Growth & development-1-
Dr.Noorjan A.M.
Definition
• Growth
; refers to an increase in the size
of the infant as a whole or of his or her
individual parts
,its progression mainly
structural. It is estimated with some
degree of reliability in term of; height,
weight, head circumference and bone age.
• Development
: refers to how a child
becomes able to do more complex things
as they get older.
Factors affecting growth and
development
1. GENETIC
2. PHYSICAL TRUMA
: any insult in pediatric age group
during prenatal, natal, post natal period
, any chemical,
immunological, and residual from certain infection may
affected the growth.
3. NUTRITIONAL
: especially during the first year of life
when there is rapid growth and development.
4. Others
; includes social
and emotional factors. I.e.
Position of child in the family, the interaction of the infant
or child with other siblings, parents divorce and death of
one parent.
Assessment of growth
• Infants
:
) 1month- 1 year of life ) the most useful
physical measurements are head circumference ,
length , and weight supplemented by observation of
nutritional status ,dentition and size of fontanel’s
• Older children
; measurement of stature and weight,
supplemented by measurement of body proportion
which includes (upper arm span and sitting height).
• Adolescence :
( 11- 21 year ) which includes in
addition to the height and weight assessments of
sexual maturity rate (S M R ) ,height velocity ,body
fat content ,skin fold thickness, mid arm and mid leg
circumference .
Parameters of growth I
Length or height :-
• At birth
the length is always in range of( 45 -55 cm.)
Average 50 cm
.The
increment in the length during first year is about 25 cm. during the
second year the increment is about 12 cm .
• So at first year the length is 75 cm, at second year 87 cm.
• Its doubled by the age of 4 years (100 cm) and tippled by age of 13
years (150 cm).
• During preschool age (2-5 years) the average increase in the height
is(7-8 cm ) per year.
• During middle child hood (6-11 years ) the average increase in the
height is(6-7 cm) per year.
Parameters of growth I
• Height gain is maximum in spring and minimal in autumn.
• At birth the ratio of the lower to upper segment of the body is
measured from symphysis pubis is approximately 1: 1.7.
• Subsequently the legs grow more rapidly than the trunk .at age of 2
years mid point in height is umbilicus, whereas in adulthood the mid
point is slightly below symphysis pubis.
• Between 2-12yrs, the formula for height is (age in yrs
×6+77).
Parameters of growth II
Weight : -
•
Is best index for nutrition and growth. with in the first week of life anew
born may lose up to 10 % of its birth weight due to( less intake of fluids ,
loss of meconium and urine and excretion of excess extra vascular fluid.)
then the weight is usually regained by the age of 10 days .
•
Birth weight ranges from 2.5- 4. kg. Average 3.5 kg. Any weight below
2.5 kg termed low birth weight. Any weight above 4. kg termed large birth
weight.
•
Weight gain is approximately 30 g / day during first month of life .and
20 g / day during 3- 4 months of life.
Parameters of growth II
•
Weight is doubled between 5- 6 month of life, tripled by the end of first
year and quad rippled by the end of second year.
•
In preschool age (2-
6years ) the average gain of weight is about 2kg per
year.
•
During middle child hood (
7-11years ) the average gain of weight is (3-
3.5kg) per year.
Parameters of growth
• There are formulas for approximate average weight of
normal infants and children.
• weight:-
• From 3-12 months the formula is
• (age in months + 9) divided by 2.
• From 1-6 years the formula (age in years x2 +8 ).
• From 7-12 years the formula (age in years x7 -5) divided
by 2.
Parameters of growth III
• Head circumference: -
• which mean occipito-frontal circumference. in normal full term
neonate is usually ranges from 33-37 Cm, average 35 Cm.
• The maximum increases in head circumference occur at first year
which mean also growth of brain.
• Its approximately increase about 2 cm / month for the first three month
.then it increase about 1 cm / month for second three month . Then it
increase about 0.5 cm / month for last six month. So at age of 6 month
average H.C. is 44 cm.
Parameters of growth III
• At age of 1 year average H.C. is 47 cm.
• At age of 2 year average H.C. is 49 cm.
• At age of 5 year average H.C. is 51 cm.
• At age of 12 year average H.C is 53- 54 cm which is the adult size.
• At birth if head circumference below 33 cm called microcephaly.
• At birth if head circumference above 37 cm this called macrocephally
Parameters of growth IV
• There are 6 fontanels:-
• anterior
• posterior
• 2 sphenoid
• 2 mastoid
• They are present at birth, the post fontanel close at
2-3 month, the ant fontanel closed by 9- 18 month of
age. The ant fontanel is diamond in shape, The usual
measurement is 2 by 2cm.
• The most common causes of delay in closure of ant
fontanel are rickets, congenital hypothyroidism, and
hydrocephaly.
Growth charts I
• The growth charts well developed more than 50 years ago .
• There are five standard charts:-
1. weight for age
2. Height (length and stature) for age.
3. Head circumference for age.
4. Weight for height.
5. The body mass index. As weight divided by the square of the height.
• Separate charts are provided for boys and girls.
• Each chart is composed of seven to eight percentile curves
representing the distribution of weight, height, or head circumference
values at each age.
• The percentile: is the percentage of individuals in the group who have
achieved a certain measured quantity or developmental mile stone.
• These are 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentile.
