Scribd Logo
Upload

Welcome to Scribd!

  • Owth & Development

    Uploaded by

    der035676
    4 views35 pages

    Original Title

    Paediatrics...Growth & Development

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    Download as pdf
    4 views35 pages

    Owth & Development

    Uploaded by

    der035676

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    Download as pdf
    of 35
    CLASS OUTLINE ew PE 1.4: Definition of Growth and Development and factors affecting normal growth and development. PE 1.2: Patterns of growth in infants, children and adolescents. PE 1.3: Methods of assessment of growth: WHO & Indian standards. PE 1.5.2: Discuss the normal developmental milestones with respect to motor, behavior, social, adaptive and language development. » Growth denotes a increase in the body mass as a result of multiplication of cells and increase intracellular substance, (quantitative change) » Development denotes acquisition of new skills for optimal functioning. (qualitative change), 7 The terms growth an development are not interchangeable, » But growth & development usually proceed concurrently. « Growth starts s from + Growth follows a predictable Sequence. + Direction of Growth 1. During fetal life: Cephalo-caudal: Head region ~trunk > leg region. 2. Inthe postnatal life: Proximo-distal: Head growth slows down Growth does not progress at the same rate at all ti a) Rapid in early childhood and adolescents. b) Slowin mid-childhood. + Notall body parts grow in the same rate at the sai + Each child grows in its own unique way of| growth. Principles of Gro owth —_aen m conception and continues until I child attain = Limbs grow rapidly. me. me time. ans adult rage |» Language development is early and advanced in girls, Principles of Development | Development is continuous process from conception to maturity. | |. Development is intimately related to maturation of CNS. * Sequence of development is identical, but rate of development varies from child to child, /* Generalized activity is replaced by specific action. Primitive reflexes are | lost before voluntary movements are acquired. '* Cephalo-caudal and proximo-distal in progression (axial peripheral). | Factors affecting Growth & development Maternal factors Nutritional deficiencies Diabetic mother Exposure to radiation Infection with TORCH Smoking/drugs Diseased placenta Placental Factors Faulty implantation Genetic Factors 1.Heredity: genes transmit physical characteristics Chromosomal / gene mutational 2.Geneticd External environment: Socio-economic status Childs nutrition Climate and season Chronic Disease Cultural factors Family structure Internal environment Hormonal influences “asulin (maximum) A ILGF “Growth Hormone =Thyroxin Emotional factors ), Pattern of growth Sg [1. General body growth = 1 + Rapid during > Fetal life & first 2 years of postnatal We \) 1 i + _- y During puberty, Lymphoid | + Relatively slow = intervening yrs a 2.The brain growth. e C + Rapid during 1 | { > Later months of fetal life and t Brass Hae > Early months of postnatal life. oT r 217. + Atbirth head size = 70 % of adults size. é z + By Zyears = 90 % of adult size. e é General |_2| 3, Gonadal growth. : | je ¢ ¥ Dormant in childhood ober 4 T ¥ Maximum in puberty. wll Z | 4. Lymphoid growth, =| feet | = Maximum in mid childhood (4 - 8 years ). oc L | ra i «isa Monitoring growth: Anthropometry a Anthropometric parameters Anthropometric parameters are measurements for evaluating growth & nutritional status. Important anthropometric parameters are: 1, Weight 2. Length(< 2 yrs)/height 3, Head circumference 4, Mid-upper arm circumference (MUAC) 5. Upper segment: Lower segment ratio Serial measurements of anthropometric parameters using same equipment are more useful than a single measurements, Rate of increase of an anthropometric parameter with time is called its Veloci e.g. Weight Velocity, Height velocity etc. SUIT - Anthropometric Indices + When 2 anthropometric parameters are combined, it is called an Anthropometric index. + Important anthropometri are: 1 BM =a 2. Height/Length-for-age - Sige 3. Weight-for-age - Gayamaieemgor eter ™ 4, Weight for height Sapa ar iepme ger”! 5, Head circumference-for-age “meat” 6, Ponderal index Weight Kg 199 ~ Geight in em) * Average Anthropometric Parameters at Term Birth Weight = 2.8-3 Kg Length = 50 Cm U:L=1.7:1 HC=35 Cm CC = 33 Cm Arm Span = 1-2 cm less than length. ie Weight Velocity + First Year: | + First 4 months = 30 gm/day | + Second 4 months = 20 gm/day | * Third 4 moths = 15 gm/day ae 3 years = 3 kg/year | + 4-10 Yrs(F) e4-tayrsemy | *24g/vear _ Above 10 Yrs - 19 years (F) = 5 kg/year + Above 12 yrs - 19 years (M) = 6 kg/year *Weight at § mo = 2 x Birth We | + Weight at 1 yr = 3 x Birth We | * Weight at 2 yr = 4 x Birth We + Weight at 7 yr = 7 x Birth Wt * WEECH’S FORMULA: 1-6 yrs=(Ageinyrs x 2 + 8) Kg Kg *7-12yrs=(Ageinyrs x 7-5 )=2 Height/Length Velocity At9mo At Birth 50Cm At3 mo 60cm At6mo 65cm 70cm [Ce EEE i | Gain in 3 - 10 (F) At12mo 75cm Gain in 1" Year 25cm 12.5cm Gain in 2™4 Year | Gain in3™ Year 75-10cm L -75 3-12 11(M) 5-75¢m/yr Above 10 -19yrs (F) 8cm/yr (F) | Above12 Yr-9yrs (M) 10. cm/yr (M) + WEECH'S formula(2-12yrs): Helght=(Age in years x 6 + 77)cm + Prediction of Adult height (cm)= Boys = (M+F+13)/2 cm Girls = (M+F - 13)/2 cm (It corresponds to + 8 cm or 25D) + Tanner's formula: Adult height =height at 2 yrs x 2 ee a Trunk VS Limb Growth Velocity + Upper segment = vertex to upper border | of symphysis pubis. [sm | 12cm smaller than length [10-1295 | Equals to height [agus | ‘=2cmmore than height + Lower segment = upper border of symphysls publs to heels Upper segment: Lower segment Abnormal US : LS Ratio US > LS(Short limbs): 1, Achondroplasia 2, Osteogenesis imperfecta 3. Rickets US < LS(Short trunk): 1, Marfun syndrome 2. Klinefelter syndrome 3. Spondylo-epiphyseal dysplasia Head Circumference Velocity > Atbirth =35 cm (term) Measurement of head circumference =33cm(preterm) —_ Occipital Praminance > Atone yr =46-47cm > Attyo yr = 49cm > ALS-6 yrs = 52cm =Adult value EE Macrocephaly & Microcephaly Macrocephaly : HC > 2 SD above median for age and sex. Causes: 1, Familial Megalencephaly 2, Hydrocephalus 3, Achondroplasia Microcephaly: HC > 3 SD below median for age and sex. Causes: 1. Familial microcephaly 2. Craniosynostosis 3. Trisomy 13,18, 21 Interpretation of Anthropometric Indices Anthropometric indices: + Weight-for-age Height/Length-for-age Weight for height HC for age Body Mass Index Ponderal Index + WHO Standard growth charts/curves(< 5. yrs) Weight-for-age Helght/Length for-age Weight for height ic for age « WHO BMI Curves/Charts(5 - 18 years) Percentile Age independent Anthropometric Parameters/indices Age dependent criteria: 1. . Length/Height . Head circumference . Chest circumference . U/L Ratio . Arm span Aan wr wWN Weight Age independent criteria: 1. Weight for height 2. Upper Mid Arm Circumference 3, BMI 4, Skinfold thickness 5. Ponderal Index a Classification of Nutritional Status - WHO BMMor-age Nutritional status Nutritional Status (xscore) MODERATE SEVERE 3 Severe UNDERNUTRITION UNDERNUTRITION malnutition te Yes Moderate | Symmetrical Edema Xe {Edematous malnutrition) fy 2-32 | ppatnutrtion , ZScore=~2t0-3 1Score<-3 We i eight for eight al ia ase | Normal TScore=-2t0-3 TScore<-3 Seliose2 | Overweight Hi [| __ Overweight _| eight for Age (Stunting) {Severe Stunting) Dad Obesity Normal ; Obesity Tal Western Children Moderate malnutrition Overweight TE See | Aslan children ‘Skinfoldthickness(mm)—[____Ponderal Index >10= Normal >2.5= Normal 6-10 = Mild to Mod malnutrition 2-25 = Symmetric IUGR <6 = Severe malnutrition <2= Asymmetric IUGR Example * Name = Amal ° Gender = Male * Age = 4years 17 days * Height = 91cm » Weight =10.5 kg Determine his nutritional status. Recommended intervals and Parameters for Monitoring Frequency | Height | Weight | Head Penile circumference length Birth v v vy | 6-14 weeks Monthly v x x 6-18 months 3 monthly v IE ¥ 18 mo-3 yrs 6monthly | % x v | 3-Syrs 6monthly | % v 6-18 yrs Yearly w w v BMI SMR ° Fine Motor & Adaptive development: tt includes coordination of eyes, hand-eyes, hand-hand, hand-mouth and hand skills. ° Hearing & Language development: It includes hearing, sounding, understanding and true speech. ¢ Personal & social development: It includes interpersonal and social skills. Major Gross Motor Milestones Timing J Gross Motor. ‘Milestones “Gweeks Head at horizontal plane in ventral, suspension{momentary) 2 months Head at horizontal, plane in ventral. ssuspension(steady) 3 months Head above horizontal plane in ventral suspension. Neck holding in pull to. sit. 4-6 months Rolls over. 6 months sits with own support. Up on. forearms when prone. 8 months Crawls (abdomen on the, ground), Sits steadily without. support. 10 months Creeps (abdomen off the, ground), Stands with support, cruises by, ‘furniture. 12 months ‘stands without support, Walks with support. 13-15months _ | Walks independently. [18 ‘months Runs, Crawl up or down stairs zeae Walks backwards, Climbs upstairs 2 feet/step Syears Climbs upstairs 1 feet/step, Rides tricycle. 4 years Going downstairs on alternate feet, Hoping. S years Skipping. Major Gross Motor Milestones Major Gross Motor Milestones Timing Fine Motor Milestones 4 weeks Fixes & follows moving object up to 90° } 3 months Fixes & follows moving object up to 180° | Hand regard( infant observes its own hands intently - disappears by $ months). | | 4months | Bidextrous reach } | 6 months Ulnar grasp, Unidextrous reach, Transfer objects between hands. | @months | Radial grasp i i 9 months Pincer grasp(immature) | 12 months | Pincergrasp(mature) | 15 months Scribbles on a paper with a pencil, Turn 2-3 pages of a book ata time, \ 18months — | Uses spoon. Tower of 2-3 cubes. Vertical strokes. _ | 2years Tower of 6 cubes, Circular strokes, Turn 1 page of book at a time. i 3 years | Tower of 9cubes, Makes bridge with cubes(3.5 yrs), Coples crc) do | | 4 ‘years Makes Staircase with cubes, Copies cross. + | | L 5 years | L-—__ Copies triangle. Major Fine Motor Milestones Fine Motor Milestones- copying skills | ZX Major Language and hearing milestones ’ 6 weeks Stills to sound || 3months Turns to sound at ear level, Coos | 4months Laughs loudly in delight ; 6 months Monosyllable( ba, da, pa) 9 months Bi- syllable babble (baba, dada, papa) 12 months 1-2 wards with meaning 18 months 6-12 wards with meaning 2years Joins 2-3 words, 5-6 body parts, Identifies 2 pictures, Uses pronoun | 3years Asks questions, Knows full name and gender, 4yrs Can sing, tells stories. | Syrs Asks meaning of words. | jai a, Major Personal and social milestones | Timing Personal and social milestones. \ 6 weeks Social smile ‘3 months Recognizes mother 6 months Recognizes stranger, Watches mirror 9 months Wave bye bye, Repeats performance on appreciation 12 months Understands simple questions- where ls papa? Starts undressing ( pulls off socks and mittens) 15 months Points to object of interest 18 months Domestic mimicry(washing, sweeping) and follows simple order(Come here). | 2years Can undress completely, Points to 3-4 body parts. | ayears Imaginative play, Can dress completely. Share toys. Names friend. | 4yrs Left and right discrimination, Group play. Can tie shoe lace, Can follow 3 step command, Helps in household task. 6 months ye », eae 15 months 3 years * By 4mo - gastro-colic reflex weakens, + By 7 months - no relation with feeding. * By 10 mo-can be placed on toilet seat. * By2yrs - trainable. * By3yrs-can withhold and postpone bowel movement. Developmental Screening Tools * Denver Developmental Screening Test (DDST-1I): + Vineland Social Maturity Scale : + Differential Ability Scales (DAS)-II : + Baroda Developmental Screening Test: * Trivandrum Development Screening Chart(TDSC): (a) 0-3 yrs (b)3-6 yrs. (c) Language Evaluation Scale Trivandrum (LEST) 0-3 YEARS Developmental Quotient » DQis the ratio of functional age to chronological age. interpretation _ Developmental Age x00) 222 Normal | Q= h nu lo. 71-84% _| Mildto moderate delay ¢ ron gic age < 70% Severe delay ° For preterm babies correct chronological age for gestational age in the first year of life. > A significant delay in 2 2 domains affecting children

    You might also like