Furdela V. PhD assistant prof. Pediatrics department #2 Evaluation of children physical development of different age group. Main principles and methods of estimation of physical development of children. Semiotics of deviation of children physical development Furdela V. PhD assistant prof. Pediatrics department #2

Physical development Change in the child that occurs over time. Changes follow an orderly pattern that moves toward greater complexity and enhances survival.

Terminology Growth Length / height Weight Head circumference Chest circumference Proportionality of these measurements Measurements should be taken at regular intervals in order to observe reliable trends. Recommendations for measurement intervals include: Infants (0-12 months): every month Young Children: at 15, 18, 24 and 30 months Ages 3+: every year

Growth Is a complex dynamic process by which the body and various structures within the body increase in size. Its results from the careful coordination of three cellular processes: an increase in the number of cells or cell hyperplasia Increase in the size or cell hypertrophy Programmed cell death or apoptosis

Length is the linear measurement for infants up to 24 months.

Height for child elder 2 years А С В

Weight of a body

Weight of a body On a pan scale up to 2 years in laying or sitting position and in standing position after 2 years A C B

Head circumference is a measurement taken around the largest part of a child’s head above the eyebrow and occipital tuberculars. Take the measurement three times and select the largest measurement to the nearest 0.1cm.

Chest circumference Measure chest circumference with paper or steel tape around chest at nipple line and under tips of scapulas at back

Phases of linear growth 1. Fetal phase (9 mo =70 cm/year) 2. Infantile phase (first two years = 23-25 cm/year) 3. Childhood phase (2-11 years = 5-7 cm/year) 4. Puberty phase (11-18 years= 8 cm/year in girls 10 cm/year in boys) Normal growth is a continuous process with a predictable pattern. It starts prenatally and continues until the epiphyses at the ends of long bones are fused. The latter occurs when full pubertal maturation is achieved. Deviations from the normal pattern of growth provide clues to state of health of child and possible underlying pathology. During this phase a single fertilised egg grows and develops over 9 mo into an infant (the growth rate or height is the fastest (70 cm/year) Although considerable growth occurs initially and length increases by 23-25 cm/year. The rate of growth rapidly declines to about 9 cm/year by second year. Through mid-childhood from age 3 years and until the onset of puberty, growth velocity remains relatively steady at around 5-7 cm/year. This phase begins with the onset of puberty and ends when adult height is attend. It is characterised by the development of secondary sex signs and a pubertal growth spurt when the growth rate increases dramatically to an 8 cm/year in girls and 10 cm/year in boys.

FEATURES of PHYSICAL DEVELOPMENT of a NEWBORN: - Weight of a body at birth 2500-4200 gram; - Length of a body - 50-52 сm.; - Head circumference - 34-36 сm; - Chest circumference - 32-34 сm.

Methods of estimation of physical development of children Method of empirical formulas Method of anthropometrical standards: - centile chart (tables) - standard deviation score (SD) or Z-score charts http://www.who.int/childgrowth/en/

Growth Grids Height, weight, circumferences are plotted against the child’s chronologic age on standardized growth charts. Normal growth - measurement between the 25th and 75th percentiles or ±1 SD indicate Either normal growth or a deviation measurements between the 10th - 25th, 75th - 90th percentiles or ± 2 SD Measurements less then 10th , above 90th percentiles or ± 3 SD are pathological.

stunted

Deviation from normal physical development at childhood Stunting (growth failure) Failure to gain weight Shot stature Malnutrition (hypotrophy) Small stature Underweight Nanism (dwarfism) Overweight Gigantism Obesity Stunting [stʌnt], затримка росту, shot stature низький ріст, nanism ['nænɪz(ə)m], dwarfism ['d(w)ôrfizəm] карликовість gigantism [jī'gantizəm] гігантизм

Growth failure – failure to maintain a normal height velocity that is appropriate for age and maturity Short stature - height less than 2 SD for age below the mean for age and gender Height less than 3 SD for age below the mean for age and gender is called Nanism (dwarfism)

Dwarfism due to growth hormone deficiency

Gigantism ancestry

Causes of tall stature Constitutional Endocrine Pituitary adenoma, Cerebral Giagantism Thyreotoxicosis Genetic diseases Klinefelter ‘s syndrome, Marfan syndrome

Microcephaly A head circumference is less then 3 SD below the mean for sex and age

weight in kg / height in m 2 Body mass index BMI in kg/m2 = weight in kg / height in m 2 Overweight: >+1SD (equivalent to BMI 25 kg/m2 at 19 years) Obesity: >+2SD (equivalent to BMI 30 kg/m2 at 19 years) Underweight (thinness): <-2SD Severe underweight: <-3SD

obecity overweight normal weight underweight BMI> 95- centile

Causes of obesity

Failure to gain weight

Malnutrition (hypotrophy) the result of a lack of essential nutrients, resulting in poorer health, may be caused by a number of conditions or circumstances. In many developing countries long-term (chronic) malnutrition is widespread - simply because people do not have enough food to eat.

Malnutrition STAGE WEIGHT DEFICITE LENTH DEFICITE I 10-20% II 20-30% II 20-30% 2-4 cm III More than 30% 7-10 cm

Stunting

weight gain adikvate Failure to gain weight

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