Dr Abeer Abuzied Atta Al Mannan 2013

1. Growth & Development Dr AbeerAbuzied Atta Al Mannan 2013

2. 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

3. 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.

4. 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.

5. 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.

6. Factor influencing growth and development • 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

7. In general factor influencing growth and development can be classified into: • Heredity and genetic factors • Environmental factors

8. 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 . • Parental traits are transmitted to the offspring. • 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

9. Characteristics of the parents: • Parents of high IQ having children of the same and vice versa. (further enhanced by environmental stimulation)

10. Race: • Growth potential; of children of different racial groups is different • E.g. African ,American ,Asian

11. 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.

12. Bio-rythym and Maturation • Daughters attaining menarche at similar age as their mothers. • Similar length of menstrual cycle.

13. Genetic Disorders: 1. Chromosomal abnormalities • E.g. Turner syndrome, down syndrome 2. Gene mutations • E.g. metabolic defects like galactosemia, • mucopolysaccharidosis

14. Environmental factors • Physical surroundings (sunshine hygiene, living standards) • Social factors (relation with other family members, teachers, friends.. etc)

15. 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 like rubella, toxoplasmosis, syphilis, herpes) • Rh incompatibility, smoking , alcohol and intake of certain drugs

16. 2- Postnatal environment • These determines the pace and pattern of growth and development • Nutrition • Infections & infestations • Trauma • socio - economic level • Climate • Cultural factors • Emotional factors • Chronic diseases • Ordinal position in the family. • Growth potentials.

17. 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 Stages of Growth and Development

18. Growth Patterns • The child’s pattern of growth is in a head-to-toe direction, or cephalocaudal, and in an inward to outward pattern called proximodistal.

19. Growth Pattern:

20. 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)

21. 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

22. Assessment of Physical growth • Weight –for- age • Height(length)-for- Age • Weight –for-height • Head and chest circumference

23. Weighing Scaler( spring Balance)

24. Measuring Head Circumference:

25. Measuring mid upper arm circumference

26. Measuring length

27. 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

28. 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

29. Normal Development Milestones

30. Factors that promote Development : • good nutrition, • emotional support, • play and • language training

31. 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

32. The growth chart

33. 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

34. Upward growth curve

35. A static Growth Curve

36. Downward growth curve

37. Uses of the growth chart: • Growth monitoring diagnostic tool • Planning and policy making • Educational tool • Tool for action • Evaluation • Tool for teaching.

38. Alternative methods of growth monitoring : • Height- for- age • Weight –for height • Arm circumference (the last two are useful when age is not known )

39. 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

40. ThanK You