Chapter 3Children’s growth and development(ii)

Believe in the innate power to grow that every child is born with. Treat each child as having strong
vitality.

(iii) Understand, believe, and help develop the child’s innate abilities. Newborn babies already havevarious abilities at birth. We need to believe in such abilities and support the fulfillment of theirpotential.
(iv) View the child from a life-course perspective to support his or her future. A life-course perspective

Learning objectives

involves understanding the child’s health based on his or her past, present, and future. We also

You will be able to gain proper understanding and explain:need to bear in mind that the health impacts of childhood conditions may not become apparent- The principles of growth and development.

until adulthood.

- The characteristics of physical and physiological growth and development from infancy to earlyadolescence.
- What is necessary for the healthy growth and development of children in light of circumstances in
Cambodia.

Teachers can instruct children according to their growth and developmental stages by learning aboutchildren’s growth and development. Teachers can also help to build environments that promote healthy
growth and development by removing factors that have adverse effects on growth and development andby instructing children and their families to avoid such factors. Furthermore, by learning the normal
patterns of growth and development, teachers can assess whether a child is developing appropriately

This chapter defines the concepts of growth and development, then provides an exposition of the common

within normal ranges and help to start addressing problems at an early stage if any abnormalities or

principles of children’s growth and development and explains the characteristics of physical and mental

problems are suspected.

growth and development from infancy to early adolescence. Lastly, we describe factors that affectgrowth and development.

1. Human development

2. Principles of growth and development
Human growth and development are considered to result from synergy between a biological maturation
process regulated by genes and a developmental process influenced by the environment and learning

The process of humans maturing from birth to adulthood is expressed in various words including

experiences of the individual. Individual variability in human growth and development results from“growth,” “development,” and “maturity.” Growth refers to the maturation process of a living organism

differences in the biological maturation process and developmental process influenced by theincreasing in quantity through cell division, in other words quantitative change in morphology orenvironment. However, there are common principles of growth and development that apply to mostbody growth. Body height and weight are representative indicators of growth. Development, on theindividuals.

other hand, is a process through which biological structures and functions undergo division anddiversification to become more complex. Through this process, latent functions emerge over time. It isa phenomenon of qualitative change also influenced by the additional effects of experience, practice,1) Most children follow a certain developmental ordertraining, education, and environment. In other words, development refers to structural and functional
growth centered on mental aspects.1

Body growth and development of motor functions progress in a certain order.

Children are still in the process of growth and development. Their minds, bodies, and social relations

For example, most children become able to hold their heads up steadily when they are 3-4 months

change daily toward maturity. It is critical for children to have healthy childhoods in order to develop

old, roll over from tummy to back when 5-6 months old, sit unsupported when 7-8 months old, start

their intellectual, physical, and emotional capacities to their full potential. Children’s healthy growth andcrawling and stand holding furniture when 9-10 months old, and by the time they reach 12 months, somedevelopment not only enrich the child’s own personal life but also lead to enrichment of society as astart to walk alone. Although there is a wide variation as to when a child reaches a certain stage of motor

whole. Since children spend much of their time at school, teachers who engage with children have a duty

function development, they mostly follow a certain order of development (Figure 3.1).

to support children’s healthy growth and development. To this end, it is important for teachers to bear
the following four points in mind and take an integrated view of the holistic health of each child,rather than a fragmented view of children’s growth and development.2(i)View the child as a whole person. Understand the unique characteristics of each child and take aholistic approach to assessing his or her health.

54

Chapter 3

Children’s growth and development

55

process). The growth velocity, however, differs by age, sex, and function of the tissue (genetic factors).
For example, body height increases from infancy to adolescence. Furthermore, the period when bodyheight increases rapidly differs between boy and girls. Neural tissue develops rapidly during infancy and
In Mother’s womb

Birth

Lifting head

Rolling overSitting with Support

early childhood, while lymphoid tissue develops throughout middle and late childhood. Note, however,that Scammon’s growth curve only gives an image of growth and development after birth and that thesize and functions of each organ and tissue are not zero at the time of birth. Let’s work on “Exercise [33]” here.

Crawling

Standing up

Walking with support

Walks alone

Figure 3.1 Stages of growth and development in babies

2) A certain direction is observed in growth and development

4)	There are critical periods and sensitive periods in a child’s growth anddevelopment5
In the biological process of growth and development, there are critically important periods for the

3,4development of certain physical and mental skills and acquisition of new patterns of behavior. If a childdoes not receive the appropriate environmental stimulus or experience to acquire a given skill during

Body growth and development of motor functions progress in a certain direction. For example, motorthat period, it becomes difficult for the child to develop the associated functions or behavior later in life.

skills develop from holding the head erect, rolling over, sitting up without support, then standing up

This period is called the critical period. In the case of sensory and motor development, for example, thealone. As seen in this order, body functions develop in the direction from head to tail (cephalocaudal

environment and experiences during infancy have a large impact on the development of binocular vision

direction), and from the center or middle to peripheral portions of the body (proximodistal direction).

(the ability to see things using both eyes) and hearing acuity. The critical period for the ability to acquire

When we look at the process of how children become able to grasp an object, they first touch things, thenlanguage is said to be up to 12 or 13 years of age, meaning that if a child grows up in an environment

start grasping things using their fingers and palms (palmar grasp), and finally become able to grasp or

where he or she cannot receive proper language input during early childhood, it becomes very difficult

pick things up with their fingers (pincer grasp) (simple to complex, general to specific). As seen here,

for the child to acquire language proficiency after reaching adolescence.

body functions develop in the direction from gross to fine motor functions (Figure 3.2).

A sensitive period is when the child is most sensitive to certain environmental stimuli effective foracquiring a new pattern of behavior, which means that the period is most suitable for acquiring thatbehavior or skill. For example, Dr. Maria Montessori (described by the American Montessori Associationas "an Italian physician, educator, and innovator, acclaimed for her educational method that builds on the(i)From head to tailway children learn naturally") advocated that the sensitive period for acquiring cognitive skills and(ii)

From center to peripheral portionssocial aspects of life is from infancy to early childhood.6,7(iii) From gross motor to fine motor functions

Although the path of individual growth and development is not completely determined biologically,
we are not endowed with unlimited plasticity while we grow up. In fact, human growth and development
is an intermediate of both, determined through the influence of both biological characteristics and growth

Figure 3.2 Directions of body growth and development3)	Continuity of growth and development and difference in growth velocity
by organ and tissue

environment.

5) Individual variability of growth becomes significant with age
The biological variability of newborn babies is rather small, but as babies grow older, individual
variability becomes larger through the influence of genetic factors and the growth environment

As seen in Scammon’s growth curves (Scammon,1930), which show the growth of various tissue types(individual difference).

over time, while there are ups and downs in the curves, growth and development of organs and tissues
continue uninterruptedly until they reach the size of the adult level represented by 100% (continuous
56

Chapter 3

Children’s growth and development

57

3. Growth and developmental periods by age

meaning that they can learn to write letters by moving a pen with the tip of their thumb, index finger, andmiddle finger. They will also become able to hold a paper cup without crushing it by applying the right

Human growth and development periods can be roughly divided according to age groups: newborn (upto 4 weeks from birth); infant (until the age of 1); early childhood (until entering primary school) divided
into toddler (1-3 years) and preschool (3-6 years); middle childhood (during enrollment in primaryamount of force as appropriate to the object.

(3) Cognitive development

school; school age, 6-12 years); and adolescent or late childhood (from secondary school to adulthood,Children at the ages of two to three start developing abstract thinking skills, the ability to form an image

or until height growth ceases; approximately 12-18 years) (Figure 3.3). Here, we will investigate theof something through perceptual experiences, and imagine things that are not being directly experienced.

details of physical growth, motor and cognitive development, and emotional and social development

When they reach the ages of four to six, they become capable of sorting and associating objects. They

during the early and middle childhood periods (Table 3.1).

also understand left and right with reference to their own body. When drawing a picture of a person, they0
1start drawing hands and feet, though not in sufficient detail.
Dramatic language development can be seen during the toddler period. After 18 months to two years

Infants
Early childhood(Toddler and preschool)

6from birth, children start joining two words in a sentence and their vocabulary rapidly expands. It is said
Enters kindergaten
Enters primary school

Middle childhood
1218Adolescence(Late childhood)

Enters secondary school

Figure 3.3 Children’s growth and development periods by age

1) Growth and development during early childhood(1) Physical growththat by the age of two children typically have a vocabulary of more than 300 words. At the ages of fourto six (i.e., preschool age), they understand that a “cat” is an “animal” and “banana” is “food.” Thismeans that they understand the definition of those words and can categorize words that represent a
concrete object into a category of abstract meaning.

(4) Emotional and social development
Emotional and social development during the early childhood period is closely associated with humanrelations, basic lifestyle habits, and play that the child experiences. Children start developing selfconsciousness and show their desires. For example, children two to three years old play individually,
doing their own things, even when there are other people around, but as they grow older, they graduallylearn to engage in the same play and interact with others. By the time they reach five to six years of age,they can share common goals and rules while playing. They develop the ability to understand other

Body height and weight steadily increase during these periods. By the time a child reaches the age of

people’s feelings from around age four and become capable of thinking from another person’s point of

five, body height and weight will increase 2.2-fold and 6-fold respectively from the time of birth. Body

view.

shape becomes more slender, approaching the shape of an adult, and the head-to-body ratio reaches
around 1:6 at the age of six. A child’s permanent teeth start to grow from around this time, with someindividual variability.

(2) Motor development(1) Physical growth and development

Gross motor skills development: a child typically starts walking around 12 months after birth, becomesPhysical growth and development are steady and gradual during the earlier half of the middle childhood

able to walk steadily by 18 months, and by the age of three, can jump and kick a ball. At ages five to six,

period. Once children enter the latter half, however, genital functions develop rapidly with somemost children become able to make complex and coordinated movements using hands and feet like

individual variability. Development of genitalia begins earlier in girls than in boys. Girls start to develop

standing on one foot, skipping on both feet, and jumping rope.

breasts and pubic hair.

Fine motor skills development: a child from 12 to 18 months old has typically mastered basic skills
like reaching out for an object, grabbing, and letting go. As children grow older, they become capable of582) Growth and development during the middle childhood period(2) Motor development

coordinated motions using tools with both hands. At ages three to four, they become able to use scissors

Children develop muscles and acquire basic motor skills over the middle childhood period. They becomeor button and unbutton clothes, which require different movements between the two hands, but still inable to jump, throw, and perform other motions much more skillfully than during the early childhood

an awkward manner. From around age four, children start showing a tendency to consistently use theirperiod. They learn how to combine basic motions using hands and feet, and attain temporal and spatial

dominant hands. By the ages of five to six, they become capable of skillfully moving finger joints,

movement skills.
Chapter 3

Children’s growth and development

59Children form groups based on a sense of unity fostered by playing together and sharing the same(3) Cognitive development

experience. This period is called the “gang age” and peer groups take on a social significance. TheseIn the cognitive aspect, children start thinking logically about specific things. By ages nine to ten, theygangs or peer groups are prominently characteristic of boys.

become able to recognize equal amounts of a substance even if it is placed in different containers. This
indicates that they have acquired the concept of “preservation” and are ready to understand such concepts
as numbers, weight, volume, and time. From ages eleven to twelve, children start to think systematicallyand infer a conclusion based on a hypothesis.

4. Factors that influence children’s growth anddevelopment

The main form of communication for children is speech during the early childhood period, but asthey grow up and attend school, they acquire other forms of communication: writing and reading. During

Historically, children’s health was defined in the same way as adult health and was hardly given special

the earlier half of the middle childhood period, children tend to write only short sentences, but willconsideration. However, it has recently been recognized that a developmental perspective needs to beeventually learn to write longer sentences using conjunctions in the latter half of this period.

incorporated into the concept of children’s health. It is becoming increasingly clear that children’s healthis determined through the interaction of many factors different from those of adults. Against this(4) Emotional and social development

background, the Committee on Evaluation of Children’s Health (National Research Council and Institute

The middle childhood period is a time when children develop social emotions such as sense of self andof Medicine, US) issued a report that proposes to define the concept of children’s health as follows to

empathy within the social framework of school. Self-consciousness can be observed from the early

include growth and development and sheds light on the factors that influence developmental health.8

childhood period, but children start to recognize and sense themselves as beings (i.e., experience their“Children’s health is the extent to which individual children or groups of children are able or enabled

own existence) through social interrelations with their peers when they enter the middle childhoodto (a) develop and realize their potential, (b) satisfy their needs, and (c) develop the capacities that allow

period. They develop feelings of capability as well as inferiority through comparison with others, andthem to interact successfully with their biological, physical, and social environments.”8

gradually establish their feelings of self-esteem. Peer-to-peer relationships also undergo change in thelater part of the middle childhood period. The peer group with which a child engages grows larger.

Table 3.1   Summary of development indicators during the early and middle childhood periods

Dimension of Development

Infancy and early childhood period

Age

0-1

Body height

1.5 times birth height

Body weight

3 times birth weight

Gross motor skills

1-2

60

4-5

5-6

4 times birth weight

6-7

Catches a ball with hands

5 times birth weightStands holding furniture Walks

Runs

Drops a ball and follows Throws a ball toward a
it with eyestargetKicks a ballSkips on one footSkips on both feet

Draws a circle

Draws a square

Draws a triangle

Fine motor skills

Emotional and social skills

3-4
Twice birth height

Draws and copies lines

Language skills

2-3

Middle childhood period

Builds a tower withblocksUses scissors

Produces first
intelligible words

Expands vocabulary

Asks questions using
interrogatives

Understands and obeys
prohibition

Plays alone apart fromparents

Plays with friends

Repeats the same
behavior when praised

Imitates phone
conversation

Likes to care foryounger children

Capable of holding a
conversation

Reads, writes, andacquires basic academic
skillsPlays in groups of threeor moreRational and theoreticalthinking

Can make inferences in
the mindAsks for permission

Can move from concrete
to abstract thinking

Chapter 3

Children’s growth and development

61

Table 3.2   Organization of Influences on Children’s Healthconditions such as water sources and toilet facilities, violence against children and child labor, andChildren’s biology

socio-economic disparity between urban and rural households. Therefore, in order to promote the healthyChildren’s behavior

development and growth of Cambodian children, it is necessary to clarify the risk factors and factors

Physical environment

promoting development and growth by targeting a wider age range of children and to address suchchallenges as school health initiatives under the national policy.

Prenatal exposures
Childhood exposures

Table 3.3   Examples of community or ecological risk factors and individual risk factors

Home, school, and work settings

among preschool children in developing countries

Child injury and the provision of safe environments

Community or ecological risk

The built environment

Individual

Poor sanitation

Repeated infections

FamilyFamineUnder-nutrition

Community

Endemic violence

Abuse and neglect

CultureLack of accessible services: preschools, schools,
libraries, health services

Very low family income

Lack of commitment to child development

Low birthweight

Social environment

Discrimination
Services
PolicyLow maternal education9

Large family size

Cited from “Committee on Evaluation of Children’s Health. Children’s health, the nation’s wealth: Assessing and improving child health.”

Short intervals between births
Low levels of developmentally enhancing parenting
practices

According to the report, there are biological, behavioral and (physical and social) environmental
factors that affect a child’s developmental health (Table 3.2). From this report, we can understand acomprehensive list of factors that affect children’s health. Biological influences include genetic

11

Cited from “A brief review of risk-factors for growth and developmental delay among preschool children in developing countries”

expressions, prenatal influences, and perinatal and postnatal events. Behavioral influences include thechild’s emotions, beliefs, attitudes, behaviors, and cognitive abilities. Environmental influences are

In light of this situation, the Cambodian Government developed the five-year National Action Plan

wide-ranging and include influences from the biological environment (e.g., infectious agents such as

on Early Childhood Care and Development, 2014-2018, which aims, as a priority, to increase school

malaria and intestinal helminths in Cambodia) and physical environment (e.g., water pollution andenrollment rates and enhance protection of all young children under six years of age, especially children

exposure to metals and pesticides in Cambodia) and social factors such as loving interactions withfrom poor families and indigenous minority groups and children with disabilities, who were mostcaregivers (e.g., domestic violence, abuse, and maternal mental health in Cambodia), socioeconomic

marginalized from early learning opportunities. Through this action plan, the Cambodian Government

resources in the family and community (e.g., income and job opportunities in Cambodia), and peer

commits to extending support and improving the quality of early childhood care and development

9

relationships and the availability and quality of services (e.g., health services in Cambodia).

throughout the nation.13

In a survey of factors affecting early childhood growth and development based on the current
situation in Bhutan, the following five main factors have been identified as contributing to growth anddevelopment in early childhood: nutrition, environment, parent’s behaviors, parenting, and social andcultural practices.10 Table 3.3 shows risk factors for growth and developmental delay in developing
countries, listing influence of both community or ecological factors and individual factors on preschool
11

children.

The issue of healthy growth and development in children is a focus of interest in Cambodia, too. The
health status of children in Cambodia largely improved in the period from 2000 to 2010: infant mortality(deaths per 1,000 live births) dropped from 95 to 45 and under-five mortality (deaths per 1,000 live
births) from 124 to 54.12 On the other hand, consistent with the risk factors noted in Table 3.3 and the
Bhutan study, there are still challenges to be resolved, such as improvement of nutritional status, hygiene
62

Exercises for further thought and research[3-1] Think of a child you are familiar with (a younger brother or sister, a child in the neighborhood,etc.) and check the child’s growth and development status according to the dimensions ofdevelopment in Table 3.1.
[3-2] Consider the potential benefits and significance for a school teacher of learning about children’s
growth and development processes.
[3-3] Check the patterns of Scammon’s growth curves on the Internet and their characteristics. Next,
think about why these pattern differences occur.
Chapter 3

Children’s growth and development63[3-4] Consider events and phenomena that are, or are likely to be, a threat to the growth and developmentof children in Cambodia.

Chapter 4

Cleanliness, hygiene and health
Learning objectives
You will be able to gain proper understanding and explain:- The principles of cleanliness and hygiene.
- With examples, diseases and conditions that arise from unsanitary and unhygienic behavior.
- With examples, good hygiene behavior and behavior to keep our bodies clean.
- With concrete examples, unhygienic environments (home, school, town/community).
- With multiple examples, diseases and conditions that arise from unhygienic environments.
- With examples, what can be done to improve unhygienic environments.
- Ideas on how unhygienic and unclean behaviors can be changed.
In this chapter, we learn about cleanliness and hygiene in relation to children, homes, schools, andcommunities. The speciﬁc learning topics are hand washing, bathing, clean water, hygienic foodpreparation, cleaning, waste separation, and water and sewage systems.

References
1

Edited by Emiko Fukuda, (Ed.) “Ningen hattatsugaku (Human development)” 5th edition, Tokyo: Chugai-Igakusha, 2019.

2

Edited by Goro Kono and Etsujiro Takahashi, (Eds.) “Hoikuno nakano hoken – Yochien/hoikusho denohokenshido no riron to jissen(Health as part of nursing – Theory and practice of health guidance in nursery schools),” revised edition, Tokyo: Houbunshorin,
2010.

3

Ruffin N.J. Human growth and development – A matter of principles. Virginia Cooperative Extension. Virginia Tech. 2019. https://www.pubs.ext.vt.edu/content/dam/pubs_ext_vt_edu/350/350-053/350-053 (FCE-134 P).pdf

4

Dhaker R. Growth and development. https://www.slideshare.net/rdhaker2011/growth-and-developmentppt

5

Schaffer H.R. Key Concepts in developmental psychology, 58-61, Los Angeles, Sage, 2006.

6

Montessori M. Six “Sensitive Periods.” https://www.montessoritrainingusa.com/sites/montessoritrainingusa.com/files/Six%20
Sensitive%20Periods.pdf

78

To lead healthy lives, we need to keep our own bodies clean and hygienic. “Cleanliness” refers to thestate or habit of keeping yourself and your surroundings free from dirt. “Hygiene” means the practice ofpreventing illness or the spread of disease by keeping yourself and your home, workplace, and community

Who-Was-Maria-Montessori

environments clean. Key behaviors in maintaining cleanliness and hygiene are washing your hands,

Committee on Evaluation of Children’s Health. Children’s Health, the Nation’s Wealth: Assessing and Improving Child Health. p.4,

brushing your teeth, and bathing.

Committee on Evaluation of Children’s Health. Children’s Health, the Nation’s Wealth: Assessing and Improving Child Health.
p.45-90, Washington DC, The National Academies Press, 2004. https://www.ncbi.nlm.nih.gov/books/NBK92200/#ch3.s1

10 Pem D. Factors Affecting Early Childhood Growth and Development: Golden 1000 Days. Journal of Advanced Practices in Nursing,
1:1, 2015. DOI:10.4172/2573-0347.1000101.
11 Ali S.S. A brief review of risk-factors for growth and developmental delay among preschool children in developing countries.
Advanced Biomedical Research. 2:91.2013 doi: 10.4103/2277-9175.122523.
12 National Institute of Statistics, Directorate General for Health, and ICF Macro, 2011. 2010 Cambodia. Demographic and HealthFirst, to prevent infectious diseases, it is important that your hands are clean (not dirty) and hygienic(no cause for disease to take effect). Hands need to be washed with water and well-lathered soap toremove dirt attached to the surface of the hands (cleanliness), while also removing the viruses andbacteria that are the cause of disease (hygiene), blocking this infection route. As explained in detail in
Chapter 7, the three main factors in the transmission of infectious diseases are pathogens (for example,
bacteria and viruses that cause disease), transmission routes (the routes whereby bacteria and viruses

Survey: Key Findings. Phnom Penh, Cambodia and Calverton, Maryland, USA: National Institute of Statistics, Directorate General

are communicated), and hosts (people’s resistance and immunity to bacteria and viruses). Transmissionfor Health, and ICF Macro. https://www.nis.gov.kh/nis/CDHS/CDHS_2010_Key_Findings.pdf

routes include direct contact, droplets, and airborne transmission. To prevent direct contact

13 The National Committee of Early Childhood Care and Development. National Action Plan on Early Childhood Care andDevelopment 2014-2018. https://planipolis.iiep.unesco.org/sites/planipolis/files/ressources/cambodia_early_childhood_national_
action_plan_2014-2018.pdf

641) Personal cleanliness and hygiene

American Montessori Association. Who Was Maria Montessori? https://amshq.org/About-Montessori/History-of-Montessori/

Washington DC, The National Academies Press, 2004. https://www.ncbi.nlm.nih.gov/books/NBK92198/#ch2.s3
9

1. Personal and environmental cleanliness and hygiene(home, school, town/community)transmission in particular, it is important to maintain cleanliness and hygiene by washing your hands,
sterilizing your ﬁngers, and sterilizing surfaces that are touched by multiple people.
Chapter 4

Cleanliness, hygiene and health65