小儿生长发育（growthanddevelopment）

Growth and Development Yang Fan Pediatric Department,Growth : defined as an increase in size of body, biological growth of an organism takes place through cell multiplication, this morphological growth can be measured clinically.,the enlargement of the organ and the system morphological growth can be measured by exact values,Development: A gradual change and expansion; advancement from a lower to a more advanced stage of complexity; increased capacity through growth, maturation, and learning,An increase in competence and adaptability A QUALITATIVE change Functioning at a higher level,Thus, since both processes are part of one whole, the combined terms growth and development form an unitary concept that indicates the quatitative and qualitative of maturational changes of an organism.,Growth is a continuous and orderly PROCESS,weight,height,Age (y),F,M,M,F,Not all tissue systems of the body grow at the same rate,Variability Not everyone is alike in the way that they grow Percentile growth/ standard deviation to the norm Racial and ethnic differences Boys vs Girls,Factors Influencing Growth,Heredity Nutrition Gender Disease Environment Hazards Socioeconomic influences,Growth Curves,Boys: 2 to 18 years,Girls: 2 to 18 years,Boys reach most of their height at age of 17 whereas girls reach theirs at around 15,Indices of Growth,Body weight (kg) the weight of a persons body. the weight of all tissues, organs and body fluids. one indicator of the nutritional status of child. the basis of drug dosage and amount of infusion.,1、The first growth spurt occurs in the first year of life (the increment is about 6kg).,Patterns of Weight Increment,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. Yearly increments increase slowly until the onset of puberty.,Birth weight 3 kg Mature babys weight gain at first month 1-1.5kg 312months weight=(month十9) /2 kg 16years weight= age 2 十8 kg 712years weight= age 7-5 / 2 kg,Attention,Weight loss: Physiological weight loss: 3 - 9% recover at 7-10th day Loss of 3% 9% of birth weight in the first few days of life is considered normal and is common for most newborns.,Height(cm),The length from vertex to plantae The index of long time nutritional status,The height for infants up to three years should be measured as recumbent length using a properly constructed measuring device. Height measurements for children over three years of age should be accomplished using vertical measuring board or fixed wall device.,Length/Stature,- Stature,- Length, 3y,3y,Stand,Supine,at birth 50cm 1 year old 75cm 2 years old 85 cm 2-12 years old=age 6 + 77,The first growth spurt occurs in the first year of life (the increment is about 25cm).,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. Yearly increments increase slowly until the onset of puberty.,Patterns of Length Increment,Shortness may be caused by malabsorption, chronic illness, psychosocial deprivation, hormonal disorders, familial patterns, or syndromes with dwarfism. Gigantism may be the result of pituitary abnormalities.,Male 10y H88cm,10y GHD,Crown-rump/Sitting height,- Crown-rump length,Sitting height,3y,Sit,Supine,3y,They give a measure of the length of the head and trunk. It is a measurement of the distance from the highest point on the head to the base sitting surface.,During the first year of life, spinal increase is faster than extremities. Later on, the extremities grow at a faster rate than the trunk, which is contribute to the body length and leading to a gradually change in relative proportions.,Changes in Overall Body Proportions,Head Circumference,HC is a measurement of perimeter of head,from eyebrows to occipital prominence. The change of the HC is related with the growth of brain and skull.,At birth 34 cm 1 year 46cm 2 years 48 cm 5 years 50cm 15 years 54cm (the same as adult),Head circumference should be measured with a tape measure at each visit during the first two years of life. A large head may be an early sign of hydrocephalus or an intracranial mass. A small head may be a result of early closure of sutures or lack of brain development.,chest circumference reprent the growth of thorax and lung at birth CC1year CC HC (cm) =age 1,Growth on Puberty,At puberty, there is a marked growth spurt(The second peak of height velocity,PHV), that is, a very rapid increase in size and weight.,Girls usually showing their pubertal growth spurt around age 911. For boys the same process begins at apx. age 1113. According to Tanner (1990), girls finish pubertal growth by about age 16 whereas boys continue to grow until approximately 18 years of age.,Sexual Precocity：Secondary sexual characteristics appear before puberty. Girls14y，Boys16y,Cranial development,Closure time of fontanel/suture,Small size or early closure： Large size or delayed closure：,Abnormality of anterior fontanel,Microcephaly,Hydrocephalus, Cretinism,Intracranial hypertension( Encephalitis, Meningitis),Dehydration,Abnormality of anterior fontanel,Bulging fontanel： Sunken fontanel ：,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 Age,Hypothyoidism, Hypopituism,Precocity of BA：,Adrenogenital syndrome, Precocity,Retardation of 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,Delayed eruption: Hypothyroidism,idiopathic Disorder :Hypothyroidism, Brain dysplasia Failing to erupt : Ectodermal dysplasia,Mechanical blockage Abnormality of dental enamel : Ectodermal dysplasia,Abnormality of Dentition,Evaluation of growth,Growth level Growth velocity Proportion,Evaluation of growth,Reliable and accurate data Single Value and series investigation reference,Choosing reference,Reference, based on a North American population by NCHS, USA, is recommended by the WHO as the international standard of growth.,Choosing reference,Besides,there are many local or national references,for example, physical growth indices of 9 cities in China.,Methods of assessment,Reference table Growth curve,Growth Curves,Boys: 2 to 18 years,Girls: 2 to 18 years,Boys reach most of their height at age of 17 whereas girls reach theirs at around 15,Growth level,Every single measurement can be plotted on a growth curve which illustrates the amount of growth in children within different age group.,Evaluation of growth,mean standard deviation： cut-off point x 2SD percentile：cut-off point P3-P97 Z score Z score=( x - x )SD Growth curve：,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）,Growth velocity can show the process of growth. Growth velocity is measured in terms of how much a child grows within a specified period of time.,Growth velocity,Neuropsychological and Behavioral Development,Nervous system anatomically complete at birth except: Myelination rapid for 2 years complete by 7 years Primitive reflexes disappear in few months,The Babys Brain-Infant Vision Development,newborn,1 month,2 months,3 months,6 months,adult,Audition,Audition is important because it relates language development. If a child has hearing loss, the child will have impaired speech, language and learning and behavioural problems stemming from difficulty in communication.,Newborns prefer sweet tastes over sour, bitter, and salty tastes. They can distinguish odors right from birth and soon learn to know the smell of their mothers milk and bodies.,BEHAVIOR DEVELOPMENT Four Attributes Gross motor Fine motor Language Personalsocial skill,Fine Motor,Physical skills involving small body movements, especially with the hands and fingers, such as picking up a coin and drawing.,Personal Social Skill,Developmental Surveillance,Periodic assessment of a childs developmental pr