growth and developmenttttttttttttt_2.ppt
- 1. GROWTH AND DEVELOPMENT • OBJECTIVES: • Define the term growth • Define the term development • State the uses of assessing growth and development • State the factors which promote growth • State the factors which impair growth • Measure growth correctly, plot the measurements on a growth chart, and interpret correctly the growth pattern of an individual child • Report the measurements to the mother and inform her how her child is growing • Outline the patterns of weight, length or height and head circumference and mid upper arm circumference growth. • Outline the patterns of gross motor, fine motor, social, speech, intellectual and emotional development. and • Assess the development of a child
- 2. What is growth? • Growth is progressive increase in size of the child or his/her parts from fertilization to maturity. Commonly taken parameters of growth are weight, length or height, occipitofrontal head circumference,and. mid upper arm circumference.
- 3. Definition of development Development is progressive acquisition of increasingly complex skills essential for independent living. Development results from maturation of the nervous system and learning reactions. Development is tracked through gross motor, fine motor, social, cognitive and emotional domains. Each of the domain follows a sequence of successive stages or developmental milestones.
- 4. Principles of growth and development Growth and development are continuous processes. The stages of growth and development are prenatal, neonatal, infancy, preschool, school and adolescent Each child grows and develops at his own individual rate. Growth and development follow a cephallocaudal progression, (from head to toe) and proximodistal progression (from the centre to the extremities).
- 5. Uses of assessing growth and development • evaluating the state of health and nutrition of a child. • ascertaining the adequacy of breast feeding, • indicating a need for intervention, • evaluating the intervention
- 6. Importance of assessing growth and development contd • Continuously normal growth and development indicate a good state of health and nutrition of a child. Abnormal growth is a symptom of disease. Hence, measurement of growth is an essential component of the physical examination. Without an assessment of growth and development, no physical examination is complete .
- 7. Factors determining growth and development Each child’s path or pattern of growth and development is determined by genetic and environmental factors. The genetic factors determine the potential and limits of growth and development. If favourable, the environmental factors, such as adequate nutrition, hormonal balance, and appropriate stimulation, facilitate the achievement of the genetic potential for growth and development. Unfavourable factors, slow or stop growth and development.
- 8. Factors adversely affecting growth and development • malnutrition, • infections, • congenital malformations, • hormonal disturbances, • disability, • emotional neglect, • lack of play, and • lack of language training.
- 9. Catch up growth • This is a sudden weight growth acceleration a rate greater than the average for age after removal of an unfavourable factor. As a result of the catch up growth, the previously lost weight is recovered. Once the lost weight is recovered, the growth rate returns to the individual’s normal rate which is determined by the individual’s genetic constitution.
- 10. More growth rate variation • A child genetically determined to be tall grows slightly more rapidly than a child genetically determined to be short. Similarly, a child genetically determined to be clever develops more rapidly than a child genetically determined to be less intelligent.
- 11. The essentials in measuring growth One measuring growth must • make the measurements accurately • use reliable equipment must and • must apply the correct measuring techniques
- 12. An individual child’s growth pattern . This is the line or graph obtained when the individual child’s successive measurements are carefully plotted on appropriate growth chart. The first plotting in the growth chart should be the birth measurement.
- 13. Interpreting a child’s growth pattern The key to the interpretation of a child’s growth pattern is observing the direction of the child’s growth pattern.The child is growing well if his or her pattern is parallel to the printed reference percentile lines. Any lateral, horizontal or downward deviation indicates danger. After interpreting a child’s growth pattern, you must report the findings to the mother or caretaker and inform her how the child is growing
- 14. Measuring the head circumference The head circumference is measured by encircling the head with an unstretchable tape measure, passing over the most prominent part of the occiput posteriorly and just above the supraorbital ridges anteriorly to obtain the greatest distance around the head. Serving as an estimate of the growth of the brain, head circumference must be measured at every visit in the first 4 or 5 years with recording in appropriate charts..
- 15. Head circumference growth pattern At birth, the head circumference of term babies averages 35cm with a range of 33-37 cm. Monthly increases are 2cm in the first quarter and 1 cm in the second quarter. The head circumference increases by 9 cm in the first 6 months and by other 4 cm in the second six months. So the average head circumference is approximately 44cm by 6 months, and 45 to 47 cm by one year, an increase of 10-12 cm in the first year. Subsequent annual increases are 2 cm in the second year, 1 cm in the third year, 0.4 in the 4th and 5th years to reach 49.2 and, 50.5cm at age 2 and 3 respectively.
- 16. Measuring the mid upper arm circumference • The mid upper arm circumference is measured using a tape. The midpoint is determined after measuring the distance between the olecranon and acromion processes. The midpoint is marked. The tape is placed around the upper arm at this midpoint. Care is taken not to pull the tape too tightly. The measurement is read.
- 17. The mid upper arm circumference growth pattern • The mid-upper arm circumference increases to about 16 cm by the end of the first year. It then increases by about 1 cm during the second to the fifth years. A 1-5- year- old well nourished child may have a mid upper arm circumference of 13.5- 17cm. Among 1- 5-year-old children, a mid upper arm circumference less than12.5cm indicates malnutrition, 12.5 to 13.5cm,risk of malnutrition.
- 18. Measuring length or height The length of a child is measured is the first 2 years of life while the height is measured in children aged more than 2 years.The length is measured using a horizontal measuring board put on the ground or on a table. The child is laid supine with the head against the fixed head board. A helper holds the child’s head so that the eye angle- external ear canal line is vertical and also keeps the body straight. With one hand, the health worker straightens the child’s legs fully by pressing the child’s knees down. With the other hand, the sliding foot board is placed to touch the child’s heels firmly. The length is then read.
- 19. Measurement of height The height is measured with a rule fixed to a vertical wall or with a stadiometer. A bare foot child stands erect with the feet together. The heels, the buttocks and the occiput lightly touch the measuring device. The head is aligned so that the external eye angle–ear canal plane is horizontal. The child is told to stand tall and is gently stretched upward by pressure under mastoid processes with the shoulders relaxed The sliding head peace is lowered to rest firmly on the head. The height is read and recorded on the chart.
- 20. Pattern of length and height growth An average term baby is 50 cm long. The birth length increases by 50% in the first year and doubles by 4 years. Between 2 and 12 years of age, the average height is (77+ 6 x age in years )cm. Height growth stops at about 18 years in girls and 20 years in boys.
- 21. Measurement of weight . The infant or child is weighed naked or with minimum clothing. The weight is best measured to the nearest 10 grams in infants and 100 grams in children using a beam balance.
- 22. Weight growth pattern An ‘average’ term newborn weighs 3.5 kg (range 2.5 kg - 4.6 kg). The birth weight must be plotted and written in the first box of the growth chart and recorded in the appropriate space on the growth chart. Within the first 3-4 days, a term newborn loses 5-10 % of the birth weight. This weight loss is usually regained in 2 weeks by term babies and longer by premature babies.
- 23. Weight growth pattern cont An average term baby doubles the birth weight in 4-6 months, triples it by one year and quadruples it by two years of age. • Average weights in kg between 3-9months= ½(age in months +9), • between 1-6 years = 2 (age in years) + 8 and • between 7-12 years it is ½(age (yr)X7 -5) To monitor growth, you must use the growth chart maternal and child health booklet. You need to study a blank growth chart to be thoroughly familiar with its contents. To start with, note that the top line represents the 2SD growth line of healthy children and the bottom line is the -2SD, the lower limit of normal weight-for-age.
- 24. Gross Motor Development At birth, the baby displays several reflexes: •Moro’s reflex, • rooting reflex, •sucking reflex •, swallowing reflex, • tonic neck reflex, • walking reflex and • grasping reflex etc. These primitive reflexes must disappear before voluntary motor activities.
- 25. Gross motor development • Head control while sitting 2 months • Pulled to sit with no head lag 3 months • Bringing hands together in midline 3 months • Asymmetric tonic neck reflex gone 4 • Sitting without support 6.5 months • Rolling back to stomach 6.5 • Standing with support 9 months • Crawling 9 months • Walking alone12 months • Running 16 months
- 26. Gross motor development milestones cont • Riding tricycle 3 years • Hopping on one foot 4 years • Skipping 5 years
- 27. Fine motor development milestones • Grasping a rattle 3.5 months • Reaching objects 4 months • palmar grasp disappearance 4 months • Transferring objects 5.5 months • Thumb-finger grasp 8 months • Turning pages of a book 12 months • Scribbling 13 months • Builds a tower of 2 cubes 15 months
- 28. Fine motor milestones contd • Building a tower of 4 cubes 18 months • Building a tower of 6 cubes 22 months • Builds a tower of 7 cubes 24 months • Imitating horizontal strokes 24 months • Building a tower of 9 cubes 30 months • Making vertical and horizontal strokes 30months • Imitates a 3 cubes bridge 4 years • Draws a man with 2-4 parts 48 months • Copies a triangle 5 years
- 29. Communication and language • Smiling in response to face or voice1.5 months • Monosylabic babble 6 months • Inhibiting to no 7 months • Following a one step command with gesture 7 months • Following a one step command without gesture 10months • Saying mama or dada 10 months • Pointing to objects 10 months • First meaningful word 1 year • Speaking 4-6 words 15 months • Speaking 10-15 words 18 months • Making a 2 word sentence 19 months
- 30. Social development • Visual preference of human face at birth • Smile to human face or voice 2 months • Smile and vocale to strangers 6 months • Preferring mother 6 months • Pats own image in a mirror 6 months • Responding to sound of name, playing peek- a boo, waving bye-bye, displaying stranger anxiety 9 months • Playing simple ball game 1 year • Indicating some desires by pointing 15 months
- 31. Social development contd • Hugging parents 15 months • Uses spoon spilling most of the food 15m • Feeding self well using spoon and cup, seeking help if in trouble, complaining when wet or soiled 18 months • Indicating that the nappy is wet 18 m • Pulling up pants 18 months • Clean and dry by day 2 years • Handling spoon well, helping to undress 2 years • Helping put things away 2.5 years • Pretending in play 30 months • Playing in parallel 36months • Full toilet training 3 years
- 32. Social development cont • Helping in dressing (unbuttoning putting on shoes) 36 months • Washing hands 36 months • Playing cooperatively 48 months • Dressing and undressing 5 years • Asking questions on meanings 5 years • Domestic role playing 5 years.
- 33. Emotional development displaying pleasure and distress 0-1 month displaying delight with smile to a human face 2 months stopping to cry on noting mother’s approaching 3-4 months displaying anger, joy, interest, fear, disgust, and surprise by distinct facial expressions 5 months manifesting elation and stranger anxiety 7 months showing affection and love to primary caretaker 10-11 months extending affection to other infants 15 months
- 34. Emotional development cont displays jealousy 1.5 years displaying humour and anxiety over possibility of punishment or disapproval 2- 3 years expresses love, anger, empathy, sadness, surprise, enjoyment 3 years manifests shame, grief, guilt and anxiety 4 years
- 35. Cognitive development • Stares momentarily where the objects disappeared 2 months • Stares at own hands 4 months • Bangs 2 cubes 8 months • Uncovers a toy after seeing it hidden 8mts • Egocentric symbolic play eg pretends to drink from a cup 12 months • Uses a stick to reach a toy 17 months • Pretending play with a doll (eg gives a doll food 17 months • Preoperational (prelogical) stage 2-5 years • Concrete logical operations 6-12 years • Concrete formal operations 13- 20 years
- 36. Assessment of development • History of the milestones • Observation of the child’s activities • Denver prescreening developmental questionnaire • Screening tests such as Denver Developmental screening test.
- 37. REFERENCE • Nelson textbook of paediatrics, 18th Edition • Current diagnosis and treatment in paediatrics. 19th Edition • Essential paediatrics, by David Hull,4th Edition • Human growth after birth by David Sinclair