Download Growth & Development

Dr Abeer Abuzied Atta Al Mannan
2013
Learning Outcomes :
Knowledge :
• Define growth and Development G & D
• Identify principles of G & D
• Describe pattern of G & D
• Describe the different stages of normal development of a child
• State Factors influencing G & D
• State the importance of assessing growth and development;
• Describe methods for assessment of G & D
• Describe the Growth Chart, its uses, main parts ,and the information it provides
Skills :
• Measure the growth accurately, plot the measurements carefully on the growth
chart and correctly interpret the child’s growth pattern;
• Report the measurements to the mother and inform her how her child is growing;
(give advice)
• Compare & interpret growth charts
Definition
• Growth is defined as the increase in the size of
an individual due to increase in number and
size of the cells.
• Development is the maturation of function
and acquisition of variety of skills for
functioning optimally in a society.
Principles of Growth and
Development
• Growth is an orderly process, occurring in
systematic fashion.
• Wide individual differences exist in growth
rates.
• Growth and development are influenced by
multiple factors.
Principles of Growth and
Development
• Development proceeds from the simple to the
complex and from the general to the specific.
• There are critical periods for growth and
development.
• Rates in development vary.
Factor influencing growth and
development
1.
2.
3.
4.
5.
6.
7.
Genetic
Nutritional
Socio-economic
Environmental: physical surrounding, psychological,
social, cultural factor
Chronic disease
Emotional and cultural like unstable family,
insecurity, loss of parents , inadequate schooling
have negative effect on growth and development
Intrauterine growth retardation and maternal
infection adversely affect the fetus and thereby
newborn
In general factor influencing growth and
development can be classified into:
• Heredity and genetic factors
• Environmental factors
Heredity and genetic
factors :
• Phenotype (A phenotype is any observable characteristic or trait
of an organism : such as its morphology , development, biochemical
or physiological properties , or behaviour .
1. Parental traits are transmitted to the offspring.
2. Height, size of the head, structure of the chest, fatty tissue ..etc
have better genetic association than other somatic
characteristics.)
•
•
•
•
•
Characteristics of the parents
Race
Sex
Bio- rhythm and maturation
Genetic disorders
Characteristics of the
parents:
• Parents of high IQ having children of the same
and vice versa. (further enhanced by
environmental stimulation)
Race:
– Growth potential; of children of different racial
groups is different
– E.g. African ,American ,Asian
Sex :
– Boys are heavier & taller than girls at birth and this is
maintained till 11 yrs of age.
– pre pubertal Growth spurt occurs earlier in girls .
– Once again the boys grow taller than girls once they reach
the prepubertal growth spurt.
Bio-rythym and Maturation
– Daughters attaining menarche at similar age as
their mothers.
– Similar length of menstrual cycle.
Genetic Disorders:
1. Chromosomal abnormalities
– E.g. Turner syndrome, down syndrome
2. Gene mutations
– E.g. metabolic defects like galactosemia,
– mucopolysaccharidosis
•
Environmental factors
– Physical surroundings (sunshine hygiene, living
standards)
– Social factors (relation with other family members,
teachers, friends.. etc)
1- Prenatal environment
• Uterus shields the fetus from external adverse
conditions.
• harmful prenatal factors
–
–
–
–
Maternal nutritional deficiencies
Mal positions
metabolic , endocrine disturbances.
Infectious diseases( or diseases
toxoplasmosis, syphilis, herpes)
like
rubella,
• Rh incompatibility, smoking , alcohol and intake
of certain drugs
2- Postnatal environment
• These determines the pace and pattern of growth and development
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–
–
–
–
–
–
–
–
–
Nutrition
Infections & infestations
Trauma
socio - economic level
Climate
Cultural factors
Emotional factors
Chronic diseases
Ordinal position in the family.
Growth potentials.
Stages of Growth and
Development
• Infancy
– Neonate
• Birth to 1 month
– Infancy
• Birth to 1 year
• Early Childhood
– Toddler
• 1-3 years
– Preschool
• 3-6 years
• Middle Childhood
– School age
– 6 to 12 years
• Late Childhood
– Adolescent
– 13 years to approximately
18 years
Growth Patterns
• The child’s pattern of growth is in a head-totoe direction, or cephalocaudal, and in an
inward
to
outward
pattern
called
proximodistal.
Growth Pattern:
Normal growth:
• Concept of normality :
A normal child may be defined as one whose
characteristics fall within the range of
measurements accepted as normal for the
majority of children in the same (or reference)
age group.
Conventionally, these limits –the limits of normal
variation- are assumed to include two standard
deviations above and below the mean(i.e
between the 3rd and 97th centiles)
Surveillance of growth and
development
• Function of the mother and child heath services
Main purpose:
• To identify those children whose are not growing
normally (look for Red flags)
• It reflects effectiveness of other components of
child care ) nutrition, sanitation, control of
infection )
It covers :
• Physical growth
• Behavioural development
Assessment of Physical
growth
•
•
•
•
Weight –for- age
Height(length)-for- Age
Weight –for-height
Head and chest circumference
Weighing Scaler
( spring Balance)
Measuring Head
Circumference:
Measuring mid upper arm
circumference
Measuring length
Why developmental
assessment?
• Early detection of deviation in child’s pattern
of development
• Simple and time efficient mechanism to
ensure
adequate
surveillance
of
developmental progress
• Domains assessed: cognitive, motor, language,
social / behavioral and adaptive
Behavioural development
• Milestones: developmental landmarks that
provide an estimate of the time when the child
can be expected to attain certain skills or points
in development
Four field :
• Motor development
• Personal-social development
• Adaptive development
• Language development
Normal Development
Milestones
Age range
Motor Development
Language and social development
Birth
When prone turns head to one side
to avoid suffocation
Cries
3-6 Months
Good head control
Can follow an object with eyes,
plays with hands
6-9Months
Can sit unsupported
Grasps actively, makes loud noises
9-12Months
Able to stand
Understands a few words, tries to
use them
9-18Months
Able to walk
Grasps small objects with thumb
and index finger
15-30Months
Able to run around as much as he
wants
Can say several words or even some
sentences
3 Years
Plays actively, is able to jump and
climb
Starts talking a lot, is curious and
asks many questions
Factors that promote
Development :
•
•
•
•
good nutrition,
emotional support,
play and
language training
The growth chart
• Is a visible display of the child`s physical growth and development.It
is designed primarily for the longitudinal follow-up (growth
monitoring ) of a child ,so changes can be interpreted .
How is it used?
• The successive weights are plotted on the growth chart .
• The plotting produces a line or graph. This line constitutes that
individual child’s growth pattern or curve
• There are two lines on the chart.
• The top line represents the average growth line of healthy boys and
the bottom line is the 3rd percentile for girls (the lower limit of
normal weight-for-age of healthy girls).
• Interpretation is done by watching the direction of the child’s
growth pattern. The direction of the growth curve indicates how
the child is growing
The growth chart
Exercise:
• Reem is 2 years .She was weighed on three
occasions. In first week of March 2013, she
weighed 9 kg, in the second week of May
2013 weighed 10.5 kg and in the second week
of July of the same year weighed 11 kg.
Using this information, plot Reem`s growth on
a paper or actual growth chart of child health
card. Is Reem’s growth adequate
Upward growth curve
A static Growth Curve
Downward growth curve
Uses of the growth chart:
•
•
•
•
•
•
Growth monitoring diagnostic tool
Planning and policy making
Educational tool
Tool for action
Evaluation
Tool for teaching.
Alternative methods of growth
monitoring :
• Height- for- age
• Weight –for height
• Arm circumference (the last two are useful
when age is not known )
The importance of antenatal care,
perinatal care , and postnatal care
• Good antenatal care is the best health insurance
for both the unborn baby and the mother.
Antenatal care is important
• Assessment of the new born baby is part of
perinatal care and is done using the Apgar Score
• Postnatal care is the service given to the mother
and the baby in the first six weeks after delivery.
These six weeks constitute the postnatal period