GROWTH

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GROWTH AND DEVELOPMENT
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Headache in children
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Pain Abdomen
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SEIZURES
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APPROACH TO A CHILD WITH FEVER
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• VOMITING

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GROWTH AND DEVELOPMENT
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GROWTH DEVELOPMENT

• Privilege of pediatricians
• Its unique for children
• Begins at conception Ends at maturity
• Terms growth development used together
  normally
• They progress together
• They can but depart under special / abnormal
  situation

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GROWTH MEANS INCREASE IN SIZE DUE TO..

• Increased number of cells
• Increase in their size
• Increase in intercellular substances
• The increase can be seen and measured accurately

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ASSESSMENT OF GROWTH

• Anthropometry
• Includes weight, height, measurement of head,
  chest, abdomen, pelvis etc.
• Tissue growth
• Skin fold thickness measuring subcutaneous fat
  and measuring muscle mass
• Radiography - appearance and fusion of various
  epiphyseal centres
• Biochemical histological examination
• Dental age

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ANTHROPOMETRY

• Most commonly used in day to day practice
• Length
• most important parameter not altered by acute
  episodic illnesses e.g. Acute diarrhea
• Referred as length when measured in lying down
  position on infantometer.
• Height measured in erect standing position on
  stadiometer

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ANTHROPOMETRY

• Total length divided
• Upper segment - head to pubic symphysis
• Lower segment - pubic symphysis to toes
• U / L segment ratio 1.71 at birth
• 11 at 7
  years

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ANTHROPOMETRY

• Weight
• Most Common important
• Accuracy is important
• Acute variation due to acute illnesses must be
  considered
• Head circumference important in first 2 years of
  life.

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ANTHROPOMETRY

• Chest circumference important in first year of
  life especially when compared to the head.
• Midarm circumference( MAC) important during
  field practice when weighing scales may not be
  available

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ANTHROPOMETRY

• Body Mass Index (BMI) Wt. IN KG
  Ht IN M2
• BMI Value is useful in assessing the nutritional
  statusNormal Value 0.25
• Weight For Height
• Age Independent Index To Assess Nutrition
• Different types of malnutrition can be assessed
  such as acute vs chronic

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ANTHROPOMETRY

• Age independent anthropometry
• Useful when the age of the child is not known .
  Also useful in field practice sessions in remote
  areas where all equipments are not available.
  Only a measuring tape can be carried and used.
• Quack stick
• Useful to assess malnutrition. Height measuring
  stick is calibrated for MAC . This was popular in
  Africa then adapted for field studies in
  other developing places

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COMPARISON OF MAC AND HC

• MAC
• HC 0.28 TO 0.3 NORMAL
• Less Than 0.28 Is Malnutrition
• Ponderal Index (PI)
• Useful For Assessment of Intrauterine Growth
  Retardation - New Born Babies

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TISSUE GROWTH

• Not useful in routine practice.
• Needs special instrument (caliper) it assesses
  skinfold thickness measured over triceps,
  subscapular region, biceps region.
• Assesses amount of subcutaneous fat

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BONE AGE AND SKELETAL MATURITY

• Epiphyseal centres appear at specific ages in Sp.
  Bones. X-rays of wrist, elbow, knee, ankle and
  pelvis are useful.
• X-ray of wrist commonly used upto 6-8 years of
  age and at puberty
• Fusion of epiphyseal centres also occurs at
  specific age in special sequence.
• Dependence upon age of the child and purpose of
  assessment, various x-rays are used.

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DENTAL DEVELOPMENT

• Eruption of teeth follow definite pattern.
• Useful for assessment of age.
• TEETH Two sets
• TEMPORARY
• PERMANENT

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TEMPORARY

• 20 in number
• All replaced by permanent teeth
• Eruption begins at 6-10 months of age
• Completed 24 30 months of age

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PERMANENT
M1
CI LI
1 2 3 4 5 6 7 8
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7 8 11 9 10 6 12 17
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VELOCITY OF GROWTH

• Means - rate of growth
• Rates vary at different ages
• Growth rate slows down with age upto 10 15
  years
• Velocity increases with onset of adolescence

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GROWTH CHARTS

• Standard charts contain Wt / Ht / HC
• For convenience they are grouped
• Birth - 3 years separate for boys girls
• 2 years 20 years separate for boys girls
• Also described as road to health , who has
  accepted charts of national centre for health
  statistics (NCHS) USA, for international use
• Velocity charts also available based on long term
  longitudinal studies

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TISSUE GROWTH

• All Tissues Do Not Grow At Same Rate, At Same
  Age.
• Four Patterns
• General Growth Curve
• Neural Growth Curve
• Lymphoid Growth Curve
• Genital Growth Curve

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GROWTH BIRTH TO PUBERTY
Phases Of Growth
Intrauterine
Extrauterine
Ovum Concpt To 2 Wks
Foetus 8 Wks To 40 Wks
Embryo 2wks To 8 Wks
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Extra uterine Period

• Neonatal Period - 1st Month Of Life
• Infancy - 1st Year Of Life
• Toddler - 1-3 Years
• Preschool / School Age - 3- 10 Yrs
• Adolescent
• Girls 10 To 17 Yrs
• Boys 12 To 18 Yrs

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NEONATAL PERIOD

• Normal Mature Newborn Wt. More Than 2.5 Kg
• Average 2.75 3.25kg
• Large New Born Wt. gt3.25 Kg
• Low Birth Wt lt 2.5kg
• Loss Of Wt During First Wk Regained By 10 Days Of
  Life
• WT increase 20-30 gm / Day FROM 10 DAYS TO 90
  Days of life
• End Of First Month - Birth Wt. 400-500gms
• Length- 50 - 52 Cm
• HEAD 33 - 35 Cm

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INFANCY

• Weight
• Wt. INCREASE 20-30gm/day UPTO 90 DAYS OR 3 MONTHS
• End of 5months double the birth wt.
• End of 1 year triple the birth wt.
• Height
• Ht. Increases by 2.5 cm/month UPTO 6 MONTHS
• 6 MONTHS TO 1 YEAR - 1.5 cm/month
• AT 1 YEAR HT 72-75 cm
• Head Circumference
• 33-35 cm AT BIRTH, INCREASES BY 2.5cm/2months
• 6 months 40-42.5 cm
• 1 YEAR 44-46 cm
• Chest - Same as head at 1 year

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PRESCHOOL PERIOD

• Wt.
• 3kg/ yr in second year
• 2 - 2.5kg/ yr 3 to 10 years
• Ht.
• 10cm in second year
• 6 - 7.5cm/ yr 3 to 10 years
• Head Circumference
• 3 - 4 cm in second year
• 2 - 3 cm in third year
• Chest - more than head in second year
• If less indicates malnutrition

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SCHOOL PERIOD

• Growth slows down after the second year
• WT. GAIN 2.5 Kg/ yr
• HT. GAIN 5 - 7cm/ yr
• Head 2-3 cm are added during the whole period
  upto adolescence

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GROWTH DURING ADOLESCENCE PERIOD EXTENDS

• 10-16 years in girls and 12-18 years in boys
• Puberty - onset of menstruation in girls 11-14
  years
• 2nd GROWTH SPURT - i..e., Acceleration of
  weight height, starts at 10 12 years, early
  in girls
• Other changes include-
• Sex maturation measured as SMR (sex maturation
  rate)
• Psychological changes
• Metabolic changes
• Emotional changes

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BONE AGE

• Useful to assess maturity of newborn especially
  in some medicolegal situations
• Some endocrine disorders like hypothyroidism
  bone age delayed

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BONE AGE RADIOLOGY

• At birth - x -ray of knee epiphyseal centres
  Present include
• Distal end of femur
• Proximal end of tibia
• Head of humerus
• Calcaneus, talus cuboid
• X-ray wrist-
• Carpal centres start appearing at 2 months
• End of 1 year 2 carpal centres
• Till 6 years 1 centre is added each year
• Pisiform 8th carpal centre appears approx 1 year
  before puberty

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DEVELOPMENT
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DEVELOPMENT

• Development means maturation of functions,
  especially of nervous system. It is a continuous
  process.
• Development delay means failure to reach desired
  level of milestone at a particular given age.
  Detection of delay at the earliest age is
  important. However disorders of speech, learning
  disabilities cannot be diagnosed before 3 years
  of age

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ASSESSMENT OF DEVELOPMENT

• Subjective difficult process
• Criteria to assess
• Motor activity
• Gross motor
• Fine motor
• Adaptive behavior
• Language
• Speech
• Hearing understanding
• Personal social behavior

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DEVELOPMENT AGE ASSESSMENT

• Helps to assess normal or otherwise.
• Developmental quotient (DQ) must be assessed in
  each area of 4 activities mentioned
• DQ Development age x100
• Chronologic age
• DQ less than 75 - suspect delay

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DIFFERENT SCALES DEVELOPED TO ASSESS DEVELOPMENT

• Gesells Development Schedule
• Denver Dev. Screening Test (DDST) - Frequently
  Used
• Bayleys Scale
• Phataks Screening Test (Indian Data)
• Trivandrum Developmental Screening Test

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MOTOR ACTIVITY

• Include gross motor achievement
• Supporting the head - 2 to 3 months
• Turning over - 3 to 4 months
• Sitting up (when made to ) - 5 to 6 months
• Sitting up by self - 6 to 7 months
• Standing up holding objects - 7 to 9 months
• Standing up by self - 10 to 12 months

• Walking - 12 to 15 months
• Climbing up the staircase 15 months
• Climbing down the staircase - 18 to 24
  months
• Kicking a ball - 2 to 3 years
• Standing on one foot - 3 to 4 years
• Hopping - 5 to 6 years
• Skipping a rope - 7 t 8 years

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Ventral suspension
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6 months
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Crawl 7-8mo
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Creep
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16 mths
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Dept of Pediatrics, FMMC
12/10/2009
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2 yrs
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Dept of Pediatrics, FMMC
12/10/2009
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18 months
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Dept of Pediatrics, FMMC
12/10/2009
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Tower of cubes
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FINE MOTOR ACTIVITY

• Pincer grasp - picking up objects with
  apposition of thumb and fingers - 10 months
• Holding a pen - 2 years
• Writing - 2 years onwards
• Painting - 3 to 5 years

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ADAPTIVE OR COGNITIVE BEHAVIOUR

• Means adaptation of motor activity to surrounding
  environmental objects which act as stimuli
• E.G., A reaction to torch light at different ages
  will be different, depending upon childs motor
  development
• Show torch light
• At 1 month will just focus and look at it
• At 3 months follows light eyes and head are
  moving
• At 6 months tries to catch and hold it
• At 1 year holds and bangs it
• At 2 to 3 years wants to experiment
• Similarly as the child grows and the motor
  activity advances his reactions will be different
  e.g., A 2 year old may hold and roll a ball but a
  3 year old will try to kick it.

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LANGUAGE

• First two years of a childs life are spent in
  hearing and understanding the language spoken by
  the family.
• In 2nd year the child tries to reproduce some
  syllables and speaks 1 3 words.
• After 2 years, proper speech is developed and
  child learns to speak sentences.

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PERSONAL SOCIAL DEVELOPMENT

• Reaction of child towards persons and its social
  activities
• 1 month old child will recognize mothers voice
  and will become quiet if crying
• 2 to 3 months old will recognize mother
• 6 to 7 months old recognizes strangers and so
  on.

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SOCIAL ACTIVITIES INCLUDE

• Sleep pattern
• Eating habits
• Control over bowel bladder
• Bowel control is acquired at 1 year
• Bladder control is acquired at 2 years
• Night bed wetting should stop by 2 1/2 to 3
  years

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EATING

• Child learns to eat by self after 1 year.
• SLEEP
• During first month of life, child sleeps 18 to 20
  hours
• At 6 months will have 2 to 3 sleep intervals.
• At 1 year will have 1 or 2 sleep intervals.
• At 2 to 3 years may sleep in the afternoon

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THANK YOU
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SEXUAL MATURITY RATING- TANNERS STAGING-GIRLS

• 12/10/2009

• Dept of pediatrics, FMMC

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SEXUAL MATURITY RATING- TANNERS STAGING-BOYS

• 12/10/2009

• Dept of pediatrics, FMMC

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