Title: Growth and Development Yang Fan Pediatric Department
1- Growth and Development
-
- Yang Fan Pediatric Department
2 Growth defined as an increase in size
of body, biological growth of an organism takes
place through cell multiplication, this
morphological growth can be measured clinically.
3- the enlargement of the organ and the system
- morphological growth
- can be measured by exact values
4- Development
- A gradual change and expansion advancement from
a lower to a more advanced stage of complexity
increased capacity through growth, maturation,
and learning
5- An increase in competence and adaptability
- A QUALITATIVE change
- Functioning at a higher level
6- Thus, since both processes are part of one
whole, the combined terms growth and development
form an unitary concept that indicates the
quatitative and qualitative of maturational
changes of an organism.
7- Growth is a continuous and orderly PROCESS
8height
M
F
weight
M
F
Age (y)
9- Not all tissue systems of the body grow at the
same rate
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11- Variability
- Not everyone is alike in the way that they grow
- Percentile growth/ standard deviation to the norm
- Racial and ethnic differences
- Boys vs Girls
12Factors Influencing Growth
- Heredity
- Nutrition
- Gender
- Disease
- Environment
- Hazards
- Socioeconomic influences
13Growth Curves
Boys 2 to 18 years
Girls 2 to 18 years
- Boys reach most of their height at age of 17
whereas girls reach theirs at around 15
14Indices of Growth
- Body weight (kg)
- the weight of a persons body.
- the weight of all tissues, organs and body
fluids. - one indicator of the nutritional status of
child. - the basis of drug dosage and amount of infusion.
15Patterns of Weight Increment
1?The first growth spurt occurs in the first year
of life (the increment is about 6kg).
2?Growth is not at the same rate in different age
The increment of weight during the first 3
months is equal to that of the following 9
months. Yearly increments increase slowly
until the onset of puberty.
16- Birth weight 3 kg
- Mature babys weight gain at first month
1--1.5kg - 312months weight(month?9) /2 kg
- 16years weight age 2 ?8 kg
- 712years weight age 7-5 / 2 kg
17Attention
- About formulae
- These formulae are used only for calculating
dosage of drug and fluid in clinic. Because the
growth is not at the same rate in different age,
especially in infant and the growth is affected
by many factors, such as gene, environment and
individual variation.
18- Weight loss
- Physiological weight loss 3 - 9
-
recover at 7-10th day - Loss of 3 9 of birth weight in the first few
days of life is considered normal and is common
for most newborns.
19Height(cm)
- The length from vertex to plantae
- The index of long time nutritional status
20- The height for infants up to three years
should be measured as recumbent length using a
properly constructed measuring device. - Height measurements for children over three
years of age should be accomplished using
vertical measuring board or fixed wall device.
21Length/Stature
lt 3y
Supine
--- Length
--- Stature
Stand
3y
22- at birth 50cm
- 1 year old 75cm
- 2 years old 85 cm
- 2--12 years oldage 6 77
23Patterns of Length Increment
The first growth spurt occurs in the first year
of life (the increment is about 25cm).
Growth is not at the same rate in different age
The increment of weight during the first 3 months
is equal to that of the following 9 months.
Yearly increments increase slowly until the
onset of puberty.
24- Shortness may be caused by malabsorption, chronic
illness, psychosocial deprivation, hormonal
disorders, familial patterns, or syndromes with
dwarfism. - Gigantism may be the result of pituitary
abnormalities.
25Male 10y H88cm
10y GHD
26Crown-rump/Sitting height
They give a measure of the length of the head
and trunk. It is a measurement of the distance
from the highest point on the head to the base
sitting surface.
lt3y
Supine
- Crown-rump length
Sit
3y
27 During the first year of life, spinal
increase is faster than extremities. Later on,
the extremities grow at a faster rate than the
trunk, which is contribute to the body length and
leading to a gradually change in relative
proportions.
28Changes in Overall Body Proportions
29Head Circumference
HC is a measurement of perimeter of
head,from eyebrows to occipital prominence. The
change of the HC is related with the growth of
brain and skull.
30- At birth 34 cm
- 1 year 46cm
- 2 years 48 cm
- 5 years 50cm
- 15 years 54cm (the same
as adult)
31- Head circumference should be measured with a
tape measure at each visit during the first two
years of life. - A large head may be an early sign of
hydrocephalus or an intracranial mass. - A small head may be a result of early closure
of sutures or lack of brain development.
32- chest circumference
- reprent the growth of thorax and lung
- at birth CClt HC 1- 2 cm
- 1 year CC HC
- gt1year CC - HC (cm) age - 1
33Growth on Puberty
- At puberty, there is a marked growth spurt(The
second peak of height velocity,PHV), that is, a
very rapid increase in size and weight.
34- Girls usually showing their pubertal growth spurt
around age 911. - For boys the same process begins at apx. age
1113. - According to Tanner (1990), girls finish pubertal
growth by about age 16 whereas boys continue to
grow until approximately 18 years of age.
35Sexual PrecocitySecondary sexual
characteristics appear
before puberty.
Girlslt8y,Boyslt10y Delayed sexual
maturity Secondary sexual
characteristics do not appear
after puberty
Girlsgt14y,Boysgt16y
36Cranial development
37Closure time of fontanel/suture
38Abnormality of anterior fontanel
Small size or early closure Large
size or delayed closure
Microcephaly
Hydrocephalus, Cretinism
39Abnormality of anterior fontanel
Bulging fontanel Sunken fontanel
Intracranial hypertension( Encephalitis,
Meningitis)
Dehydration
40Bone development
Osteite (center of ossification), which is
located near ends of long bones (epiphyses), with
growth plates. It is very important for bones
growth in length.
41The sequence of appearance of secondary centers
42Bone age
Bone age is that the age should be according
to the osteite number for normal child. The most
commonly used standards are those of Gruelich and
Pyle, which require radiographs of the left hand
and wrist knee films are sometimes added for
younger children(usually less than 1 year old).
43 Abnormality of Bone Age
Retardation of BA
Hypothyoidism, Hypopituism
Adrenogenital syndrome, Precocity
Precocity of BA
44Dentition
- Primary teeth
- Primary teeth are 20 totally.
- The first eruption is at about 6 months(410
months) . - The timing of tooth eruption is more variable
than other developmental parameters
45Primary teeth
- Delayed eruption is usually considered when there
are no teeth by approximately 12 months of age. - The last eruption of primary teeth is at 22.5
years of age.
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47Abnormality of Dentition
Delayed eruption Hypothyroidism,idio
pathic Disorder Hypothyroidism, Brain
dysplasia Failing to erupt
Ectodermal dysplasia,Mechanical
blockage Abnormality of dental enamel
Ectodermal dysplasia
48Evaluation of growth
- Growth level
- Growth velocity
- Proportion
49Evaluation of growth
- Reliable and accurate data
- Single Value and series investigation
- reference
50Choosing reference
Reference, based on a North American
population by NCHS, USA, is recommended by the
WHO as the international standard of growth.
51Choosing reference
Besides,there are many local or national
references,for example, physical growth indices
of 9 cities in China.
52Methods of assessment
- Reference table
- Growth curve
53Growth Curves
Boys 2 to 18 years
Girls 2 to 18 years
- Boys reach most of their height at age of 17
whereas girls reach theirs at around 15
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55Growth level
Every single measurement can be plotted on a
growth curve which illustrates the amount of
growth in children within different age group.
56Evaluation of growth
- mean standard deviation cut-off point x
2SD - percentilecut-off point P3--P97
- Z score Z score( x - x )SD
- Growth curve
-
-
57Example(Weight of girls) P3 P25
P50 P75 P97 1y 7.49 8.54 9.18
9.91 11.37 (kg) -2SD -1SD
1SD 2SD 1y 7.18 8.21 9.24 10.27
11.30 (kg) The weight of a one year old
girl is 8.2 kg. Growth level
X
W/A P3-P25 W/A
-(1SD2SD)
X
58Growth velocity
Growth velocity can show the process of
growth. Growth velocity is measured in terms of
how much a child grows within a specified period
of time.
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60Neuropsychological and Behavioral Development
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62- Nervous system anatomically complete at birth
- except
- Myelination
- rapid for 2 years
- complete by 7 years
- Primitive reflexes disappear in few months
63The Babys Brain-Infant Vision Development
newborn
1 month
2 months
3 months
6 months
adult
64 Audition
Audition is important because it relates
language development. If a child has hearing
loss, the child will have impaired speech,
language and learning and behavioural problems
stemming from difficulty in communication.
65 Newborns prefer sweet tastes over sour, bitter,
and salty tastes. They can distinguish odors
right from birth and soon learn to know the smell
of their mothers milk and bodies.
66BEHAVIOR DEVELOPMENT Four Attributes
Gross motor Fine motor Language
Personalsocial skill
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68Fine Motor
Physical skills involving small body movements,
especially with the hands and fingers, such as
picking up a coin and drawing.
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70Personal Social Skill
71Developmental Surveillance
- Periodic assessment of a childs developmental
progress with the aim of detecting
pre-symptomatic disability
72- Longitudinal and multidimensional developmental
monitoring. - Over-reliance on isolated developmental scales
and tests should be avoided.
73- Screening tests Screening procedures should be
brief, simple, cheap and reliable - Diagnostic tests
74What do we look for in developmental screening?
- Normal growth pattern
- Height, weight, head circumference
- Achievement of developmental milestones(indicatin
g neurological development) - Gross motor function
- Fine motor function and vision
- Hearing and speech
- Social behaviour and play
75Screening tests
- Pediatric periodic health supervision
- Standardized developmental screening instruments
- Not diagnostic
- when abnormal, diagnostic evaluation should be
done
76- DDST
- children under 6 yrs
- PPVT
- from 4 to 9yrs
- especially for children delayed in language
77Diagnostic tests
- Gesells test
- from 4 weeks to 3yrs
- Bayley from 2 to 30 months
- WPPSI from 4 to 6.5yrs
- WISC-R from 6-to 16yrs
78Thank You