1、CHILD GROWTH &DEVELOPMENTHU YanDepartment of Primary Child CareChildrens Hospital1. To master growth patterns of common used growth parameters.2. To understand how to assess growth and development. 3. To know the important regularities of growth and development.AimDefinitionPatterns of physical grow
2、thOther indices of growthRegularities of growth and developmentGrowth assessment Growth : defined as an increase in size of body, biological growth of an organism takes place through cell multiplication, this morphological growth can be measured clinically. Development : is the association process o
3、f differentiation of the organism, in which growing tissues and organs take on increased complexity of function(physiological, motor, cognitive, affective). Thus, since both processes are part of one whole, the combined terms growth and development form an unitary concept that indicates the quatitat
4、ive and qualitative of maturational changes of an organism. Physical growth can be assessed by various anthropometric measurements. Increment(kg/y )Increment（kg）Weight (kg)Age 2y Puberty 2kg /y 23m6912m1224m3At birth336331、 The first growth spurt occurs in the first year of life (the increment is ab
5、out 6kg). Patterns of Weight Increment2、Growth is not at the same rate in different age : The increment of weight during the first 3 months is equal to that of the following 9 months. 3 、Yearly increments increase slowly until the onset of puberty. These formulae are used only for calculating dosage
6、 of drug and fluid in clinic. Because the growth is not at the same rate in different age, especially in infant; and the growth is affected by many factors, such as gene, environment and individual variation. AttentionWeight loss: Loss of 3% 9% of birth weight in the first few days of life is consid
7、ered normal and is common for most newborns. Length/Stature- - StatureStature- - LengthLength 3y2yPuberty 57cm /y 573m61627512m8524m50At birth111212132510101、 The first growth spurt occurs in the first year of life (the increment is about 25cm). 2、Growth is not at the same rate in different age : Th
8、e increment of weight during the first 3 months is equal to that of the following 9 months. 3 、Yearly increments increase slowly until the onset of puberty. Patterns of Length Increment- - Crown-rump Crown-rump length length- Sitting Sitting height height3y3ySitSitSupineSupine3y3y They give a measur
9、e of the length of the head and trunk. It is a measurement of the distance from the highest point on the head to the base sitting surface. During the first year of life, spinal increase is faster than extremities. Later on, the extremities grow at a faster rate than the trunk, which is contribute to
10、 the body length and leading to a gradually change in relative proportions. 0.500.500.550.550.600.600.650.650.700.700.750.750.800.803m3m12m12m2y2y6y6yBoysBoysGirlsGirls HC is a measurement of perimeter of head,from eyebrows to occipital prominence. The change of the HC is related with the growth of
11、brain and skull. AgeHC(cm)Increment(cm)At birth343m40612m46624m4825y50215y5354341、 The first growth spurt occurs in the first year of life (the increment is about 12cm). 2、The increment of HC during the first 3 months is equal to that of the following 9 months. Patterns of HC Increment3 、 Rapid, dec
12、elerating growth of HC . (At birth, the head is of the neonates body. By adulthood, it is only 1/8th the size of the body. )4 、The shape of head and circumference are affected by not only diseases, but also heredity. Small HC HC increase too fastCerebral dysplasia, MicrocephalyHydrocephalusAbnormal
13、of HCGrowth on PubertyPhysical developments in height & weight:occur very rapidly in infancycontinue at a relatively steady pace throughout childhoodslow down towards puberty At puberty, there is a marked growth spurt(The second peak of height velocity,PHV), that is, a very rapid increase in size an
14、d weight. Girls usually showing their pubertal growth spurt around age 911. For boys the same process begins at apx. age 1113. According to Tanner (1990), girls finish pubertal growth by about age 16 whereas boys continue to grow until approximately 18 years of age.Sexual Precocity：Secondary sexual
15、characteristics appear before puberty. Girls8y，Boys14y，Boys16yCranial developmentFontanel/suture At birthTime of closureAnterior fontanel1.5-2cm1818mPosterior fontanel0.5-0.71-2mCranial sutureSmallest3-4mHow to measure the size of anterior fontanelAbnormality of anterior fontanelMicrocephalyHydrocep
16、halus, CretinismIntracranial hypertension( Encephalitis, Meningitis)Abnormality of anterior fontanelposterior curvature of thoracic vertebra sit by himself at 6 months stand and walk by one year old anterior curvature of lumbar vertebra posterior curvature of sacral vertebraanterior curvature of cer
17、vical vertebra hold head up by 3months Osteite (center of ossification), which is located near ends of long bones (epiphyses), with growth plates. It is very important for bones growth in length. Bone developmentThe sequence of appearance of secondary centers Bone age Bone age is that the age should
18、 be according to the osteite number for normal child. The most commonly used standards are those of Gruelich and Pyle, which require radiographs of the left hand and wrist; knee films are sometimes added for younger children(usually less than 1 year old). DentitionPrimary teeth:Primary teeth are 20
19、totally. The first eruption is at about 6 months(410 months) . The timing of tooth eruption is more variable than other developmental parameters Delayed eruption is usually considered when there are no teeth by approximately 12 months of age. The last eruption of primary teeth is at 22.5 years of ag
20、e. Primary teethDelayed eruption Hypothyroidism,idiopathicDisorder Hypothyroidism, Brain dysplasiaFailing to erupt Ectodermal dysplasia,Mechanical blockage Abnormality of dental enamel Ectodermal dysplasiaAbnormality of DentitionIndividual variation Child has rather big variation individually in gro
21、wth and development, even if the identical twins, owing to some factors such as heredity, sex, environment and education etc. An important part of well-child care is the assessment of a childs growth,that is to make sure that children are growing normally. Why do growth assessmentPrinciplesRepresent
22、ation of resultsContents of growth assessmentReliable and accurate data Single Value and series investigationReference and standardPrinciplesMeasurement errorMeasurement error4040454550505555606065657070757580808585909095951001000 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24cmLengt
23、h,girlsLength,girls Reference, based on a North American population by NCHS, USA, is recommended by the WHO as the international standard of growth. Besides,there are many local or national references,for example, physical growth indices of 9 cities in China. +2SD-2SDP3P50P97Statistics reviewXGrowth
24、 curveMethods of assessmentReference tableGrowth curve Example1：（Weight of girls） P3 P3 P25 P50 P75 P97P25 P50 P75 P971y1y 7.49 8.54 9.18 9.91 11.377.49 8.54 9.18 9.91 11.372y2y nyny -2SD -1SD +1SD +2SD-2SD -1SD +1SD +2SD1y1y 7.18 8.21 9.24 10.27 11.307.18 8.21 9.24 10.27 11.302y2y nyny X XExample2：
25、（：（Height of boys）50506060707080809090100100110110120120130130140140150150160160170170180180190190Boys:height2 4 6 8 10 12 14 16 18 -2SD -2SDXAge ( year ) +2SD +2SDXXResults： P97Example：（：（Weight of girls） P3 P25 P3 P25 P50 P75 P97P50 P75 P971y1y 7.49 8.54 9.18 9.91 11.37 (kg)7.49 8.54 9.18 9.91 11.
26、37 (kg) -2SD -1SD +1SD +2SD-2SD -1SD +1SD +2SD1y1y 7.18 8.21 9.24 10.27 11.30 (kg)7.18 8.21 9.24 10.27 11.30 (kg) The weight of a one year old girl is 8.2 kg.Growth level：X XX W/A P3-P25 W/A -（1SD2SD）0 01 12 23 34 45 56 67 78 89 91010111112121313141415150 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
27、 19 20 21 22 23 24kgWeightWeight，GirlsGirlsegeg：An infant at the 3rd percentile of weight for age Attention 1Attention 2Time for correctionExample:A girl，20m old.Weight 8.8kg，Length 79cm，HC 47.6cm.Gestational age:32Weeks.Correcting:Correcting:18mW W：P3-P10P3-P10L L：P20-P30P20-P30Assessment:Assessmen
28、t:20mW W：P3P97ExampleBMI=W(kg)/H2(m) Example: if an 8 year old boy weighs 26.8 kg (50-75th percentile for age) and is 130.4 cm tall, his BMI would be calculated as follows: 26.8/(1.304)(1.304) = 15.8. Trunk-leg ratio It is the most common index of shape and is a measure of the relative length of the trunks and legs. Usually, the ratio of sitting height/total height(SH/TH) can reflect trunk-leg ratio. A 2 years old boyExampleReviewPatterns of physical growth;Skeleton and dental development ;4 regularities of growth;3 indices of growth assessment.
