Dr Nishant Verma Assistant Professor - PowerPoint Presentation

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Dr Nishant VermaAssistant ProfessorDepartment of PediatricsKing George’s Medical University, Lucknow

Normal Growth

and

Development

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Definitions GrowthIncrease in size or massWt, Ht, HCDevelopment

Maturation of functions

Motor, Language, Vision, Hearing

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Growth

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Why is it important ?

Is my child normal ???

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Laws of Growth1. Growth is a continuous and orderly process

Ovum 0-14 days of gestation

Embryo 14d-9wk

Fetus 9wk-birth

Newborn 1

st

4wk of life

Infancy 1

st

year

Toddler 1-3yr

Preschool 3-6yr

School age 6-12yr

Adolescence 10-20yr

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Laws of GrowthGrowth pattern of every individual is uniqueOrder of growth is

cephalocaudal

and distal to proximal

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Laws of Growth3. Different tissues grow at different rates

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Factors affecting growth

Fetal Growth

Post natal Growth

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Fetal Growth

Maternal

Factors

Sex

Fetal Hormones

Placental

factors

Fetal Growth

Factors

Genetic

potential

Nutrition

Infections

Age

Built

Complications

T4, Insulin, GH,

Glucocorticoids

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Postnatal Growth

Social

Factors

Nutrition

Infections and

Diseases

Hormones

Sex

Genetic

potential

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Postnatal Growth

Social

Factors

Infections and

Diseases

Hormones

Nutrition

Sex

Genetic

potential

Parental Education

Cultural Factors

Emotional Factors

Poverty

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How to measure growth ?

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Anthropometric measuresWeightLength / HeightHead circumferenceChest circumference

Mid upper arm circumference

BMI

Others: Arm span, US:LS ratio

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WeightMinimum clothingDevice Birth wtDouble – 5moTriple – 1yr

Quadruple – 2yr

3 – 12 mo

(Age in mo + 9)/2

1 – 6 yr

2 (Age in yr) + 8

7– 12 yr

[7 (Age in yr ) -5]/2

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Length / HeightAge 0 -2 yr – lengthAge > 2yr – standing heightLength at birth ~ 50cm1yr ~ 75cm ; 2yr ~ 90cmDoubles

How to measure

2 – 12 yr

6 x(Age in yr) + 77

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Length / Height

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Head/Chest/MUA circumference

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How to interpret growth ?

4 yr boy

Weight – 10kg

Height – 85cm

Head circ – 48cm

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Growth Charts

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Growth Charts

4 yr boy

Weight – 10kg

Height – 85cm

Head circ – 48cm

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WHO Growth Charts (2006)Study in 6 countries: developed & developing, Upto 5 years

Wt for age, Ht for age, Wt for Ht, BMI, Head Circumference, mid arm, triceps,

subscapular

skin fold

Only on breast fed babies with no environmental constraints to growthCross sectional + longitudinal dataZ scores

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Z – scoresNormal distributionZ = (Observed value - mean) / SD

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How to differentiate acute from chronic malnutrition from growth chart ?

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Development

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Principles of DevelopmentDevelopment is continuous process

Sequence of development is same in all children, but rate of development varies

Generalised mass reflexes replaced by specific responses

Cephalocaudal

direction

Early primitive reflexes lost

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Domains of Development

Gross

Motor

Fine Motor

(Adaptive)

Vision

Social

Hearing

Language

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Gross motor milestonesVentral SuspensionNewborn – head flops down

4-12 wks – brings head to plane of body and then above plane of body

Pull to sit

Newborn – head lag

By 16-20 wks – head in plane of body or ahead with back straight

Prone:

Newborn – can turn head to 1 side

1

mth

– lifts chin momentarily

3

mths

– lifts head and upper chest

6

mths

–lifts head & chest5-8 mths – rolls over, first back to side and front

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Sitting: 5 mths – sits with support8

mths

– sits steadily with back straight, without support

10

mths – pulls from supine to sitting position

Standing:

4

mths

-Bears weight on legs

9

mths

– early stepping movements, pulls to standing with help of furniture

10

mths

– cruising

13 –15 mths – walks unsupported15 mths – walks sideways/backwardsClimbing stairs –

2 yrs – climbs stairs – 2 feet per step

3 yrs – climbs up stairs – one foot per step

4 yrs – climbs down one foot per step

Gross motor milestones

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Key Gross motor milestones3 mths – neck holding

5

mths

– sitting with support

8 mths – sitting without support9 mths –standing with support

10 months – cruising

12

mths

– standing without support

14

mths

– walking without support

18

mths

– running

24 mths – walking upstairs

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Fine Motor milestonesIncludes eye coordination, hand eye coordination, hand mouth coordination and manipulation with handsTested with red ring, pen torch, red cubes (2.5 cm), pellet, cup with handle, spoon, book with thick pages, red pencil/crayon, paper

Eye coordination

:

4 wks – regards torch/red ring kept at 20 cm in front

6 wks – follows object from side to side –unsteadily

2-3

mths

– follows with steady movements of eyes

Binocular vision by 3-6

mths

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Hand eye coordination:3 mths – Grasp reflex disappears4

mths

– tries to grasp red ring dangling in front but may overshoot

5

mths – reaches out & grasps object with ulnar side6 mths – immature

palmar

grasp,

transfers objects from hand to hand

9-12

mths

–

immature to mature pincer grasp

Fine Motor milestones

5

mo

6

mo

7

mo

9

mo

12

mo

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Scribbling:12-24 mths – scribbles2 yrs – copies vertical line

2 ½ yrs –copies horizontal line

3 yrs – circle

4 yrs – cross, rectangle

5 yrs – copies cross, triangleHandedness

Tower of cubes

Fine Motor milestones

Age

Tower

15mo

2

18mo

3

2yr

6; Imitates Train

2.5yr

8;

Imitates Train with chimney

3yr

9; Imitates Bridge

4yr

Imitates Gate

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Personal & Social Development1 mth - regards face of mother/caretaker

2

mth

- social smile

3 mths - recognizes mother/caretaker6 mths - enjoys mirror

7-8

mths

- separation anxiety

9

mths

- waves bye-bye

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LANGUAGE DEVELOPMENT1 mth - turns head towards sound

3-5

mths

-

vowel sounds, gurgles6 mths

-

monosyllables

9

mths

-

bisyllables

10

mths

- understands spoken speech

12

mths - speaks 2 words with meaning18 mths - 20 words24 mths - joins 2-3 words in a short sentence3 yrs - 250 words

BOWEL & BLADDER CONTROL

:

Early months -

gastrocolic

reflex



defecates after each feed

7

mths

- no relation to feeds

Toilet trainable by 18mths - 2 yrs

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Developmental Screening

Developmental Surveillance

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DEVELOPMENTAL SCREENING:Denver Development Screening Test: Most widely used

4 scales

125 items

Baroda Development Screening Test:

Adapted from Bayley scales for Indian childrenTrivandrum Development Screening Test

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