GROWTH AND DEVELOPMENT OF THE CHILDREN

1. Ministry of Health Republic of Tajikistan GROWTH AND DEVELOPMENT OF THE CHILDREN SodikovNaimzhon MD

2. PEDIATRICS • The word paediatrics and its cognates mean healer of children; they derive from two Greek words: παῖς (pais = child) and ἰατρός (iatros = doctor or healer). "Pediatrics is concerned with the health of infants, children and adolescents, their growth and development, and their opportunity to achieve full potential as adults." (Richard E.Behrman in Nelson's Textbook of Pediatrics)

3. PROPEDEUTIC OF CHILDREN DISEASE • Propaedeutics or propedeutics is a historical term for an introductory course into a discipline: art, science, etc. Etymology: pro- + Greek: paideutikós, "pertaining to teaching". • Propaedeutics may be defined as knowledge necessary for learning, but not for proficiency.[1] • In medicine, the terms "propedeutics"/"propedeutic" specifically refers to preliminary collection of data about patient by observation, palpation, temperature measurement, etc., without specialized diagnostic procedures.

4. Aim of lecture • To know the periods of childhood; • To know the patterns of child development; • To know importance of genetic and hereditary factors in the pathology of childhood; • To know especially the age of Pathology. • To learn how to measure height, weight, head and chest circumference of the child.

5. Periods in a child's development

7. Prenatal (intrauternie) period • Human prenatal development is divided into an embryonic period and a fetal period. The embryonic period begins with fertilization and ends eight weeks later. The fetal period begins in eight weeks after fertilization and ends at birth. Thus it includes the end of the first trimester, and the whole of the second and third trimesters. During this time, the fetus grows from about 3 grams to more than 3 kilograms on average, and the organs that appeared in the preceding embryonic period develop further, structurally and functionally.

8. Fertilization

9. Teratogenic agents

10. Prenatal period

12. CONGINETAL MALFORMATIONS

13. Neonatal period Neonatal period defines the first 4 weeks of life after birth. It divides to : • early neonatal period (from birth to 7 days) – totally 168 hours. This period is the most responsible for the child’s adaptation to extrauterine existence. • Late neonatal period (from 8 days to 28 days) - The most important characteristic of this stage are the intensive development of analyzers (primarily visual), the beginning of the development of motor coordination, the formation of conditioned reflexes, the occurrence of emotional, visual and tactile contact with the mother.

14. Apgar score The test is generally done at one and five minutes after birth, and may be repeated later if the score is and remains low. Scores 3 and below are generally regarded as critically low, 4 to 6 fairly low, and 7 to 10 generally normal. A low score on the one-minute test may show that the neonate requires medical attentionbut is not necessarily an indication that there will be long-term problems, particularly if there is an improvement by the stage of the five-minute test. If the Apgar score remains below 3 at later times such as 10, 15, or 30 minutes, there is a risk that the child will suffer longer-term neurological damage. There is also a small but significant increase of the risk of cerebral palsy. However, the purpose of the Apgar test is to determine quickly whether a newborn needs immediate medical care; it was not designed to make long-term predictions on a child's health.

15. Apgar score

16. The main physiologic features of neonates (newborns) • Sign of maturity • Transient state • Appearance of pulmonary respiration • Appearance of enteral nutrition • Features of physical development • Features of thermoregulation • Composition of urine and frequency of urination • Physiologic features of blood

17. Infancy • It lasts from the 29th day of life to a year. • During this period, the main stages of adaptation to extrauterine life has been completed, the mechanism of breastfeeding enough formed, there is a very intense physical, the mental, motor and intellectual development of children.

18. Toddlerhood • period – form 1 up to 3 years. It is characterized by some reduction in the rate of physical development of children and a greater degree of maturity of the basic physiological systems. • Intensively increases muscle mass, end eruption of milk teeth, rapidly increasing motor capabilities, intensive development all analyzers, improved speech, clearly defined personality traits and behaviors.

19. The main physiologic features of toddlers • Characterization of physical development • Features of particular frequency, rate and type of breathing • Physiologic features of gastrointestinal tract (GIT) • Physiologic features of blood • Loss of passive immunity

20. Preschooler • Period - from 3 to 7 years. During this period rapidly developing intelligence, improved memory, improved coordinated movement, formed individual interests and hobbies, the length of the limb gradually, fall baby teeth and begin to grow the permanent teeth.

21. Primary school age • At this age children is constant replacement of deciduous teeth, improves memory, increases intelligence, independence and formed endurance and stamina, increasing range of interests.

22. Secondary school age • This is the most difficult period of psychological development, the formation of the will, conscience, citizenship, and morality. This period is characterized by an abrupt change in the function of the endocrine glands. This is the period of pubertal development and pubertal growth spurt.

24. PHYSICAL DEVELOPMENT OF CHILDREN

25. Physical development - dynamic process of growth and biological maturation of the child at different periods of childhood. • The main criteria of physical development in children are: • weight • height • head circumference • chest circumference • proportion of these indicators

26. Rules for the measurement of body weight • Child up to 6 months is placed on the special children’s scale in the supine position.

27. Rules for the measurement of body weight • Baby older than 6-7 months may be measured on the same scale in a sitting position. • Child after a year in the measurement of body weight to be in a standing position.

28. Neonatal (Newborn) Weight Loss • A weight loss of 5% in the first week of life is considered normal for the bottle fed infant. A loss of 7% is average in the first week for the breastfed infant, 10% is the absolute maximum (Lawrence and Lawrence 397-398).

29. Why Do Babies Lose Weight? • There are several theories about why neonates lose weight. The most common theory is that babies are born with extra weight to help with the stress caused by labor and the transition to extrauterine life. Also the extra fat stores are there because mother's mature milk does not come in for 3-5 days.

30. The pattern of weight gain in infants

31. Weight gain in premature babies

32. 1 - weight of children between 0 and 6 months2 - weight of children between 6 and 12 months 1) - weight of birth + 800 gr. x n = n – number of months of first 6 months 2) (800 x 6) + 400 x (n-6) = n – number of months

33. Weight of children btw Age and 10 years 10,5 (average body weight of the child 1 year) + 2 x n = n – years of age Example: • Child - 3 years old. Mom says that body weight at 1 year was 11 kg. So: 11+2x3= 17 kg.

34. Weight of children upper 10 years • After 10 years annual of weight gain in body is 4 kg. Example: Childe 13 years old. 10,5+2x10+4x3= 42,5 kg.

35. Height of children • Height - the equipment must be regularly calibrated and maintained. In children over 2 years of age, the standing height is measured as illustrated (pic.a). In children under 2 years, length is measured lying horizontally (pic.b), using the mother to assist. Accurate length measurement in infants can be difficult to obtain, as the legs need to be held straight and infants often dislike being held still. For this reason, routine measurement of length in infancy is often omitted from child surveillance, but it should always be performed whenever there is doubt about an infant's growth.

38. The pattern of length gain in infants

39. Head circumference Head circumference is generally measured on infants and children until age three years.Head circumference or OFC [occipital frontal circumference] is measured over the most prominent part on the back of the head (occiput) and just above the eyebrows (supraorbital ridges). This can be translated to mean the largest circumference of the head.

40. Head circumference

41. Head and chest circumference

42. Chest circumference • Circumference of the chest in infants measures in lying position, in older children - standing. The child must be in a state of rest, arms down. Beginning of tape should be located in the left hand of the underarms, back strip is held at an angle of the shoulder blades, and in front - at the lower edge of the areola. • Measure the circumference of the chest of the child is carried on inhalation and exhalation.

43. Calculate the circumference of the chest may be as follows: • for children up to 6 months. - 45 - 2 (6 - n) • from 6 to 12 months. - 45 + 0,5 (n - 6) n - the child’s age in months • from 1 year to 10 years - 63 - 1.5 (10 - n) • 10 years and older - 63 + 3 (n - 10) n - the child’s age in years

44. Abdomen circumference • Abdomen circumference measured at the level of navel.

46. Disorders • Hypotrophy (malnutrition) (Gr. - υποτροφια, Lat. Hypotrophia) – nutritional disorder characterized by varying degrees of deficit in body weight. • Distinguish congenital (prenatal) and acquired (postnatal)hypotrophy. • In hypotrophy I degree thick subcutaneous fat is reduced in all areas of the body except the face. The first thinning on the abdomen. Mass deficit of 11-20%. • In the II degree of hypotrophy weight loss is 25-30%. Subcutaneous layer remains only on the face, especially thinned it on abdomen and legs. • In hypotrophy III level weight loss is more than 30%. Externally - extreme exhaustion, skin a pale gray color, is completely absent subcutaneous fat layer

48. Marasmus and Kwashiorkor • Severe protein-energy malnutrition in children usually leads to marasmus, with a weight less than 60% of the mean for age, and a wasted, wizened appearance. Skinfold thickness and mid-arm circumference are markedly reduced, and affected children are often withdrawn and apathetic. • Kwashiorkor is another manifestation of severe protein malnutrition, in which body weight is 60-80% of expected and generalisedoedema is present.

50. Paratrophia • Paratrophia - the result of chronic violations of feeding infants, which is characterized by an increase in body weight compared with normative data for 10% or more. • Paratrophia classified to: I level - 11-20%; II level - 21-30%; III level - 31% or more. • The reason may be exogenous and endogenous factors: inappropriate feeding of the child, often artificial feeding, constitutional disposition, metabolism disorders (rapid absorption and assimilation of fats and carbohydrates in the gastrointestinal tract).