1. INTRODUCTION TO CHILD HEALTH DEVELOPMENTAL TERMINOLOGY
Robyn Smith
Department of Physiotherapy UFS
2012

2. After this lecture the learner should be able to:
Define important developmental terms
Explain weight/height/ head circumference for age ratios
Interpret child mortality statistics
Familiarise learner with Road to Health Chart

3. Is the terminology relevant to physiotherapists?
Working with babies and children in early intervention services we have to understand the relevant developmental terminology
Enables us to accurately interpret important information in child’s history & medical records
Helps us communicate effectively with interdisciplinary team & parents
Helps us identify children potentially at risk of developing developmental difficulties

4. Pregnancy
Period calculated from the first day of the woman’s last menstrual period
Period expressed in weeks
Normal duration is weeks
1st trimester: first 13 weeks
2nd trimester: 14 to 26 weeks
3rd trimester: 27 weeks to the birth of the foetus

5. Paediatrics
Healthcare services provided to the child from birth through adolescence
Prevention
Diagnosis
treatment
South Africa:
Birth to the age of 13 years
Europe & USA :
Birth through adolescence

6. Phases of Growth Embryo conception end 8th wk
Foetus 9th week gestation until birth
Neonate 1st 28 days of life
Baby/infancy 1st year of life
Toddler 2nd year of life
Preschooler up until school going age
(2-5 years)
Scholar from school going age
(>6 years till school leaving age)
Adolescent after onset puberty (10-19 yrs)

7. Neonatal terminology Gestation
Term baby born between weeks of pregnancy
Premature baby born <37 completed weeks of pregnancy
Post mature Baby born > 42 completed weeks of pregnancy

8. Neonatal terminology Birth Weight NBW 2 500 – 4 000g LBW <2 500g
VLBW <1 500g
ULBW <1 000g

9. Neonatal terminology Weight for gestation
SGA small for gestational age
growth parameter below 10th percentile
AGA appropriate for gestational age
Growth parameters between th and 90th percentile
LGA Large for gestational age
Growth parameters above 90th percentile

10. Neonatal terminology Chronological age
age in weeks or months from date of delivery
Corrected age
premature infants where the number of weeks born prematurely have been deducted from the chronological age

11. So when do we stop correcting age?
Controversy still exists where between ages of 12/12
and 18/12 one should stop correcting for age
Decide on an age for your clinic and
be consequent in
applying it in your assessments

12. Apgar Score Scoring system developed by Dr. Virginia Apgar in 1960’s
This score /10 is used to evaluate the infant’s physical condition after birth –pulse, crying, respiration, HR, activity
Score is taken a 1 minute, 5 minutes and 10 minutes after birth.

13. Apgar Score Scores Heart rate Respiratory rate Weak Strong cry1 2
Heart rate
Absent
≺ 100/min
≻100/min
Respiratory rate
Weak
Strong cry
Muscle tone
Flaccid
Some flexion
Good flexion
Reflexes
No response
Grimace
Cough/ sneeze
Colour
Pale/ blue
Blue
Pink
Apgar Score

14. Hypoxic Ischaemic Encephalopathy (HIE) or neonatal asphyxia
Insult to the foetus or newborn due to a lack of oxygen (hypoxia) and/or perfusion (ischaemia) to various organs
Staged according to the Sarnat & Sarnat classification system:
grade I (mild)
Grade II (moderate)
Grade III (severe)
Stage II and III are usually accompanied by convulsions and neurological dysfunctions
Stage I associated with a normal outcome

15. Head circumference Microcephalic
Abnormally small head size in relation to the body
e.g. brain atrophy
Macrocephalic
Abnormally large head size in relation to body
e.g. hydrocephalus
Head circumference is measured with a tape measure around the broadest part of forehead
Measured at developmental follow up and charted on a chart in relation to age. Good indicator of if the brain in growing appropriately for age

16. Head size in an infant...interesting fact
Higher ratio to the head size versus
rest of body weight
Infant brain =30% total bodyweight
Adult brain = 3 % total bodyweight

17. Head circumference

18. Weight and height terminology

19. Weight and height terminology
Child’s weight in g or kg
used to evaluate physical growth
Reflects on immediate nutritional status of child
Underweight for age may indicate acute or more chronic nutritional problems

20. Weight and height terminology
Length/Height
Child length in cm or m is measured
Length for age <3rd percentile child is considered to be stunted or of short stature
Stunted growth usually indicates a longer term and more chronic nutritional problem

21. Evaluation of Growth

22. Growth Charts
Normal distribution curve over a spectrum of ages for weight and height
Different charts for boys and girls
Charts differ for gender and age
WHO/ CDC 2000 charts available at most clinics or on the Road to Health charts carried mothers

23. Interpretation of growth charts
Health professionals must be able to interpret charts
Monitor growth and development over time
Trend over time more important single reading
Road to health card/ clinic card
Every month during first year and every six months during second year life
50th percentile = % of expected growth
Low values weight may indicate an acute or chronic problem
Low values for height for age indicates a chronic problem

26. Childhood statistics

27. Mortality rates
33% of the South African population under age of 15 years
Investment in the health and wellbeing of the children of South Africa is an investment in the future development of our country
The mortality rates are a fundamental indicator of
child health in the country ,and
understanding the causes of death of children and identifying how the numbers can possibly be reduced

28. Mortality rates
Child health has been identified as a priority by the WHO and the national DOH.
Many childhood deaths are preventable .Therefore the reduction in childhood mortality, especially in children under age of 5 years has gained much priority in South Africa:
Improved maternal health and antenatal care provided to mothers
Better perinatal and neonatal care provided baby
Reduction in the transmission rate of HIV from mother to child
Reduction in the number of road traffic accidents and violent crime

29. Interpreting perinatal statistics
Liveborn infant : foetus over 500g, irrespective of gestational age born, who shows signs of life
Stillborn infant: foetus over 500g, irrespective of gestational age born, who shows no evidence of life

30. Interpreting perinatal statistics
Perinatal mortality rate: probability of a child (stillborn and live born) dying within the first seven days of life, per 1000 births. The perinatal period commences at 22 completed weeks of gestation and ends seven completed days after birth.(47/1000)
Neonatal mortality rate : probability of infants dying before age of 1 month, per 1000 live births (SA ranked 19); (21/1000)
Infant mortality rate: probability of children dying between birth and one year of age 1000 live births. (SA ranked 43)
Under-five mortality rate - Probability of dying between birth and exactly five years of age, per 1000 live births. (ranked 62); (57/1000)
(UNICEF Statistics, 2011)

32. Top causes of death in children under age of 1 year in South Africa
HIV related diseases 2
Low birth weight 3
Diarrheal diseases 4
Perinatal respiratory disease 5
Lower respiratory tract infections 6
Neonatal infections 7
Birth asphyxia & birth trauma 8
Protein energy malnutrition 9
Congenital heart disease 10
Neural tube defects

33. Top causes of death in children under age of 5 years in South Africa Rate dropped from 60 to approximately 40 per 1000 children, the 10 top causes in order of priority are: 1
HIV related diseases 2
Low birth weight 3
Diarrheal diseases 4
Lower Respiratory tract disease 5
Protein energy malnutrition 6
Neonatal infections 7
Birth asphyxia & birth trauma 8
Congenital heart disease 9
Motor and pedestrian vehicle accidents 10
Bacterial meningitis

34. Top causes of death in children under age of 5 -14 years in South Africa
HIV related diseases 2
Road traffic accidents 3
Homicide/ violence 4
Diarrhoeal disease 5
Fire 6
Lower respiratory tract infections 7
Meningitis 8
Tuberculosis 9
Nervous system disease 10
Protein energy malnutrition

36. Road to Health Chart
Road to Health chart / Baby card is a card issued by ward or clinic service providers on first contact
Instrument that can be used by health professionals to monitor development
Card is kept by mother and she should carry it whenever attending any healthcare services

37. Road to Health Chart This card provides information regarding:
Perinatal history (gestation, birth weight, length, Apgar Scores, method of delivery, mothers serology)
Growth & development aspects (growth charts)
Immunisations
Vitamin supplementation
Brief summary on illness & disease
Mothers are to keep the child for as long as possible throughout
childhood and into adulthood as contains valuable information

38. References Images courtesy of GOOGLE (2011)
Growth and Development. In Coovadia, H.M. & Wittenberg, D.F. (eds) in Paediatrics and Child Health. A manual for health professionals in developing countries. 4th ed. Oxford city Press: Cape Town pp 21-40
Van der Vyver, A.E. Normal Growth in Paeditric doctors lectures for Physiotherapy students. (Unpublished)
Goldson, E. & Reynolds, A. Child development and Behaviour Hay, W.W.; Myron, J. L.; Sondheimer, J.M. & Deterding, R.R. (eds). In current diagnosis and treatment in Paediatrics. 18th ed. McGraw-Hill companies: NewYork pp65-101

39. References
Aubert, E.J. Motor development in the normal child in Pediatric Physical Therapy. Tecklin, J.S. (Eds) in Pediatric Physical Therapy. Lippincott, Williams & Wilkins. Baltimore pp17 -65
Smith, R Paediatric dictate, UFS (Unpublished)
Smith, R Normal development (Class notes, Unpublished)
UNICEF/ Medical Reasearch Council of South Africa. Bradshaw, D; Bourne, D & Nannan, N. What are the leading causes of death in children in south Africa
available online at;
National Department of Health Road to Health Chart
Tshabalala, MD Introduction to child health. History and physical examination. University of Pretoria, Department of Physiotherapy