INTRODUCTION TO CHILD HEALTH DEVELOPMENTAL TERMINOLOGY

1. INTRODUCTION TO CHILD HEALTH DEVELOPMENTAL TERMINOLOGY Robyn Smith Department of Physiotherapy UFS 2012

2. After this lecture the learner should be able to: • Define important developmental terms • Explain weight/height/ head circumference for age ratios • Interpret child mortality statistics • Familiarise learner with Road to Health Chart

3. Working with babies and children in early intervention services we have to understand the relevant developmental terminology Enables us to accurately interpret important information in child’s history & medical records Helps us communicate effectively with interdisciplinary team & parents Helps us identify children potentially at risk of developing developmental difficulties Is the terminology relevant to physiotherapists?

4. Pregnancy • Period calculated from the first day of the woman’s last menstrual period • Period expressed in weeks • Normal duration is 38-42 weeks • 1st trimester: first 13 weeks • 2nd trimester: 14 to 26 weeks • 3rd trimester: 27 weeks to the birth of the foetus

5. Paediatrics • Healthcare services provided to the child from birth through adolescence • Prevention • Diagnosis • treatment • South Africa: Birth to the age of 13 years • Europe & USA : Birth through adolescence

6. Phases of Growth • Embryo conception end 8th wk • Foetus 9th week gestation until birth • Neonate 1st 28 days of life • Baby/infancy 1st year of life • Toddler 2nd year of life • Preschooler up until school going age (2-5 years) • Scholar from school going age (>6 years till school leaving age) • Adolescent after onset puberty (10-19 yrs)

7. Neonatal terminology Gestation • Term baby born between 38-42 weeks of pregnancy • Premature baby born <37 completed weeks of pregnancy • Post mature Baby born > 42 completed weeks of pregnancy

8. Neonatal terminology Birth Weight • NBW 2 500 – 4 000g • LBW <2 500g • VLBW <1 500g • ULBW <1 000g

9. Neonatal terminology Weight for gestation • SGA small for gestational age growth parameter below 10th percentile • AGA appropriate for gestational age Growth parameters between 10th and 90th percentile • LGA Large for gestational age Growth parameters above 90th percentile

10. Neonatal terminology Chronological age age in weeks or months from date of delivery Corrected age premature infants where the number of weeks born prematurely have been deducted from the chronological age

11. So when do we stop correcting age? Controversy still exists where between ages of 12/12 and 18/12 one should stop correcting for age Decide on an age for your clinic and be consequent in applying it in your assessments

12. Apgar Score • Scoring system developed by Dr. Virginia Apgar in 1960’s • This score /10 is used to evaluate the infant’s physical condition after birth –pulse, crying, respiration, HR, activity • Score is taken a 1 minute, 5 minutes and 10 minutes after birth.

13. Apgar Score

14. Hypoxic Ischaemic Encephalopathy (HIE) or neonatal asphyxia • Insult to the foetus or newborn due to a lack of oxygen (hypoxia) and/or perfusion (ischaemia) to various organs • Staged according to the Sarnat & Sarnat classification system: • grade I (mild) • Grade II (moderate) • Grade III (severe) Stage II and III are usually accompanied by convulsions and neurological dysfunctions Stage I associated with a normal outcome

15. Head circumference • Microcephalic Abnormally small head size in relation to the body e.g. brain atrophy • Macrocephalic Abnormally large head size in relation to body e.g. hydrocephalus Head circumference is measured with a tape measure around the broadest part of forehead Measured at developmental follow up and charted on a chart in relation to age. Good indicator of if the brain in growing appropriately for age

16. Head size in an infant...interesting fact Higher ratio to the head size versus rest of body weight Infant brain =30% total bodyweight Adult brain = 3 % total bodyweight

17. Head circumference

18. Weight and height terminology

19. Weight and height terminology Weight • Child’s weight in g or kg • used to evaluate physical growth • Reflects on immediate nutritional status of child • Underweight for age may indicate acute or more chronic nutritional problems

20. Weight and height terminology Length/Height • Child length in cm or m is measured • Length for age <3rd percentile child is considered to be stunted or of short stature • Stunted growth usually indicates a longer term and more chronic nutritional problem

21. Evaluation of Growth

22. Growth Charts • Normal distribution curve over a spectrum of ages for weight and height • Different charts for boys and girls • Charts differ for gender and age • WHO/ CDC 2000 charts available at most clinics or on the Road to Health charts carried mothers

23. Interpretation of growth charts • Health professionals must be able to interpret charts • Monitor growth and development over time • Trend over time more important single reading • Road to health card/ clinic card • Every month during first year and every six months during second year life • 50th percentile = 90 -100% of expected growth • Low values weight may indicate an acute or chronic problem • Low values for height for age indicates a chronic problem

26. Childhood statistics

27. Mortality rates • 33% of the South African population under age of 15 years • Investment in the health and wellbeing of the children of South Africa is an investment in the future development of our country • The mortality rates are a fundamental indicator of • child health in the country ,and • understanding the causes of death of children and identifying how the numbers can possibly be reduced

28. Mortality rates • Child health has been identified as a priority by the WHO and the national DOH. • Many childhood deaths are preventable .Therefore the reduction in childhood mortality, especially in children under age of 5 years has gained much priority in South Africa: • Improved maternal health and antenatal care provided to mothers • Better perinatal and neonatal care provided baby • Reduction in the transmission rate of HIV from mother to child • Reduction in the number of road traffic accidents and violent crime

29. Interpreting perinatal statistics • Liveborn infant : foetus over 500g, irrespective of gestational age born, who shows signs of life • Stillborn infant: foetus over 500g, irrespective of gestational age born, who shows no evidence of life

30. Interpreting perinatal statistics • Perinatal mortality rate: probability of a child (stillborn and live born) dying within the first seven days of life, per 1000 births. The perinatalperiod commences at 22 completed weeks of gestation and ends seven completed days after birth.(47/1000) • Neonatal mortality rate : probability of infants dying before age of 1 month, per 1000 live births (SA ranked 19); (21/1000) • Infant mortality rate: probability of children dying between birth and one year of age 1000 live births. (SA ranked 43) • Under-five mortality rate - Probability of dying between birth and exactly five years of age, per 1000 live births. (ranked 62); (57/1000) (UNICEF Statistics, 2011)

32. Top causes of death in children under age of 1 year in South Africa

33. Top causes of death in children under age of 5 years in South AfricaRate dropped from 60 to approximately 40 per 1000 children, the 10 top causes in order of priority are:

34. Top causes of death in children under age of 5 -14 years in South Africa

36. Road to Health Chart • Road to Health chart / Baby card is a card issued by ward or clinic service providers on first contact • Instrument that can be used by health professionals to monitor development • Card is kept by mother and she should carry it whenever attending any healthcare services

37. Road to Health Chart • This card provides information regarding: • Perinatal history (gestation, birth weight, length, Apgar Scores, method of delivery, mothers serology) • Growth & development aspects (growth charts) • Immunisations • Vitamin supplementation • Brief summary on illness & disease Mothers are to keep the child for as long as possible throughout childhood and into adulthood as contains valuable information

38. References • Images courtesy of GOOGLE (2011) • Growth and Development. In Coovadia, H.M. & Wittenberg, D.F. (eds) in Paediatrics and Child Health. A manual for health professionals in developing countries. 4th ed. Oxford city Press: Cape Town pp 21-40 • Van derVyver, A.E. Normal Growth in Paeditric doctors lectures for Physiotherapy students. (Unpublished) • Goldson, E. & Reynolds, A. Child development and Behaviour Hay, W.W.; Myron, J. L.; Sondheimer, J.M. & Deterding, R.R. (eds). In current diagnosis and treatment in Paediatrics. 18th ed. McGraw-Hill companies: NewYork pp65-101

39. References • Aubert, E.J. Motor development in the normal child in Pediatric Physical Therapy. Tecklin, J.S. (Eds) in Pediatric Physical Therapy. Lippincott, Williams & Wilkins. Baltimore pp17 -65 • Smith, R. 2009. Paediatric dictate, UFS (Unpublished) • Smith, R. 2009. Normal development (Class notes, Unpublished) • UNICEF/ Medical Reasearch Council of South Africa. Bradshaw, D; Bourne, D & Nannan, N. What are the leading causes of death in children in south Africa available online at; http://www.unicef.org/southafrica/SAF_publications_mrc.pdf • National Department of Health . 2011. Road to Health Chart • Tshabalala, MD. 2009. Introduction to child health. History and physical examination. University of Pretoria, Department of Physiotherapy