GROWTH

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GROWTHDEVELOPMENT
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EVALUATION OF GROWTHDEVELOPMENT

• 1) Fetal growth and development.
• 3-4yr- 9-10yr.
• Puberty.
• 2) Postnatal growth of major organ systems
• Brain and head
• Lymphoid systems
• Reproductive systems
• 3) Growth pattern- head
• -chest (offen 6
  months)
• -extremites (9-12
  months)
• 4) Biologic variation genetic structure
• 5) Secular trend positive or negative

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STAGES OF CHILDHOOD

• Prenatal
• 1) Embrionic (0-10 wk)
• 2) Fetal (10-40 wk)
• Postnatal
• 1) Newborn (0-4 wk)
• 2) Infancy (1-12 months)
• 3) Toddler (1-3 yrs)
• 4) Preschool (4-5 yrs)
• 5) School (6-10/ 6-12 yrs)
• 6) Puberty (10-18/12-20 yrs)

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HEALTY CHILD

• GROWTH
• Weight, height,head circumference, chest
  circumference, the ratio of body parts
• DEVELOPMENT
• Teeth, bone, neuromotor, intelligence, sexual

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HEALTY CHILD

• WEIGHT BW is regained by 10th-14th day. Average
  weight gain/day
• 0-6 mon 20-30g/day (150-250 g/wk)
• 6-12 mon 15-20 g/day (100-150g/wk)
• 12-24 mon50 g/wk
• BW doubles at 4 mon, triples at 12 mon,
  quadriples at 24 mon.
• After age two years average annual gain until
  adolescence 2.3 kg

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HEALTHY CHILD

• At birth 3.25 kg
• 3-12 mo age(mon)9/2
• 1-6 yr age(yr)x28
• 7-12 yr age(yr)x7-5/2

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HEALTHY CHILD

• HEIGHT By end of first year birth length
  increases by 50. Birth length doubles by 4 yr,
  triples by 13 yr.
• Average height gain during second year 12cm
  third year 9cm,fourth year 7cm,after fourth year
  to puberty 5-6cm
• After age 2 year average annual growth until
  adolescence5 cm

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HEALTY CHILD

• At birth 50 cm
• At 1 yr 75 cm
• 2-12 yr age(yr)x6 77
• First 6 mon 8 cm (3 mon) 8 cm (3mon)
• Second 6 mon 4cm (3 mon) 4 cm (3mon)
• 8844cm

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HEALTHY CHILD

• Midparental height for girls
• (fathers h-13)(mothers h)/2
• Midparental height for boys
• (mothers h13)(fathers h)/2
• For full-term infants, size at birth reflects the
  influence of the uterine environment however,
  size at 2 yr correlates with mean parental
  height, reflecting the influence of genes

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HEALTHY CHILD

• HEAD CIRCUMFERENCE
• At birth head/height ¼ ? ? (adult)
• At birth HC 35 cm
• 3 mon 40.5 cm
• 6 mon 43 cm
• 12 mon 46 cm
• 4 yr 50.4 cm
• 5 yr 50.8 cm

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HEALTHY CHILD

• CHEST CIRCUMFERENCE
• At birth 33 cm
• 12 mn 47 cm
• 5 yr 55 cm
• 14 yr 74 cm
• NB HCCC
• gt1 yr CC gtHC

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HEALTHY CHILD

• THE PROPORTIONS OF BODY
• Head-Pubis/Pubis-Foot 1.7 (NB)
• 10 yr 1
• Adolescence lt 1
• Sitting height 0.7 At birth
• 0.57 3 yr

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HEALTHY CHILD

• GROWTH CHARTS
• 5 gender spesific charts (2000-CDC)
• 1)Weight for age
• 2)Height for age
• 3)HC for age
• 4)Weight for height
• 5)BMI over 2 yrs of age

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HEALTHY CHILD

• Charts with lines for the 3rd and 97th
  percentiles are available
• -2sD, 3. per 2sD 97.per
• Decreasing by 2 percentile is acceptable until 4
  years of age
• www.who.int/childgrowth/mgrs/en/.

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Growt charts
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Growt charts
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HEALTHY CHILD

• DENTAL DEVELOPMENT

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HEALTHY CHILD

• EVALUATION OF OSSEOID MATURATION
• Determining the age (choronologic)
• Predicting adult height
• Determinig the growth status.
• The distal femoral and proximal tibial
  epiphyses are ossified in the normal full-term
  infant (first three months)
• Examination of the hand and wrist.
• At 2-6 month of age capitate-hamate
• The fusion of the humeral capitellum ? first
• Distal radial fusion ? last

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HEALTHY CHILD

• 6 fontanelles ant (3-18 mons),post,2 lambdoid,2
  sphenoid
• Sutura clossure puberty

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HEALTHY CHILD

• NEUROMOTOR DEVELOPMENT
• Sefalo-Caudal
• Proximo-Distal
• VISION NB shiny things
• 2 wk 45º - 90º
• 2 mn 180º
• 5-6 yrs full

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HEALTY CHILD

• Beginning to smile at 4 weeks
• Repetetive meaningless sounds 40 wk (ma-ma,da-da
  etc.)
• A few words ? at 1 yr brief sentence ? 2yr make a
  sentence ? 3 yr
• Sits briefly ? 6-7 mons
• Walking without help ?1 yr
• Grasping objects ? 4-6 mons
• Grasping with thumb and forefinger ? 9 mons
• May complain when wet or soiled ?15-18 mons

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GROWTH FAILURE

• HEIGHT
• 1)hormonal factors
• GHRF ? GH ? IGF1 postnatal, IGF2 fetal IGFBP 3
  postnatal , IGFBP2 IGFBP1 fetal
• Thyroxin
• Corticosteroids
• Insulin
• Gonadal hormones
• 2) Skeletal system
• 3) Genetic,midparental height
• 4) Enviromental factors,nutrition

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• EVALUATION
• Height under 3.percentile
• Velocity of height is decreased,
• 1-2yr under 10cm,2-3yr under 7cm,3-4yr under
  6cm and 4-puberty under 4cm
• Bone age
• Height age
• Chronological age
• Target height

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GROWTH FAILURE

• Classification(1)
• Primary usually bone age is normal
• -genetic
• -IUGR
• -chromosom anomalies
• -skeletal dysplasia

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GROWTH FAILURE

• Secondary bone age lt choronolojical age
• Constitutional
• Psycological
• Nutritional deficiency
• Chronic disease
• Hormonal disorders

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GROWTH FAILURE

• Classification (2)
• Pathologic sceletal dysplasia, endocrine
  anomalies, IUGR, choromosom anomalies, chronic
  disease, malnutrition
• Nonpathologic genetic, constitutional,
  idiopathic.

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GROWTH FAILURE

• GENETIC GROWTH FAILURE
• Determining the parents percentile norms.
• Bone age /lt choronologic age. Birth weight ? N
• Usually found in other family members.
• Results of growth are normal.
• No therapy (GH can be administered)

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GROWTH FAILURE

• IUGR
• Twins, premature catch-up growth
• IU infections
• Alcohol, smoke
• Hypertension, eclampsia
• Nutritional defects
• Placental insufficiency
• Birth length, HC ?
• Hypoplastic Adults, GH N

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GROWTH FAILURE

• CHOROMOSOMAL ANOMALIES
• 1)Down syndrome (Trisomy 21)
• MR, hypotonia, flat occiput, epichantic folds,
  protruding tongue, prominent malformed ears,
  congenital hearth defects, criptorchidism, simian
  crease, short broad hands, hypoplasia of middle
  phalanx of 5.th finger, gap between 1st. and 2nd.
  toes, high arched palate, strabismus, short neck,
  small teeth, intestinal atresia, imperforate anus

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GROWTH FAILURE

• 2) Turner syndrome (45 X0)
• Short stature, gonadal dysgenesis, primary
  amenorrhea, mental retardation eye-ear
  abnormalities, LBW, lymphedema on hands and feet,
  no breast development, infertility.

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Turner syndrome (45 X0)
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GROWTH FAILURE

• SKELETAL DYSPLASIAS Growth failure begins
  antenatally. Short shaft. Adolescence height is
  short.
• Growth and bone age are affected equally.
• Development defects of skeleton
• Dysplasias disorders of growth
• Dysostoses malformation of bone
• Idiopathic osteolyses pathologic resorbtion of
  bone

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GROWTH FAILURE

• Achondroplasia
• A.D.
• Reduced rate of qualitatively normal endochondral
  bone formation
• Rhisomelic shortening of the limbs re-cognized at
  birth
• Large head size
• Frontal bossing
• Depression of nasal bridge

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GROWTH FAILURE

• The hands are short and broad
• Normal neuromuscular tone is usually gained by
  2-3 yr
• Dental malocclusion
• Hypochondroplasia
• Recognized from 2-3 yr
• A.D.
• Head and face are normal

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achondroplasia
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hypochondroplasia
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GROWTH FAILURE

• CONSTITUTIONAL GROWTH DELAY
• Lenght and weight are normal at birth.
• Growth decelarates after 4-12 months.
• By 2-3 year growth resumes at a normal rate of 5
  cm/year.
• Bone age similar to height age lt chronologic age.
• Other family members can be affected.
• Achive normal adult height
• Delayed puberty ( can require a short cause of
  testosteron to initiate puberty)

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GROWTH FAILURE

• PSYCOLOGICAL Enviromental factors
• In infancy ? hospitalization
• Cortical inhibition ? hypothalamic inhibition
• MALNUTRITION Inadequte protein and carbohydrate
  intake
• Height and bone age lt chronologic age
• Weight decelerates, too.

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GROWTH FAILURE

• CVS PDA, VSD, AS, PS, TGA, Fallot
• GIS Chron dis, colitis ulserosa, malabs
  syndrome, celiak dis, CF, chronic
  gastroenteritis, chr liver dis,
• UGS chr GN, NS, RTA

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GROWTH FAILURE

• HORMONAL DISORDERS
• GH def congenital aplasia/hypoplasia of the
  pituitary
• Acquired craniopharyngioma
• Idiopathic
• Reseptor defect
• Normal size and weight at birth
• IGF-I is a screening test for diagnosis
• GH is determined with stimulation tests
• GH is increased after puberty begins
• Chr age is greater than bone age and bone age is
  greater than height age

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GROWTH FAILURE

• Delayed closure of epiphyses permits growth
  beyond the age when normal persons cease to grow
• The head is round. Face is short and broad
• Nose is small
• Mandible and chin are underdeveloped
• Late teeth eruption
• Extremites are proportional
• Delayed sexual maturation

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GROWTH FAILURE

• Hypothyroidism,Chr age is greater than height age
  and height age is greater than bone age
• D.M.
• Pubertas preacox idiopathic, gonadal tm
  congenital surrenal hyperplasia.
• Pseudohypoparathyroidism PTH ? N , Ca ? ?
• Cushing excess of glucocorticoids, moon face,
  central obesity, hypertension, striate (surrenal
  hyperplasia, adenoma, carsinoma)

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Hypothyroidism
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