1. 少年儿童生长发育 与营养 汕头大学医学院第二附属医院 马廉教授 / 贺谷雨教授

2. Children condition ChinaIndiaCubaKoreaColombia Under 5years Mortality 419883031 Under 1 year mortality 337062326 The number of death (<5y) (<5y)81.32400.11.43 Loss of weight 10536608 Water75889510091 Healthinstitution3831959985

3. 《中国居民营养与健康状况》 卫生部，科技部、国家统计局 200410 月 12 日 5 岁以下儿童生长迟缓率和低体重率分别为 14.3 ％和 7.8 ％，在农村，特别是贫困农村儿童，两 项指标更高。 5 岁以下儿童生长迟缓率和低体重率分别为 14.3 ％和 7.8 ％，在农村，特别是贫困农村儿童，两 项指标更高。 据调查，体内缺铁、锌的学生，比正常学生智 商（ IQ ）低 5 ～ 8 分，学习工作能力低 16.3 ％；儿童 时期碘缺乏，成年后劳动能力下降 10 ％。 据调查，体内缺铁、锌的学生，比正常学生智 商（ IQ ）低 5 ～ 8 分，学习工作能力低 16.3 ％；儿童 时期碘缺乏，成年后劳动能力下降 10 ％。

4. 生长发育 Growth and Development To understand the regular rule of growth,development & the affecting factors To understand the regular rule of growth,development & the affecting factors To master the criteria of the growth & the development To master the criteria of the growth & the development

5. 生长发育的一般规律 Regular rule of growth & development A continuous process A continuous process Unbalanced growth of each system Unbalanced growth of each system Rules in general : Rules in general : upper to lower, proximal to distal, rough to fine, inferior to superior, simple to complication upper to lower, proximal to distal, rough to fine, inferior to superior, simple to complication Difference among individuals Difference among individuals

6. 影响生长发育的因素 Affecting Factors of Physical Growth 遗传因素 genetic factors 遗传因素 genetic factors 环境因素 environmental factors 环境因素 environmental factors 营养 nutrition 营养 nutrition 疾病 disease 疾病 disease 孕母情况 pregnancy 孕母情况 pregnancy 生活环境 living environment 生活环境 living environment

7. 体重 Body Weight (BW) Criterion of growth & nutrition condition Criterion of growth & nutrition condition Differ in speed of BW increase Differ in speed of BW increase The younger, the faster The younger, the faster First peak: newborn-1 year First peak: newborn-1 year Second peak: adolescence Second peak: adolescence

8. 体重 Body Weight (BW) At birth boy(3.3±0.4)kg, At birth boy(3.3±0.4)kg, girl(3.2±0.4)kg girl(3.2±0.4)kg -1 mon increased 1-1.5 kg -1 mon increased 1-1.5 kg -3 mons increased to 6 kg -3 mons increased to 6 kg -1 year increased to 9 kg -1 year increased to 9 kg BW(kg) ＝ (age of mons + 9)/2 BW(kg) ＝ (age of mons + 9)/2 -2 years increased to 12 kg -2 years increased to 12 kg 2-6 years BW(kg) ＝ age of yrs×2 ＋ 8 2-6 years BW(kg) ＝ age of yrs×2 ＋ 8 7-12 years BW(kg) ＝ (age of yrs×7-5)/2 7-12 years BW(kg) ＝ (age of yrs×7-5)/2

9. 身高（长） Body Height(BH) Criterion of bone growth the same regular rules as BW Criterion of bone growth the same regular rules as BW At birth BH 50cm At birth BH 50cm 1year BH 75cm 1year BH 75cm 2years BH 85cm 2years BH 85cm 2-12years BH(cm) ＝ age of yrs×6 ＋ 77 2-12years BH(cm) ＝ age of yrs×6 ＋ 77

10. 身高（长） Body Height(BH) 上部量 upper part 从头顶至耻骨联合上缘 上部量 upper part 从头顶至耻骨联合上缘 下部量 lower part 从耻骨联合上缘至足底 下部量 lower part 从耻骨联合上缘至足底

11. 坐高 Sitting Height (SH) Criterion of skull & spine growth Criterion of skull & spine growth ＜ 3yrs (crown-rump length) ＜ 3yrs (crown-rump length) SH/BH: at birth 0.67 SH/BH: at birth 0.67 14 years 0.53 14 years 0.53 下肢增长速度随年龄增长而加快 下肢增长速度随年龄增长而加快

12. 指距 finger distance Criterion of long bone growth of upper limb Criterion of long bone growth of upper limb Normal value: finger distance is scarcely less than BH Normal value: finger distance is scarcely less than BH

13. 头围 Head Circumference(HC) Criterion of skull & brain growth Criterion of skull & brain growth At birth 33-34 cm At birth 33-34 cm 1 year 46 cm 1 year 46 cm 2 years 48 cm 2 years 48 cm 5 years 50 cm 5 years 50 cm 15 years 54-58 cm 15 years 54-58 cm

14. 胸围 Chest Circumference(CC) Criterion of thorax & lungs growth Criterion of thorax & lungs growth At birth CC 32cm At birth CC 32cm 1 year =HC 1 year =HC ＞ 1 year CC ＞ HC ＞ 1 year CC ＞ HC

15. 上臂围 Upper Arm Circumference Criterion of muscle, bone, fat, & skin growth in upper arm Criterion of nutrition condition Criterion of muscle, bone, fat, & skin growth in upper arm Criterion of nutrition condition ＜ 1yr gain rapidly ＜ 1yr gain rapidly 1-5yrs gain slowly 1-5yrs gain slowly ＜ 5yrs ＞ 13.5cm best nutrition ＜ 5yrs ＞ 13.5cm best nutrition 12.5-13.5cm better nutrition 12.5-13.5cm better nutrition ＜ 12.5cm malnutrition ＜ 12.5cm malnutrition

16. 头颅骨发育 Growth of Skull 颅骨缝 cranial suture 颅骨缝 cranial suture closed in 3-4 mons closed in 3-4 mons 前囟 anterior fontanelle 前囟 anterior fontanelle closed in 1-1.5 yrs closed in 1-1.5 yrs 后囟 posterior fontanelle 后囟 posterior fontanelle closed in 6-8 weeks closed in 6-8 weeks

17. 脊柱的发育 Growth of Spine to reflex growth of vertebrae to reflex growth of vertebrae 3 mons raising head 颈椎前凸 3 mons raising head 颈椎前凸 6 mons sitting 胸椎后凸 6 mons sitting 胸椎后凸 1 year walking 腰椎前凸 1 year walking 腰椎前凸

18. 长骨的发育 Growth of Long Lone 1-9yrs ossific center ＝ age(yrs) +1 1-9yrs ossific center ＝ age(yrs) +1 骨龄：骨化中心与标准图谱比较，相当于 某一年龄标准图谱时，该年龄即为骨龄。 骨龄：骨化中心与标准图谱比较，相当于 某一年龄标准图谱时，该年龄即为骨龄。

19. 牙齿的发育 Growth of Teeth 乳牙 primary teeth 20 乳牙 primary teeth 20 4-10mons eruption 4-10mons eruption completion by 2.5yrs completion by 2.5yrs <2yrs number ＝ age(mons) －（ 4~6 ） <2yrs number ＝ age(mons) －（ 4~6 ） 恒牙 permanent teeth 32 恒牙 permanent teeth 32 6yrs eruption 6yrs eruption 20-30yrs completion 20-30yrs completion 7-8yrs exchange 7-8yrs exchange

20. 体格生长的评价 evaluation 发育水平 developmental level 发育水平 developmental level 生长速度 growth speed 生长速度 growth speed 匀称程度 equable degree 匀称程度 equable degree

21. 神经反射的发育 Nerve Reflexes existing by birth, persisting for a life existing by birth, persisting for a life 角膜反射 corneal reflex 角膜反射 corneal reflex 结膜反射 conjunctival reflex 结膜反射 conjunctival reflex 瞳孔反射 pupillary reflex 瞳孔反射 pupillary reflex 咽反射 pharyngeal reflex 咽反射 pharyngeal reflex 吞咽反射 deglutition reflex 吞咽反射 deglutition reflex

22. 神经反射的发育 Nerve Reflexes not existing by birth but appearing gradually after 4-6 mons not existing by birth but appearing gradually after 4-6 mons 腹壁反射 abdominal reflex 腹壁反射 abdominal reflex 提睾反射 cremasteric reflex 提睾反射 cremasteric reflex 腱反射 tendon jerk 腱反射 tendon jerk

23. development of the children’s apperceive: vision The newborn already has vision, but can only see something clear in the distance of 15-20cm ； The child can stare at the light source 1 month old, and can move his head on the level for 90 degrees; They like to see his own hands 3-4 months old, and can move his head on the level for 180 degrees;

24. vision They can see small objects 8-9 months old ； They can see small objects 8-9 months old ； They can distinguish perpendicular lines and horizontal lines since 2 years old; can distinguish different colors since 5 years old; the depth of vision have developed fully since 6 years. They can distinguish perpendicular lines and horizontal lines since 2 years old; can distinguish different colors since 5 years old; the depth of vision have developed fully since 6 years.

25. language language 7-8m: call ba/ma; 7-8m: call ba/ma; 12m: briefness word; 12m: briefness word; Hearing : The hearing is bad when a baby was born,because the drums have no air, is good after 3-7 days,and prefect since the 4th year.

26. 生长发育歌谣 Ballad for Growth & Development 一哭二笑三咿呀 四月哈哈望妈妈 一哭二笑三咿呀 四月哈哈望妈妈 五抓六坐握足玩 七翻八爬九叫爸 五抓六坐握足玩 七翻八爬九叫爸 十站对指十二走 看图说话在十八 十站对指十二走 看图说话在十八 两岁能用勺吃饭 喜怒分明命令发 两岁能用勺吃饭 喜怒分明命令发 三岁学穿鞋和袜 长成大娃别娇他 三岁学穿鞋和袜 长成大娃别娇他

27. Normal childhood nutrition Normal childhood nutrition

28. Nutrition 在婴儿发育的关键时期，某一营养素是否足量或 缺乏，可能导致长期、甚至永久性的影响. 在婴儿发育的关键时期，某一营养素是否足量或 缺乏，可能导致长期、甚至永久性的影响. 婴儿期的营养影响到今后的心血管疾病的危险因 素（血压、脂肪代谢、胰岛素抵抗、体脂）. 婴儿期的营养影响到今后的心血管疾病的危险因 素（血压、脂肪代谢、胰岛素抵抗、体脂）. 早期营养会对以下方面有影响：终身的血压、胆 固醇水平、代谢、胰岛素抵抗、体脂、动脉硬化、 骨骼健康、行为学习能力、甚至寿命的长短. 早期营养会对以下方面有影响：终身的血压、胆 固醇水平、代谢、胰岛素抵抗、体脂、动脉硬化、 骨骼健康、行为学习能力、甚至寿命的长短.

29. Nutritional requirements A satisfactory dietary intake should meet the normal requirements of the following A satisfactory dietary intake should meet the normal requirements of the following Energy Energy Lipids: linolenic acid ; linoleic acid; arachidonic acid ;DHA Lipids: linolenic acid ; linoleic acid; arachidonic acid ;DHA carbohydrate: glucoprotein; glucolipide; proteoglycan carbohydrate: glucoprotein; glucolipide; proteoglycan protein protein Vitamin Vitamin Trace elements Trace elements water water meal fiber meal fiber

30. Energy The major determinants of energy expenditure: The major determinants of energy expenditure: Basic metabolism Basic metabolism Thermic effect of food Thermic effect of food Physical activity Physical activity Excreta Excreta Growth Growth

31. Energy expenditure

32. Total energy need <1y 100~120 (average 110) Kcal / kg / d 1~3y 100 Kcal / kg / d 15y 50~60 Kcal /kg / d

33. Distribution of Calories ProteinLipid Carbohydrate 15%35%50% (4 Kcal / g)(9 Kcal / g)(4 Kcal / g)

34. Infant feeding Incorrect, inadequate and/or overfeeding can all be harmful. Incorrect, inadequate and/or overfeeding can all be harmful. Forms of Feeding: Forms of Feeding: ⅰ. Breast Feeding ⅰ. Breast Feeding ⅱ. Bottle/Artificial Feeding ⅱ. Bottle/Artificial Feeding ⅲ. Addition of Solids ⅲ. Addition of Solids

35. Breastfeeding This is the preferred method for most infants. In general, there is no doubt that breast is best. This is the preferred method for most infants. In general, there is no doubt that breast is best. Breastfeeding in early infancy may be life-saving in developing countries, and is subject to fashion and custom in developed countries. Breastfeeding in early infancy may be life-saving in developing countries, and is subject to fashion and custom in developed countries.

36. Advantages of breastfeeding Quality Quality Anti-infective properties Anti-infective properties secretory IgA, secretory IgA, lysozyme, lysozyme, phagocytic cells, phagocytic cells, lactoferrin(irron-binding agent), promotes growth of non-pathogenic flora lactoferrin(irron-binding agent), promotes growth of non-pathogenic flora

37. Advantages of breastfeeding Better nutritional qualities Better nutritional qualities Easily digested protein Easily digested protein Low renal solute load Low renal solute load A favourable calcium to phosphate ratio A favourable calcium to phosphate ratio Nutrition protein: Nutrition protein: fat: fat: sugar sugar others: others: growth regulation factor growth regulation factor

38. Advantages of breastfeeding Emotional --- if successful, promotes maternal-infant bonding Emotional --- if successful, promotes maternal-infant bonding Reduction of the mortality rate Reduction of the mortality rate Reduction in the risk of maternal breast cancer Reduction in the risk of maternal breast cancer Economy, convenience, temperature propriety Economy, convenience, temperature propriety

39. Disadvantages of breastfeeding Volume of intake uncertain Volume of intake uncertain Transmission of drugs, e.g. laxatives, anticoagulants, antineoplastics Transmission of drugs, e.g. laxatives, anticoagulants, antineoplastics Nutrient deficiencies: Nutrient deficiencies: Insufficient vitamin K to prevent haemorrhagic disease of the newborn Insufficient vitamin K to prevent haemorrhagic disease of the newborn Vitamin D deficiency (rickerts) may occur if there is prolonged breast-feeding and delayed weaning Vitamin D deficiency (rickerts) may occur if there is prolonged breast-feeding and delayed weaning Emotiona--- failure to establish breastfeeding may be a cause of emotional upset Emotiona--- failure to establish breastfeeding may be a cause of emotional upset

40. Feeding Methods Start feeding within 30 min after delivery Start feeding within 30 min after delivery mother-baby in the same room, feed on demand, but not more frequent than 3 hourly mother-baby in the same room, feed on demand, but not more frequent than 3 hourly Feed on both breasts, to stimulate the milk production Feed on both breasts, to stimulate the milk production

41. Feeding Methods put nipple and most of the mammary areola into baby’s mouth put nipple and most of the mammary areola into baby’s mouth After feeding, hold baby vertical, pat baby on the back, to encourage burping, and prevent milk regurgitation After feeding, hold baby vertical, pat baby on the back, to encourage burping, and prevent milk regurgitation

42. Bottle/Artificial Feeding If breast feeding is contraindicated, or inadequate breast milk If breast feeding is contraindicated, or inadequate breast milk Can be exclusive bottle feeding, or mixed breast ﹠ bottle Can be exclusive bottle feeding, or mixed breast ﹠ bottle

43. Bottle/Artificial Feeding Types of milk powder(formula) : cow milk-based, goat milk-based, soya-based, others Types of milk powder(formula) : cow milk-based, goat milk-based, soya-based, others Select milk products appropriate for age & weight, avoid hypoconcentration or hyperconcentration. Select milk products appropriate for age & weight, avoid hypoconcentration or hyperconcentration.

44. Bottle/Artificial Feeding Nutrition protein: Nutrition protein: fat: fat: sugar sugar others: others: Quantity of milk/day:150ml/kg/day (30ml milk has 20- 22kcal,150ml has 110kcal), divided into 6-8 feeds/24 hours

45. Bottle/Artificial Feeding Milk: Milk: Make up milk from milk powder - read instructions on the can e.g. milk powder:water-1:4 by volume,1:8 by weight Make up milk from milk powder - read instructions on the can e.g. milk powder:water-1:4 by volume,1:8 by weight 8% sugar milk:100kcal/100ml; 8% sugar milk:100kcal/100ml; Energy:100-120kcal/kg; Energy:100-120kcal/kg; Water :150ml/kg. Water :150ml/kg.

46. Bottle/Artificial Feeding Sterilize bottle, nipple etc properly Sterilize bottle, nipple etc properly Feeding frequency and interval are like breast feeding. Feeding frequency and interval are like breast feeding. During feeding, tilt milk bottle upwards to fill the nipple with milk to avoid sucking air. During feeding, tilt milk bottle upwards to fill the nipple with milk to avoid sucking air. Drop the milk on your hand before feeding to test the temperature. Drop the milk on your hand before feeding to test the temperature.

47. Weaning Weaning, the introduction of solid food is usually initiated between the age of 3 and 6 months. Weaning, the introduction of solid food is usually initiated between the age of 3 and 6 months. At this stage the infant can coordinate swallowing and has reasonable head control. After 6 months, breastfeeding alone becomes nutritional inadequate and continued breastfeeding without introduction of solids will lead to energy, vitamin andiron deficiency. At this stage the infant can coordinate swallowing and has reasonable head control. After 6 months, breastfeeding alone becomes nutritional inadequate and continued breastfeeding without introduction of solids will lead to energy, vitamin andiron deficiency.

48. Addition of solids “solids” are food other than milk -starts from 4-6 months Rule: -from less to more -from thin to thick -from fine to rough -gradually from simple/one type, to varied/many types varied/many types

49. Introduction of solids agesfeeding 3 — 4 months Cereals. E.g baby rice 4 — 5 months Pureed fruit and vegetables, meat 6 — 7 months Able to chew,e.g. rusks introduce lumpy foods and variety of tastes and textures 8 — 9 months Bread and butter, fruid 12 months Real food in small bits

50. 谢 谢！