Growth

Growth − A process by which a living being or any of its parts increases in the physical
size and mass either by multiplication or by enlargement of component cells
− Measured quantitatively
Significance Of Growth − Early detection of pathologic deviations
− Prevent the unnecessary evaluation of children with acceptable normal
variations in growth
− Normal growth is a reflection of overall health and nutritional status
Factors Affecting Growth − Genetics
− Gender
− Race/Ethnicity
− Hormonal Factors
− Environment
Genetics − Parental characteristics such as height, head size, and general physique may
be transmitted from parents to their offspring
− Certain chromosomal abnormalities, metabolic disorders may adversely affect
growth potential
Gender − Boys > Girls
Race Or Ethnicity − Caucasian > Asian
Hormonal Factors − Growth hormones
− Insulin like growth factor 1
− Sex steroids
− Thyroid hormones
Environment − Prenatal vs Postnatal
− Nutrition, infection and neurotoxin
− Chronic illnesses and parasitic infections have been implicated in decrease
linear growth
− Socioeconomic factor
− Cultural factors
Pattern Of Growth − Normal human growth is PULSATILE
− Period of rapid growth (“growth spurts”) are separated by periods of no
measurable growth
Growth Spurts − Infancy
− Puberty
− The progression of growth is interpreted within the context of GENETIC
POTENTIAL for a particular child
Newborn − Average birthweight of FILIPINO CHILDREN: 3000 g
− Average length: 50 cm
− Head circumference: 32-37 cm
Growth Rate − Height gain in centimeters per year vs age in years
Skeletal Growth − Coincide with height gain
− Females: 14 years old
− Males: 17 years old
Genital Tissues − Grow slowly before puberty
− They double in size during ADOLESCENCE when they mature and become
functional
Lymphatic Tissue − Small but well developed at birth
− Reaches adult dimensions by 6 years old
− Peaks about 10-12 years old after which it decrease in size
CNS − Brain continues to grow dramatically after birth
− Myelination of the cerebrum is complete by 2 years old
Teeth − Eruption usually occur at 6 months of age- mandibular central incisors
 − Eruption of permanent teeth begins at around 6 years old and completed at
around 18 years old
Growth Measurements − Weight
− Height/length
− Head circumference
− Chest circumference
− Body mass index
− Mid upper arm circumference
− Triceps skin fold thickness
Weight − For 2 years old or cannot stand: tared weighing or use infant scale
− For 2 years old above: weigh alone
<6 months Weight in grams= age in months x 600 + birth weight
6-12 months Weight in grams= age in months x 500 + birth weight
Expected Weight Of A Child Kilograms
At birth 3.4 kg
3-12 months Age (months)+9
2
1-6 years Age (year) x 2 +8
7-12 years Age ( year ) x 7−5
2
Following Changes In At 4-5 months 2x Birthweight
Weight At Different Ages 1 year 3x Birthweight
2 years 4x Birthweight
3 years 5x Birthweight
5 years 6x Birthweight
7 years 7x Birthweight
10 years 10x Birthweight
Weight Gain Per Day NB- 3 months 30 g/day
3 – 6 months 20 g/day
6 – 12 months 10 g/day
− Children gain 2 kg/year between 2 years and puberty
− A prepubertal child whose weight velocity is <1 kg/year should be monitored
closely for progressive nutritional deficits
Length Or Height − < 3 years old use recumbent length
− 3 years old and above are able to stand; use standing height
Filipino Child Centimeters
At birth 50 cm
At 1 year old 75 cm
− 25 cm—average gain
Total Average Gain In Length Gain
Length During 1st Year Birth – 3 months 9 cm
3 – 6 months 8 cm
6 – 9 months 5 cm
9 – 12 months 3 cm
Computing Height For 2 Height in cm = Age in Years x 5 + 80
Years And Above
Expected Height 1 year 1.5 x Birth length
2 years ½ mature height
3 years 3 feet tall
4 years 2 x birth length
13 years 3 x birth length
 − A prepubertal child whose height velocity is <5cm/year should be monitored
closely
Normal Variant Of Linear − Familial short stature
Growth − Delayed constitutional Growth
− Growth velocity is normal
Feature Familial Short Stature Constitutional Delay
Parents’ Stature Small (one or both) Average
Parents’ puberty Usual Timing Delayed
Birth Length Normal Normal
Growth (0-2 years) Normal Normal to Slow
Growth (puberty) Normal Slow
Bone Age Normal Delayed
Timing of puberty Normal Delayed
Puberty Growth Rate Lower Range of Diminished
Normal
Adult Height Short Normal
Predicted Height − Projected height
− Midparental Height
Projected Height − Determined by extrapolating the child’s growth along the current channel to
the 18 to 20 year mark
Midparental Height − Used to check if consistent with genetic potentials
FH −13 cm+ MH
− Girls:
2
MH +13 cm+ FH
− Boys:
2
− For both girls and boys, 8.5 cm on either side of this calculated value (target
height) represents the 3rd to 97th percentiles for anticipated adult height
Head Circumference − Measured until 2 years old
Occipital Frontal − Status of brain growth
Circumference − At birth, head circumference is at 35 cm
− Should be monitored routinely during the first 3 years of life
− Measured over the most prominent part of the occiput and just above the
supraorbital ridges
− Indicator of disturbances in the skull
− 1-2 cm larger than chest circumference
Growth In Head Birth – 3 months 2 cm
Circumference Per Month 3 – 6 months 1 cm
6 – 12 months 0.5 cm
1 – 3 years 0.25 cm
4 – 6 years 1 cm/year
Chest Circumference − Not routinely taken
Birth – 5 months HC =/> 2 cm CC
5 months – 2 years HC = CC
>2 years HC< CC
BMI − >2 years old
− A valid predictor of adiposity
− Best clinical standard for defining obesity
− BMI= wt(kg) / ht (m)2
Mid Upper Arm − Measurement of thinness
Circumference − Colors of the tape
− Red: 0 – 11.5 cm
− Yellow: 11.5 – 12.5 cm

Triceps Skin Fold Thickness
Growth Charts
Examples Of Growth Charts
Special Growth Charts
Premature Infants
Abnormal Patterns Of
Growth
− Green: from 12.5 cm
− Acute Severe Malnutrition: <11.5 cm
− Index of nutrition
− Body fat content
− To determine the child’s growth percentiles, the weight and length (or height)
should be plotted in the appropriate growth chart at each well-child visit and
as indicated at interval visits
− WHO CGS: <5 years old
− CDC/NCHS: 5-19 years old
− Weight for age
− Length for age
− Head circumference for age
− Weight for length
− Turner syndrome
− Down syndrome
− Williams syndrome
− Achondroplasia
− Prematurity
− Correction for Gestational Age
− Weight up to 24 months of age
− Stature up to 40 months of age
− HC up to 18 months of age
− Growth can be slowed or accelerated by a variety of conditions
− Changes in growth may be the first sign of a pathologic condition
(inflammatory bowel disease, hypercortisolism, thyroid dysfunction)
− Poor weight gain
− Obesity
− Short stature
− Tall stature
− Microcephaly
− macrocephaly