Growth and development assessment in children

Engidaw Ambelu

1. GROWTH AND DEVELOPMENT ASSESSMENT IN CHILDREN For Anesthesia 2 nd yr Yordanos Girma (MD) April 18,2018 18-Apr-18 1

2. Outline O bjective s I ntroduction Principles of growth and development Growth and d evelopment assessment for each age group 18-Apr-18 2

3. Objectives By the end of this session, we are expected to: Define growth and development Identify the significances of knowing age expected growth and development . Mention the principles of growth and development. List factors affecting growth and development. Mention types of growth and development. Describe the stages of development. Be able to do developmental and growth assessment. 18-Apr-18 3

4. Growth Growth refers to an increase in physical size of the whole body or any of its parts. It is simply a quantitative change in the child’s body. It can be measured in Kg, pounds, meters, inches, ….. etc 18-Apr-18 4

5. Development Development refers to a progressive increase in skill and capacity of function. It is a qualitative change in the child’s functioning. It can be measured through observation. 18-Apr-18 5

6. Importance of Growth and Development Assessment Knowing what to expect of a particular child at any given age. Gaining better understanding of the reasons behind illnesses. Helping in formulating the plan of care. Helping in parents ’ education in order to achieve optimal growth & development at each stage . 18-Apr-18 6

7. Principles of Growth & Development Continuous process Predictable Sequence Don ’ t progress at the same rate Not all body parts grow in the same rate at the same time. Each child grows in his/her own unique way. Each stage of growth and development is affected by the preceding types of development. 18-Apr-18 7

8. Cont…… 18-Apr-18 8

9. Determinants of Growth and Development Biologic influences a. Genetic b. Intelligence c. Pre & postnatal conditions d. Sex – girls tend to learn to walk speak & acquire sphincter control early and boys heavier and longer e. Hormonal influences f. Temperament 18-Apr-18 9

10. Cont…. II. Psychologic influences a. Bonding b. Attachment III . Social & environmental factors a. Familial conditions b. Order of birth c. Handicaps – deafness, blindness, illnesses d. Mothering e. Environment 18-Apr-18 10

11. Periods of growth and development Embryo 0-8 weeks Fetus 9 wk – birth Neonate birth – 28 days Infant birth – 12 month Toddler 1-2 yrs Pre school 2-5 yrs School age 6-10yrs Adolescence 10-18 yrs 18-Apr-18 11

12. Types of growth and development Types of growth: - Physical growth (Ht, Wt, head & chest circumference) - Physiological growth (vital signs … ) Types of development: - Motor development - Cognitive development - Social and Emotional development - Language development 18-Apr-18 12

13. Growth assessment Growth in children is usually steady and predictable, and good references are available for assessment and comparison. Growth is a key component of nutritional status and indicator of health and well-being for the individual. The most powerful tool in growth assessment is the growth chart Selecting the correct growth chart for sex, age is essential to the assessment. 18-Apr-18 13

14. Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics ( NCHS) Growth curves. Weight-for-age Length/height-for-age Weight-for-length/height BMI 18-Apr-18 14

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17. Normal vital signs according to age 18-Apr-18 17 Age Heart rate (beats\min) Respiratory rate (breaths/min) Blood pressure(mmHg) Birth-28 days 100-160 30-60 60-80/40-50 1-12 months 110-150 35-45 60-100/40-60 1-3 year 70-110 20-30 90-105/55-70 3-6 year 65-110 20-25 95-110/60-75 6-12 years 60-95 14-22 100-120/60-75 12+ years 55-85 12-18 110-135/65-85

18. Development Motor development Gross motor Fine Motor the child's ability to control - level of coordination of the different parts of the body different body parts - require normal neurological - G overned by large cerebral area & usually not affected in nutritional disorders. development as well as adequate muscle mass and tone . . 18-Apr-18 18

19. Cont…. Important domains of fine motor development inorder of maturity include i ) Eye coordination e.g. visual fixation ii) Eye-hand coordination e.g. reaching- out for objects iii) Hand coordination e.g. grasp maturity iv) Hand-hand coordination e.g. transfer of objects v) Hand-mouth coordination e.g. feeding himself. 18-Apr-18 19

20. Cognitive development Cognitive development is the foundation of intelligence. Intelligence as the ability to learn or understand or to deal with new situations. The foundational aspects of cognitive development include memory representational competence attention processing speed Successful cognitive development requires progress in all these domains. 18-Apr-18 20

21. Cont… The assessment of infant and child intelligence depends on progression through two developmental domains: problem-solving and language Problem-solving involves the manipulation of objects to achieve a specific goal. Language - broad concept that involves the representation of thoughts and ideas using culturally agreed upon arbitrary signals for the exchange of ideas. 18-Apr-18 21

22. Cont….. Language skills are the single best indication of intellectual ability, and evidence exists that early language skills are related to later reading skills. Expressive language – The ability to produce or use language. - Guttural, prelinguistic , and linguistic Receptive language   – The ability to understand language. Speech – is a manifestation of language that uses decodable vocal sounds as the medium of exchange. 18-Apr-18 22

23. Social and Emotional development The infant is surrounded by a social network. Sensory processing is influenced by the infant’s social needs. Social milestones begin with bonding, which reflects the feeling of the caregiver for the child. Attachment takes place within a few months and represents the feeling of the infant for the caregiver. Coinciding with the development of social skills is a child’s emotional development Emotion has three elements: neural processes, mental processes (feelings), and motor expression (facial, verbal)  18-Apr-18 23

24. 0-2 months Physical growth Average birth weight = 3.4kg Average length = 50cm Average head circumference= 35cm weight may initially decrease 10% below birth weight in the 1st wk Infants regain or exceed birth weight by 2 wk of age and should grow at approximately 30 g/day during the 1st mo This is the period of fastest postnatal growth 18-Apr-18 24

25. Cont…. Physiological growth Respiration – The prime need of the new born Circulation - Pulmonary vascular resistance falls & peripheral vascular resistance increases - The existing right to left should be reversed - Transition from fetal to adult type of circulation - Normally new born hearts beats 120- 160 min. Hematology - High hemoglobin level 17 -19 gm/dl - Life span of RBCS is short - High leukocyte count 18-Apr-18 25

26. Cont… 3. Language & social - Cries - Protrudes tongue - Hearing is well developed & prefers high pitched sound - Near sighted - Spontaneous smile 4. Cognitive/ Behavioral development - Regards on face 18-Apr-18 26

27. Infancy 1. Physical growth Weight Birth weight doubles by 5 th mn and triples by11-12mn Weight 3-12mn= age in mn + 9 2 Length increase by 25 = 75 cm at 12mn Head circumference = increase by 12cm in 1 st yr increase by 2cm/ mn in 1 st 3mn increase by 1cm/ mn 3-6mn increase by o.5cm/ mn 6-12mn 18-Apr-18 27

28. Cont….. 2. Dentition starts at age 5-6mn no teeth at age 4mn then erupts 4 teeth every 4 month till 20 teeth. milk/ temporary/ deciduous teeth 18-Apr-18 28

29. Cont… 3. Motor development Gross motor At 2 months Hold head erects in mid-position Turn from side back At 3 months Hold head erects and steady Open or close hand loosely Hold object put in hand 18-Apr-18 29

30. Cont….. 4 months Sit with adequate support Roll over from front to back Hold head erect and steady while in sitting position Bring hands together in midline and plays with fingers Grasp objects with both hands 18-Apr-18 30

31. Cont….. 5 months Balance head well when sitting Sit with slight support Pull feet up to mouth when supine Grasp objects with whole hand (Rt. or Lt.) Hold one object while looking at another 18-Apr-18 31

32. Cont…. At 6 months Sit alone briefly Turn completely over(abdomen to abdomen) Lift chest and upper abdomen when prone Hold own bottle 18-Apr-18 32

33. Cont…. 7 months Sit alone Hold cup Imitate simple acts of others 8 months Sit alone steadily Drink from cup with assistance Eat finger food that can be held in one hand 18-Apr-18 33

34. Cont….. 9 months Rise to sitting position alone Crawl (i.e., pull body while in prone position) Hold one bottle with good hand-mouth coordination 10 months Creep well (use hands and legs) Walk but with help Bring the hands together 18-Apr-18 34

35. Cont….. 11 months Walk holding on furniture Stand erect with minimal support 12 months Stand-alone for variable length of time Sit down from standing position alone Walk in few steps with help or alone (hands held at shoulder height for balance) Pick up small bits of food and transfers them to his mouth 18-Apr-18 35

36. Cont…… Fine motor - 6-7 mn Transfers object from one hand to the other - 9-10 mn pincer grasp 18-Apr-18 36

37. Cont…… 4. Language 1-2 months: coos 2-6 months: laughs and squeals 8-9 months babbles: mama/dada as sounds 10-12 months: “mama/dada specific 5. Social development He learns that crying brings attention The infant smiles in response to smile of others 7mn shows fear of stranger (stranger anxiety). He responds socially to his name 18-Apr-18 37

38. Toddler Physical growth During this period, growth slows considerably Physical growth Weight for age > 1yr Weight= (age in yrs X 2)+8 Height – increases by 1cm/ mn (Age in yrs X 5) +80 Head circumference increases 10cm from 1yr till adulthood HC increases 2cm from 1 st -2 nd year 18-Apr-18 38

39. Cont……. Neurodevelopment growth Gross motor 15 months Walk alone Creep upstairs Assume standing position without falling 18 months Runs stiffly, walks up stairs with one hand held 24 months Runs well, walks up and down stairs, one step at a time, jumps 18-Apr-18 39

40. Cont….. Fine motor 15mn- Hold a cup with all fingers grasped around it scribble 18mn- Hold cup with both hands Transfer objects hand-to hand at will 24mn -Can hold a crayon and color vertical strokes -Turn the page of a book -Build a tower of six blocks 18-Apr-18 40

41. Cont…… Adaptive/cognitive 15 mn Makes tower of 3 cubes 18mn Makes tower of 4 cubes, imitates scribbling, imitates vertical stroke 24mn Makes tower of 7 cubes, scribbles in circular pattern, imitates horizontal stroke 18-Apr-18 41

42. Cont…… Social development 15mn hugs parents 18mn Feeds self 24mn Handles spoon well, helps to undress 18-Apr-18 42

43. Cont……. 5. Language 15 mn follows simple commands, may name a familiar object, responds to name 18mn 10 words (average), names pictures, identifies one or more parts of body 24mn Puts 3 words together (subject, verb, object) 18-Apr-18 43

44. Preschool stage Physical growth Weight: - 2 kg per year, Wt gain in the age 2-5 yrs 1-6 yr= (age in yr x 2)+ 8 Linear growth: - height  by 6-7 cm per year Brain growth: HC increases by 1-2 cm per year Dental development: - all 20 1 tooth erupted by the age 3 yr 18-Apr-18 44

45. Cont…… 2. Neurodevelopment Gross motor: 30mn Goes up stairs alternating feet 3 yr Rides tricycle, stands momentarily on one foot 4yr Hops on one foot; throws ball overhand, uses scissors to cut out pictures, climbs well 5yr Skips Fine motor : - 3rd year copies circle - 3rd year rides tricycle - 4th year copies a square 18-Apr-18 45

46. Cont….. 3. Social/Language - language dev’t is rapid during the age of 2-3y - From 100 to 2,000 words - From 3 word to complex sentences 18-Apr-18 46

47. Summary of Stages of Gross motor 18-Apr-18 47

48. Cont……. 18-Apr-18 48

49. Summary of stages of Fine Motor 18-Apr-18 49

50. Cont……. 18-Apr-18 50

51. School age Age between 6-12 years referred as middle child hood or latency Self esteem becomes a central issue - Able to evaluate themselves - perceive others’ evaluation of them 18-Apr-18 51

52. Cont…. Muscular strength, coordination & stamina increases progressively Sexual organs remain physically immature but interest in gender differences & sexual behavior become active & increase progressively until puberty 18-Apr-18 52

53. Cont…. Physical growth Weight gain is 3-3.5Kg/ year Wt for age 7-12yr = (age (yr)x7)-5 2 Height: -increase by 6cm per year Brain growth:- HC ↑ by 2-3 cm throughout this period Dental development Loss of deciduous teeth starts by 6 year First molar (6year molar) erupts (The 1st permanent teeth) Replacement with & adult teeth occurs at a rate 4 per year for the next 5 years. 18-Apr-18 53

54. Cont…. 2.Neurodevelopment Gross motor 6-8 ride bicycle, sporty Fine motor 6th year copies a diamond & draws a man with 12 details At 7th yr draw a man with 16 detail 9-10yr draw man with many details Typing skill Musical instrument 18-Apr-18 54

55. Cont…… 3. Social/language Receptive language Expressive language Identify with same sex parents adopting them as role models Further separation from the family 18-Apr-18 55

56. Adolescent The age group of 10 -18 years Growth spurt occurs here - Height increase by 6-7 cm Puberty occurs early in females Sexual Maturity Rating (SMR)/Tanner stage - Rated from 1-5 1. Boys - Testes - Penis - Pubic hair 2. Girls - Breast - Pubic hair 18-Apr-18 56

57. Cont….. . Physical growth Weight: Growth spurt begins earlier in girls (10–14 years, while it is 12–16 in boys) Males gains 7 to 30kg, while female gains 7 to 25kg 18-Apr-18 57

58. Cont…. Height: By the age of 13, the adolescent triples his birth length Males gains 10 to 30cm in height. Females gains less height than males as they gain 5 to 20cm. Growth in height ceases at 16 or 17 years in females and 18 to 20 in males 18-Apr-18 58

59. Secondary sexual characteristics Male Genital changes Appearance of pubic, axillary , and facial hair Voice change Female Breast changes, pelvic diameter widens Growth of pubic and axillary hair Onset of menarche 18-Apr-18 59

60. Classification of sexual maturity states in girls 18-Apr-18 60

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62. Classification of sex maturity states in boys 18-Apr-18 62

63. Cont…. 18-Apr-18 63

64. Red Flags It is a quick reference guide for assessing development. It outlines a range of functional indicators or domains commonly used to monitor healthy child development. It will assist in identifying when a child could be at risk of not meeting developmental milestones, triggering an alert for the need for further investigation. It can be used in conjunction with validated developmental screening tools. 18-Apr-18 64

65. Motor Red flags 18-Apr-18 65 Age Red Flags 4 months Lack of steady head control while sitting 9 months Inability to sit 12 months Inability to transfer objects from hand to hand 15 months Abnormal pincer grasp 18 months Inability to walk independently

66. Cognitive red flags 18-Apr-18 66 Age Red Flag 2 months Lack of visual fixation 4 months Lack of visual tracking 6 months Failure to turn to sound or voice 9 months Lack of babbling consonant sounds 24 months Failure to use single words 36 months Failure to speak in three- word sentences

67. Social- Emotional Red Flags 18-Apr-18 67 Age Red Flag 6 months Lack of smile or other joyful expressions 9 months Lack of reciprocal vocalizations, smiles , or other facial expressions 12 months Failure to respond to name when called Absence of babbling Lack of reciprocal gestures( showing, reaching, waving) 15 months Lack of single words Lack of proto-declarative pointing or other showing gestures 18 months Lack of simple pretend play Lack of spoken language/gesture combinations 24 months Lack of two-word meaningful phrases(without imitating or repeating) Any age Loss of previously acquired babbling, speech or social skills

68. Failure to thrive (FTT) It is a term used to describe inadequate growth or inability to maintain growth. It is not a disease, but a sign that is better thought of as a final common pathway of many medical, psychosocial, and environmental processes that lead to poor growth in a young child. Criteria for FTT have become more specific. Today, there are three distinct criteria to describe a child who has FTT, using the standard growth charts of the National Center of Health Statistics: these are 18-Apr-18 68

69. 1)A child younger than 2 years of age whose weight for height is below 2SD or below the 3rd or 5 th percentile for age on more than one occasion. 2) A child younger than 2 years of age whose weight is less than 80% of the ideal weight for age. 3) A child younger than 2 years of age whose weight crosses two major percentiles downward on a standardized growth grid. 18-Apr-18 69

70. Causes of FTT Etiologies of failure to thrive were grouped as organic and nonorganic. Organic failure to thrive refers to a major disease process or a single or multiple organ dysfunction. Nonorganic failure to thrive suggests insufficient emotional or physical nurturing without distinct pathophysiologic abnormality. 18-Apr-18 70

71. Developmental Delay A child who doesn’t reach his or her developmental milestones at the expected age Occur in 2-3% of the population having with enormous impact on the affected children Gross Motor delay vs Global Developmental Delay Developmental Regression 18-Apr-18 71

72. 18-Apr-18 72 Thank You!!!!!!