Growth and Development pdf - D.Raid

Growth and Development

د.رائد كرين العكيلي

اتمنى لكن عام دراسي سعيد

General Objective:

By the end of this lecture, the student will be able to discuss growth and

development of children.

Specific Objectives:

By the end of these lectures, the student will be able to:

• Identify the importance of growth and development.

• Define growth and development.

• Mention the principles of growth and development.

• List factors affecting growth and development.

• Mention types of growth and development.

• Identify the stages of development.

Growth and development

— growth : is the physical increase in body size and appearance caused by

increasing size and numbers of cells (e.g. human being started from a

single cell to 3.5 kg at birth).

— Development : progressive increase in capacity to learn and think and

gain various skills and functions it continue throughout life.

— Maturation: completed growth and development.

Stages of development:-

— Embryonic stage (prenatal period):- from conception to birth.

— Infancy stage: - from birth to the end of the 1

year.

— -Newborn period (from birth to 28 days of age).

— - Infancy period (from 28 days to 1 year of age).

— Early childhood: - from 1-6 years of age.

—

- Toddlers: - from 1-3 years of age.

— - Preschool: - from 3-6 years of age.

— Middle childhood (school age):- from 6-11 years of age.

— Adolescent stage: - 11-20 years of age.

- Early adolescent 11-14 years.

— - Middle adolescent 14-17 years.

— - Late adolescent 17-20 years.

— Adulthood stage: - from 20-60 years of age (20-40 young adult, 40-60

old adult).

— Elderly stage: - > 60 years.

Factors affecting growth and development

Prenatal :

Maternal illness , infection , or malnutrition .

Maternal exposure to toxins, teratogens, alcohol , illicit drugs , anticonvulsants ,

antineoplastics , or anticoagulants .

Decreased fetal movements

Intrauterine growth retardation

Family history of deafness , blindness , or mental retardation

Chromosomal abnormalities .

Perinatal :

Asphyxia : Apgar scores of 0 – 3 at 1

min .

Prematurely , low birthweight . Abnormal presentation .

Postnatal :

Meningits , encephalitis

Seizure disorder

Hyperbilirubinemia : bilirubin > 25 mg / dL in full-term infant

Severe chronic illness

Child abuse and neglection

- Genetic

- Nutritional .

Principles of Growth & Development

• Continuous process

• Predictable Sequence

• Don’t progress at the same rate (↑ periods of growth rate in early

childhood and adolescents & ↓ periods of growth rate in middle

childhood)

• Not all body parts grow in the same rate at the same time.

• Each child grows in his/her own unique way.

• Each stage of growth and development is affected by the preceding types

of development.

Assessment of growth and development according to the age :

1. Infant : using measurement length , weight , head circumference .

Supplemented by : Observation of nutritional state dentition , size and

patency of fontanelles .

2. Older child : Measurements are : height , weight .

Supplemented by :

Measuring the length of the body segments such as :

Extremities span sitting height

3. Adolescence :

( 11 – 20 years ) , in addition to height , weight there are :

a. Assessment of sex maturity rate ( SMR ) .

b. Height velocity and weight velocity .

c. Skin fold thickness .

d. Body fat content ( especially in female ) .

e. Arm and leg circumference may be useful in estimation of male

Mass .

A growth chart with predictable pattern or growth curves is used to plot and

monitor a child’s growth through the years. These growth chart allow for

comparison between children of the same age and sex, also allow for

comparison of the child’s current measurements with the child’ previous

measurements.

There are different types of growth charts (e.g. weight for age, height for age,

head circumference for age, skin fold measurement, and mid-arm

circumference). Each chart composed of 7 percentile curves representing

distribution of weight, height, and head circumference at each age.

The term Percentile indicates the percentage of children at a given age on X

axis whose measured value fall below the corresponding value on Y axis. 50th

percentile is the median of values above which and below which 50% of the

observed values fall, also is termed standard value.

Standard growth charts are used to determine if the child’s pattern is appropriate

or if for some reasons the child’s growth is above or below a standardized

normal range.

New born

Weight : average about 3.5 kg. (2.5kg-4.25 kg)

Length : average about 50 cm . ( 45 – 55 cm ) .

Head circumference : average about 35 cm . ( 33 – 37 cm ) .

The posture of the new born infant tends to be partial flexion.

The respiratory rate for adequate gas exchange , which is the priority at birth ,

ranges from 35 to 50 breaths / min. The normal heart rate ranges from 120 – 160

beats / min. Transient murmurs are common .

The first stool ( meconium ) are generally passed within 24 hr . on the 3

– 4

day when milk feedings are established , a transitional greenish brown stools

that may contain milk curds occur. The typical brown stool occurs after a further

3– 4 days interval. Stools relate to the frequency and amount of feeding : usually

there are 3 – 5 stools / day by the end of the 1

wk. On a particular day in the 1

month, stools may range from 0 to 7 / day , particularly with breastfeeding .

The temperature of mother and infant are virtually the same at birth. The infant's

temperature usually falls transiently and is restored by 1– 8 hr. The caloric

requirement for normal temperature and activity is about 55 kcal / kg / 24 hr .

By the end of the 1

wk total caloric needs are 110 kcal / kg / 24 hr.

The extra-cellular fluid compartment constitutes 35% of the newborn's body

weight . During the first few days of life there is a loss of fluid that usually

averages 6 – 10 % of body weight . Excessive loss and poor intake may lead to

fever and dehydration . After the 1

week the newborn's oral water requirement

ranges between 120 and 150 mL/kg/24hr.

Glomerular filtration rate ( GFR ) and urine output are low during the first

days of life but increase rapidly in the first few weeks . During the 1

wk ,

proteinuria is common and the urine may contain urates , which may stain the

diaper pink.

The newborn infant's hemoglobin ( Hb ) ranges from 17 to 19 g/dL ( 30 % is

Hb A and the rest HbF ). Leukocytes are about 10.00 mm3 at birth and increase

during the first 24hr , with a relative neutrophilia. Counts of 25.00 – 35.00 may

occur . After the 1

wk , the total white blood cell count is usually below 14.000

and characterized by the relative lymphocytosis of infancy and early childhood .

Establishment of normal hemostatic depends on acquisition of normal intestinal

flora and production of vitamin K .

Maternal hormones transferred by the placenta may produce transient

enlargement of the breasts and genital secretions .

The gamma globulin level (IgG ) of the newborn is similar to that of the mother

and protects against many viral and some bacterial infections . Maternal

immunoglobulins IgM, IgA, and IgE, however do not cross the placenta in

significant amounts. IgM may be formed by the fetus in response to in utero

infection.

The infant's IgG falls to a low level by about 3 mo as maternally transferred

antibody disappears . Subsequently IgG rises as the infant produces his or her

own immunoglobulins ; it is usually normal by about 6 mo .

Pattern of development

* Cephalic Caudal .

( reaching , grasping , transferring , manipulating ) .

* Proximal distal .

( use thumb to pork , explore objects )

Thumb opposition fine pincer grasp

Primitive reflexes



Present at birth , assess the functional integrity of the brain stem and basal

ganglia .



Any asymmetry or absence of primitive reflexes may indicate a

significant CNS abnormality and requires further evaluation .



Any delay in the expected disappearance of the reflexes may requires an

evaluation of the CNS .

Primitive reflexes

Reflex

Description

Age of

appearance

Age of

disappearance

Moro

By allowing the infant , head gently to move

back suddenly . This results in abduction and

extention of the arms followed by adduction

and flextion of arms and legs .

Birth

4 – 6 mo

Rooting reflex

Tactile stimulus the corner of the infant mouth ,

resulting in infant mouth turn toward the

stimulus .

Birth

4 – 6 m

Sucking reflex

Any object placed in the newborn mouth . The

infant responds with vigorous sucking

Birth

4 – 6

Grasp

Occur when placing an object , such as a

finger , onto the infants palm ( palmar grasp )

or sole ( plantar grasp ) . The infant responds

by flexing fingers or the toes .

Birth

Palmar grasp 3 –

4 mo, plantar

grasp 6 – 8 m

Asymmetric

tonic neck reflex

By placing the infant supine and turning the

head to side . This results in ipsilateral

extension of the arm and leg into a ( fencing )

position .

The contra lateral side flexes as well

Birth

4 – 6 m

Trunk

incurvation

Stroking the skin along the edge of the

vertebrae produces curvature of the spine with

the apex opposite to the direction of the stroke .

Birth

4 – 6 Mo

Placing

Infant places foot on examining surface when

dorsum of foot is brought into contact with the

edge of the surface .

Birth

4 – 6 mo

Parachute

With the infant sitting , tilting to either side

results in extension of the ipsilateral arm in a

protective fashion .

6 – 8 Mo

Never

(There is other primitive reflexes not mentioned her)