Human Growth & Development - I - PDF

Human Growth & Development - I Introduction to Growth & Development 0  Learning objectives: By the end of this lecture, you will be able to: 1. Define growth, development and maturation. 2. Identify the importance of studying human gr...

Human Growth & Development - I Introduction to Growth & Development 0  Learning objectives: By the end of this lecture, you will be able to: 1. Define growth, development and maturation. 2. Identify the importance of studying human growth & development. 3. Mention the principles of growth and development. 4. Enumerate the factors affecting growth and development through the life span. 5. Mention types of growth and development. 6. State the developmental age periods. 0 Learning objectives: By the end of this lecture, you will be able to: 7. Define the neonatal period & infancy. 8. Describe the physical growth & development of normal neonate. 9. Describe the physical growth & development of normal infant. 0  I. Growth III. Development Definition: Definition: Changein system andFunction An increase in the physical size of the It is a series of progressive changes that whole body or any of its parts. occurs in a systematic, organized and predictable pattern as a result of maturation and experience (interaction with II. Maturation : = Readiness environment). Definition: So it is a process of change in growth and Physical and or mental changes capability overtime. that reflect readiness of an individual to do certain activity( So, development refers to the progressions (gain) & quickly & effortlessly). regressions(loss) that occurs during the life span as a result of growth & maturation and learning (experience).  Difference between Growth (G)& Development(D) Growth Development Quantitative Qualitative Ends with maturity Continuous from womb to grave Cellular multiplication Organization of all parts produced by growth Is an aspect (part) of development Is an integrated whole which growth is a part. Doesn’t depend on maturation and learning Depend on maturation & learning Observable & measurable changes Observable (not direct) May or may not bring development Is possible without growth 0  Clinical importance of studying human G & D:- 3481131 µ 1. Knowing what to expect of a particular child at any given age (understanding what’s normal and what’s not, spot diagnosis of possible signs of trouble). 2. Gaining a better understanding of the reasons behind illnesses i.e. enables the early detection of any pathologic deviations (e.g, poor weight gain due to a metabolic disorder, short stature due to inflammatory bowel disease). 3. Helping in formulating the plan of care. 4. Prevent the unnecessary evaluation of children with acceptable normal variations in growth. 0 5. Helping in parents’ education in order to achieve optimal growth & development at each stage ( Parents can easily capture the teachable moments in everyday life to enhance their child's language development, intellectual growth, social development and motor skills). 0  Principles (characteristics) of Growth & Development 1. Continuous process: throughout lifespan 2. Predictable Sequence. 3. Not Uniform: Different parts of the body grow in a different rate 4. Don’t progress at the same rate (rapid during infancy, early childhood & adolescents and slow during middle childhood). 1 5. Individualized process: Each child grows in his/her own unique way. 6. Each stage of G&D is affected by the preceding types of development. 7. G & D proceed in regular related directions: Cephalo-caudal, Proximodistal & General to specific 0 e 0  Factors affecting Growth & Development Hereditary Environmental factors: Pre-natal environment Maternal factors during pregnancy: Fetal factors: 1. Nutritional deficiencies 1. Mal-position in uterus 2. Diabetic mother 2. Faulty placental implantation 3. Exposure to radiation 4. Infection with German measles 5. Smoking 6. Use of drugs 0  Post-Natal Environment: External environment: Internal environment: 1. Socio-economic status of the family 1. Child’s intelligence 2. Child’s nutrition 2. Hormonal influences 3. Climate and season 3. Emotions 4. Child’s ordinal position in the family 5. Number of siblings in the family 6. Family structure (single parent or extended family … ) 0 Types of growth & development Growth Development 00 Physical Physiological Motor Cognitive Emotional Social Height Vital signs Weight Head & chest circumference 0 Vital statistics 0  Vital statistics It refers to the measured data about the events that mark life e.g birth, death, marriage, divorce, separation. The vital statistics system is the total process of both: (a) collection of information (b) Analysis of the obtained information and its dissemination in a statistical form. 0  Vital statistics Definition: Numerical records or data of the vital events in our life by which the growth and health parameters of any community can be studied. Sources: 1. Population census X 2. Civil registration system 3. National sample survey 4. Sample registration system 5. Health survey 0  Important vital statistics Crude Death Rate (CDR) Specific Death rates (ASDR) (age, sex, race, cause…….) -Age specific Death rate - Sex specific Death rate 1 - Race specific Death rate - Cause specific Death rate Infant Mortality rate (IMR) Neonatal Mortality Rate Post-neonates Mortality Rate Maternal Mortality Rate (MMR) 0 0  0 1 t 0 Neonatal & Infancy Periods 0 Newborn stage Newborn stage is the first 4 weeks or first month of life. It is a transitional period between the intrauterine life & extra uterine environment. Normal Newborn Physical growth Weight: Causes of weight loss during the 1st 2.700 grams – 4 kg week of life:- Wt. loss 5% -10% by 3-4 days 1. Withdrawal of hormones from mother. after birth. 2. Loss of excessive extra cellular fluid. Wt. gain starts by 10th days of life:- Ss during s the first 4 month, 3. Passage of meconium (feces) and urine. ¾ kg/m 4. Limited food intake. ½ kg/m during the next 4 month ¼ kg/m during last 4 month. 0  Height: Boys ≈ 50 cm Girls ≈ 49 cm Normal range for both = 47.5- 53.75 cm Head circumference 33-35 cm Give an idea about the brain growth The measurement may be inaccurate during scalp edema & cranial moulding and we have to wait to the 4th or 5th day. Skull has 2 fontanelles (anterior & posterior) Anterior fontanelle Diamond in shape it is inthe center It is located between 2 frontal & 2 parietal bones, at the junction of the sagittal, coronal and frontal sutures. Between 3-4 cm in length and 2-3 cm width It closes at 12-18 months of age It corresponds to the Bregma of the adult skull Posterior fontanelle Triangular Located between occipital & 2 parietal bones Closes by the end of the 1st (6-8 weeks) month of age It correspond to the Lamda of the adult skull  Chest circumference At birth, it is usually 2–3cm less than head circumference. At 6-12 months, both becomes equal. After the 1st year of age, it is 2.5 cm greater than head circum. By the age of 5 years, it is 5 cm greater than head circumference. Motor Development Gross motor development: Fine motor development: The newborn's movements are Holds hand in fist. characterized by being:- When crying, the baby draws arms Random, and legs to the body. Diffuse, Uncoordinated Reflexes carry out bodily functions and responses to external stimuli.  Neonatal Reflexes Sucking am Grasp Fencing response) Tonic-neck (fencing) Galant (trunk incurvation) Rooting Toe curling Moro reflex Cognitive development The cognitive development of newborn infant is difficult to understand or observe it. Emotional development The newborn infant expresses his emotion just through cry for hunger, pain or discomfort sensation. Infancy Infant stage It is the period which starts at the end of the first month up to the end of the first year of age. Infant's G & D is rapid during this period.  Normal infant 599,5W Physical growth: Weight: The infant gains : - Birth to 4 months → ¾ kg /month - 5 to 8 months → ½ kg / month - 9 to 12 months → ¼ kg /month The infant will double his birth wt. by 4-5 months and triple it by 10-12 months. Calculating infant’s weight during 1st year of life Infants from 3-12 month jjblf.tl 951 Weight = Age in months + 9/2 Example: The weight of a 7 months old infant = 7 plus 9 divided by 2 = (7+9)/2 = 16/2 = 8 kg  Height: 0-3 month, the length increases about 3 cm /month. 4-6 month, it increases 2 cm /month. At 7 – 12 months, it increases 1.5 cm per month. Head circumference: 0-3 month, It increases about 2 cm /month. 4-12 month, ½ cm/month. Posterior fontanelle closes by 6-8 w of age. Anterior fontanelle closes by 12-18 months of age. Chest circumference: By the end of the 1st year, it becomes equal to head circumference.  Teeth eruption (Dentition): It starts by 5–6 months of age. It is called "Milky teeth" or "Deciduous teeth" or "Temporary teeth". Motor development 11 0  Emotional development: His emotions are instable, where it is rapidly changes from crying to laughter. His affection for or love family members appears. By 10 months, he expresses several beginning recognizable emotions, such as anger, sadness, pleasure, jealousy, anxiety and affection. By 12 months of age, these emotions are clearly distinguishable. Cognitive Development Infants have mental structures called schemes which is the organized pattern of behaviors that are used to interact with the environment in certain way. Child learns by experience (actively construct the knowledge through interaction with environment) according to cognitive theory of piaget. Experience provides the basis for developing schemes. Example: the infant has a scheme for sucking, one for grasping that become differentiated over time. The way to suck on the bottle is completely different to that on a pacifier. 0  Social development He learns that crying brings attention. The infant smiles in response to smile of others. slsdsz.by The infant shows fear of stranger (stranger anxiety). He responds socially to his name. IPs3 The infant develops sense of trust. Through the infant's interaction with caregiver (mainly the mother), especially during feeding, he learns to trust others through the relief of basic needs.  Speech Milestones 1-2 months: coos 2-6 months: laughs and squeals 8-9 months: babbles, mama/dada as sounds 10-12 months: specific, “mama/dada 18-20 months: 20 to 30 words – 50% understood by strangers 22-24 months: two word sentences, >50 words, 75% understood by strangers 30-36 months: almost all speech understood by strangers References: www.emedicine.com www.uptodate.com http://www.cdc.gov/growthcharts/who_charts.htm Kaplan Medical, Lecture Notes 2016 ; pediatric & internal medicine