Growth and Development

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Growth and Development
DR. REKHA DUTT
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• GROWTH- It is increase in physical size.
• Development It is increase in skills and
  functions.
• Normal growth and development occur
• if there is optimum nutrition,
• freedom of recurrent infections
• and freedom from adverse genetic and
  environmental influences.

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Determinants of growth and development

• Genetic inheritance
• Nutrition
• Age more in fetal life, infancy and puberty
• Sex
• Physical surroundings
• Psychological factors
• Infection and parasitosis
• Economic factors
• Birth order, education of parents

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Normal growth

• A normal child is that whose characteristics fall
  with in the range of measurements accepted as
  normal for majority of children in same age
  group.
• Normal variations are assumed to include 2
  Standard Deviation above and below the mean
  i.e.3rd and 97th centiles.

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Surveillance of growth and development

• It is done to identify those children who are not
  growing normally.
• Weight for age A single weight record only
  indicates size at the moment but does not give
  any information whether a childs weight is
  increasing or decreasing. Repeated measurements
  at intervals ideally monthly from birth to 1
  year,2 monthly during 2nd year and 3 monthly
  should be taken upto 5 years of age.
• A baby should gain 500gm/month for first 3
  months, doubles the birth weight by 5 months
  ,trebles by 1 year and quadruples by 2 years.

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• Height for age Birth length is approx. 50 cm.It
  increases by 25 cm at first year and another 12
  cm during second year.
• Low height for age also called as stunting. It
  reflects past and chronic malnutrition.
• Weight for height Low weight for height is
  nutritional wasting or emaciation( acute
  malnutrition).
• Head and chest circumference At birth head
  circumference is approx. 34 cm.It is about 2 cm
  more than chest circumference. By 6-9 months the
  two measurements become equal after which chest
  circumference takes over head circumference.

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Behavioral development

• Motor development
• Head holding 3 months
• Sits without support 6-8 months
• Crawling- 9 months
• Stands with support 10-11 months
• Walks 12-14 months
• Language development
• Experimenting with noises 6-8 months
• First words 10-11 months
• Short sentences 24 months
• Sociopersonal development
• Looks at mother and smile 6-8 weeks
• Recognizes mother 4-5 months
• Suspicious of strangers 9-10 months

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Growth Chart

• Definition It is a visible display of a childs
  physical growth and development.
• First designed by David Morley .
• Growth chart offers a simple and inexpensive way
  of monitoring weight gain.
• Any deviation from normal detected by
  comparison with reference curves.

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The WHO growth chart

• It has two reference curves.
• Upper reference curve -the median (50th
  percentile) for boys.
• Lower reference curve 3rd percentile for
  girls
• Space between two growth curves called weight
  channel or road to health zone of normality for
  most population.

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Interpretation

• Normal - growth line above 3rd percentile and
  will run parallel to reference curves
• Abnormal- flattening or falling of childs
  weight curves signals
• growth failure
• Earliest sign of PEM
• Precede clinical signs by weeks or even months
• Such child needs special care
• Objective- keep child above 3rd percentile

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Growth Chart Used In India

• It has four reference curves.
• Top most curve 80 of the median (50th
  percentile) of the WHO reference standard.
• Lower lines represent 70 ,60 and 50 of the
  standard.
• 80 median weight is approximately equal to 2 SD
  below the median which is the conventional lower
  limit of normal range.
• Purpose of reference curve It indicates degree
  of malnutrition.

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INTERPRETATION

• 1st degree (grade 1)malnutrition- childs weight
  between 80 and 70 lines.
• 2nd degree (grade 2 or moderate) malnutrition
  childs weight between 70 and 60 lines.
• 3rd degree (grade 3 severe) malnutrition -weight
  below 60 line.
• Grade 4-weight below 50 line.
• Weight b/w top 2 lines is considered
  satisfactory.

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Management

• Weight b/w curves 1 3-undernourished,require
  supplementary feeding at home
• Weight below curve 3-consult the doctor and
  follow his advice.
• Weight below curve 4-hospitalized for treatment

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Uses of growth chart

• Growth monitoring
• Diagnostic tool
• Planning and policy making
• Educational tool
• Tool for action
• Evaluation
• Tool for teaching

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• Referencewww.commedutm.org/pics/ug-presentations/
  growthchart.

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