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1、CHILD GROWTH &DEVELOPMENT,HU YanDepartment of Primary Child CareChildrens Hospital,To master growth patterns of common used growth parameters.2. To understand how to assess growth and development. 3. To know the important regularities of growth and development.,Aim,DefinitionPatterns of physical gro
2、wthOther indices of growthRegularities of growth and developmentGrowth assessment,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.,Development : is the association process
3、of differentiation of the organism, in which growing tissues and organs take on increased complexity of function(physiological, motor, cognitive, affective).,Thus, since both processes are part of one whole, the combined terms growth and development form an unitary concept that indicates the quatita
4、tive and qualitative of maturational changes of an organism.,Physical growth can be assessed by various anthropometric measurements.,is composed of tissues, organs ,systems and fluid, etc. is a common and sensitive measurement of physical growth, especially for evaluating present nutrient state.,Wei
5、ght,Increment(kg/y ),Increment（kg）,Weight (kg),Age,2y Puberty 2kg /y 2,9,12m,12,24m,3,At birth,3,3,6,3,3,1、 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 d
6、uring the first 3 months is equal to that of the following 9 months. 3 、Yearly increments increase slowly until the onset of puberty.,About formulae: 312months: weight(kg)=(age month+9)/2 These formulae are used only for calculating dosage of drug and fluid in clinic. Because the growth is not at th
7、e same rate in different age, especially in infant; 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,
8、- Stature,- Length, 3y,3y,Stand,Supine,Linear growth is a measurement of the vertical distance from the highest point on the head to the heel.,Increment(cm/y ),Increment（cm）,L/S (cm),Age,2yPuberty 57cm /y 57,75,12m,85,24m,50,At birth,1112,1213,25,10,10,1、 The first growth spurt occurs in the first y
9、ear 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/Sittin
10、g 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 o
11、n, 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.,The ratio of sitting height/total height,Puberty,Defining the classification of short stature,Abnormal(Disproportionate) A syndrome with short li
12、mbs（Achondroplasia, hypothyroidism,etc）,Disproportionate,Proportionate,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.,1、 The first growth spurt occurs in the first year of life (th
13、e increment is about 12cm).,2、The increment of HC during the first 3 months is equal to that of the following 9 months.,Patterns of HC Increment,3 、 Rapid, decelerating growth of HC . (At birth, the head is of the neonates body. By adulthood, it is only 1/8th the size of the body. )4 、The shape of h
14、ead and circumference are affected by not only diseases, but also heredity.,Small HC HC increase too fast,Cerebral dysplasia, Microcephaly,Hydrocephalus,Abnormal of HC,Growth on Puberty,Physical developments in height & weight:occur very rapidly in infancycontinue at a relatively steady pace through
15、out childhoodslow down towards 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
16、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,Skeleton developmentDentition development,Cranium：Fontanel Cranial sutureSpinal
17、developmentBone development,Cranial development,Closure time of fontanel/suture,How to measure the size of anterior fontanel,Small size or early closure：Large size or delayed closure：,Abnormality of anterior fontanel,Microcephaly,Hydrocephalus, Cretinism,Intracranial hypertension( Encephalitis, Meni
18、ngitis),Dehydration,Abnormality of anterior fontanel,Bulging fontanel： Sunken fontanel ：,Spinal development,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 ap
19、pearance 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(usual
20、ly 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
21、 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 teeth,6y：First molar78y：primary teeth are exfoliated instead by permanent teeth a
22、ccording to the eruption order.12y：Second molar18y：Third molar Totally：32,Delayed eruption Hypothyroidism,idiopathicDisorder Hypothyroidism, Brain dysplasiaFailing to erupt Ectodermal dysplasia,Mechanical blockage Abnormality of dental enamel Ectodermal dysplasia,Abnormality of Dentition,Growth and
23、development are a continuous, series of distinct stages process.,Girls,Boys,Imbalance development of different 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, env
24、ironment 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,PrinciplesRepresentation of resultsContents of growth assessment,Reliable and accurate data Single Value and series
25、investigationReference 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 24,97503,cm,Length,girls,Choosing reference,Reference, based on a North American population by NCHS, USA, is recommended by the WHO a
26、s 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.,+2SD,-2SD,P3,P50,P97,Statistics review,Growth curve,Methods of assessment,Reference tableGrowth curve,Example1：（Weight of girls） P
27、3 P25 P50 P75 P971y 7.49 8.54 9.18 9.91 11.372y ny -2SD -1SD +1SD +2SD1y 7.18 8.21 9.24 10.27 11.302y ny,X,Growth levelGrowth velocityProportion of body,Growth level,Every single measurement can be plotted on a growth curve which illustrates the amount of growth in children within different age grou
28、p.,Results： P97,Example：（Weight of girls） P3 P25 P50 P75 P971y 7.49 8.54 9.18 9.91 11.37 (kg) -2SD -1SD +1SD +2SD1y 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,
29、97503,kg,Weight，Girls,eg：An infant at the 3rd percentile of weight for age,Failing to growGrowing normallyRecovering form growth failure,Attention 1,For premature infants: we should minimize the effect of gestation by subtracting the weeks of prematurity (40 weeks is considered as full term)from the
30、 postnatal age .,Attention 2,Height:40m Weight: 24m Head circumference: 18m,Time for correction,Example:A girl，20m old.Weight 8.8kg，Length 79cm，HC 47.6cm.Gestational age:32Weeks.,Correcting:18mW：P3-P10L：P20-P30,Growth velocity can show the process of growth. Growth velocity is measured in terms of h
31、ow much a child grows within a specified period of time.,Growth velocity,Serial height,Serial height,50,60,70,80,90,100,110,120,130,140,150,160,170,180,190,Boys:height,4 6 8 10 12 14 16 18,-2SD,Age ( year ),+2SD,P 97,P 3,P 50,Normal,Result representation,Normal,Descending,Accelerated,No gains,Slowed
32、,The birth weight of a girl is 2.3Kg.When she is 3 months old, the weight is 5.4Kg （Growth level： P3 ） Growth velocity： The increment of weight :3.1kg Reference:3.08Kg/0-3m Normal,Example,proportion of body,Weight to statureTrunk-leg ratio,Weight for length,W/L,Body mass index,BMI,P97,W/L: It indica
33、tes 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)
34、(1.304) = 15.8.,Trunk-leg ratio,It is the most common index of shape and is a measure of the relative length of the trunks and legs. Usually, the ratio of sitting height/total height(SH/TH) can reflect trunk-leg ratio.,Result representation(Claculating)Ratio of SH/THReference Normal（Proportionate） R
35、atio of SH/TH Reference Abnormal（Disproportinate）,A 2 years old boy，his length is 65cm，crown-rump length is 42cm。crown-rump length/ length（4265= 0.65）0.650.59（Reference） Abnormal,Hypothyroidism,Example,Review,Patterns of physical growth;Skeleton and dental development ;4 regularities of growth;3 indices of growth assessment.,
