Child Development and Growth

Growth and Development

• Growth refers to the increase in size and weight of a baby/child's organs and limbs, and is a critical indicator of children's health.
• Optimal growth occurs only when a child is healthy, well-nourished, and emotionally secured.

Characteristics of Growth

• Growth is characterized by increased body mass, morphological remodeling, and functional maturation, which distinguishes children from adults.
• Growth follows a top-to-bottom (cephalocaudal) and proximodistal (center-to-outside) pattern.

Influencing Factors

• Genetic adaptations can influence growth, but environmental factors can also significantly impact growth, such as eating habits, diseases, and personal care, as well as housing and sanitation conditions.

Physical Development

• The physical domain encompasses changes in the size, shape, and qualities of the body.
• Physical growth and development entail distinct physiological processes that follow parallel trajectories yet have common meaning.

Growth Monitoring and Promotion

• Growth monitoring and promotion (GMP) systems have been deployed for decades, involving monthly weighing of children under 5 years old at health facilities or communities, along with group or individual counselling and teaching on healthy eating choices.
• The child growth monitoring program aims to identify children with growth abnormalities early, allowing for rapid evaluation and treatment.

Measuring Growth

• Monitoring a child's growth, including weight, height, and head circumference, is crucial for recognizing growth abnormalities and ensuring enough nutrition of the child.

Distinction between Growth and Development

• Growth refers to a gain in size, height, weight, and length that can be measured, whereas development refers to changes in shape, form, or structure that lead to enhanced functioning.
• Improved functioning indicates qualitative improvements that lead to maturity.

Importance of Growth and Development

• Living organisms rely heavily on their growth and development.
• Development is a gradual process that leads to maturity, and optimal growth leads to optimal development.
• The first five years of life are commonly referred to as the "golden age" due to their sensitivity to the environment, rapid development, and irreversible nature.
• Efforts to promote growth and development are crucial at that time, as poor growth and development can lead to developmental abnormalities and other risk factors.

Growth Charts

• WHO growth curve for the 21st century is a new international growth reference for children from birth to five years of age.
• The curves reflect the growth of children living in healthy environments who are fed following guidelines that promote optimal growth in infancy and early childhood.
• The normal range is defined as a Z score between -2.0 and +2.0, which corresponds to the 2nd and 98th percentiles.
• Z-scores indicate the number of standard deviations from the mean.

WHO Growth Charts vs. CDC Growth Charts

• WHO growth charts indicate a growth norm, whereas the CDC growth charts serve as a growth reference.

Children's Anthropometric Standards

• Children's Anthropometric Standards in Indonesia refer to WHO Child Growth Standards for children aged 0-5 years and The WHO Reference 2007 for children 5 to 18 years.
• These standards are used to assess or determine the nutritional status of children.
• Assessment of children's nutritional status is carried out by comparing the results of body weight and length/height with Children's Anthropometric Standards.

Preterm Growth Charts

• Preterm growth charts, such as Fenton growth charts, are used for preterm infants, especially less than 37 weeks gestational age.
• Fenton charts can be used from 22 weeks gestation to 10 weeks post-term.
• WHO charts are important for tracking the growth of preterm newborns discharged less than 37 weeks.
• Corrected postnatal age is valid for up to two years.
• Corrected age for preterm children is computed as actual age in weeks - (40 weeks - gestational age at birth in weeks).

Anthropometric Measurements

• Anthropometry is the most accurate way for clinicians to determine nutritional status.
• Weight, length, weight for length, and head circumference are the most common anthropometric measures for children under the age of two.
• Weight, height, body mass index (BMI), and head circumference are the most common measures taken on children over the age of two.
• Measurements should be collected and documented anytime a newborn or kid encounters a healthcare practitioner, such as for immunizations, well-baby visits, or disease treatment.

Measurements for Assessing Growth and Nutritional Status

• Weight, length, height, head circumference, mid-upper arm circumference, triceps skinfold, and subscapular skinfold are the measurements taken for assessing growth and nutritional status of children.

Weight Measurement

• The scale used for weighing children should have solid construction and durability, electronic (digital readout), and be capable of measuring up to 150 kg.
• The scale should be accurate to 0.1 kg (100g) and allow for tared weighing.
• When measuring infants under 2 years old in a recumbent position, a hospital-grade platform scale should be used.
• The scale should be calibrated on a routine basis, and the following steps should be followed: • Remove shoes, clothing, and diapers from the infant. • Place the scale in the “zero” position before you place the infant on the scale. • Make sure the child is on the center of the platform. • Record the measurement to the nearest decimal fraction. • Remove the child from the scale.
• Tared weighing is used for children under the age of two or unable to stand.
• The scale should be placed on a hard horizontal surface so that the display is clearly visible.
• When weighing a child older than 24 months, a parent/caregiver or trained assistant should help position the child in the middle of the scale and help keep the child standing still.