2. خدایا : چه دارد آن که تو را ندارد و چه ندارد آن که تو را دارد.( امام حسین ع ) رشد طبیعی در کودکان M.JARI.MD

3. اهمیت ارزیابی رشد 1- ارجاع کودک توسط سطوح 1 و 2 1- ارجاع کودک توسط والدین 3- همراهی اختلالات وبیماریهای جسمی با رشد غیر طبیعی 4- همراهی اختلالات وبیماریهای روحی روانی با رشد غیر طبیعی 5-......

4. Growth: Increase of physical parameter: Weight Length(height) Head circumference(HC) )Bone age-Us/Ls ratio-…)

5. Normal Growth: 1-Adequate caloric intake 2-Adequate caloric absorption 3-Excessive caloric intake

6. Weight: B Birth W=2500-3500 gr Age=10-14 days: w=birth w Age=1-2 mo w= birth w+(days-10)×(20-30 gr) مثال : شیرخوار 40 روزه باوزن تولد 3000 : وزن مطلوب =3000+(30×20-30)=3600-3900 gr

7. Weight: Age=3-4 mo w= birth w+(50×20-30 gr) +(days×15-20 gr) : مثال : شیرخوار 100 روزه باوزن تولد 4000 وزن مطلوب =4000+(50×20-30 )+40 ×(15-20)=5600- 6300 gr W gain in 5-12 mo =10-15 gr daily

8. Weight: Age=5-6 mo: W=BW×2 Age=12 mo: W=BW×3 Age=24 mo: W=BW×4

9. Weight: 3-12 mo: W=[age(mo)+9]/2 1-6 yr: W=[age(yr)×2]+8 7-12yr: W=[age(yr)×7]-5/2

10. Height: New born : B L=48-50 cm Age=1-12 mo L=BL+[age(mo)×2] cm مثال : شیرخوار 9 ماهه با قد تولد 50 : قد مطلوب =50+(9×2)=68 cm Age=13-24 mo L=75+ [ (mo)×1] cm : مثال : شیرخوار 20 ماهه با قد تولد 50 قد مطلوب =75+(8×1)=83 cm Age=24-36 mo H=87+ [ (mo)×0/5] cm Age=36-48 mo H=93+ [ (mo)×0/5] cm

11. Height BL~50 1 yr : L~75 2 yr : L~87 3 yr : H~93 4 yr : H~100(=BL×2) 2-12 yr H=[age(yr)×6]+77 cm

12. Head circumference At birth : B HC=33-36 cm 1-3 mo HC=BHC+(age×2) cm (6) : مثال : شیرخوار 2 ماهه با دور سر تولد 35 HC مطلوب =35+(2×2)=39cm 4-6mo HC=BHC+6+(mo×1) cm (3) : مثال : شیرخوار 5 ماهه با دور سر تولد 34 HC مطلوب =34+6+(2×1)=42cm 7-12mo HC=BHC+9+(mo×0/5) cm (3) Age=1 yr HC=BHC+12 cm (~48-50)

13. Growth assesment  Weight for age curve  Height for age curve  HC for age curve  Weight for Height curve  BMI curve

14. F T T : Statistics and Risk Factors: § FTT accounts for 15% of all pediatric hospital admissions § Most common cause is under nutrition  § Socioeconomic risk: Increased incidence with urban and rural areas of poverty Risk factors of poverty include: poor knowledge of infant/child nutrition, financial hardship, and social problems/stressors

15. Risk factors: § Maternal risk: Children of mothers <18y have shown poorer growth in the 1 st year of life § Abuse and neglect risk: 5-10%of FTT were registered for abuse FTT children are four times more likely to be abused than controls

16. Definition: There is vast heterogeneity of definitions/parameters for failure to thrive. Most literature accepts any of the following three parameters: 1. Weight less than the 3 rd or 5 th percentiles on more than one occasion 2.weight –for height less than 80% ideal 3. Weight that crosses two percentile lines 4. Weight less than 60% Ideal Body Weight for age However, studies have shown that there is no one anthropometric definition

17. 1. Inadequate Caloric Intake: a. Anatomic – cleft palate, choanal atresia, micrognathia b. Feeding issues – breastfeeding problems, poor technique, improper formula preparation, poor 612mo transition to solids, parental restriction due to health concerns, poor knowledge of nutrition c. Psychosocial – poor mother infant bonding, child neglect/abuse, emotional deprivation, maternal mental health d. Neurologic – noromotor control, hypotonia, lack of suck coordination, hydrocephalus

18. 2. Inadequate Caloric Absorption: a. Emesis – GERD, GI obstruction, drugs, food insensitivity, metabolic disorders b. Mal absorption – chronic diarrhea, celiac disease, giardiasis, cystic fibrosis, food insensitivity, proteinlosing enteropathy, excessive juice intake

19. 3. Excessive Caloric Expenditure: a. Congenital and acquired heart disease b. Chronic hypoxemia or pulmonary disease c. Hyperthyroidism d. Metabolic disorders e. Immun0deficiencies f. Recurrent infection Other underlying etiologies include increased lead

20. Interventional Approach: All evaluations begin with a thorough history including: § Feeding History § Developmental History § Psychosocial History § Family History § Prenatal/Birth History

21. Hospitalization is indicated if: § Abuse or neglect is suspected § Caretaker is impaired § Severe malnutrition is present § Patient is refractory to outpatient management

22. Thank you