Growth and development

Growth and development

Dr. Ban A Hameed Department of Pediatrics Al-Kindy college of medicine

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

GENETIC 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. NUTRITIONAL: especially during the first year of life when there is rapid growth and development. Others; includes social, emotional and cultural 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 : ( mean 0- 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’sOlder 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. 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.

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. 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 (2-5 years ) the average gain of weight is about 2kg per year. During middle child hood (6-11years ) the average gain of weight is (3-3.5kg) per year.

Parameters of growth

At age of 7 years the average child weight is 7 times of his birth weight. There are formulas for approximate average height and weight of normal infants and children. For 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

For Height:- At birth the length is about 50cm.at one year the length about 75cm. Between 2- 12 yr the formula (age in year x 6 + 77). 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. 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:- weight for age Height (length and stature) for age. Head circumference for age. Weight for height. 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.

Growth charts II

By definition, the 50th percentile is the median, the value above (and below) which 50% of the observed values fall. It is also termed the standard valueThe analysis of growth patterns provides critical information for diagnosis of several conditions example: Failure to thrive: - in this condition the child’s weight is below the 5th percentile or drops down more than tow major percentile lines. Weight for height below the 5th percentile remains the single best growth chart indicator of acute under nutrition. In chronic mal nutrition the body weight decrease. The height decreases too so their weight for height curves may appear relatively normal but in sever cases the head circumference decrease also.

Growth

Growth

Developmental Assessment

Development testing is a routine part of examination of any child especially infants and young children. The purpose is to identify development delay early so that, if possible the cause may be corrected and appropriate help organized for the child and family. There are standers for the age at which normal children achieve particular skills. The developmental skills can be divided into four main categories. postural and movement (gross motor ) Vision and fine manipulation. Hearing and speech. Social behavior.

First 3 months

1. posture and movement (gross motor) :- The term new born infant in supine position lies with his elbow is flexed; knee and hips are partly flexed The term new born infant in prone position lies on his abdomen, the pelvis is high and knee up under his abdomen. The prone new born infant can turn his face from side to side. By 1 month of age the infant can raise the head briefly to the plain of body. By 2 month the infant can sustain the head in that plane. By 3 month the infant can raise the head above the plane and his legs can be extended as well. In supine position; at 4-8 week the head lags when the infant is pulled from supine to sitting position and there is no head control. By 12 week there is some head control. Between the age of 4-12 week tonic neck posture predominates on supine position.

First 3 months

2. Vision and fine manipulation:- In the first few days of life infant watch his, her mother, can fixate on objects placed close to or move through their line of vision 20-30 cm from child face. At first 4 week the infant fixate his eyes on face or light in the line of vision. At end of 4 week the infant can watches persons and follows moving object. At 8 week the infant follows moving object 180 degree. In fine motor movement the infant within 4 week of life can make contact with stationary objects with in their reach and elicit reflex grasp.

First 3 months

3. Hearing and speech:- When the infant hear a sound may quite, blink, or startle or cry. The infant here made no real language but vocalization, he may coos (make noise) at 8 week of life. Small throaty noise begins at about 4 week, some vowel sounds are produced by 8 week and are usually uttered with pleasure at social contact by 12 week. 4. Social behavior:- By 2-6 week infants may appear more comfortable with family persons than strangers. Fragmentary smiles may manifest soon after birth, fully developed social smile occur between 3-5 week. Primitive reflexes: - at birth Moro reflex active, placing and stepping reflex and grasp reflex also active At 12 week Moro response disappeared.

3-6 months

1. posture and movement By the age of 3 month an infant on prone position can raise his head and chest with arm extended. By 4 month the head can be raised to vertical axis and turned easily from side to side. By 4 month when the infant is pulled from supine to sitting position, the head is held steady with out bobbing this means good head control. By 3-4 month predominate posture is head maintained in the midline, the arm and legs in symmetric position and hands together in the middle. By 6 month infants usually sit for few minutes on firm surface such as the floor with legs abducted and extended and hand for ward for supporting. At 5-6 month infant can pulled from sitting to standing position and support their weight on extended legs. At 5-6 month infant can rolls over at first from prone to supine position then after 1 month from supine to prone position. And he is able to support his weight on the hands with extended arms.

3-6 months

2. Vision and fine manipulation;- Infant can follow an object over an arc of 180 following it up ward and down ward. At 4 month infant can make contact with objects of moderate size, grasping them and bring them to the midline and to the mouth for visual and oral exploration. At 6 month can approaches the objects with ulner border of the hand (palmer grasp) At 6-6.5 month most infant can grasp a large object such as rattle and transfer it from hand to hand.

3-6 months

3. Hearing and speech:- At 6 month hearing is tested by a sound made at 45cm away from the ear but at the level of ear, slightly behind him using high pitch sound. At 6 month infant start babbling sounds. 4. Social behavior At 4 month infants start laugh aloud at pleasurable social contact and show displeasure by changes of expression or crying. At 6 month infants very excited when see food and protest if a toy taken away from him. At 6 month infant starts to imitate, for example if you tap on the table he will do the same.

3—6Months

6-12 month


1. posture and movement:- At 7 month prone infants can pivot in pursuit of an object. At 7 month they can assume a sitting position with support. Between 8-9 month they can assume a sitting position un supported with back straight. From 6 month the child starts to take weight on his legs. At 9 month a child bounces or stamps when supported and able to stand steadily for a short time as long as their hands are held. At 9-10 month start crawling either on his hands and knee this called creeping or crawling on his abdomen on which the child pull himself forward by his hands. Some infants crawl by sitting on their buttocks this called bottom shuffling. At 12 months infant taken 10 steps unsupported.

6-12 month

2. Vision and fine manipulation:- The infant can follow objects in all directions. At 9 month infant approaches the objects with radial border and taken it in a scissor grasp between side of thumb and index finger before transferring it to other hand and putting it in his mouth. At 12 month he approaches the object with index finger and picks it up precisely between the end of the thumb and index finger this called unassisted pincer movement of for finger and thumb (pincer grasp). At 10 months they wave bye-bye. At 12 month infant enjoy simple games with a toy such as ball and can release object into offered hand. At 9-10 month they can club hands.

6-12 month

3. Hearing and speech:- At 7 month the infant turn to sound 45 cm lateral to ear. At 9 month the infant turn promptly to sound 90 cm lateral and diagonally to ear. At 12 month the infant turn to sound 90 cm vertically above his head. The optimal age at which to test hearing is 9 month. At 6-7 month the infant can make repetitive vowel sounds. At 8 month the infant can make repetitive constant sounds (ba-ba, ma-ma, and da-da). At 9-10 month the infant can make sounds he say (mama, dada) At 12month the infant can make single ward like mum, dog. 4. Social behavior Between 6-8 month infants develop anxiety on separation from regular caretaker. Between 9-10 month infants usually are less dependant on presence of care takers. At 9-10 months infant starts to respond to sound of name. .

6—12Months

Second year


1. posture and movement;- At 15 month the infant can walk alone and crawls up stairs. At 18 month they can run stiffly and can climb up stairs with one hand is held. At 20 month they can go down stairs with one hand is held. At 24 month they can run well, walks up and down stairs and they can jump.

Second year

2. Vision and manipulation:- At 2 year vision is tested by showing small toys hold at three meters away from him and ask him to match them or if he can name them. At 15 month the child can place a pellet into a small bottle and can put 3 cubes on top of another. At 18 month the child can dump the pellet from bottle and can build a tower of 3-4 cubes, he can imitates scribbling, imitate vertical stroke. At 24 month the child can build a tower of 6-8 cubes. At 24 month the infant can do circular scribbling, imitate horizontal stroke, folds paper once imitatively.

Second year

3. Hearing and speech;- At age of 15 months the child follows simple commands and respond to his name. At 18 month the child can speak 10 words (average). name pictures, identifies one or more parts of body. At 2 years he can puts 3 wards together (subject, verb, and object) Follow simple instructions and under stand single request example (bring the ball). Hearing is tested 90 cm out of his sight at a level of the ear At 2 years he can identify at least 4 parts of his body.

Second year

4. Social behavior:- At 18 month the child cooperates with feeding and drinks from an ordinary cup using 2 hands. At 2 years he handles the spoon well. He copy mother to do things about the house (brushing, and cleaning) At 18 month he is able to tell his mother when he is about to urinate or go to potty. At 2 years he can identify 2-3 objects (book with figures) ask him to show you where the car is. He also listens to stories with pictures. Until the end of 2 years, the play usually solitary.

Third year

1. Posture and movement:- The child can goes up stairs alternating feet. He can stands momentarily on one foot. He can rides tricycle. 2. Vision and fine movement:- He can build a tower of 9-10 cubes. He can imitate construction of bridge of 3 cubes. At 30 month of age the child makes vertical and horizontal strokes but not joint them to make a cross. And he can imitate circular stroke. At 36 month the child the child can copies a circle and imitate a cross. Test near and far vision 3 meter away using five letter matching test or animals.



Third year


3. Hearing and speech:- For test hearing ask the child to obey simple spoken instructions at a distance 3 meter away. Example point to his head or mouth. At 30 month the child can refer to him self as I or me. At 36 month the child knows his age and name and his sex. He counts 3 objects correctly and he can repeat 3 numbers or a sentence of 6 syllables. At 3 year child can match basic colors. 4. Social behavior:- The child plays simple games (in parallel with other children)

He helps in Dressing (unbuttons clothing and put on shoes) He washes hands. He is dry and clean day and night at 3 years, while at 2.5 year he is dry during day only.

4-5 year

1. Posture and movement: Alternating foot is used to descent stairs by 4 years. At 48 month he can hop on one foot. Throw ball over head. At 60 month he can skip. 2. Vision and fine movement:- Test vision at 3 meters with both eyes and with separate eye and use 7 letter matching test. At 4 years he copies cross and square. At 60 month he draws triangle from copy. Name longer and heavier of two things. 3. Hearing and speech:- Hearing is tested at 3 meters away using voices, spoken instructions or toes and watch for his speech. At 48 month he counts 4 pennies, he tells a story. At 60 month he names 4 colors, count 10 digits and repeats sentence of 10 syllables. 4. Social behavior:- At 48 month he plays with other children. He goes to toilet alone. At 60 month he dresses and UN dresses.

Development

Assessment of development during middle child hood(6-11 years ):- 1-Gross motor development:- At age of 6years the child is -Able to walk on balance beam. - Able to skip using a skipping rope. - Mature jumping. 2- Vision and fine movement:- At age of 5-6 years the child can use a 3finger grasp of pencil .and use fingers to generate movement. At age of 6years the child can copy complex shapes like diamond. At age of 6-7 years the child can form most letters and number correctly. At age of 6-7 years the child also can write consistently on lines.

Development

3- Hearing and speech:- 6-7 years:- can give short oral reports. - Talks about past events in detail. -Knows the seasons. -Can name the days of a week, and time of day. 7-8 years:- -Can use appropriate grammar in their speech and written work. 4- Social behavior :- 6 years :- can sit at a desk and follow teacher instruction. - Packing the bag of school with assistance. 6-7 years:- -Enjoys playing in small group. 7years:- - Showering independently. -Packing a bag for school with little assistance.

Development

5-Reading and Writing:- At age of 6 years the child can read a few short regularly spelled words.eg:- their names. At age of 6-7 years the child able to write regular basic words. At age of 7 years the child can write complete sentence with punctuation At age of 8 years the child can write at least two sentences with appropriate grammar and punctuation.

MATURITY

Child maturity can be assessed by different ways which includes:- Skeletal maturity. Dental maturity. Sexual maturity. Neurological maturity.

MATURITY

Skeletal maturity This can be assessed by bone age which is determined by appearance and numbers of bone and state of fusion of epiphysis, particularly by X- ray of wrist and hand in young children and infants. And by X- ray of elbow in older children.

MATURITY

Dental maturity The first tooth appears at 5-9 month it is the lower central incisor then upper central incisor, upper lateral incisor, lower lateral incisor, first molar, canines (cuspid), second molar. During first year total number of teeth is 6-8. During second year total numbers of teeth 12-16, the child completes the deciduous teeth which are 20 in number at 2.5 years. While the first permanent tooth appears is the first molar at age of 6 years, when the shedding of deciduous teeth begins.

MATURITY

Sexual maturity this will starts from the age at which secondary sexual characteristics appears. Between 10 and 20 years of age, children undergo rapid changes in body size, shape, physiologic and psychological functions. Adolescence proceeds across 3 periods. EARLY Adolescence between (10-13 yr). MIDDLE Adolescence between (14-16 yr). LATE Adolescence between (17-20 yr).

MATURITY

Sexual maturity The resulting sequences of somatic and physiological changes give rise to Sexual maturity rate (S M R) or tanner stages. This is divided into 5 stages of sex maturation. In girls, the first visible sign of puberty is the appearance of breast buds between (8-13 yr) there is also enlargement of ovaries, uterus, thickening of endometrium and vaginal mucosa. Pubic hair become darker and increase in amount. Axillary hair appears with axillary perspiration. Menarche starts during middle adolescence usually between (9-16 yr). Menses usually begin after appearance of breast bud by 2- 2.5 years.

MATURITY

Sexual maturity In boys testicular enlargement begin at 9.5 years. Scrotum becomes darker and enlarged. Pubic hair become darker starts to curl and increase in amount.

Axillary hair appears, axillary perspiration, and then facial hair appears with change in voice. For both sexes, growth acceleration begins in early adolescence, but peak growth velocities are not reached until middle and late adolescence. Boys typically peak 2-3 yr later than girls and continue their linear growth for approximately 2-3 yr after girls have stopped.