Growth and Development Yang Fan Pediatric Department

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• Growth and Development
• Yang Fan Pediatric Department

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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.
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• the enlargement of the organ and the system
• morphological growth
• can be measured by exact values

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• Development
• A gradual change and expansion advancement from
  a lower to a more advanced stage of complexity
  increased capacity through growth, maturation,
  and learning

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• An increase in competence and adaptability
• A QUALITATIVE change
• Functioning at a higher level

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• 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.

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• Growth is a continuous and orderly PROCESS

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height
M
F
weight
M
F
Age (y)
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• Not all tissue systems of the body grow at the
  same rate

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• 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

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Factors Influencing Growth

• Heredity
• Nutrition
• Gender
• Disease
• Environment
• Hazards
• Socioeconomic influences

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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

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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.

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Patterns of Weight Increment
1?The first growth spurt occurs in the first year
of life (the increment is about 6kg).
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.
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• Birth weight 3 kg
• Mature babys weight gain at first month
  1--1.5kg
• 312months weight(month?9) /2 kg
• 16years weight age 2 ?8 kg
• 712years weight age 7-5 / 2 kg

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Attention

• About formulae
• These formulae are used only for calculating
  dosage of drug and fluid in clinic. Because the
  growth is not at the same rate in different age,
  especially in infant and the growth is affected
  by many factors, such as gene, environment and
  individual variation.

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• 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.

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Height(cm)

• The length from vertex to plantae
• The index of long time nutritional status

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• 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.

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Length/Stature
lt 3y
Supine
--- Length
--- Stature
Stand
3y
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• at birth 50cm
• 1 year old 75cm
• 2 years old 85 cm
• 2--12 years oldage 6 77

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Patterns of Length Increment
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.
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• 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.

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Male 10y H88cm
10y GHD
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Crown-rump/Sitting height
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.
lt3y
Supine
- Crown-rump length
Sit
3y

• Sitting
• height

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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.
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Changes in Overall Body Proportions
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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.
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• At birth 34 cm
• 1 year 46cm
• 2 years 48 cm
• 5 years 50cm
• 15 years 54cm (the same
  as adult)

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• 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.

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• chest circumference
• reprent the growth of thorax and lung
• at birth CClt HC 1- 2 cm
• 1 year CC HC
• gt1year CC - HC (cm) age - 1

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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.

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• 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.

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Sexual PrecocitySecondary sexual
characteristics appear
before puberty.
Girlslt8y,Boyslt10y Delayed sexual
maturity Secondary sexual
characteristics do not appear
after puberty
Girlsgt14y,Boysgt16y
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Cranial development
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Closure time of fontanel/suture
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Abnormality of anterior fontanel
Small size or early closure Large
size or delayed closure
Microcephaly
Hydrocephalus, Cretinism
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Abnormality of anterior fontanel
Bulging fontanel Sunken fontanel
Intracranial hypertension( Encephalitis,
Meningitis)
Dehydration
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Bone 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.
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The sequence of appearance of secondary centers
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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).
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Abnormality of Bone Age
Retardation of BA
Hypothyoidism, Hypopituism
Adrenogenital syndrome, Precocity
Precocity of BA
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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

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Primary teeth

• 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.

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Abnormality of Dentition
Delayed eruption Hypothyroidism,idio
pathic Disorder Hypothyroidism, Brain
dysplasia Failing to erupt
Ectodermal dysplasia,Mechanical
blockage Abnormality of dental enamel
Ectodermal dysplasia
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Evaluation of growth

• Growth level
• Growth velocity
• Proportion

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Evaluation of growth

• Reliable and accurate data
• Single Value and series investigation
• reference

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Choosing reference
Reference, based on a North American
population by NCHS, USA, is recommended by the
WHO as the international standard of growth.
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Choosing reference
Besides,there are many local or national
references,for example, physical growth indices
of 9 cities in China.
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Methods of assessment

• Reference table
• Growth curve

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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

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Growth level
Every single measurement can be plotted on a
growth curve which illustrates the amount of
growth in children within different age group.
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Evaluation of growth

• mean standard deviation cut-off point x
  2SD
• percentilecut-off point P3--P97
• Z score Z score( x - x )SD
• Growth curve

-
-
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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
W/A P3-P25 W/A
-(1SD2SD)
X
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Growth velocity
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.
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Neuropsychological and Behavioral Development
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• Nervous system anatomically complete at birth
• except
• Myelination
• rapid for 2 years
• complete by 7 years
• Primitive reflexes disappear in few months

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The Babys Brain-Infant Vision Development
newborn
1 month
2 months
3 months
6 months
adult
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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.
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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.
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BEHAVIOR DEVELOPMENT Four Attributes
Gross motor Fine motor Language
Personalsocial skill  
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Fine Motor
Physical skills involving small body movements,
especially with the hands and fingers, such as
picking up a coin and drawing.
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Personal Social Skill
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Developmental Surveillance

• Periodic assessment of a childs developmental
  progress with the aim of detecting
  pre-symptomatic disability

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• Longitudinal and multidimensional developmental
  monitoring.
• Over-reliance on isolated developmental scales
  and tests should be avoided.

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• Screening tests Screening procedures should be
  brief, simple, cheap and reliable
• Diagnostic tests

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What do we look for in developmental screening?

• Normal growth pattern
• Height, weight, head circumference
• Achievement of developmental milestones(indicatin
  g neurological development)
• Gross motor function
• Fine motor function and vision
• Hearing and speech
• Social behaviour and play

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Screening tests

• Pediatric periodic health supervision
• Standardized developmental screening instruments
• Not diagnostic
• when abnormal, diagnostic evaluation should be
  done

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• DDST
• children under 6 yrs
• PPVT
• from 4 to 9yrs
• especially for children delayed in language

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Diagnostic tests

• Gesells test
• from 4 weeks to 3yrs
• Bayley from 2 to 30 months
• WPPSI from 4 to 6.5yrs
• WISC-R from 6-to 16yrs

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Thank You