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GROWTH PARAMETRES AND THEIR ASSESSMENT by Dr. Azher Shah Associate Professor Department of Paediatrics Azra Naheed Medical College, LAHORE.

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Presentation on theme: "GROWTH PARAMETRES AND THEIR ASSESSMENT by Dr. Azher Shah Associate Professor Department of Paediatrics Azra Naheed Medical College, LAHORE."— Presentation transcript:

1 GROWTH PARAMETRES AND THEIR ASSESSMENT by Dr. Azher Shah Associate Professor Department of Paediatrics Azra Naheed Medical College, LAHORE

2 Goals Growth?Development?Methods for Nutritional Assessment?Growth Parametres?How to utilize growth charts?

3 Growth & Development Growth Quantitative increase in size of body and can be measured in terms of HEIGHT and WEIGHT Development Qualitative functional maturation assessed in terms of acquisition of skills and ability to cope with the situation

4 Growth & Development (Cont…) Growth and development are so closely related that they are usually assessed simultaneously

5 Growth Assessment Goals of Growth Assessment To determine if there are growth abnormalities that point to the presence of an underlying disease To prevent nutritional disorders and the increased morbidity and mortality that accompany them

6 Growth Assessment (Cont…) Nutritional Assessment It is quantitative evaluation of nutritional status Four components Dietary, medical, and medication history Physical examination Anthropometric and body composition measurements Laboratory tests

7 Anthropometry HeightWeightBody Mass IndexHead Circumference

8 Growth Charts Growth measurements should be plotted on growth charts Growth is most rapid in healthy children during early infancy and adolescence Serial measurements must be obtained Children whose length, height, or weight measurements fall below the 5th percentile, above the 95th percentile, or cross two major centile curves are at nutritional risk

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13 WHO Child Growth Standards WHO growth charts describe normal child growth from birth to 5 years under optimal environmental conditions These standards can be applied to all children everywhere The reference lines on the WHO growth charts are either percentile lines or z-scores The WHO standards define a population that is somewhat longer and leaner than the CDC references; this discrepancy is most dramatic during mid and late infancy The WHO standards are less likely to categorize a child as undernourished, and more likely to categorize a child as overweight

14 Length or Height Length is measured in children younger than 2 years who are measured in the recumbent position Height or stature is measured in children older than 2 years who are measured while standing Measurement should be performed three times to improve accuracy, and the mean should be plotted on a standardized growth chart For a given individual, measured length is typically greater than standing height

15 Length or Height (Cont…) Average length at birth is 50 cmIncreases 25 cm in first year of lifeAt 3 years 90 cmAt 4 years 100 cm Then height increases by 5 cm / year until puberty when growth spurt of 9-10 cm / year for 2-3 years

16 Age Length or Height in Centimeter At Birth 50 At 1 year years [Age(years)x6]+77

17 Weight Weight measurements should be obtained on a scale that has been calibrated properly Infant should be weighed without diapers and to the nearest 0.01 kg Older child should be measured without shoes, in little or no outer clothing, and to the nearest 0.1 kg Measurement should be plotted on a standardized growth chart

18 Weight (Cont…) Average weight at birth is 3.2 kg (7 lbs)Birth weight is doubled at 5-6 months of ageTripled at one year4 times at 2 years of ageAnnual increase is about 2 Kg / year till puberty

19 Age Weight (kg) At Birth months Age (months) years [Age(years)x2] years [Age(years)x7]-52

20 Body Mass Index (BMI) BMI characterizes the relative proportion between the child's weight and height BMI is calculated from the weight and square of the height as BMI = body weight (kg) ÷ height (meters) squared BMI a valid predictor of adiposity, and is therefore the best clinical standard for defining obesity in children and adults BMI greater than the 85th percentile is overweight and greater than the 95th percentile is obese BMI less than the 5th percentile is underweight

21 Weight for Height Like BMI, the ratio of weight to height can be used to predict adiposity For children aged 0 to 2 years, the ratio of weight to length is generally used instead of BMI For children aged 3 to 5 years, BMI for age and weight- for-height measures predict adiposity equally well A child's weight-for-height can be compared to normal standards using a chart

22 Head Circumference Head circumference is measured at the maximum diameter through the glabella and occiput to the nearest 0.01 cm Recorded value should be the mean of three measurements It is measured in children from birth to 3 years of age because this is the period of rapid brain growth It should be measured in older children with abnormal growth because it may be helpful in determining the etiology Measurement should be plotted on a standardized growth chart

23 Head Circumference Abnormal head growth is defined as a head circumference (also called fronto-occipital circumference) greater than two standard deviations above or below the mean for a given age, gender, and gestation Microcephaly is a head circumference greater than two standard deviations below the mean Macrocephaly is a head circumference greater than two standard deviations above the mean

24 Growth Velocity (for Height) Height velocity measurements are the most sensitive in detecting growth abnormalities early in the course of all types of chronic illness Any child older than 2 years whose height velocity is less than 4 cm/year should be monitored carefully for progressive nutritional deficits During puberty, peak height velocity is 5 to 11 cm/year in boys, and 6 to 10 cm/year in girls; the age of peak height velocity varies substantially

25 Growth Velocity (for Weight) Any prepubertal child whose weight velocity is less than 1 kg per year should be monitored carefully for progressive nutritional deficits During puberty, weight gain is more rapid; peak weight velocity is generally between 1 and 4 kg per six months in a healthy population

26 Malnutrition The degree of acute and chronic malnutrition can be assessed clinically using various anthropometric measurements During periods of nutritional deprivation, weight deficits occur initially, followed by length or height deficits and finally by head circumference deficits

27 Obesity The clinical evaluation of a child with obesity includes assessment of the BMI or weight-to-height ratio Precise measurement of the body fat content is not generally necessary or helpful for clinical decision-making

28 Short or Tall Stature Radiographic studies of bone age can help to clarify the presence of abnormal growth patterns

29 Summary Growth and DevelopmentGrowth parametersUse standardized growth charts

30 QuestionsComments


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