GROWTH AND DEVELOPMENT

Dr B RATH
Professor & Head
Dept of Pediatrics

Growth & Development

Growth connotes Increase in size and weight
of tissue
Increase in number of cells
Increase in cell size

Development connotes functional maturation

of systems and organs
Note: both are usually closely related but not
always
Both have a limit

Importance of study of growth

To know the normal pattern of growth
To pick up deviations from normal so as to
pick up undernutrition, obesity, short stature,
micro and macrocepahly at the earliest

Growth parameters

Weight
Height
Head circumference
Mid arm circumference
Others : less commonly used

BMI
US:LS
Skin fold thickness
Leg length, etc

Assessment of parameters
Weight:
Prefer electronic scale; beam balance and spring
balance are also used, but less accurate
To be recorded with minimal clothing
In neonatal period: should be recorded before
feeding
For children who are uncooperative, substraction
method used

 Height
Stadiometer after 2 years
Infantometer < 2 years, measures length

Head in Frankfurt plane

Heels, buttocks, back and occiput in the same
plane
Heels touching each other
What if: stadiometer and infantometer not
available?

PREPARATION OF STANDARD GRAPHS

Many standards; Harvard, NCHS, CDC, WHO,
ICMR, Dr K N Aggarwal etc
Current reference standard : WHO (which is
cross sectional study from 5 different
countries)
Percentiles calculated mathematically
1 SD corresponds to 84 / 16th percentile
2 SD corresponds to 97 / 3rd percentile

GROWTH CHARTS

Velocity of Growth

WHAT YOU MUST KNOW

FORMULA TO CALCULATE WEIGHT

3-12 nonths
[Age (m) +9] 2 kg

1-6 years
[Age (yrs) x 2 ] + 8 kg

7-12 years
{[Age (yrs) x 7 ] 5} 2 kg

More info on growth data

Average birth weight 2.8 2.9 kg
Weight gain during first 3 months 25-30 gms/day
Next 3 months 15-20 gms /day
Next 6 months 10-15 gms/day

Head circumference: at birth 33-34 cms

2 cms/ months in first 3 months
1 cm/ month x next 3 months
0.5 cm / month x next 6 months

PLOTTING AND INTERPRETING

GROWTH DATA

The Z score
[ Observed value mean ] SD

FACTORS AFFECTING GROWTH

Net result of genetic potential and

environmental factors
Genetic factors
Genetic diseases: trisomies, pygmies
Genetic bone disease: achondroplasia,
hypochondroplasia, chondrodysplasias, Morquio
disease

Environmental factors
NUTRITION
Depends on availability of food, socioeconomic status,
literacy of parents, food fad
Inability to swallow : CP

EMOTIONAL
Emotional deprivation

FACTORS AFFECTING GROWTH

Normal Body systems

Normal body homeostasis

pH, measured cations and anions and adequate O2 supply to
tissues

Normal endocrine function

Growth hormaone, thyroid hormone, sex hormones, insulin

Chronic Diseases

Chronic Malabsorption
CHD
C lung/ Liver D
ESRD
Chronic inflammtory disease ( TB/JRA/SLE)
Malignancy
Chronic Bowel Disease

FACTORS AFFECTING GROWTH

Intra uterine factors
Placental
TORCH infections
Gestational diabetes

More notes
Every child is expected to maintain his/her own
channel of growth
Growth may be uneven. Periods of growth arrest
may be followed by periods of catch up growth
Correction for immmaturity is done upto age of 2
years but not thereafter
Expected final height
Boys = mid parental height + 6.5 cm
Girls = mid parental height - 6.5 cm