HUMAN GROWTH & DEVELOPMENT

1. HUMAN GROWTH & DEVELOPMENT

2. Introduction The process of human growth and development is a complex phenomenon. It is under the control of both genetic and environmental influences, which operate in such a way that, at specific times during the period of growth, one or the other may be the dominant influence. The concepts of growth and development are fundamental to the practice of nurses.

3. Throughout the period of child development, major milestones are accomplished. For each of these developmental periods, important aspects of care involving areas of nutrition, language, safety, and discipline must be addressed. Special areas involving communication, pain perception, and medication administration are essential for providing care for both mother and child.

4. Definitions Growth: an increase in number and size of cells as they divide and synthesize new protein result in increased size of the whole or any of its part. Development: Gradual maturation of organs and its functioning systems, maturation start from lower to more advanced stages of complexity.

5. Growth is an essential feature of a child and this distinguishes him or her from an adult. The process of growth starts from the time of conception of the fertilized ovum and continues until the child grows into a fully mature adult.

6. The two terms growth and development are often used together, they are not interchangeable because they represent two different aspects of dynamic of change, those of quantity and quality. Growth and development usually proceed concurrently; but not always interrelated.

7. Determinants of growth Genetic Influences: This refers to factors those are responsible for the characteristic and patterns of individual growth, certain anomalies and some of the familial diseases. • Phenotype: tall parents have tall children; the size of head is more closely related to that of parents than the size and shape of hand and feet. • Race: growth potential of children of different racial groups is variable.

8. Sex: puberty growth spot occurs earlier in girls but at full maturity their mean height and weight is less. • Hormonal factors: pituitary growth Hormone (GH) is directly related to growth. • Genetic disorders: growth and development are adversely affected by certain genetic disorders on two types:

9. Chromosomal abnormalities: several chromosomal defects manifested in sever growth disturbances as turner syndrome "45 chromosomes that one X chromosome is missed" or down syndrome "47 chromosome with trisomy 21". • Gene mutation: result in inherited disorder of growth i.e. Classic galactosemia(a genetic condition in which the body can't process a simple sugar called galactose caused by deficiency in the enzyme galactose -1-phosphate transferase)

10. Environmental Influences 1. Nutrition Fetuses those are belonged to undernourished and anemic mothers are usually small. The average infant birth weight born to mothers receiving nutrition supplement during pregnancy is higher than those of infant of malnourished mothers.

11. 2. Chemical agents Pregnant women who receive some drugs as thalidomide during the first trimester affect in differentiation of organs which are developing at that period thus resulting in birth defects (infants were born with phocomelia (malformation of the limbs). Androgen hormones initially accelerate the skeletal growth but epiphyses of bones close prematurely so bone growth stop early result of born of infant shorter than normal.

12. 3. Trauma Head injury may lead to brain damage. Fracture of the end of bone may damage the growing end thus retarded the skeletal growth.

13. 4. Infections Maternal infection as TORCH infection leads to congenital malformation of the fetus and the children growth retarded. Also infections and parasitic disease in children reduce the velocity of growth.

14. Social influences 1. Socioeconomic level Children of families with high socioeconomic level have better nutrition and hygienic condition so there is less infection and may have more security and emotional stability and so they have the chance to grow better than those of low socio economic status families.

15. 2. Natural resources Abundant natural resources, industrial and agricultural activity in the country, the raise in gross material product and per capita, income reflected in better nutrition and education of children in the community and so accelerate growth and development of children of those communities.

16. 3. Climate The velocity of growth may vary in different seasons and usually lighter in spring and lower in summer. Infection and parasitic infestations are common in hot humid climate. On the other hand, climates have a significant effect on agriculture productivity, availability of food and capacity for hand work of people.

17. 4. Cultural factors Methods of child rearing and infant feeding in the community are determined by cultural practices and traditions which influence the nutritional status and growth of the children.

18. 5. Parents and family • Parents have an influence affects in the growth and development of their children in extreme manner as the next: • Maternal age at infant birth. • Health status of mother in pre and post-natal period. • Number of family members and socioeconomic status. • Education of the parents and their temperaments. • Play and learning of the children in the family and community that learning and development are connect together as oxygen and hydrogen in water.

19. Importance of study of growth and development 1. Public health screening Assessment of growth and development is the most powerful tool for early identification of children who may not look obviously sick but has suboptimal health and nutrition or suffering from latent illness. Remedial measures undertake at this point of time are much more useful for prevention of diseases and promotion of their health.

20. 2. Indicator of general health and nutrition of the community Pooled data of growth and development of children in the community is an indirect indicator of health and nutrition status of the entire community, when it is compared with similar data collected simultaneously from other population subgroup.

21. 3. Evaluation of social action Effectiveness of medical or social measure for promotion health of the community can be evaluated by comparing the growth data before and after the remedial action is taken.

22. 4. Clinical aspects of practice Development history helps in determining retrospectively the time of onset of many diseases which are likely to affect the process of growth. Response to treatment in a sick child may be documented by observing its effect on the subsequent growth experiences of child.

23. Laws of growth and development There are definite and predictable pattern in growth and development that are continues, orderly and progressive. These patterns which referred also as trends or principles are universal and basic to all human beings that discussed as the next:

24. 1. Directional trends Growth and development proceed in regular related directions and reflect to the physical development and maturation of neuromuscular functions according to the following directions:

25. a. Cephalocaudal: head to tail direction that the head develops before the extremities that the children can control head before controlling of trunk and extremities, hold their back erect before they stand and use their eyes before hands. b. Proximal to distal trend: Direction of development starts from midline to peripheral, that children control shoulder before mastery of their hands and control hand before fingers.

26. c. Mass to specific: differentiation trend describe development from small operation to complex activities and functions from global to specific behavior. d. Sequential trends: In all dimensions of growth and development there is definite predictable sequence with each child normally passing through every stage. Infant creeps before stand and stands before walk. Infant babbles before form words that finally forming sentence.

27. 2. Growth pattern of every individual is unique The growth and development of every child is individualized but the general pattern of growth and development is predictable. 3. Infant grows and develops at different rates Different infant's tissue and organs are growing and mature at different rate during life span i.e. growth of male and female gonads begins to mature in the late childhood.

28. Assessment of Growth Assessment of infant‘s growth is crucial during different stages of life because periodic assessment of infants and children permits early detection of growth deficiencies and deviations from normal standards. During assessment the nurse should take the following points in his/her consideration:

29. Physical growth assessment is usually carried out using tables and charts. The measurements which are commonly done are weight, height, and head circumference. Newly chest circumference is done for newborns to assess fetal growth at birth.

30. There is wide range of normal variation among infants and children of the same chronological age. These normal differences are described in terms of percentiles. Comparison of the child percentile with those of the previous examination of the same child can detect abnormalities in his growth.

31. Assessment of Development Developmental pediatrics is referred to maturation of the structure and functioning of the organs from fetal viability to full growth. It's intimately related to the maturation of CNS. Developmental assessment includes 4 areas as the next:

32. 1. Gross motor: the normal acquisition of motor skill depends on: • Loss of primitive reflexes. • The development of postural control (Cephalocaudaldirection). • Increase ability to interpret the visual information as distance. • The development of movement pattern which are adjustable to environmental circumstances.

33. 2. Fine motor and vision • Integration of visual input and motor output is necessary for development of accurate manipulative skills. • Manipulative skills start from crude palm grasp and gradually developed till fine pincer grasp that reached at 12 months old.

34. 3. Speech and hearing • Speech, as a system of communication is an essential future of human life. Nurse should assess preferences of the baby for some human voices and face as parent.

35. 4. Personal-social • Include assessment of child social reaction to other persons. Even neonates are socially active as they are able to elicit attention of their parents. • During the second half of the first year, the baby starts to recognize the familiar adults and develop strong attachment to her/his care giver.

36. Assessment of maturity • Maturity is continuous process through life Can be assessed by three aspects: • 1-sexual maturity can be assessed by development of secondary sex characters. • 2-skeletal maturity is assessed by radiograph of wrist and is recorded as bone age (years) range from birth -18 yrs. • Dental maturation is assessed by panorama of mandible and maxilla and scoring the stage of maturation of each tooth.

37. Catch-up growth Unusual acceleration of growth which follow recovery from acute illness. it is complete if the growth data for the child return to child‘s original percentile before deficit occur . Is not always complete ,however it appear to depend on the timing ,severity and duration. More common in infant but may be delayed. Can occur in Wt at any age until the time of epiphyseal fusion and head circumference until the suture of cranial vault interlock at 5 year

38. Growth velocity chart GV chart is used to assess a child ‘s growth over several period of time. Calculate child growth rate by recording his /her height at 2 points in time that are at least 150 day apart then compare it with normal growth rate of children at the same age and sex.

39. Growth chart Are the primary tool for recognition of unusual growth . Some of these charts were developed from nationally representative sample to obtain estimates for the total population The curve are usually for 3rd,5th,10th,25th,50th,75th,90th.95th, and the 97th,percentile.

40. Children whose measurement fall within the 5th, and 95th,are considered normal growth range. Sudden or sustained change in percentile indicate chronic disorder, emotionally difficulty or nutritional intake problem. These findings require further assessment of the physical status of the child such as dietary intake or serum laboratory studies.

41. Growth disorder 1-Intra uterine growth restriction (IUGR) Referred to fetal growth has been constrained . It is defined as birth weight less than the 10th, percentile for weight for gestational age curve small for gestational age ,commonly synonymous to IUGR It is compared by matching infant birth weight to his/her gestational age based on WHO fetal growth standard chart.

42. 2. Failure to thrive Descriptive non specific term . Include :malaise ,weight loss, poor self care that can be seen in older children. The most common definition is weight less than the 3rd,to 5th, percentile for age on more than one occasion . Or weight measures that fall 2 major percentile lines using the standard growth charts.

43. 3. Kwashiorkor deficiency of protein with low or inadequate supply of calories . Occur between 1-4 years of age when infant weaned from breast once the second child is born.

45. 4. Marasmus • Is a condition primarily caused by deficiency in calories and energy . • marasmus is a form of severe protein energy malnutrition characterized by energy deficit. • Child looks emaciated ,body weight may reduced less than 80 %of the average weight that correspond to the height. • Occurrences increase prior to age 1 year where as kwashiorkor after than 18 months. • Prognosis is better than for kwashiorkor .

47. 5. Dwarfism Generally refers to a group of genetic disorder characterized by shorter than normal skeletal growth(an adult height of less than 147 cm) Majority of children with this condition have average sized parents

48. Primitive reflexes Most of newborn‘s physical behavior appear to be reflexive in nature. These reflexes disappear as their nervous system become mature. Then they are replaced by more voluntary , coordinated movement. Absence or persistence of the early reflexes is used to evaluate the health and maturation of nervous system.

49. Moro reflex • Response of loud noise ,causing body to stiffen and arm to go up and out then forward and toward each other thumb and index finger will assume C –shape. • Present at birth and disappear at 3-6 months of age. • Absent in brain damaged babies ,depressed babies due to narcotics at birth . • Assymetrical reflex in fracture of clavicle or humerus or brachial palsy and shoulder dislocation. • Persistent reflex in C.P.