Anganwadi Supervisor Paper-2: Child Development, Extension and Social Work · Chapter 1

Growth and development, prenatal and postnatal care

What to remember

Growth is an increase in size (measurable, such as weight and height); development is an increase in skill and function (such as walking and speaking). Growth is quantitative; development is both quantitative and qualitative.
Development follows set patterns: from head to foot (cephalocaudal), from centre to outer parts (proximodistal), and from general to specific. Every child follows the same order, but at an individual speed.
A healthy baby depends on good care before birth (prenatal), at birth, and after birth (postnatal). Regular antenatal check-ups, iron and folic acid tablets, tetanus protection, safe delivery, early breastfeeding and newborn care save the lives of mothers and babies.

Growth and development: meaning and difference

Growth means a physical increase in the size of the body or its parts. It can be measured in kilograms and centimetres. It stops when the person reaches maturity.

Development means orderly changes in structure and function leading to better skill and ability: physical, motor, language, social, emotional and thinking (cognitive). It continues from conception to death.

Maturation means the unfolding of inborn patterns controlled by heredity. Learning is change through experience and practice. Both are needed: a child cannot walk until the muscles and nerves are mature, but practice improves skill.

Feature	Growth	Development
Meaning	Increase in size	Increase in skill and function
Nature	Quantitative	Quantitative and qualitative
Measurement	Easily measured	Observed, harder to measure
Period	Stops at maturity	Lifelong
Example	Height rising	Learning to speak

Principles of development

1. Development is continuous: it never stops, though speed varies.
2. It is sequential: a child sits before standing, and babbles before words.
3. Cephalocaudal: control starts at the head and moves down (head control, then sitting, then walking).
4. Proximodistal: control starts near the body's axis and moves outward (shoulder control before finger control).
5. It goes from general to specific: a baby waves the whole arm before picking a small object with finger and thumb (mass to specific).
6. There are individual differences in rate; the order, however, is the same.
7. Different parts grow at different rates: the brain grows most rapidly in the first years; the reproductive system grows mainly in adolescence.
8. Early development is the foundation; early years are critical.
9. Heredity and environment work together and are inseparable.
10. Development is predictable in general direction.

Factors affecting growth and development

Heredity: the genes from both parents fix potential height, build, skin colour and some diseases.
Environment: home, family, stimulation, school, and the community.
Nutrition: good nutrition before and after birth is vital for brain and body. Malnutrition causes stunting and weak learning.
Health and disease: repeated infections slow growth.
Hormones: growth hormone, thyroxine and sex hormones (thyroid lack in childhood causes slow growth and mental slowness).
Gender, birth order and family size.
Socio-economic status, education of parents and love, care and stimulation.
Prenatal factors: the mother's health, diet and habits.

Stages of the life span (child-related)

Stage	Period
Prenatal	Conception to birth (about 40 weeks, or about 9 months)
Neonatal	Birth to 28 days
Infancy	Birth to 1 year (some books: to 2 years)
Early childhood (toddler and pre-school)	1 to 6 years
Middle childhood	6 to 12 years
Adolescence	About 10 to 19 years

Some developmental milestones (approximate ages)

Age	Milestone
About 6 to 8 weeks	Social smile
About 3 months	Holds head steady
About 6 months	Rolls over; sits with support; first milk tooth may appear
About 8 to 9 months	Sits alone, crawls
About 12 months	Stands with help; says first words; walks holding furniture
About 12 to 15 months	Walks alone
About 2 years	Two-word sentences; runs
About 3 years	Rides a tricycle; short sentences

All milk teeth (20) usually come by about two and a half to three years. Children who miss milestones by a clear margin need developmental screening and referral. Remember these are ranges, not exact dates.

Prenatal development

Life begins at conception, when a sperm from the father unites with an ovum from the mother, making a zygote. Each human cell has 46 chromosomes in 23 pairs. Sperm and ovum carry 23 each. The sex of the child is decided by the father's sperm: an X-carrying sperm gives a girl (XX) and a Y-carrying sperm gives a boy (XY).

Stages of prenatal development:

Stage	Period	Main events
Germinal (ovum)	Conception to about 2 weeks	Cell division, travel along the fallopian tube, implantation in the uterus
Embryonic	About 2 to 8 weeks	Organs form; heart begins to beat; most sensitive period for birth defects
Foetal	About 9 weeks to birth	Growth and maturing of organs; movements felt by mother (quickening) in the middle of pregnancy

The placenta passes oxygen and nutrients to the baby and removes waste. The umbilical cord links the foetus to the placenta. The amniotic fluid cushions the baby. The first three months (the first trimester) carry the greatest risk of malformations.

Genetic and chromosomal conditions: Down syndrome is due to an extra chromosome 21 (trisomy 21); Turner syndrome is a female with a single X (45, X); Klinefelter syndrome is a male with an extra X (47, XXY). Haemophilia and colour blindness are X-linked.

Teratogens (agents that harm the foetus):

Infections such as rubella (German measles), especially in early pregnancy: heart defects, deafness, cataract. Also syphilis, toxoplasmosis, HIV and Zika
Alcohol: foetal alcohol syndrome
Tobacco: low birth weight, premature birth
Drugs, such as thalidomide (limb defects), and unsafe self-medication
Radiation (X-rays)
Malnutrition and lack of folic acid, iodine and other nutrients
Maternal age (very young or older), diabetes, Rh incompatibility (Rh-negative mother and Rh-positive baby)

Prenatal (antenatal) care

Antenatal care (ANC) is care for a pregnant woman to keep her and the baby healthy and to find problems early. Early registration, ideally in the first three months, is advised, as is a minimum of four check-ups, with extra visits for high-risk women. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) offers free check-ups by doctors on a fixed day each month.

Components of ANC:

1. Registration and history; pregnancy confirmation; expected date of delivery.
2. Examination: weight, height, blood pressure, haemoglobin, urine (sugar and albumin), blood group and Rh, abdominal examination, foetal heartbeat. Ultrasound when advised.
3. Tetanus protection (Td vaccine; two doses or a booster as per records).
4. Iron and folic acid tablets and calcium as advised.
5. Nutrition and rest advice.
6. Birth planning: place of delivery, transport, money, blood donor.
7. Danger sign education: bleeding, severe headache, blurred vision, swelling of face and hands, fits, high fever, reduced baby movement, leaking fluid, severe weakness or breathlessness.
8. Counselling on breastfeeding, family planning and newborn care.
9. Testing and treatment for HIV, syphilis, malaria, and anaemia as relevant.

Pregnancies with risk (high-risk pregnancy) include teenage or older age, very short height, severe anaemia, high blood pressure, diabetes, previous caesarean or stillbirth, twins and bleeding. They need referral to a hospital with facilities. Institutional delivery is encouraged under the Janani Suraksha Yojana (JSY), a cash incentive scheme for safe delivery.

Postnatal care

The postnatal period (puerperium) is the six weeks after delivery when the mother's body returns to its non-pregnant state. Postnatal care includes examination of both mother and baby, ideally within 24 hours, then on days 3, 7 and 42 (home visits by ASHA are part of home-based newborn care).

Care of the mother: rest, nutritious food and fluids, hygiene of the perineum and breasts, iron and folic acid and calcium for a period, breastfeeding support, family planning counselling for spacing, and watching for danger signs: heavy bleeding, foul discharge, fever, severe pain, breast problems, and low mood or depression (postpartum blues are common in the first days; persisting or severe low mood is postpartum depression and needs medical help).

Care of the newborn:

Dry and wrap the baby, keep warm (skin-to-skin contact). Delay the first bath for at least 24 hours (or per local guidance).
Breastfeed within one hour. Give colostrum. No pre-lacteal feeds.
Clean cord care: keep the cord clean and dry; nothing is applied (as per current guidance).
Immunisation at birth: BCG, zero dose oral polio and the first hepatitis B dose.
Kangaroo mother care for low birth weight babies: skin-to-skin contact on the mother's chest, with exclusive breastfeeding.
Watch for danger signs: poor feeding, fast breathing, fever or low body temperature, fits, yellow palms and soles, pus on the cord.
Weigh the baby, and register the birth.

Apgar score: assesses the newborn at one and five minutes after birth on five points, each scored 0, 1 or 2 (total 10): Appearance (colour), Pulse (heart rate), Grimace (reflex response), Activity (muscle tone) and Respiration. A score of seven to ten is normal; below seven needs help.

Newborn reflexes: rooting (turns towards touch on the cheek), sucking, swallowing, grasp (palmar), Moro (startle: arms spread and then drawn in), Babinski (toes fan out when the sole is stroked), stepping (walking reflex) and tonic neck. Many disappear in the first months; absence at birth or persistence beyond the usual age needs checking.

Exam traps

Growth is a physical increase; development includes skill, language, emotion and thinking.
The father's chromosome decides the sex of the baby, not the mother's.
Cephalocaudal means head to foot; proximodistal means centre to outer parts.
The embryonic stage (not the foetal) is the most sensitive for malformations.
Down syndrome is trisomy 21; Turner is 45, X; Klinefelter is 47, XXY.
Apgar is scored out of 10; it has five signs, each scored 0 to 2.
Neonatal period is the first 28 days; the postnatal period of the mother is six weeks.
Colostrum is given, not discarded; pre-lacteal feeds (honey, water) are avoided.

One-liners

1. Growth is measurable increase in size.
2. Development is orderly change in function and skill.
3. Cephalocaudal development moves from head to toe.
4. A human cell has 46 chromosomes.
5. The father decides the sex of the child.
6. Rubella in early pregnancy can cause heart defects and deafness.
7. Down syndrome is due to an extra chromosome 21.
8. Folic acid prevents neural tube defects.
9. Apgar score is taken at one and five minutes.
10. Kangaroo mother care helps low birth weight babies.
11. The neonatal period is the first 28 days.
12. Breastfeeding should start within one hour of birth.

Practice questions

Growth refers to
1. improvement in skill and function
2. change in attitude
3. increase in size of the body or its parts
4. learning through practice
Answer
C. increase in size of the body or its parts
Growth is a measurable increase in size.
Development refers to
1. only increase in weight
2. only increase in height
3. loss of function
4. orderly changes in structure and function
Answer
D. orderly changes in structure and function
Development includes skill, language, social, emotional and thinking changes.
Development proceeding from head to foot is called
1. cephalocaudal
2. general to specific
3. mass to specific
4. proximodistal
Answer
A. cephalocaudal
Cephalocaudal means head to tail direction.
Development proceeding from the centre of the body to the outer parts is called
1. sequential
2. proximodistal
3. cephalocaudal
4. maturation
Answer
B. proximodistal
Shoulder control comes before finger control.
The sex of a child is decided by the chromosome contributed by the
1. grandmother
2. mother
3. doctor
4. father
Answer
D. father
A Y-carrying sperm gives a boy and an X-carrying sperm gives a girl.
The number of chromosomes in a normal human body cell is
1. 44
2. 46
3. 48
4. 23
Answer
B. 46
There are 23 pairs, so 46 chromosomes.
Down syndrome is caused by
1. an extra chromosome 21
2. rubella infection
3. a missing X chromosome
4. an extra Y chromosome
Answer
A. an extra chromosome 21
It is trisomy 21.
Turner syndrome is characterised by
1. an extra chromosome 21
2. an extra X in a male
3. a single X chromosome in a female
4. extra Y in a male
Answer
C. a single X chromosome in a female
Turner is 45, X.
Klinefelter syndrome is
1. 45, X in a female
2. XX in a male
3. 47, XXY in a male
4. trisomy 21
Answer
C. 47, XXY in a male
A male with an extra X chromosome.
The stage of prenatal development when organs form and malformations are most likely is the
1. embryonic stage
2. germinal stage
3. late foetal stage
4. neonatal stage
Answer
A. embryonic stage
Organs form between about 2 and 8 weeks.
Implantation of the zygote in the uterus occurs in the
1. foetal stage
2. embryonic stage only
3. germinal stage
4. postnatal stage
Answer
C. germinal stage
The germinal stage runs from conception to about two weeks.
The structure that passes oxygen and nutrients from mother to foetus is the
1. fallopian tube
2. placenta
3. ovary
4. amnion
Answer
B. placenta
The placenta is the exchange organ.
Infection in early pregnancy that causes heart defects, cataract and deafness in the baby is
1. typhoid
2. dengue
3. common cold
4. rubella
Answer
D. rubella
Rubella (German measles) is a classic teratogen.
Foetal alcohol syndrome is caused by
1. iodine intake
2. exercise
3. sunlight
4. alcohol intake in pregnancy
Answer
D. alcohol intake in pregnancy
Alcohol is a teratogen.
Neural tube defects are prevented by adequate
1. folic acid
2. vitamin K
3. vitamin C
4. sodium
Answer
A. folic acid
Folic acid is vital before and in early pregnancy.
The minimum number of antenatal check-ups advised is
1. ten
2. four
3. one
4. two
Answer
B. four
At least four antenatal visits are advised; more for high-risk women.
The vaccine given to pregnant women to protect mother and newborn from tetanus is
1. BCG
2. rabies
3. Td (tetanus and diphtheria)
4. measles
Answer
C. Td (tetanus and diphtheria)
Td protects against tetanus.
The cash incentive scheme for institutional delivery is
1. Janani Suraksha Yojana
2. Mission Indradhanush
3. PM POSHAN
4. Poshan Abhiyaan
Answer
A. Janani Suraksha Yojana
JSY promotes safe institutional delivery.
The neonatal period is the first
1. six months after birth
2. 7 days after birth
3. one year after birth
4. 28 days after birth
Answer
D. 28 days after birth
Neonatal means the first 28 days.
The postnatal period (puerperium) for the mother is about
1. one year
2. six weeks
3. six months
4. six days
Answer
B. six weeks
The body returns to the non-pregnant state in about six weeks.
The Apgar score is assessed at
1. one and five minutes after birth
2. one hour and six hours
3. one month and one year
4. one day and one week
Answer
A. one and five minutes after birth
It is repeated at five minutes.
The maximum total Apgar score is
1. 5
2. 20
3. 7
4. 10
Answer
D. 10
Five signs scored 0 to 2 each.
Which is NOT a component of the Apgar score?
1. respiration
2. pulse
3. birth weight
4. muscle tone
Answer
C. birth weight
Apgar covers appearance, pulse, grimace, activity and respiration.
The reflex in which a newborn spreads arms when startled is the
1. rooting reflex
2. Moro reflex
3. stepping reflex
4. grasp reflex
Answer
B. Moro reflex
The Moro reflex is the startle reflex.
The reflex in which the baby turns towards a touch on the cheek is
1. swallowing
2. Moro
3. Babinski
4. rooting
Answer
D. rooting
The rooting reflex helps the baby find the nipple.
Skin-to-skin contact and exclusive breastfeeding for a low birth weight baby is called
1. pre-lacteal feeding
2. kangaroo mother care
3. swaddling
4. phototherapy
Answer
B. kangaroo mother care
KMC keeps the baby warm and promotes breastfeeding.
Which is a danger sign in a newborn?
1. sleeping most of the day
2. hiccups
3. poor feeding with fast breathing
4. occasional sneezing
Answer
C. poor feeding with fast breathing
Poor feeding, fast breathing, fever and fits need urgent care.
A child begins to sit without support at about
1. 8 to 9 months
2. 1 month
3. 3 years
4. 2 months
Answer
A. 8 to 9 months
Sitting alone occurs around the second half of the first year.
A child usually walks alone at about
1. 4 years
2. 12 to 15 months
3. 3 months
4. 6 months
Answer
B. 12 to 15 months
Independent walking occurs between 12 and 15 months.
A mother says her 2-year-old child speaks no words at all and does not respond to sound. The best step is
1. give more sweets
2. wait until age ten
3. refer for hearing and developmental screening
4. scold the child
Answer
C. refer for hearing and developmental screening
A clear delay needs early screening and referral.
A pregnant woman in the second trimester reports severe headache, blurred vision and swelling of the face. This is
1. normal in pregnancy
2. a sign of good health
3. a danger sign needing urgent referral
4. treated only with rest at home
Answer
C. a danger sign needing urgent referral
These may signal pre-eclampsia, which is dangerous.
Which is a correct statement about heredity and environment?
1. only heredity matters
2. both act together in development
3. only environment matters
4. neither matters after birth
Answer
B. both act together in development
Development is the product of both.
Consider: 1. Growth is quantitative. 2. Development is quantitative and qualitative. Which is/are correct?
1. 1 only
2. 2 only
3. Both 1 and 2
4. Neither 1 nor 2
Answer
C. Both 1 and 2
Both statements are correct.
Consider: 1. Growth continues throughout life. 2. Development continues throughout life. Which is/are correct?
1. 1 only
2. 2 only
3. Both 1 and 2
4. Neither 1 nor 2
Answer
B. 2 only
Growth stops at maturity, while development is lifelong.
Consider: 1. The mother's ovum decides the sex of the baby. 2. The father's sperm decides the sex of the baby. Which is/are correct?
1. 1 only
2. 2 only
3. Both 1 and 2
4. Neither 1 nor 2
Answer
B. 2 only
The ovum always carries an X chromosome.
Consider: 1. The first trimester carries the greatest risk of malformations. 2. Teratogens harm only after the eighth month. Which is/are correct?
1. 1 only
2. 2 only
3. Both 1 and 2
4. Neither 1 nor 2
Answer
A. 1 only
Teratogens act at various times, most dangerously in early pregnancy.
Consider: 1. Honey and water should be given as pre-lacteal feeds. 2. Colostrum should be given to a newborn. Which is/are correct?
1. 1 only
2. 2 only
3. Both 1 and 2
4. Neither 1 nor 2
Answer
B. 2 only
Pre-lacteal feeds are avoided.
Consider: 1. Immunisation at birth includes BCG. 2. Immunisation at birth includes the oral polio zero dose and hepatitis B. Which is/are correct?
1. 1 only
2. 2 only
3. Both 1 and 2
4. Neither 1 nor 2
Answer
C. Both 1 and 2
Both are given at birth as per the national schedule.
Consider: 1. Rh incompatibility can harm a baby of an Rh-positive mother and Rh-negative baby. 2. The risk arises when an Rh-negative mother carries an Rh-positive baby. Which is/are correct?
1. 1 only
2. 2 only
3. Both 1 and 2
4. Neither 1 nor 2
Answer
B. 2 only
Risk arises when an Rh-negative mother has an Rh-positive baby.
Match the condition (I) with its cause (II). I: a. Down syndrome b. Turner syndrome c. Klinefelter syndrome d. Neural tube defect. II: 1. 47, XXY 2. Trisomy 21 3. Folic acid deficiency 4. 45, X.
1. a-2, b-1, c-4, d-3
2. a-4, b-2, c-1, d-3
3. a-3, b-4, c-1, d-2
4. a-2, b-4, c-1, d-3
Answer
D. a-2, b-4, c-1, d-3
Down-trisomy 21; Turner-45,X; Klinefelter-47,XXY; neural tube-folic acid.
Match the stage (I) with its period (II). I: a. Germinal b. Embryonic c. Foetal d. Neonatal. II: 1. 9 weeks to birth 2. Conception to about 2 weeks 3. First 28 days after birth 4. About 2 to 8 weeks.
1. a-1, b-4, c-2, d-3
2. a-4, b-2, c-1, d-3
3. a-2, b-1, c-4, d-3
4. a-2, b-4, c-1, d-3
Answer
D. a-2, b-4, c-1, d-3
Germinal 0-2 weeks; embryonic 2-8; foetal 9-birth; neonatal 28 days.
Match the milestone (I) with the approximate age (II). I: a. Social smile b. Head control c. Walks alone d. Two-word sentences. II: 1. 12 to 15 months 2. 2 years 3. 6 to 8 weeks 4. 3 months.
1. a-3, b-4, c-1, d-2
2. a-3, b-4, c-2, d-1
3. a-1, b-4, c-3, d-2
4. a-4, b-3, c-1, d-2
Answer
A. a-3, b-4, c-1, d-2
Smile 6-8 weeks; head control 3 months; walking 12-15 months; two-word sentences 2 years.
Which agent was linked to limb defects in babies when taken by pregnant women?
1. thalidomide
2. folic acid
3. paracetamol in correct dose
4. iron tablets
Answer
A. thalidomide
Thalidomide is a known teratogen.
First milk teeth usually appear at about
1. 3 years
2. 1 month
3. 10 years
4. 6 months
Answer
D. 6 months
The first tooth appears around six months; all 20 by about 2.5 to 3 years.
The Pradhan Mantri Surakshit Matritva Abhiyan provides
1. free antenatal check-ups by doctors on a fixed day each month
2. free electricity
3. free house to women
4. free school meals
Answer
A. free antenatal check-ups by doctors on a fixed day each month
PMSMA offers assured antenatal check-ups.

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