas the available studies have several
lim itations. The studies are usually based on data form lim ited sam ples w hich do not
represent Indian children in any statistical sense. The lim ited coverage o f data is
largely because o f lack o f any netw ork o f developm ental
increasing specialization in our
research as well as
attem pts to understand various aspects o f child
developm ent independently (Srivastava 1998).
141
The research usually use western scales adopted to the Indian situation, this
type o f trend is a very coninioii one show ing the inlluenee o f western research
m ethodology on hidian social scientist. These researches fulfill one basic need, that of
giving som e type o f m uch needed developm ental norm s or patterns for Indian children.
These researches can serve as the basis for further developm ental research as well as
the developm ent o f tools specifically for the needs o f our population in hidia.
D eprivation is one o f the m ajor concerns o f the researches in Indian and is
woven in re.seaich designs in one form or the other. It may be studied as urban-rural,
higher caste-low er caste or S.H.S differences. A nother favourite field for research is
that o f cognitive developm ent based on the piagetian m odel. In India as elsew here in
the w orld, m ost o f the studies have been replications o f conservation studies at the
concrete operational level. Some correlation and intervention studies have also been
attem pted recently.
D espite the
developm ent,
antecedent
aw areness am ong
individual
difference
scholars that the trend
in growth
and
in patterns o f developm ent and definitive
consequent relationships can be best studied through the use o f
longitudinal designs. The research should proceed in a system atic m anner through a
coordinated series o f researchers focussing on specified
problem s areas o f social
relevance. H ence, m ore field studies m ay be able to deal w ith the problem and provide
solutions to the policy makers.
Finally it can be said that a fast clianging society dem ands an increase in the
adaptive
capacity o f an individual and developm ent o f dispositions favourable to
change. T his can be view ed as a consequence o f change, can be actively developed to
facilitate change and self-reliance, in term s o f future perspective, as m uch attention
needs to be paid to developm ent o f theeryand
em pirical research on fundam ental
processes^ as in responding to social pressures to seek solutions to social problem s
(Bevli 1990).
142
m
-D
DEVELOPMENT
STUDIES
Development Studies
I:
Standard Test
Hemgreii and Perssoii (1999) presented a new model for com bined assessment
o f m otor perform ance and behaviour (CAM1>B) in 3 year old children. It is intend lor
sim ultaneous use w ith a scale for assessm ent o f m otor-perceptual developm ent. The
child's perfonnance
is observed
and com pared
with detailed descriptions of
performance in gross and fine m otor functions, and descriptions o f coordination,
attention and social behaviour, included in a protocol. An overall evaluation is also
made. These assessm ents have been perform ed in a longitudinal follow-up study of
children. It was observed that CAM PB together with the m otor perceptual scale was
feasible in these 3 year old children and CAM PB was sensitive enough to detect
difference betw een children.
D orthy and Brow n (1984) conducted a study to provide a standardized test
procedure to assess som e areas o f developm ent in children betw een 18 m onths to four
and a h a lf years o f age. The study show s the im portance o f the 27-33 m onths period in
the developm ent o fsitu atio n al understanding. Young children develop along a luimbcr
o f pathw ays sim ultaneously, i.e., language, perform ance, vision, hearing and m otor
fuirction. The Bus Puzzle tests developing language skills and som e perform ance
skills. It gives som e insight into visual and hearing behaviour although not m easuring
visual or hearing acuity. The Bus Puzzle Test has been designed to explore developing
language skills and perform ance skills.
C ulturally
appropriate
techniques
for
m onitoring
child
psychosocial
developm ent w ere prepared and tested in China, India and Thailand on a total o f
28,139 children R epresentative groups aged betw een birth and 6 years were exam ined
and the results w ere used to produce national developm ent standards-separately for
143
rural and urban children in China and India, and for all children com bined in Thailand
- which are considered to be more satisfactory than foreign based standards. In each
country, betw een 13 and 19 key m ilestones o f psychosocial developm ent were selected
for a sim plified developm ental screening operation and these have been incorporated
on a hom e-based record o f a child 's growth and developm ent (Landsdown el al 1996).
A m ulti centric cross sectional collaborative study was undertaken in 3 centres
in India with the main aim o f developing sim ple and reliable indicators for the early
detection o f developm ental disabilities in children under 6 years o f age and to compare
the age o f attainm ent o f developm ental m ilestones in children in the three regions. 1he
study provided a sim ple low-cost and culture-appropriate psychosocial developm ental
screening test battery w hich can be used with ease by trained public health grass-roots
functionaries. T his instrum ent was standardized on a large rural, tribal and urban
sam ple com prising m ore than 13000 children from 3 regions in India. The procedure
for sam pling, selection o f items and m ethodology for standardization o f the instrum ent
in the Hyderabad region detailed in this paper were replicated in other centres as well.
Quality control o f data was ensured through inter-rater and test-retest m easures o f
reliability. During pre-testing, 66 culture -appropriate m ilestones were selected fmally
from a larger item pool. The 50th percentile age reference values o f the Hyderabad
study children and those obtained by other 2 centres were com parable (V azir el al
1994 a).
A screening test for the assessm ent o f the m otor-m ental developm ent o f infants
was developed by selecting item s from the Bayiey Scales o f Lifant D evelopm ent
(BSID). Borado norm s as a sim ple and quick test for use in the door to door survey by
health w orkers. T he reason for choosing BSID and the criteria for the selection o f
item s are described. The m ethod o f using the screening test in com m unity surveys and
144
in office practise is discussed. Some aspects o f the developm ent o f our screening test
and the Denver D evelopm ent Screening l est (UDS f) are com pared. A routine use of
our test is recom m ended for follow ing the developm ent o f normal children as well as
for screening from com m unity children with possibility o f developm ent delay, fhe
later m ust be referred for detailed testing on the full scales (Phatak and Khurana 1990).
The Trivandrum D evelopm ent Screening Chart (FD SC ) was designed by
selecting 17 test item s from BSID (Baroda Norm s). It was validated botli at the
hospital and com m unity level against the standard DDST. TDSC had a sensitivity o f
66.7% and specificity o f 78.8%; w hich m akes it an acceptable sim ple screening tool
even for the com m unity level w orker (Nair et al 1991).
A culture appropriate and sim ple test battery consisting o f 67 test items was
developed and field tested in Haryana, India in 1987-89. Trained field workers
adm inistered the tests to 3731 pre-school children in 47 random ly related villages o f a
district, irrespective o f their physical/m ental status. Percentile age values were
constructed for various developm ental m ilestones included in the cultural appropriate
test battery. The locally relevant, sim ple and low cost developm ental tests and
reference values w ill be used for early detection o f developm ental disabilities at
prim ary care level (K um ar et al 1995).
D ixit and Patel (1994) in their study on Psychosocial developm ent o f urban
children reveal that using S h a k ir’s classification the children did not suffer from any
m alnutrition. A nalysis o f data revealed "at p a r ” perform ances in Gross Motor,
H earing and S e lf H elp Skills and delays in vision and Fine M otor, Language and
Concept
Skills.
Social
skills
were
particularly
advanced.
For
developm ental
assessm ent, the W HO suggested culture appropriate Psychosocial Basic l est Battery
was used.
145
Six hundred and nineteen infants and young ciiildien IVoni the shim s o f
Jabalpur were screened by twenty trained param edical workers using the W oodside
Screening Technique. A second scicen was given by the author within three days of
the 1st screen on 350(56.6% ) children, Ihe tester/author agreem ent was 97%. 1he
results o f the w oodside screening Teclm ique were validated against the Standard
G esell's Schedules. The specificity and sensitivity rates o f 88 and 83% respectively
were better than the original Denver Developm ental Screening Test (77% each). Over
referral rates which vary between 10-28'!o were com parable to the original Denver
Developm ental Screening Test. The under referral rate was 24%. All children tested
belonged to the deprived sections o f society, having weights below 50th percentile o f
Harvard Standards, hisepite o f this 74% o f children scored above and at par on the
G e se ll’s
developm ental
Schedule,
Only
11%
children
show ed
developm ental
abnorm ality (G upta and Patel 1991).
Phatak (1984 a) conducted a study on m otor and m ental developm ent o f
nonnal babies. 150 full term norm al babies were adm inistered 11 m otor and 19 rnental
tests based on Bayley Scales o f hifant D evelopm ent (BSID ) in the neonatal period.
Results o f age placem ents are com pared to extrapolated results as reported in “Baroda
n o rm s”. 5 m otor and 6 m ental tests from above w ere passed by 100% o f sam ple
babies o f specified ages and are hence listed as possible indicators failure on w hich
could be regarded as need for follow -up studies o f developm ent. A pen picture o f th e'
abilities o f the Indian baby aged 6 weeks com pares well with its reported British
counter part.
Phatak et al (1984) analysed records o f 3 to 10 longitudinal developm ent
testing in each o f 21 babies (1 full term norm al, and 20 prem ature and other high risk
babies) w ith a view to establish the validity o f 11 pre selected indicators o f
14
^
developm ent in the neonatal period. 4 m otor and 3 m ental items were noted as valid or
prom ising based on persistence o f delayed perform ance patterns in 60% o f the sample.
The use o f these tests as quick developm ental tests in neonatal wards and well baby
clinics is recom m ended,
G aussen (1984) has stated that there is a wide gap betw een recent research
models o f infant developm ent and available clinical procedures. He has reported that
there are lim itations o f current assessm ent instrum ents, with special reference to
m otor-im paired infants. These lim itations are especially important for assessm ent and
intervention strategies with im paired infants (0-30 m onths). It is suggested that new
assessm ent m ethods are needed to tap the processes underlying developm ental change
and more accurately reflect the com plexity o f factors affecting developm ent.
II:
Norm s
U klonskaya, el al (I9 6 0 ) reported then- observations about the developm ent o f
static and psychom otor functions during the first year o f life.
The physical
developm ent o f these children was norm al. The observations o f hidian babies were
com pared w ith R ussian standard norm s o f psychom otor developm ent. Results revealed
that hidian babies w ere on par with Russian babies brought up under nursery care up
to 7 m onths and after that their developm ent was retarded. This retardation was
explained by referring to the com plicated psychom otor functions o f crawling, standing
with support, toddling and speaking which required special adult attention and
training, and to the m other's lack o f such know ledge about training and bringing up
babies.
Studies from India and abroad indicate that average or norm al children usually
lift their head for a short span o f tim e w hen on stom ach by about the first or second
month (Frankenburg and Dodd 1967; W HO - ICM R study 1991) and the head is held
14r|
steady in silling posilioii by about the fourth month (Geseli 1971). Sitting without
support by children by about six inonlhs o f age. I hesc observations were made in a
study involving m ore than 13,000 rural, tribal and urban children from three regions in
India (W IIO -IC M R Study 1991).
Before learning to stand, some children pass through a stage o f crawinig as a
means o f locom otion. This is usually achieved by average children around the seventh
month w hile standing w ithout support is achieved by 10-12 m onths (W HO ICM R
Study, 1991).
Pathak (1970) revealed that the rate o f m otor and mental growth was fast upto
six m onths, after w hich the rate decreased and becam e steady during 1 2 - 1 6 months.
Sex differences in m otor and m ental developm ent were observed in babies belonging
to upper socio-econom ic status and urban areas. The urban upper socio-econom ic
group seem ed to be perform ing better than all other groups except on the m otor scale
for the first six to seven m onths. The urban environm ent suggested positive influences
on m ental perform ance. The trends o f m otor and m ental growth were sim ilar in Indian
and foreign babies on Bayley scales. The validity and reliability o f Bayley scales as
applied to bidian babies was acceptable.
M uralidharan (1974) reported that urban children are found to be faster in
m otor developm ent than rural and industrial children. The regional differences
rem ained the sam e irrespective o f the area. A com parison o f the present result with
G esell's Study show ed that on the w hole, the present sam ple appeared to be a little
more accelerated in developm ent than G e sse ll’s sam ple, in m ost o f the m otor skills.
Bhandari and Ghosh (1979) in their longitudinal study o f Gross M otor
Developm ent o f children found that in general, m ale children achieved som e o f the
developm ental stages significantly earlier in a num ber o f test item than the female
148
ones. After using G essell's norm s as the standard it was Ibiind tiiat the majority o f
children were developing normally.
NIN (1984-85) conducted a survey in 23 villages 20-30 Km from Hyderabad
on 706 infants to gather information on developm ental m ilestones am ong rural Indian
infants. Data obtained from these studies should that several o f tlie milestones
especially neck-holding, crawling, sitting and indication o f desire by pointing, occur at
an earlier age am ong these rural infants as com pared to the ones reported from
developed countries. It is reassuring that rural Indian infants do not suffer from any
retardation in developm ental m ilestones.
The attem pt m ade by a child to scribble occurs around 14 to 15 m onths among
average Lidian children (W H O -IC M R Study, 1991) com pared to about 10 m onths
among A m erican C hildren (Bayley, 1969). It should be borne in m ind, how ever, that
even norm al children vary greatly in attainm ent o f specific skills. N o child is expected
to achieve steps o f grow th and developm ent at exactly the ages reported in 'norm ative'
studies. The traditional exploration for m otor developm ent is based on the process o f
maturation. T hat is an infant will acquire the ability to sit, stand, walk, run and grasp
biologically, irrespective o f w hether he/she receives conscious training. A more
m odern proposition, how ever, stresses on the im portance o f the opportunity offered for
developm ent o f skills and the negative influence that restriction can have on skill
acquisition (L ansdow n and W alker, 1991).
The developm ent o f fine prehension (i.e., the act o f grasping) am ong infants
involves the integration o f visual and neuro-m uscular com ponents. A n organization o f
patterns can be perceived w ithin the progress o f behaviours such as those o f reaching
and grasping. T his organised pattern includes the ability o f the eye to see and the hand
to grasp. Studies in India indicate that infants are able to reach for objects by about 3
149 I
or 4 months (W H O -IM C R, 1991; Phatak and Klnirana. 1990) and they can grasp an
object by about 5 to
6
m onths. These ages o f attainm ent are com parable witli western
figures (Bayley, 1969; Franken burg and Dood, 1967; Gessell 1971).
Robson (1984) reported that m ajority o f normal infants crawl on hands and
knees as the predom inant m eans o f m oving from place to place before they get
themselves to standing. Others Shuflle in a silting position, creep on the abdomen or
roll and tend to w alk m uch later than the crawlers. The earliest w alkers have no
observable pre-w alking locom otion - They ju st stand up and walk. In m any instances,
the age at w hich one loco m otor m ilestone is attained co-relates well with the age at
which subsequent m ilestones appear, thus perm itting prediction o f the age o f standing
and walking.
Ill:
Factors
The earliest w ork about growth and developm ent during infancy was reported
by V enkatachar (1930). On the basis o f various com parisons it was revealed that
follow ing factors seem to be related to m ental retardation, in order o f their importance
-
w eak physical constitution, extrem es o f poverty and riches, im m aturity and
inexperience o f m others, lack ol suitable com panions at hom e and illiteiacy ol patents.
The perform ance o f these babies was also com pared w ith that o f A m erican babies. The
M ysore children appeared to be superior to A m erican children in tests o f pursuit and
m anipulative reactions below six m onths o f age.
C ertain em otional factors like fear and anxiety m ay have a negative influence
on the c h ild ’s attainm ent o f m otor skills. D angerous accidents w hile jum ping or
running m ay produce fear and tim idity. A nxiety on the part o f parents also may
prevent at tim e child from practicing new and com plicated skills because o f fear o f
taking risks. O ver-enthusiasm from adults m ay inhibit a self-conscious child as also a
ri5 o i
fear o f failure against parental expectations. Often the developm ent o f courage or
timidity am ong children occur as byproducts o f skill learning in the course o f motor
development.
Studies on m otor developm ent o f urban and rural children in India indicate
some differences in the age o f attainm ent o f m otor skills o f these children (W HO ICM R Study, 1991). lii a large multi centric cross-sectional study M uralidharan (1971)
found that urban children could throw a ball at a greater distance com pared to
industrial or rural children while industrial children were ahead in kicking the ball to a
greater distance. On tasks such as standing, w alking and running, urban children were
ahead and were able to attain these skills by two and a h a lf to three years o f age
follow ed by children from industrial areas who attained them by three to three and a
half years o f age. C om pared to G esell's norm s, Indian children w ere found to be ahead
on most skills o f m otor developm ent except ascending and descending the steps and
taking a running board jum p.
Babies and pre-school children with severe visual disabilities have been
studied by Sonksene e! al (1984) in a developm cntally oriented clinical research
setting. Severe congenital visual disability delays and alters developm ent in all areas;
the im pact on m otor developm ent is com plex with m uch secondary to delay in other
areas.
T he age o f learning to w alk m ay be delayed by m alnutrition. (Sigm an et al,
1989) and occasionally by obesity (Jaffa, 1982). A nything w hich keeps a child o ff his
feet, w hether illness, m ism anagem ent or institutional life will retard walking
(Illingw orth 1991)..The c h ild 's personality has an im portant bearing on the age at
w hich he w alks w ithout help. Fam ilial factors are im portant in achieving various
m ilestone (Illingw orth 1991). Sex does not play any m ajor role during infancy in
activity level regaidiiig m otor developnieiit. But as tlic child enter social play age,
these differences can be seen.
1
he girls are seen playing passive games as compared to
boys who indulge in building etc (Sharm a 1995 and Illingworth 1991). Small family
size was associated with better m otor developm ent by a study conductcd by IJpadhyay
et 0/(1992).
A part from differences due to the urban-rural environm ents, other factors such
as debilitating diseases, chronic and repeated infections and a lack o f nourishing diet
are com m only involved synergistically and can influence m otor developm ent, children
from poor illiterate and socio-econom ically disadvantaged fam ilies are especially
vulnerable to childhood infectious diseases such as diarrhoea, w hooping cough,
jaundice, m easles, chicken pox etc. These diseases can im pair the imm une system and
thereby produce not only growth retardation but also affect physical strength and
m otor function in children (Reddy and V azir et al 1998 b).
U padhyay et al (1983) conducted a study on m ental developm ent and physical
growth o f 46 pre-school children (2-5 years) o f non-goitrous and goitrous m others.
Gesell developm ent schedule was used to assess their developm ental quotients (DQ).
The anthroprom etric characteristics o f the two groups show ed significant difference in
m eans for w eight, height and head circum ference. How ever, the m ean chest
circum ference and the triceps skin fold thickness were significantly higher in the
children o f goitrous m others.
The DQ in tlie children o f goitrous m other w as significantly lower as com pared
to the non-goitrous group. Further analysis o f the developm ental pattern for m otor,
adaptive, language and personal social perform ance in these groups show ed that
language developm ent was significantly inferior for the goitrous group. M oreover, all
152
the developm ental scores dem onstrated lower mean values with the severity of
maternal goitre.
Gilbert et al (1982) suggested that fathers have a significant impact on all
aspects o f ch ild 's developm ent. But in an extensive review o f the literature looking at
potential influences on child developm ent. Lamb et al., (1986) concluded that there
was no evidence that the father's role is necessary in any aspect o f child development.
They suggest that in his abscncc, developm ent usually proceeds quite normally. I hey
further suggested that the im plication o f such a conclusion is that although increased
parental involvem ent may increase the m agnitude o f paternal inlluence, it does not
have effects on children, sufficient to justify a conclusion that increased paternal
involvem ent w ould be beneficial to all children and their families.
Arya, S. (1980) reported that there are significant differences in maternal
activities such as
'show s a ffe c tio n ', 'sm ile s', talks to infant and p a ts ', thereby
signifying that m others o f well nourished showed m ore m aternal care than those o f
under-nourished children. I he infants o f I IBW and LBW differed significantly in their
activities such as 'vocalizes',
‘cries', 'fusses', 'b u rp s’ and 'sucks'. Thus it was
observed that tiicre was a correlation between m othering and infant activities and birth
w eight o f infants.
A nandalakshm y (1990) highlights the crucial role played by the m other in
optim izing infant developm ent. Clearly one should aim at educating m others on the
value o f stim ulating play activities and at providing them w ith skills that would enable
them to offer a stim ulating environm ent for their infants.
A ntonovsky (1981) has stated that low level o f m aternal affection prolongs the
period o f child dependency.
153
W a t s o n ( 1 9 5 9 ) s t a t e d th a t i f it is i n a t c m a l attitiicie w h i c h m o s t p r o f o u n d l y
in fl u e n c e l a t e r p e r s o n a l i t y d e v e l o p m e n t .
D enise
el al ( 1 9 8 4 ) i n d i c a t e d tliat m o t h e r s m a y f a c ilita te e a r ly l a n g u a g e
d c v c l o iiin e n t. I h c y c o n c h i d c t i th a t m o t h e r s m a y be a n e l l e c t i v e t e a c h i n g la n g u a g e lor
very y o u n g children.
On exam ining the predictive validity o f early m otlier-infant interaction for
developm ent in early childhood, Deborah and Lewis (1984) found that percentage
responsivity m easures are the best predictors o f child perform ance. I'he researches
found that proxim al and vocal responsivity were related to reading and conversation
while distal responsivity to infant distress were related to math achievem ent.
Tiffany and M artin (1984) found that separation from m other during the birth
o f another child resulted in increase in fantasy play w hich was interpreted as active
coping both w ith the stress o f separation and altered interactions follow ing the arrival
o f a new sibling. T hey further found that follow ing the m other's return, there were
decreases in positive affect, activity level, heart rate and active sleep suggestive o f
depression. These effects were attributed to the arrival o f the sibling.
Puckering el al (1995) conducted a study to see M other-Child interaction and
the cognitive and behavioural developm ent o f children with poor growth. It was
observed that the cognitive developm ent o f 23 inner-city children identified as stunted
in growth, but otherw ise healthy, was significantly retarded as com pared to a m atched
group. C hild behavioural adjustm ent in both groups was linked to m aternal negativity.
A garw ai el al (1991
b) showed that effect o f hom e environm ent in
developm ent and intelligence was o f higher m agnitude as com pared to status and
family variable and nutritional status during 1-3 years o f age.
p i 54
Denise et al. (1984) found no system atic significant relationsliips between
difficult
tem peram ent
and
other
aspects
of
infants
developm ent,
parental
characteristics or the hom e environm ent.
Karg c'/ a!. (1992) revealed that environm ental
problem s alTccling the
developm ent o f thought processes and nutrient intake proceed both growth and
leam ing failure. Both w eight and height were significantly related to a measure of
neurodevelopm ent.
David et al. (1993) reported that frequent family relation was associated with
delay in growth or developm ent, learning disorders, school failure and frequent
behavioural problem s in these children.
Vazir et al (1998) conducted a study to assess the psycho-social developm ent
o f well nourished and mal-nouri.shed children aged 0-6 years. The results revealed that
m al-nouiished
children
attained
developm ental
m ilestones
at
a
later
age.
Developm ental delay am ong the nial-nourished was especially observed in areas like
vision and fine m otor, language and com prehension and personal social. The delay
was to the extent o f 7-11 m onths in these areas in different age groups. Paternal
involvem ent w ith child care especially, father spending tim e, telling stories and taking
child for outing was found to be im portant for positive psycho-social developm ent.
Others significant factors included parents teaching child, sm all family size and
paternal occupation.
B hargava et al (1982) a longitudinal study language developm ent in sm all-fordates children from birth to 5 years. The study com prised 40 norm al sm all-for-date
children and forty norm al term infants w eighing 2501 g. Both the groups were
matchcd on m ajor dim ensions o f socioeconom ic status, such as per capita income,
m aternal education, num ber o f sibling and sex. The results indicated w idening o f the
155
d e v e l o p m e n t a l g a p b e l w c e i i t h e t w o g r o u p s witli th e a d v a n c e m e n t o f a g e . 1 liis tr e n d in
d e p a i l u r e b r o u g h t i n to f o r e t h a t t h e r e is a n i n n a t e p a ra lle l c o g n i t i v e a b ility w h i c h
proceeds a n d a d v an c e s verbal language d e v elo p m en t o v e r the period o f d evelopm ent.
T h i s n o n - v e r b a l l a n g u a g e a b ility is a b s t n i c t b \ n a t u r e .
I he s n i a l h f o r - d a t c c h i l d i c n
s u ffe re d a d e v e l o p m e n t a l a r r e s t in t h e a cc |u is itio n o f a b s t r a c t i o n a n d h e n c e th e g a p
w i d e n e d p r o g r e s s i v e l y w i t h t h e a d v a n c e m e n t o f a ge.
Chathopadhay (1971) found that sex difference were not signilicant in
language developm ent. Urban children were better than rural children. Children o f
educated parents were found to be better in language developm ent than children o f less
educated parents,
Saraswati (1989) has
reported that there was a positive relationship between
cognitive and social developm ent o f children. It was found be better than that o f the
rural children. C ognitive and social developm ent were related to variables
like
educational and occupational level o f the parents, size o f the family and family
income.
The longitudinal
growth studies were undertaken at Baroda to collect
information about how children progress during infancy and to com pare their
perform ances w ith that o f babies from other countries . The adopted version o f
B ayley's scale o f infants developm ent was used. The results revealed that tiiere is close
association betw een m otor and m ental developm ent. The exploratory analyses o f the
babies classified into accelerated and related growth patterns indicate trends o f
relationship, w ith the type o f growth pattern for follow ing factors-parental education,
age difference betw een parents, fam ily incom e, fa th e r’s
weight and birth order. The urban upper
occupation, child 's birth
Socioeconom ic group seem s to perform
better, except for the first 6-7 m onths on the m otor scale. The urban environm ent
156
suggests a positive inllucncc on tlie mental pci rornuiiicc ol Ixibics. I he
I r c n ils
o f motor
and mental scores on Baylay scales ol'Infant Development Research I omi -1961 tend
to be sim ilar in India, Am erica, British and Israel babies. Indian babies, especially
upper S.F,. group tend to score higher than Anieric.in, British and Israel babies on Ihc
motor scale for the first 15 months. Am erican babies surpass alier 16 months. On the
mental scale babies from Upper S-class in Barotia score higher than Am erican and
British babies. Israel babies score highest.
M uralidharan and Bevli (1990) conducted a study on the growth and
developm ent o f Indian children in aspects such as m otor, adaptive, social-personal and
language. The study revealed that urban children are faster in their developm ent
compared to the rural and industrial children. The industrial children were found to be
better than their rural counter parts. Children o f Calcutta and Hyderabad showed a
laster rate o f developm ent in various aspect when com pared with {iesell norms. Indian
children show ed retardation w here handling o f picture books or picture cards was
involved.
In another multi centric .study involving more than 13,000 rural tribal and
urban children aged 0-6 years (W H O -IC M R study, 1991) it was found that urban
children attained som e o f the gtass m otor skills such as lifting head w hile on stom ach,
standing alone, w alking backw ards and hopping at a slightly younger age com pared to
their rural and tribal counter parts. O ther gross m otor skills such as, standing on one
foot with support, carrying a w ooden block on head, and getting up from squatting
position, w ere attained at younger ages by rural tribal children com pared to urban
children.
Susan et al (1990) conducted a study on
6 6
H aitian-A m erican children to
determ ine the parenled and early childhood inlluenccs on the developm enl. Results
157
showed that the urban sam ple was advanced on the mental Dev elopm ent Index o f the
Bayley scales. Regression analyses showed birth weight and the Home Score
measuring child-rearing
environm ent to
be significant
predictors o f mental
development, w hile psychoniotor developm ent was related to birth weight and
household crowding.
Li and Zhang (1998) found that there was significant differences in physical
developm ent and growth o f children between various regions. I hey concluded lhal
regional differences in the devpt-and growth o f children is still present in China, but,
begins to narrow.
Phatak (1974) conducted a longitudinal study to test the m otor and mental
developm ent o f babies up to 30 m onths. The results show ed tliat the differentiating
feature o f patterns started m anifesting clearly after the age o f 13 m onths. M others
education, fathers education and liimily income show ed signilicant relationship wilh
accelerated and retarded pattern during the second year o f life. The higher level o f
each o f these factors
w as related to the accelerated patterns. Birth order (beyond4)
suggested som e relations w ith the patterns o f developm ent under study.
In a study conducted by Bhogle (1979) results revealed that children when
provided w ith supplem entaiy food and basic child care through m edical help im proved
considerably. The results show ed that children in experim ental groups were superior
to children in the control group in their m otor developm ent and that control group
children w ho w ere denied the program show ed general retardation, patlicularly afler
the age o f 18-20 m onths.
A brol et al (1994) in the study revealed that full term S p D (sm all for date)
perform ed significantly poorly on all item s under cluster interactive processes. They
158 I
pcirom icd pooiiy in cluslcis ol niolor processes and orgaiii/,utioiial processes, (stale
control)
Godbole et al (1977) conducted a longitudinal study on sixty high risk babies
and followed them lor a period o f one year. Uayley scales o f Infant Development
(Baroda N orm s) w as used for assessing the outcom e at one year. The results revealed
that babies w ith absence o f social sm ile, abnormal neuro behaviour at three months
and absent pulling to sit position, absent voluntary reach and absent voluntary reach
and absent transfer ol objects, remaiuctl dclaycti al one year. I he specilicity of each o f
these items was 100%. These items had a positive predictive value o f 100%. I he main
objective o f the study w as to find out a few sim ple and
easily elicitable items at three
and six m onths o f age that can predi ct neuro developm ental outcom e at one year in
high risk babies.
Rose (1994) conducted a study to exam ine the relation between physical
growth and cognitive developm ent in infants grow ing in India. Underweight infants
perform ed poorly on tw o cognitive m easures and failed to show the clear age - related
im provem ent in speed o f processing found am ong the heavier infants.
I
159
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