Growth and Development Yang Fan Pediatric Department

1. Growth and Development Yang Fan Pediatric Department

2. 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.

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

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

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

6. 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.

7. Growth is a continuous and orderly PROCESS

8. height M F weight M F Age (y)

9. Not all tissue systems of the body grow at the same rate

11. 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

12. Factors Influencing Growth • Heredity • Nutrition • Gender • Disease • Environment • Hazards • Socioeconomic influences

13. 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

14. Indices of Growth Body weight (kg) • the weight of a person’s 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.

15. 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.

16. Birth weight 3 kg Mature baby’s weight gain at first month 1--1.5kg 3—12months weight=(month十9) /2 kg 1—6years weight= age × 2 十8 kg 7—12years weight= age× 7-5 / 2 kg

17. 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.

18. 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.

19. Height(cm) • The length from vertex to plantae • The index of long time nutritional status

20. 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.

21. Length/Stature < 3y Supine ---Length • ---Stature Stand ≥3y

22. at birth 50cm • 1 year old 75cm • 2 years old 85 cm • 2--12 years old=age × 6 + 77

23. 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.

24. 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.

25. Male 10y H88cm 10y GHD

26. 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. <3y Supine - Crown-rump length Sit ≥3y • Sitting • height

27. 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.

28. Changes in Overall Body Proportions

29. 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.

30. At birth 34 cm 1 year 46cm 2 years 48 cm 5 years 50cm 15 years 54cm (the same as adult)

31. 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.

32. chest circumference reprent the growth of thorax and lung at birth CC< HC 1- 2 cm 1 year CC= HC >1year CC － HC (cm) =age － 1

33. 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.

34. Girls usually showing their pubertal growth spurt around age 9~11. • For boys the same process begins at apx. age 11~13. • According to Tanner (1990), girls finish pubertal growth by about age 16 whereas boys continue to grow until approximately 18 years of age.

35. Sexual Precocity：Secondary sexual characteristics appear before puberty. Girls<8y，Boys<10y Delayed sexual maturity：Secondary sexual characteristics do not appear after puberty Girls>14y，Boys>16y

36. Cranial development

37. Fontanel/suture At birth Time of closure Anterior fontanel 1.5-2cm ≦18m Posterior fontanel 0.5-0.7 1-2m Cranial suture Smallest 3-4m Closure time of fontanel/suture

38. Abnormality of anterior fontanel Small size or early closure： Large size or delayed closure： Microcephaly Hydrocephalus, Cretinism

39. Abnormality of anterior fontanel Bulging fontanel： Sunken fontanel ： Intracranial hypertension( Encephalitis, Meningitis) Dehydration

40. Bone development • Osteite (center of ossification), which is located near ends of long bones (epiphyses), with growth plates. It is very important for bone’s growth in length.

41. The sequence of appearance of secondary centers

42. Bone age Bone age is that the age should beaccording to the osteite numberfor normal child. The most commonly used standards are those of Gruelich and Pyle, which require radiographs ofthe left hand and wrist; knee filmsare sometimes added for youngerchildren(usually less than 1 year old).

43. Abnormality of Bone Age Retardation of BA： • Hypothyoidism, Hypopituism • Adrenogenital syndrome, Precocity Precocity of BA：

44. Dentition • Primary teeth: • Primary teeth are 20 totally. • The first eruption is at about 6 months(4~10 months) . • The timing of tooth eruption is more variable than other developmental parameters

45. 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 2~2.5 years of age.

47. Abnormality of Dentition • Delayed eruption: • Hypothyroidism,idiopathic • Disorder :Hypothyroidism, Brain dysplasia • Failing to erupt : • Ectodermal dysplasia,Mechanical • blockage • Abnormality of dental enamel : • Ectodermal dysplasia

48. Evaluation of growth • Growth level • Growth velocity • Proportion

49. Evaluation of growth • Reliable and accurate data • Single Value and seriesinvestigation • reference

50. Choosing reference Reference, based on a North American population by NCHS, USA, is recommended by the WHO as the international standard of growth.