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Growth and Development Yang Fan Pediatric Department.

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Presentation on theme: "Growth and Development Yang Fan Pediatric Department."— Presentation transcript:

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 1. the enlargement of the organ and the system 2. morphological growth 3. 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. 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

8 weight height Age (y) F M M F

9 Not all tissue systems of the body grow at the same rate

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11 Variability n Not everyone is alike in the way that they grow n Percentile growth/ standard deviation to the norm n Racial and ethnic differences n Boys vs Girls

12 Factors Influencing Growth Heredity Nutrition Gender Disease Environment – Hazards – Socioeconomic influences

13 Growth Curves Boys: 2 to 18 years Girls: 2 to 18 years n Boys reach most of their height at age of 17 whereas girls reach theirs at around 15

14 Indices of Growth Body weight (kg) the weight of a persons body. the weight of a persons body. the weight of all tissues, organs and body fluids. the weight of all tissues, organs and body fluids. one indicator of the nutritional status of child. one indicator of the nutritional status of child. the basis of drug dosage and amount of infusion. the basis of drug dosage and amount of infusion.

15 1 The first growth spurt occurs in the first year of life (the increment is about 6kg). Patterns of Weight Increment 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 kg 312months weight=(month 9) /2 kg 312months weight=(month 9) /2 kg 16years weight= age × 2 8 kg 16years weight= age × 2 8 kg 712years weight= age× 7-5 / 2 kg 712years weight= age× 7-5 / 2 kg

17 About formulae: 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. Attention

18 Weight loss: Physiological weight loss: 3 - 9% recover at 7-10th day 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.

19 Height(cm) The length from vertex to plantae The length from vertex to plantae The index of long time nutritional status 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. 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. Height measurements for children over three years of age should be accomplished using vertical measuring board or fixed wall device.

21 Length/Stature --- Stature --- Length < 3y 3y Stand Supine

22 at birth 50cm at birth 50cm 1 year old 75cm 1 year old 75cm 2 years old 85 cm 2 years old 85 cm years old=age × years old=age ×

23 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. Patterns of Length Increment

24 Shortness may be caused by malabsorption, chronic illness, psychosocial deprivation, hormonal disorders, familial patterns, or syndromes with dwarfism. 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. Gigantism may be the result of pituitary abnormalities.

25 Male 10y H88cm 10y GHD

26 Crown-rump/Sitting height - Crown-rump length - Sitting height <3y Sit Supine 3y 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.

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.

28 Changes in Overall Body Proportions

29 Head 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 At birth 34 cm 1 year 46cm 1 year 46cm 2 years 48 cm 2 years 48 cm 5 years 50cm 5 years 50cm 15 years 54cm (the same as adult) 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. 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 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. 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 CC< HC 1- 2 cm at birth CC< HC 1- 2 cm 1 year CC= HC 1 year CC= HC >1year CC HC (cm) =age 1 >1year CC HC (cm) =age 1

33 Growth 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 9~11. For boys the same process begins at apx. age 11~13. According to Tanner (1990), girls finish pubertal growth by about age 16 whereas boys continue to grow until approximately 18 years of age.

35 Sexual Precocity Secondary sexual characteristics appear before puberty. Girls<8y Boys<10y Delayed sexual maturity Secondary sexual characteristics do not appear after puberty Girls>14y Boys>16y

36 Cranial development

37 Closure time of fontanel/suture Fontanel/suture At birth Time of closure Anterior fontanel 1.5-2cm 18 m Posterior fontanel m Cranial suture Smallest 3-4m

38 Small size or Small size or early closure early closure Large size or delayed closure delayed closure Abnormality of anterior fontanel Microcephaly Hydrocephalus, Cretinism

39 Intracranial hypertension( Encephalitis, Meningitis) Dehydration Abnormality of anterior fontanel Bulging fontanel Bulging fontanel Sunken fontanel Sunken fontanel

40 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. Bone development

41 The sequence of appearance of secondary centers

42 Bone 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 Abnormality of Bone Age Hypothyoidism, Hypopituism Precocity of BA Precocity of BA Adrenogenital syndrome, Precocity Retardation of BA Retardation of BA

44 Dentition Primary teeth: Primary teeth are 20 totally. The first eruption is at about 6 months(4~10 months). The timing of tooth eruption is more variable than other developmental parameters

45 Delayed eruption is usually considered when there are no teeth by approximately 12 months of age. The last eruption of primary teeth is at 2~2.5 years of age. Primary teeth

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47 Delayed eruption: Hypothyroidism,idiopathic Disorder :Hypothyroidism, Brain dysplasia Failing to erupt : Ectodermal dysplasia,Mechanical blockage Abnormality of dental enamel : Ectodermal dysplasia Abnormality of Dentition

48 Evaluation of growth Growth level Growth level Growth velocity Growth velocity Proportion Proportion

49 Evaluation of growth Reliable and accurate data Single Value and series investigation reference reference

50 Choosing reference Reference, based on a North American population by NCHS, USA, is recommended by the WHO as the international standard of growth.

51 Choosing reference Besides,there are many local or national references,for example, physical growth indices of 9 cities in China.

52 Methods of assessment Reference table Growth curve

53 Growth Curves Boys: 2 to 18 years Girls: 2 to 18 years n Boys reach most of their height at age of 17 whereas girls reach theirs at around 15

54 AGEP3P5P10P20P30P40P50P60P70P80P90P95P

55 Growth level Every single measurement can be plotted on a growth curve which illustrates the amount of growth in children within different age group. Every single measurement can be plotted on a growth curve which illustrates the amount of growth in children within different age group.

56 Evaluation of growth mean standard deviation cut-off point x ± 2SD mean standard deviation cut-off point x ± 2SD percentile cut-off point P 3 --P 97 percentile cut-off point P 3 --P 97 Z score Z score=( x - x )÷SD Z score Z score=( x - x )÷SD Growth curve Growth curve

57 Example Weight of girls P3 P25 P50 P75 P97 1y (kg) -2SD -1SD +1SD +2SD 1y (kg) The weight of a one year old girl is 8.2 kg. Growth level X X W/A P3-P25 W/A - 1SD 2SD

58 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. Growth velocity

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60 Neuropsychological 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

63 The Babys Brain-Infant Vision Development newborn1 month2 months 3 months6 monthsadult

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.

66 BEHAVIOR DEVELOPMENT Four Attributes Gross motor Fine motor Language Personalsocial skill

67 gross motor Physical skills involving large body movements such as lifting head, walking, and jumping.

68 Fine 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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70 Personal Social Skill

71 Developmental Surveillance u Periodic assessment of a childs developmental progress with the aim of detecting pre-symptomatic disability

72 Longitudinal and multidimensional developmental monitoring. Longitudinal and multidimensional developmental monitoring. Over-reliance on isolated developmental scales and tests should be avoided. Over-reliance on isolated developmental scales and tests should be avoided.

73 Screening tests: Screening tests: Screening procedures should be brief, simple, cheap and reliable Diagnostic tests Diagnostic tests

74 What do we look for in developmental screening? u Normal growth pattern l Height, weight, head circumference u Achievement of developmental milestones (indicating neurological development) l Gross motor function l Fine motor function and vision l Hearing and speech u Social behaviour and play

75 Screening tests Pediatric periodic health supervision Pediatric periodic health supervision Standardized developmental screening instruments Standardized developmental screening instruments Not diagnostic Not diagnostic when abnormal, diagnostic evaluation should be done when abnormal, diagnostic evaluation should be done

76 DDST DDST children under 6 yrs children under 6 yrs PPVT PPVT from 4 to 9yrs from 4 to 9yrs especially for children delayed in language especially for children delayed in language

77 Diagnostic tests Gesells test Gesells test from 4 weeks to 3yrs from 4 weeks to 3yrs Bayley from 2 to 30 months Bayley from 2 to 30 months WPPSI from 4 to 6.5yrs WPPSI from 4 to 6.5yrs WISC-R from 6-to 16yrs WISC-R from 6-to 16yrs

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