儿科儿童生长发育PPT课件.pptx

儿童体格生长发育,.,年龄分期生长发育的指标影响生长发育的因素,.,AgeGroup年龄分期,Humandevelopmentprogressesthroughasequenceofevents,theselandmarksshouldoccuratapproximatelythesameage.Itiseasiertograspdevelopmentbyfocusingonspecifickeyagegroup.儿童的生长发育既循序渐进又有阶段性，某些里程碑式的事件应在某一年龄出现。注意关键年龄段更易于把握生长规律。,.,Thefetalperiod胎儿期40周,Themostdramaticeventsingrowthanddevelopmentoccurbeforebirth.Thetransformationofasinglecellintoaninfant.生长发育过程中最令人激动的事件发生在出生前：单个细胞发育成胎儿。,.,Embryonicperiod:8wkTherudimentsofallmajororgansystemshavedeveloped.weight:9g,length:5cm胚胎期8周各主要器官系统雏形初现。重量：9克，长度：5厘米。,.,Fetalperiod:9-40wkIncreaseincellnumberandsize,structuralremodelingofseveralorgansystems.Duringthethirdtrimester,weighttriplesandlengthdoubles.Termweight:3250g,length:50cm.胎儿期9-40周细胞数量与体积增加，器官系统结构重组，孕晚期发育迅速：体重增加3倍，身长增加2倍。孕末期体重平均3250克，身长50厘米。,.,Theneonatalperiod4wk新生儿期,Adaptationtoextrauterineliferequiresrapidandprofoundphysiologicchanges,includingaerationofthelungs,reroutingofthecirculation,andactivationoftheintestinaltract.Toobtainnourishment,toavoidhypothermiaorhyperthermia,andtoensuresafety,neonatesmustreactappropriatelytoanexpandedrangeofsensorystimuli.适应宫外生活时，新生儿在生理上需要经历快速而深刻的变化，包括肺泡扩张充气、循环径路改变、肠道功能激活等。为了获取营养物质、避免体温过低或过高并保障安全，新生儿需要对纷繁的外界刺激做出适当的反应。,.,Anewbornsweightmaydecrease10%belowbirthweightinthe1stwkasaresultofexcretionofexcessextravascularfluidandpossiblypoorintake.Infantsshouldregainorexceedbirthsweightby2wkofageandshouldgrowatapproximately30gdayduringthe1stmonth.生后第一周，由于多余的细胞外液被排出体外及摄入不足，新生儿的体重会比出生体重减少10。生后两周时应恢复或超过出生体重，此后至满月，体重每日增加30克左右。,.,Limbmovespurposelessly,smilingoccursinvoluntarily,eyegazing,headturning,andsuckingunderconsciouscontrol.新生儿有无目的的肢体运动、无意微笑，可凝视及转头，会有意识地吸吮。,.,Basictrustdevelopsasinfantslearnthattheirurgentneedsaremeetregularly.Infantsdoesnotconsistentlyexperiencefeedingasthepleasurablereductionoftensionoftenshowincreasedirritabilityandphysiologicalinstability(spitting,diarrhea,poorweightgain)aswellasbehavioralproblem.由于基本需求得到规律的满足，新生儿期会建立基本信任感。饥饿时不能规律地体验到喂奶快乐的婴儿，常显示烦躁不安和生理不适（呕吐，腹泻，体重不增）及行为障碍。,.,Theinfantperiod婴儿期0-12月,Normalchildrenfollowatrajectoryofincreasingphysicalsizeandcomplexityoffunction.婴儿期体格发育步入了快速增长的轨道，各项功能也日趋复杂。,.,3m:liftshead6m:sitsaloneforashortperiod9m:standsalone12m:walksindependently,.,Theprimaryemotionsofanger,joy,interest,fear,disgust,surprise,andtantrumsappear,separationsbecomedifficult.初级感情出现：表现生气、高兴、感兴趣、害怕、讨厌、吃惊和发脾气等，与父母难以分离。,.,Thetoddler幼儿期2-3岁,Thegrowthrateslowersfurtherinthe2ndyearoflife,thenatasteadyrate,weightgain:2kg/yr,length:5-7cm/yr.第二年生长速度减慢，然后较为恒定，体重每年增加2公斤，身高每年增加5-7厘米。,.,Walksalone,crawlsupstairs,walksupanddownstairs,runstiffly,thenrunswell,jumpsandopensdoors.18mo:10words;24mo:puts3wordstogether;36mo:knownfullname,ageandsex,counts3objects,repeats3numbers.可以独自走动，上下楼梯、跑步跳跃、开门等。18个月时会说10个单词；24个月会把3个单词连在一起说；36个月时知道自己名字、年龄、性别，会数3种物品，重复3个数字。,.,Preschoolyears学龄前期4-6岁,Gains2kginweightand7cminheightperyear.Throwing,catching,andkickingballs,ridingonbicyclesanddancing.Tower9cubes,imitatesgate,copycross,circle,andsquare.Languageoccursmostrapidly.Vocabularyincreasesfrom50-100wordstomorethan2000.体重每年增加2公斤，身高每年增长7厘米。学会扔球、接球、踢球，会骑车、跳舞。会垒9块积木，模拟垒门、画十字、圆圈和方块。语言发展迅速，词汇量从50-100个单词增加都2000个以上。,.,EarlySchoolYears学龄期6-12岁,Growthduringtheperiodaverages3-3.5kgand6cmperyear.Childisjudgedaccordingtheirabilitytoproducesociallyvaluedoutputs,suchasgoodgradesandhomeruns.Attentionandreceptivelanguageaffecteachoyheraswellaseveryotheraspectoflearning.学龄期体重平均每年增加3-3.5公斤，身高增长6厘米。对学龄期儿童的评价开始注重其社会化表现，如在学校的成绩和家务劳动能力。注意力和语言能力互相影响并关系到学习的其他方面。,.,Adolescence青春期12-20岁,Fosterthetransitionfromchildhoodtoadulthood.Betweentheagesof10and20yr,childrenundergorapidchangesinbodysize,shape,physiology,andpsychologicandsocialfunctioning.Adolescenceproceedsacrossthreedistinctperiods:early,middle,andlate.However,individualvariationissubstantial.从儿童到成人的转型期。从10岁到20岁，儿童经历了身体上，生理上、心理上，及社会角色的快速转变。此期又可分为早、中、晚三期，个体差异很大。,.,Physicalgrowthindicators,Growthassessmentisanessentialcomponentofpediatrichealthsurveillancebecausealmostanyproblemwithinthephysiologic,interpersonal,andsocialdomainscanadverselyaffectgrowth.,.,Weight,UsefulNumbersandFormulas,.,Length/height,.,Sittingheight,Sittingisthelengthofheadtotuberosity.Bodyproportionsfollowasequenceofregularchangeswithdevelopment.Proportionalitycanbeassessedbymeasuringthelowerbodysegment,andtheupperbodysegment.Theratioofupperbodysegmengtdividedbylowerbodysegment(U/Lratio)equalsapproximately1.7atbirth,1.3at3yr,and1.0afterage7yr.HigherU/Lratioarecharacteristicofshort-limbdwarfismorbonedisorderssuchasrickets.,.,Headcircumference头围,Sincetheheadcircumferenceiseyebrowontheedgeoftheexternaloccipitalprotuberancearoundthehightestpointofmaximumdiameterofthefirstweek.新生儿的头围平均为34cm，1岁时平均为46cm,2岁时48cm，5岁时约为53-54cm，与成人相近。,.,Chestcircumference胸围,Chestcircumferencereferstothecircumferenceoftheloweredgeofthenippleandthetwocornersofthelowerlimb.Itrepresentsthedevelopmentofthechestandlungs.出生时胸围平均为32cm，婴儿期胸围增长最快，1岁末胸围与头围相等，大约为46cm，第二年约增加3cm，3-12岁胸围平均每年增加1cm，胸围超过头围的厘米数约等于周岁数减1.,.,Armcircumference上臂围,Thearmcircumferencerepresentsthedevelopmentofthearmmusc