Growth, Development, and Behavior in children.pptx

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1. Growth and Development in children

2. Growth implies, principally, an increase in the size of the body as a whole or of its individual parts. Development is mainly related to the nervous system. It means acquiring functions and skills that involves motor, social, emotional and intellectual abilities of the child Growth and development

3. Principles of Growth and Development Development is a continuous process from conception to maturity . This means that development occurs in utero , and birth is merely an event in the course of development , The sequence of development is the same in all children, but the rate of development varies from child to child .

4. Development is intimately related to the maturation of the nervous system. Growth is an orderly process, occurring in systematic fashion. Rates and patterns of growth are specific to certain parts of the body. Wide individual differences exist in growth rates.

5. Development proceeds from the simple to the complex and from the general to the specific . Development occurs in a cephalocaudal and a proximodistal progression

6. Factors affecting Growth and Development Genetic factors Prenatal and post natal factors Sex Endocrine system Nutrition Diseases

7. Developmental Milestones- gross motor (ambulation) fine motor (manipulation) communication and language cognitive

8. The First Year Age 0-2 Months The average term newborn weighs approximately 3.4 kg ( 7.5lb); The average length about 50 cm (20 in) Head circumference are 35 cm (14 in) in term infants., At 6 th month-44cm and at 1yr 47cm.

9. A newborn's weight may initially decrease 10 % below birthweight in the 1st wk as a result of excretion of excess extravascular fluid and limited nutritional intake . Infants regain or exceed birthweight by 2 wk of age and should grow at approximately 30 g (1 oz)/day during the 1st mo . This is the period of fastest postnatal growth

10. Holds head steady while sitting Started social smiles in response to face, voice Stares momentarily at spot where object disappeared Crying normally peaks at about 6 wk of age , when healthy infants may cry up to 3 hr/day

11. Age 2-6 Months Between 3 and 4 mo of age, the rate of growth slows to approximately 20 g/day By 4 mo, birthweight is doubled . Pulls to sit, with no head lag Palmar grasp gone Transfers object hand to hand

12. Age 6-12 Months Sits without support(6mo ) Rolls back to stomach The 6 mo old infant has discovered his hands and will soon learn to manipulate objects the emergence of a thumb-finger grasp ( 8-9 mo) a neat pincer grasp by 12 mo . Many infants begin crawling and pulling to stand around 8 mo .

13. Tooth eruption occurs, usually starting with the mandibular central incisors . Says “ mama ” or “ dada( 8-10 mo ). Uncovers toy (after seeing it hidden(8-9mo). Some walks alone( 12mo ). Speaks first real word(a sound used consistently to refer to a specific object or person)-10mo. pretends to drink from cup( 12mo ).

14. The Second Year Age 12-18 Months Toddlers have relatively short legs and long torsos, with exaggerated lumbar lordosis and protruding abdomens. The appearance is that of genu varus (bowleg) Walks alone, can run(16mo ). walks up stairs with one hand held( 18mo ).

15. Age 18-24 Months Height and weight increase at a steady rate during this year. By 24 mo, children are about half of their ultimate adult height. Ninety percent of adult head circumference is achieved by age 2 yr, with just an additional 5 cm gain over the next few years

16. Uses stick to reach toy( 17mo ). Speaks 2-word sentences (e.g., “Mommy shoe”) 19mo .

17. Gross motor 9 month old: crawl 1 year: stand independently from a crawl position 13 month old: walk and toddle quickly 15 month old: can run

18. Fine motor Newborn has very little control . Objects will be involuntarily grasped and dropped without notice. 6 month old: palmar grasp – uses entire hand to pick up an object 9 month old: pincer grasp – can grasp small objects using thumb and forefinger

19. Red Flags..Developmental Delay Unable to sit alone by age 9 months Unable to transfer objects from hand to hand by age 1 year Abnormal pincer grip or grasp by age 15 months Unable to walk alone by 18 months Failure to speak recognizable words by 2 years

20. The Preschool Years(2-5yr) Somatic and brain growth slows by the end of the 2nd yr of life, with corresponding decreases in nutritional requirements and appetite, and the emergence of “picky” eating habits . Increases of ~2 kg in weight and 7-8 cm (2-3 in) in height per yr are expected. Birthweight quadruples by2.5 yr of age. The head will grow only an additional 5 cm between ages 3 and 18 yr.

21. All 20 primary teeth have erupted by 3 yr of age Bowel and bladder control emerge during this period. Knows age and sex Bed-wetting is normal up to age 4 yr in girls and age 5 yr in boys Language development occurs most rapidly between 2 and 5 yr of age characterized by magical thinking

22. Helps in dressing (unbuttons clothing and puts on shoes); washes hands, copies circle,rides tricycle,( 3yr ) . Copies cross and square, tells story, goes to toilet alone(4yr ). Draws triangle ; Dresses and undresses; asks questions about meaning of words; Skips( 5yr ). As a rule of thumb, between the ages of 2 and 5 yr, the number of words in a typical sentence equals the child's age (2 by age 2 yr, 3 by age 3 yr, ...

23. Middle Childhood(6-11yr) Growth during the period averages 3-3.5 kg and 6-7 cm (2.5 in) per year Loss of deciduous (baby) teeth is a more dramatic sign of maturation, beginning around 6 yr of age

24. fine motor Writing skills improve Fine motor with more focus Building: models Sewing Musical instrument Painting Typing skills Technology: computers

25. gross motor 8 to 10 years : team sports Age ten: match sport to the physical and emotional development

26. Red flags: School failure Lack of friends Social isolation Aggressive behavior: fights, fire setting, animal abuse

27. AVERAGE WEIGHT IN KG At birth 3.5 3–12 mo age(mo)+9 2 1-6 yr age(yr)X2 +8 7-12 yr age(yr)X7-5 2 AVERAGE HEIGHT IN CENTIMETERS At birth 50 At 1 yr 75 2–12 yr age (yr) × 6 + 77

28. Adolescence Between 10 and 20 yr of age, young children undergo rapid changes in body structure and physiologic, psychologic , and social functioning the transition from childhood to adulthood. It proceeds across three distinct periods Early, Middle, and Late Each marked by a characteristic set of salient biologic, psychologic , and social issues

29. Early adolescence/SMR 2/ Age 10-13yrs Refers the stage of puberty Appearance of 2 nd ry sex characteristics Beginning of rapid growth Girls; Adrenarche -as early as 6 years Breast bud- 8-12 yrs/ SMR 2 Menarche- 12yrs Peak ht is earlier than boys

30. Early adolescence/SMR 2/ Boys Testicular enlargement—SMR 2 at 91/2 yrs Penile growth SMR 3

31. Middle Adolescence/SMR 3-4/ Age 14-16yrs Period of rapid growth Peak height followed by peak weight after 6 months (1 st stretch and filling effect) 1 st muscle mass and then strength Body mass Increase in males by 90%---muscle mass Decrease in females by 75%---SC fat

32. Late Adolescence Age 17-18 yrs At which physical maturity gained Slower rate of growth

33. Assessment of Growth A critical component of pediatric health surveillance is the assessment of a child's growth. Growth : is an increase in size and results from the interaction of genetics, health, and nutrition. The most powerful tool in growth assessment is the growth chart used in combination with accurate measurements of height, weight, head circumference, and calculation of the body mass index (BMI ).

34. Growth chart/curve A growth chart or curve is a graph that records changes in the child‘s growth over time compared to normative growth rates. Growth chart is an easy and systematic way to follow CHANGES IN GROWTH OVER TIME for an individual child.

35. Types of Growth charts growth curves that are commonly used in our country 1. WHO children Growth Charts the WHO curve is prepared based on data from different developed and developing countries it is more representative and close to our context therefore it is better to use these curves. The growth indicators include weight for age, height/length for age, weight for height/length, and body mass index (BMI

36. 2. CDC Growth Curves CDC growth curves are a lso disaggregated by age and sex and extend from birth to 20 years Data are representative of the developed population, both demographically and in terms of breast-feeding prevalence.

37. Each chart is composed of percentile curves, representing the cross-sectional distribution of weight, length, stature, head circumference, weight for length, or BMI at each age. The percentile curve indicates the percentage of children at a given age on the x -axis whose measured value falls below the corresponding value on the y -axis

38. The data are presented in 5 standard gender-specific charts: (1) weight for age; (2) height (length and stature) for age; (3) head circumference for age; (4) weight for height (length and stature) for infants; and (5) BMI for age for children over 2 yr of age

39. Low ht for age ,normal wt for ht ; Shows growth failure in the past Low ht for age and wt for height for age; Past and current growth failure Normal ht for age and low wt for ht for age; Current nutritional problem

40. we can’t use these graphs with disorders like chromosomal disorders and achondroplasias For premature infants, overdiagnosis of growth failure can be avoided by subtracting the weeks of prematurity from the postnatal age when plotting growth parameters, In premature infants, correction should be done till ; 18 months for head circumference 24 months for weight 40 months for length

41. Nutritional insufficiencies must be differentiated from; 1. Congenital pathologic short stature Born as small Chromosomal abnormalities Familial short stature Same as parents Growth curve is parallel and below the normal

42. Dental Development ; It includes mineralization, eruption and exfoliation of teeth. Mineralization starts at 2 nd trimester and continous upto 25 years Delayed eruption where there is no teeth at 13 months . All decidous teeth by 3yrs All permant teeth by 25 yrs Common causes Hypothyroidism Hyperparathyroidism Familial Idiopathic Nutritional Chronic illness

43. Newborn Evaluation Classification History physical examination

44. Neonate – from 1 st day of life to 28 days The American Academy of Pediatrics recommends that all newborns be classified by birth weight and gestational age . Infants are classified as preterm (<37 weeks ), term ( 37-42 weeks), postterm (> 42 weeks).

45. According to birth weight Normal wt : 2500gm – 4000 gm Macrosomia : > 4000 LBW(1500-2500 gm) VLBW(1000-1499gm) EVLBW(<1000gm)

46. Based on Weight and Gestational Age 1. Appropriate for gestational age (AGA). Weight for gestational age is between 10th and 90th percentiles AGA is indicative of appropriate intrauterine growth . 2. Large for gestational age (LGA ). weight for gestational age is above the 90th percentile 3. Small for gestational age (SGA ). weight for gestational age is below the 10th percentile symmetric ( head circumference , length, and weight equally affected) or asymmetric (with relative sparing of head growth ).

47. History in Neonatal Pediatrics Age of the new born Maternal age ,gravidity and parity Gestational age(LNMP), ANC follow up status and problems detected Basic maternal investigations during follow up -HCT, BLD GROUP & RH, VDRL, HBsAg , PIH CT

48. Past medical illnesses in the mother and family, including previous siblings: cardiopulmonary disorders, infectious diseases, genetic disorders, jaundice, diabetes mellitus

49. Events occurring in the present pregnancy : vaginal bleeding medications, acute illness Description of the labor How did labor started? duration of labor Describe how the membrane ruptured?, duration ? Color of the aminiotic fluid. Was it before or after the onset of labor ?

50. delivery ( cesarean section, anesthesia or sedation, use of forceps, Place of delivery Out come - sex - weight - apgar score - twining need for resuscitation Fetal presentation, Describe the condition of newborn soon after

51. Assessment of gestational age Gestational age can be determined prenatally by the following techniques: date of last menstrualperiod , date of first reported fetal activity (quickening usually occurs at 16-18 weeks), first reported heart sounds (10-12 weeks by Doppler ultrasound examination),

52. Postnatal assessment of gestational age New Ballard Score Neurologic characteristic Physical characteristic Part of general examination Accuracy within 1-2 weeks The examination consists of six neuromuscular criteria and six physical criteria

53. Physical Examination Examination of the newborn should include an evaluation of growth and an observation of behavior . Temperature, pulse, respiratory rate, color , tone, activity, and level of consciousness of infants should be monitored frequently until stabilization.

54. Vital signs The average term newborn weighs approximately 3.4 kg ( 7.5lb); The average length about 50 cm (20 in) Head circumference are 35 cm (14 in) in term infants. The normal pulse rate ( 120-160 beats/min ) T he normal respiratory rate ( 30-60 breaths/min )

55. The normal skin temperature in the neonate is 36.0-36.5 °C (96.8-97.7 °F). The normal core (rectal) temperature is 36.5-37.5 °C (97.7-99.5 °F ). Axillary temperature may be 0.5-1.0 °C lower (95.9-98.6 °F).

56. Anthropometrics. Serial measurements of weight, length, and head circumference allow for evaluation of growth patterns . Normal growth customarily falls between the 10th and 90th percentiles when plotted on growth charts based on intrauterine growth curves and adjusted for gestational age.

57. Head circumference 1.normal - when it is between 10th and 90th percentiles 2. Microcephaly - when it is below the 10th percentile 3. macrocephaly -when it is above the 90th percentile

58. General Appearance SKIN A . Color 1 . Plethora (deep, rosy red color ). 2 . Jaundice (yellowish color 3. Pallor (washed-out, whitish appearance 4 . Cyanosis ( bluish color ) a. Central cyanosis (bluish skin, including the tongue and lips . b. Peripheral cyanosis (bluish skin with pink lips and tongue ). c. Acrocyanosis (bluish hands and feet only).

59. B. Rashes Milia . Milia is a rash in which tiny, sebaceous retention cysts are seen . 2. Erythema toxicum . numerous small areas of red skin with a yellow white papule in the center are evident

60. C. Nevi . Mongolian spot. are dark blue or purple bruise-like macular spots usually located over the sacrum . lanugo Fine, soft, immature hair, frequently covers the scalp and brow and may also cover the face of premature infants. Tufts of hair over the lumbosacral spine suggest an underlying abnormality such as occult spina bifida , a sinus tract, or a tumor

61. Head Note the general shape of the head . The head circumference of all infants should be charted Inspect for any cuts or bruises secondary to forceps or fetal monitor leads Anterior and posterior fontanelles . Molding is a temporary asymmetry of the skull resulting from the birth process

62. Caput succedaneum , is a diffuse edematous swelling of the soft tissues of the scalp that may extend across the suture lines Cephalhematoma is a subperiosteal hemorrhage that never extends across the suture line. It can be secondary to a traumatic delivery or forceps delivery. Hematocrit and bilirubin levels should be monitored in these patients . Most cephalhematomas resolve in 2-3 weeks .

63. Subgaleal hematoma . Hemorrhage bleeding occurs below the epicranial aponeurosis . It can cross over the suture line and onto the neck or ear . Craniosynostosis . is the premature closure of one or more sutures of the skull. Craniotabes , a benign condition, is a softening of the skull that usually occurs around the suture lines and disappears within days to a few weeks after birth.

64. Face Inspect the general shape of the nose, mouth, and chin F ace should be noted with regard to dysmorphic features, which are often associated with congenital syndromes. neck abnormalities should be seen like goiter , cystic hygroma , branchial cleft rests, teratoma , hemangioma

65. Chest A . Observation. Tachypnea , sternal and intercostal retractions, and grunting on expiration indicate respiratory distress. B. Breath sounds . Normally, the breath sounds are bronchovesicular C. shape of chest D. Breasts in a newborn

66. Heart. Observe for heart rate , rhythm, quality of heart sounds, active precordium , and presence of a murmur . Palpate the pulses (femoral, pedal, radial, and brachial) .

67. Abdomen A . Observation . Obvious defects may include an omphalocele , in which the intestines are covered by peritoneum and the umbilicus is centrally located, or a gastroschisis , in which the intestines are not covered by peritoneum (the defect is usually to the right of the umbilicus ). A scaphoid abdomen may be associated with a diaphragmatic hernia .

68. Auscultation. Listen for bowel sounds. Palpation . Check the abdomen for distention , tenderness, or masses Umbilicus. Genitalia should be evaluated Anus and rectum. Check for patency of the anus to rule out imperforate anus. Check the position of the anus

69. Extremities . Examine the arms and legs Trunk and spine . Check for any gross defects of the spine

70. Nervous system First , observe the infant for any abnormal movement ( eg , seizure activity) or excessive irritability. Then evaluate the following parameters. A. Muscle tone 1. Hypotonia . Floppiness and head lag are seen. 2. Hypertonia . Increased resistance is apparent when the arms and legs are extended .

71. B. Reflexes. The following reflexes are normal for a newborn infant . 1. Rooting reflex. Stroke the lip and the corner of the cheek with a finger and the infant will turn in that direction and open the mouth. 2. Glabellar reflex (blink reflex). Tap gently over the forehead and the eyes will blink. 3. Grasp reflex. Place a finger in the palm of the infant's hand and the infant will grasp the finger .

72. 4. Moro reflex. Support the infant behind the upper back with one hand, and then drop the infant back 1 cm or more to¾but not on¾the mattress. This should cause abduction of both arms and extension of the fingers. Asymmetry may signify a fractured clavicle, hemiparesis , or brachial plexus injury. 5 sucking reflex

73. Movement. Check for spontaneous movement of the limbs, trunk, face, and neck. E . Peripheral nerves 1. Erb-Duchenne paralysis involves injury to the fifth and sixth cervical nerves. There is adduction and internal rotation of the arm. The forearm is in pronation ; the power of extension is retained . The wrist is flexed. 2. Klumpke's paralysis involves the seventh and eighth cervical nerves and the first thoracic nerve . The hand is flaccid with little or no control

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