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خدایا: چه دارد آن که تو را ندارد و چه ندارد آن که تو را دارد. (امام حسین ع)

رشد طبیعی در کودکان M.JARI.MD. خدایا: چه دارد آن که تو را ندارد و چه ندارد آن که تو را دارد. (امام حسین ع). اهمیت ارزیابی رشد. 1-ارجاع کودک توسط سطوح 1و2 1-ارجاع کودک توسط والدین 3-همراهی اختلالات وبیماریهای جسمی با رشد غیر طبیعی 4-همراهی اختلالات وبیماریهای روحی روانی با رشد غیر طبیعی

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خدایا: چه دارد آن که تو را ندارد و چه ندارد آن که تو را دارد. (امام حسین ع)

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  1. رشد طبیعی در کودکان M.JARI.MD خدایا:چه دارد آن که تو را ندارد و چه ندارد آن که تو را دارد.(امام حسین ع)

  2. اهمیت ارزیابی رشد 1-ارجاع کودک توسط سطوح 1و2 1-ارجاع کودک توسط والدین 3-همراهی اختلالات وبیماریهای جسمی با رشد غیر طبیعی 4-همراهی اختلالات وبیماریهای روحی روانی با رشد غیر طبیعی 5-......

  3. Growth: Increase of physical parameter: Weight Length(height) Head circumference(HC) )Bone age-Us/Ls ratio-…)

  4. Normal Growth: 1-Adequate caloric intake 2-Adequate caloric absorption 3-Excessive caloric intake

  5. Weight: B Birth W=2500-3500 gr Age=10-14 days: w=birth w Age=1-2 mo w= birth w+(days-10)×(20-30 gr) مثال: شیرخوار40 روزه باوزن تولد3000 : وزن مطلوب=3000+(30×20-30)=3600-3900 gr

  6. Weight: Age=3-4 mo w= birth w+(50×20-30 gr) +(days×15-20 gr) :مثال: شیرخوار100 روزه باوزن تولد4000 وزن مطلوب=4000+(50×20-30)+40×(15-20)=5600-6300 gr W gain in 5-12 mo =10-15 gr daily

  7. Weight: Age=5-6 mo: W=BW×2 Age=12 mo: W=BW×3 Age=24 mo: W=BW×4

  8. Weight: 3-12 mo: W=[age(mo)+9]/2 1-6 yr: W=[age(yr)×2]+8 7-12yr: W=[age(yr)×7]-5/2

  9. Height: New born : B L=48-50 cm Age=1-12 mo L=BL+[age(mo)×2] cm مثال:شیرخوار9 ماهه با قد تولد50 : قد مطلوب=50+(9×2)=68 cm Age=13-24 mo L=75+ [ (mo)×1] cm :مثال:شیرخوار20 ماهه با قد تولد 50 قد مطلوب =75+(8×1)=83 cm Age=24-36 mo H=87+ [ (mo)×0/5] cm Age=36-48 mo H=93+ [ (mo)×0/5] cm

  10. Height BL~50 1 yr : L~75 2 yr : L~87 3 yr : H~93 4 yr : H~100(=BL×2) 2-12 yr H=[age(yr)×6]+77 cm

  11. Head circumference At birth : B HC=33-36 cm 1-3 mo HC=BHC+(age×2) cm (6) :مثال:شیرخوار2ماهه با دور سر تولد35 HCمطلوب=35+(2×2)=39cm 4-6mo HC=BHC+6+(mo×1) cm (3) :مثال:شیرخوار5ماهه با دور سر تولد34 HCمطلوب=34+6+(2×1)=42cm 7-12mo HC=BHC+9+(mo×0/5) cm (3) Age=1 yr HC=BHC+12 cm (~48-50)

  12. Growth assesment • Weight for age curve • Height for age curve • HC for age curve • Weight for Height curve • BMI curve

  13. F T T : Statistics and Risk Factors: • § FTT accounts for 15% of all pediatric hospital admissions • § Most common cause is under nutrition • § Socioeconomic risk: • Increased incidence with urban and rural areas of poverty • Risk factors of poverty include: poor knowledge of infant/child nutrition, financial hardship, and social problems/stressors

  14. Risk factors: § Maternal risk: Children of mothers <18y have shown poorer growth in the 1 st year of life § Abuse and neglect risk: 5-10%of FTT were registered for abuse FTT children are four times more likely to be abused than controls

  15. Definition: There is vast heterogeneity of definitions/parameters for failure to thrive. Most literature accepts any of the following three parameters: 1. Weight less than the 3 rd or 5 th percentiles on more than one occasion 2.weight –for height less than 80% ideal 3. Weight that crosses two percentile lines 4. Weight less than 60% Ideal Body Weight for age However, studies have shown that there is no one anthropometric definition

  16. 1. Inadequate Caloric Intake: a. Anatomic – cleft palate, choanalatresia, micrognathia b. Feeding issues – breastfeeding problems, poor technique, improper formula preparation, poor 612mo transition to solids, parental restriction due to health concerns, poor knowledge of nutrition c. Psychosocial – poor mother infant bonding, child neglect/abuse, emotional deprivation, maternal mental health d. Neurologic – noromotor control, hypotonia, lack of suck coordination, hydrocephalus

  17. 2. Inadequate Caloric Absorption: a. Emesis – GERD, GI obstruction, drugs, food insensitivity, metabolic disorders b. Mal absorption – chronic diarrhea, celiac disease, giardiasis, cystic fibrosis, food insensitivity, proteinlosing enteropathy, excessive juice intake

  18. 3. Excessive Caloric Expenditure: a. Congenital and acquired heart disease b. Chronic hypoxemia or pulmonary disease c. Hyperthyroidism d. Metabolic disorders e. Immun0deficiencies f. Recurrent infection Other underlying etiologies include increased lead

  19. Interventional Approach: All evaluations begin with a thorough history including: § Feeding History § Developmental History § Psychosocial History § Family History § Prenatal/Birth History

  20. Hospitalization is indicated if: § Abuse or neglect is suspected § Caretaker is impaired § Severe malnutrition is present § Patient is refractory to outpatient management

  21. Thank you

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