Growth Lecture (1) PDF

Growth & development Lecture (1) – growth assessment  LECTURE 01 ASSESSEMENT OF GROWTH Definitions ▪ It is the natural increase in size of the body as a whole and of its separate...

Growth & development Lecture (1) – growth assessment  LECTURE 01 ASSESSEMENT OF GROWTH Definitions ▪ It is the natural increase in size of the body as a whole and of its separate parts. Growth ▪ It results from: increase in size and multiplicaton of cells. ▪ It includes: weight, height, head circumference, etc…. ▪ it Means ① Functional maturation of organs & systems ② Acquisition of new skills & functions. Development: ③ Ability to adaptation & assuming responsibilities ▪ It is expressed as: Gross motor, Fine motor, Language and Social milestones. ❖ Both growth and development are not separable (i.e. go parallel to each other). FACTORS AFFECTING GROWTH :- ① Genetic ▪ e.g. short stature caused by achondroplasia →  growth ② Endocrine ▪ Growth hormone and thyroid hormones. ▪ Poor maternal and child nutrition during pregnancy and lactation → ③ Nutritional growth ④ Chronic infections ▪ e.g. Tuberculosis and debilitating diseases → growth ⑤ Physical activity ▪ Bed ridden children do not grow normally. Higher socio- ⑥ ▪ Better chance for growth and development. economic status ⑦ Environmental Dr.Noaman Page 1  Pediatrics - DU Growth Stages of growth & development 1 Prenatal Embryonic stage Fetal stage Period of ▪ Organogenesis. ▪ Period of rapid growth & development. ▪ From 12th to 40th week of gestation. ▪ First 12 weeks of gestation Duration 2nd trimester 3d trimester (1st trimester). more growth in length more growth in weight 2 Perinatal  From the 20th week of fetal life to the 28th day after delivery. 3 Postnatal ① Neonatal period ▪ First 4 weeks after birth. ▪ 1-24 months. ② Infancy ▪ Period of most rapid physical growth & mental development. 2-12 years. ① Early childhood: 2-6 years. ③ Childhood ✓ Toddler age or Preschool age ② Late childhood (School age) : 6-12 years. ④ Adolescence ▪ 12-18 years Assessment of growth  Methods of assessment: ① Anthropometric measures ② Teething. ③ Fontanelles. ④ Osseous Growth (Bone age). ⑤ Growth Charts (Curves). Dr.Noaman Page 2  Pediatrics - DU Growth  How can you assess physical growth? ① Get an accurate body measurement e.g. weight, height, head circumference, etc. ② Compare this measurement with growth standards obtained from normal individuals of the same age, sex and community. ✓ This can be done by one of two methods: 1. Comparison of this single measurement with average for age and sex. 2. Plot this measurement on percentile charts/tables. (1) Anthropometric measures ① weight ⑤ Mid arm circumference ② Length/Height, ⑥ Skin fold thickness ③ Occipto-Frontal head circumference ⑦ Arm span -Height relationship, ④ OFC and chest circumference ratio ⑧ Proportions of upper segment and lower segment 1 Weight At birth ▪ Average weight is 3-3.5 kg. wt=6 kg at 4 months 1st 4 months 750 g/month (3/4 kg) double During infancy 2nd 4 months  500 g/ month (1/2 kg) wt = 8 kg at 8 months wt=9 kg at 12 months 3rd 4 months 250 g/month (1/4 kg) triple During early ▪ weight increases by 2 kg/year. childhood Weight in kg = (Age in years X 2) +8 (from 1-6 years) During late ▪ weight increases by 2.5 kg/year. childhood Age in years X7 Weight in kg = -5 (from 7-12 years) 2 Dr.Noaman Page 3  Pediatrics - DU Growth 2 Length or Height  How to measure Under 2 years Over 2 years ▪ Length is measured in supine position. ▪ Height is measured in standing position.  Measurements At birth ▪ 50 cm First 3 months ▪ Increases 3 cm/month Second 3 months ▪ Increases 2 cm/month From 7-12 months ▪ Increases 1.5 cm/month From 1-2 years ▪ Increases 1 cm/month After the 2ndyear Height = age in years x 5 + 80 at 4 years Birth length X 2 at 12 years Birth length X 3  This is only affected in long standing malnutrition for at least 6-12 months. LENGTH/HEIGHT MEASUREMENT Length Height ▪ Less than 2 years ▪ More than 2 years ▪ Recumbent ▪ Standing / Sitting  Child is in supine position, looking straight upward ✓ Two people are required to measure length accurately: Person A Person B ▪ Trunk & pelvis are ① Straighten child's legs, hold ankles together with toes pointed aligned with the upward measuring device ② Move the footboard firmly against the soles of the feet surface ③ Read the measurement to the nearest 0.1 cm Dr.Noaman Page 4  Pediatrics - DU Growth Standing height Sitting(trunkal) height ① Subject sits erect facing forward ② Shoulders and upper arms relaxed ③ Forearms and hands extended ① Standing back to wall. horizontally with palms facing each ② Heels at the wall, ankles together. other. Technique ③ Knees and spine straight against a ④ Thighs are parallel vertical metal rule. ⑤ Knees are flexed 90°with the feet in line with the thighs. ⑥ Measure vertical distance ( ) sitting surface and head top Figure 3 Occipto-Frontal head circumference (OFC)  Clinical value: OFC reflects the rate of brain growth. Maximum rate of brain growth & OFC is during the 1st year At birth ▪ 35 cm First 3 months ▪ Increases 2 cm/month Next 9 months ▪ Increases 0.5 cm/month : Dr.Noaman Page 5  Pediatrics - DU Growth 4 OFC and chest circumference (CC) ratio  Chest circumference is measured: at level of xiphiodprocess in mid inspiration.  Clinical value: Suspect malnutrition if OFC/C.C > 1 beyond 6 months. Age OFC/CC ratio At birth >1 At 6 months Equal 1 at 1st year 95th centile Dr.Noaman Page 7  Pediatrics - DU Growth 8 Body surface area (BSA) 𝐇𝐞𝐢𝐠𝐡𝐭 (𝐜𝐦) 𝐱 𝐖𝐞𝐢𝐠𝐡𝐭 (𝐤𝐠) 𝐁𝐒𝐀 (𝐦²) = √ 𝟑𝟔𝟎𝟎 (2) Teething A Primary = Deciduous or Milky teeth  Teething starts at 6-9 months and completed at 24 months.  The lower jaw incisors precedes the upper jaw by one B Secondary (permanent) Teeth  Teething start at the 6th years and completed at 22nd years  Eruption follow exfoliation immediate or may lag 4-5 months Dr.Noaman Page 8  Pediatrics - DU Growth (3) FONTANELLS A Posterior fontanell ▪ Closed at birth OR Normally ▪ Opened < 0.5 cm and closes within 2 months. ▪ Opened > 1 cm ornot closed within 4 months. ▪ Causes: ① Prematurity Abnormally ② Increased intra cranial tension ③ Mongolism ④ Cretinism B Anterior fontanell  Clinical value: Assessment of growth At birth At 6 months At12 months At18 months 3 fingers (» 3-4 cm) 2 fingers 1 finger closed. Large fontanel Small fontanel (premature closure; (delayed closure) before 6 months) (DACRO HI) ① Down syndrome ② Achondroplasia 2 C ③ Congenital hypothyriodism ① Craniosynostosis ④ Rickets ② Congenital hyperthyroidism ⑤ Osteogenesisimperfecta ⑥ Hypopituitarism ⑦ Increased intra cranial tension C 2 sphenoid fontanels D 2 mastoid fontanels Dr.Noaman Page 9  Pediatrics - DU Growth (4) OSSEOUS GROWTH  Normally: there are 5 secondary ossific centers at birth  In:- ① Lower end of femur. ④ talus ② Upper end of tibia. ⑤ cuboid. ③ Calcaneus,  X ray knee in newborn:  Help assess intrauterine skeletal maturation;  It is a good screening tool for congenital hypothyroidism  Carpal bones start ossification after birth as follow:- The 1st carpal bone The 2nd carpal bone ossifies at about 2nd month of age ossifies by the end of the first year  Later on, one carpal bone ossifies approximately each year till the 6th year;  The 8th bone usually ossifies at the 12th year of age. Dr.Noaman Page 10  Pediatrics - DU Growth  Carpal center : are not usually present at birth but appear about 2 months of age  2 carpal centers are present at one year of age  One additional carpal center appear each year ,so that 7 are present at 6 years of age 12m 18m 3y 6y Dr.Noaman Page 11  Pediatrics - DU Growth (5) GROWTH CHARTS(CURVES) ① Assess growth and normal growth variations among children. Values ② Early predictor of malnutrition (flattening of weight curve). ③ Monitor success of treatment of malnutrition. ① Percentile growth curves : Each chart is composed of 7 curves 97th percentile Highest normal. 90th percentile High normal 75th percentile Above average 50th percentile Average th 25 percentile Below average th 10 percentile Low normal Examples 3rd percentile Lowest normal ✓ Normal child on percentile curves ✓ Should lie between the 3rd AND 97th percentile curves. So, values < 3rd or above 97th are abnormal. ✓ On serial measurement deviation of the child from his own percentile curve is abnormal. ② Growth velocity curves : Rate of growth is maximal in infancy and during pubertal spurt. percentile ▪ If you look at the heights of 100 normal children aged 10 years, born on the same day and having the same sex, ✓ you can notice how variable they are from each other and still all are Meant by normal. ▪ By arranging these 100 children in a row with the shorter anteriorly and the taller posteriorly, ✓ then the position of each child in this row will be his "percentile" ▪ Horizontal axis ⇨ represent age N.B ▪ Vertical axis ⇨ represent growth parameter data ① The normal range of each measurement falls between 3rd and 97th percentile. How to use ② Any child with a single measurement below the 3rd percentile or above the 97th percentile should be investigated for abnormal growth. ③ Plotting sequential measurements of a child's weight, for example, on a Dr.Noaman Page 12  Pediatrics - DU Growth growth chart will show his own weight curve in term of percentile which should be constant throughout the growth period. ④ Any deviation of this curve > 2 major percentiles is used for early detection of abnormal growth. ⑤ If for example the child's weight was at 50th percentile at birth and until 6 months, then it dropped to 15th centile, this means development of malnutrition. ① Follow up of growth. ② Early detection of deviation from normal growth (e.g. growth retardation). Value ③ Helps in excluding organic problems as a cause of minor complaints (e.g mother complains that baby is not feeding "well" while his weight curve is NOT affected). Dr.Noaman Page 13  Pediatrics - DU Growth Dr.Noaman Page 14