儿童保健生长发育体格发育（英文）课件

CHILD GROWTH and the growth is affected by many factors, such as gene, environment and individual variation. Attention Weight loss: Loss of 3% 9% of birth weight in the first few days of life is considered normal and is common for most newborns. Length/Stature - Stature - Length 2yPuberty 57cm /y 57 3m6162 7512m 8524m 50At birth 1112 121325 1010 1、 The first growth spurt occurs in the first year of life (the increment is about 25cm). 2、Growth is not at the same rate in different age : The increment of weight during the first 3 months is equal to that of the following 9 months. 3 、Yearly increments increase slowly until the onset of puberty. Patterns of Length Increment Crown-rump/Sitting heightCrown-rump/Sitting height - Crown-rump length - Sitting height 14y，Boys16y Skeleton Skeleton developmentdevelopment Dentition Dentition developmentdevelopment CraniumCranium：FontanelFontanel Cranial sutureCranial suture Spinal developmentSpinal development Bone developmentBone development Cranial development Closure time of fontanel/sutureClosure time of fontanel/suture Fontanel/suture At birth Time of closure Anterior fontanel 1.5-2cm18m Posterior fontanel 0.5-0.71-2m Cranial suture Smallest3-4m How to measure the size of anterior fontanel Small size or Small size or early closure early closure： Large size or Large size or delayed closure delayed closure： Abnormality of anterior fontanel Microcephaly Hydrocephalus, Cretinism Intracranial hypertension( Encephalitis, Meningitis) DehydrationDehydration Abnormality of anterior fontanel Bulging fontanelBulging fontanel： Sunken fontanel Sunken fontanel ： Spinal developmentSpinal development AgeAgeMovementMovementMusclesMusclesCurvatureCurvature 3m3m Lift Lift headhead CervicalCervical CervicalCervical （anterioranterior） 6m 6m Sit Sit alonealone LumbarLumbar ThoracicThoracic （posteriorposterior） 1212mm Walk Walk alonealone Lower Lower extremitiesextremities LumbarLumbar （anterioranterior） posterior curvature of thoracic vertebra sit by himself at 6 months stand and walk by one year old anterior curvature of lumbar vertebra posterior curvature of sacral vertebra anterior curvature of cervical vertebra hold head up by 3months Osteite (center of ossification), which is located near ends of long bones (epiphyses), with growth plates. It is very important for bones growth in length. Bone development The sequence of appearance of secondary centers Bone age Bone age is that the age should be according to the osteite number for normal child. The most commonly used standards are those of Gruelich and Pyle, which require radiographs of the left hand and wrist; knee films are sometimes added for younger children(usually less than 1 year old). Abnormality of Bone AgeAbnormality of Bone Age HypothyoidismHypothyoidism, , HypopituismHypopituism Precocity Precocity of BAof BA： AdrenogenitalAdrenogenital syndrome, syndrome, PrecocityPrecocity Retardation Retardation of BAof BA： Dentition Primary teeth: Primary teeth are 20 totally. The first eruption is at about 6 months(410 months) . The timing of tooth eruption is more variable than other developmental parameters Delayed eruption is usually considered when there are no teeth by approximately 12 months of age. The last eruption of primary teeth is at 22.5 years of age. Primary teeth Permanent teethPermanent teeth 6y6y：First molarFirst molar 7 78y8y：primary primary teeth are teeth are exfoliated exfoliated instead by instead by permanent teeth permanent teeth according to the according to the eruption orde eruption order. r. 12y12y：Second molarSecond molar 18y18y：Third molar Third molar TotallyTotally：3232 Delayed eruption Hypothyroidism,idiopathic Disorder Hypothyroidism, Brain dysplasia Failing to erupt Ectodermal dysplasia,Mechanical blockage Abnormality of dental enamel Ectodermal dysplasia Abnormality of Dentition Growth Growth and and development development are are a a continuous, continuous, series series of of distinct distinct stages stages cess. GirlsGirls BoysBoys Imbalance development of different Imbalance development of different systems and organs. systems and organs. Individual variation Child has rather big variation individually in growth and development, even if the identical twins, owing to some factors such as heredity, sex, environment and education etc. An important part of well-child care is the assessment of a childs growth,that is to make sure that children are growing normally. Why do growth assessment Principles Representation of results Contents of growth assessment Reliable and accurate data Single Value and series investigation Reference and standard Principles Measurement error 40 45 50 55 60 65 70 75 80 85 90 95 100 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 9797 5050 3 3 cm Length,girls Choosing referenceChoosing reference Reference, based on a North American population by NCHS, USA, is recommended by the WHO as the international standard of growth. Choosing referenceChoosing reference Besides,there are many local or national references,for example, physical growth indices of 9 cities in China. +2SD-2SD P3 P50 P97 Statistics review Growth curve Methods of assessment Reference table Growth curve Example1：（Weight of girls） P3 P25 P50 P75 P97 1y 7.49 8.54 9.18 9.91 11.37 2y ny -2SD -1SD +1SD +2SD 1y 7.18 8.21 9.24 10.27 11.30 2y ny X Example2：（Height of boys） Boys:height 2 4 6 8 10 12 14 16 18 -2SD Age ( year ) +2SD P P 97 97 P P 3 3 P P 50 50 GrowthGrowth level level G Growthrowth velocity velocity P Proportionroportion of body of body Growth levelGrowth level E Every single measurement can very single measurement can be plotted on a growth curve be plotted on a growth curve which which illustrates the amount of illustrates the amount of growthgrowth in children within in children within different age group. different age group. Results： P97 Example：（Weight of girls） P3 P25 P50 P75 P97 1y 7.49 8.54 9.18 9.91 11.37 (kg) -2SD -1SD +1SD +2SD 1y 7.18 8.21 9.24 10.27 11.30 (kg) The weight of a one year old girl is 8.2 kg. Growth level： X X W/A P3-P25 W/A -（1SD2SD） 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 9797 5050 3 3 kg Weight，Girls eg：An infant at the 3rd percentile of weight for age Failing to growFailing to grow Growing normallyGrowing normally Recovering form growth failureRecovering form growth failure Attention 1 For premature infants:For premature infants: we should minimize the effect of we should minimize the effect of gestation by gestation by subtractingsubtracting the weeks the weeks ofof prematurity prematurity (40 weeks is (40 weeks is considered as full term)considered as full term)from the from the postnatal agepostnatal age . . Attention 2 Height:Height:4040mm Weight: Weight: 2424mm Head circumference: Head circumference: 1818mm Time for correction Example: A girl，20m old.Weight 8.8kg，Length 79cm， HC 47.6cm. Gestational age:32Weeks. Correcting:18m W：P3-P10 L：P20-P30 Assessment:20m W：P97 P97 W/L: It indicates the range of weight for definite length. The weight of a 2 years old boy is 14kg，the length is 76cm. Reference table：W/L P97 Example BMI=W(kg)/H2(m) Example: if an 8 year old boy weighs 26.8 kg (50-75th percentile for age) and is 130.4 cm tall, his BMI would be calculated as follows: 26.8/(1.304)(1.304) = 15.8. Trunk-leg ratio It is the most common index