growth and development .ppt for primary health care provider
- 1. Chapter Two GROWTH AND DEVELOPMENT Sisay Shewasinad 11/27/24
- 2. Learning Objectives At the end of this unit, student will be able to: Identify the difference between growth and development Describe milestones of normal growth and development Detect deviation from normal growth and development Use growth-monitoring chart to assess nutritional status of under 5 children List the factors affecting growth & development 11/27/24
- 3. Brain storming What is he difference b/n growth and development? Be in your active learning group and discuss 10 min
- 4. 赫姻看敬岳鞄
- 5. GROWTH Growth is the process of physical maturation resulting an increase in size of the body and various organ. It occurs by multiplication of cells and an increase in intracellular substance. It is Quantitative changes of the body which can be measured in Inches/Centimeters/pounds/kilograms. Growth is progressive and measurable phenomenon
- 6. DEVELOPMENT Development is the process of functional and physiological maturation of the Individual. It is progressive increase in skill and capacity to function. It is related to maturation and myelination of the nervous system. It includes Psychological , Emotional and Social changes. It is Qualitative aspect of maturation and difficult to measure.
- 7. Development A continuous, orderly series of conditions that leads to activities, new motives for activities, patterns of behavior, skill & ability to function (maturation) (Quality) Development is maturation in form and function Growth & development is a continuous process. Growth and development go together but at different speeds Continuous, orderly, sequential processes All humans follow same pattern Sequence of each stage predictable Development proceeds from simple to complex Learning helps or hinders process 11/27/24
- 8. Physical growth refer to change in physical size including Body measurement (anthropometric measurement) Dentition Skeletal & sexual development Physiological growth 11/27/24
- 9. Neurological/mental the maturity of child & which assessed the Intelligence Motor Emotional social & speech devt Children at first are able hold the big things by using both arms, In the next part able to hold things in a single hand, then only able to pick small objects like peas, cereals etc. 11/27/24
- 10. Importance of growth & dev.t measurement Very sensitive indication of child health Use to identify dev.t problem as early as possible & to act accordingly Use to estimate child age Suitability for adaptation legal issues Use full for follow up of children Tell the nutritional status of given community
- 11. Factors affecting growth & development. 1.Genetic factors: - growth & development is genetically determined. e.g Hemophilia & chromosomal disorders ( down syndrome) 2. Environmental factors: a. Physical surroundings e.g lack of sunshine, poor hygiene, & poor soci-economic condition. b. Intrauterine or prenatal factors (maternal nutrition, infections, drugs, radiation & other illness during pregnancy) c. Psychological e.g relation with such parents, teachers & others. 11/27/24
- 12. Cont 3. Disease chronic illness e.g chronic nephritis & congenital heart disease & hormonal problem. 4. Emotional factors e.g loss of parents, Insecurity, disturbed child & parent re/ship e.t.c negative impact on growth & development 5. Nutrition :nutritional deficiency both qualitative & quantitative retards physical growth.
- 13. Cont Anthropometry: scientific study of the measurement of the human body. It includes assessment of physical growth, & mental development.
- 14. Parameters of growth assessment 1. Wt for age growth faltering 2. Ht for age "stunting" 3. Wt for Ht "wasting" 4. Head circumference
- 15. Weight: Normal birth weight is 3400gms (normal range - 2500 4000gms). Double birth Wt at 5 6 months of age. Triple birth Wt at 1 years of age. Quadruple birth Wt at 2 years of age. Newborns lose 5-10% of body Wt immediately. It gains birth weight by 10 14 days of age. Newborns gain 25-30gms/day during the 1st 5 6 months. 15gm/day in the remainder of the 1st year and 2 3kgs/yearly after 1st year.
- 16. To enhance accuracy of Wt measurement: Use the same scale at each visit. Scales should be zeroed daily. Infant scales should be used for children < 20 kg. Remove all clothing including diaper. Weigh infant supine and older infants sitting. Record Wt to the nearest 0.1 kg.
- 17. Formula to estimate average Wt: Age Wt (in Kg) At birth 3.25 3 12 months Age (in months) + 9 2 1 6 yrs Age (in yrs) x 2 + 8 7 12 yrs Age (in yrs) x 7 5 2
- 18. Height/Length Ht growth in structure progress less rapidly than Wt. Normal newborn length is 46-50 cms. Increase 25 30cms in first year of life. During the 1st year growth is very rapid especially during the initial 6 months. After first year, gain 6 8cms yearly. Birth length doubles by 3 4 years. At 4 years = 100cm, then increases about 5-6 cm/year Birth length triples by 13 years. Eventual adult Ht can be approximated by doubling childs Ht by 2 years of age (i.e. Ht at 2 yrs of age half adult Ht). Wt in lying position (crown to heel length) 0.5 cm > than standing ht. Acute malnutrition doesnt affect height
- 19. The required principles to measure the Height or Length include: What is the difference between length and height? Length Measure length of children up to 2 yrs Use supine position, which requires 2 people. Straight knees and keep ankles in neutral position. Record measurement to the nearest 0.5 cm.
- 20. Height Measure Ht for children > 2 yrs old. Use a tape meter or a measuring tape plastered on a wall. Remove shoes. Make sure the legs are close to each other and the heels, the buttock and the back of the head touches the wall or are in straight line. Place a ruler or a hard paper on top of the head to perpendicular to the wall to take the measurement. If there is large hair, press gently.
- 21. Formula to estimate Ht of children b/n 2 to 12 years Age Ht (in Cm) At birth 50-51cms At 1 year 75cms 2 12 years Age (in yrs) x 6 + 77
- 22. Height (ht) Under five year of age ht. Is measured in lying position is known as crown heel length. Length at birth =50c.m Length at 6 months =65 c.m Length at 1year =75 c.m Length at 2 year = 85 c.m Length at 3 year =95 c.m Length at 4 year =100 c.m (double) then increase about 5-6 c.m /year
- 23. 3.Headcircumference (H.C) Is an indirect estimation of size of the brain because expanding head size reflects the growth & differentiation of the NS. -At birth H.C 35c.m, at 6 month 43 c.m, at 1 year =45c.m at 2 years =48c.m at 5 years 50c.m (almost adult size) The head grows 12 cm (about 10 12cms)in circumference in the first 12 months. 6 cm of this is in the first three months. 3 more cm During the next three months the rest 3cm grow in the rest months. During second years, increases only 2-3cms Brain reaches adult size at about 12 years of age. 11/27/24
- 24. Cont Increases in HC parallel to the rapidly growing CNS. Average newborn HC is 35cms (normal range 32.6 37.2cms). The infant has relatively larger head than the adult. At birth the head is quarter of the whole body length but in an adult it is only one eight.
- 25. HC is measured by taking the greatest distance around the mid forehead-above the ears to the most prominent-occiput (maximal-fronto-occipital circumference) or Measure at the level of supra orbital ridges and occipital prominence Record measurement to the nearest 0.5 cm. The result may: Below normal range-abnormally small = micro-cephalous Above normal range-abnormally large head = usually hydrocephalus
- 26. Mid Upper Arm Circumference (MUAC): The MUAC MUAC remains nearly constant from 1-5 years. In the first month the arm of the new born is longer than the leg. MUAC MUAC works for 6 month 5 years child. Useful to assess a child present nutritional status Used for screening purpose (not helpful for Dx). should measured in all children who have a very low wt/ age Measured at the left arm mid -point b/n the tip of the shoulder and the tip of the elbow. The normal value > or = 12cms. < 12.cm indicates malnutrition; < 11.5 cm is severe malnutrition
- 28. 4. Chest circumference (CC): is measured at the level of the breast nipples during mid respiration.. The average chest circumference at birth is 31 c.m. At one-year chest circumference is equal to H.C, and then chest circumference continues to grow relatively faster than the head. At birth by 2-4 cm<HC, at 1yr chest circumference = CH, then the chest grows faster 11/27/24
- 29. Dental growth Temporary teeth 20in# The 1st temporary teeth is the lower central incisors erupt at about 6-8 months of age. Children start teething at the age of 6 months. A new tooth appears approximately every month. This makes the number of teeth roughly equal to the age in months minus six. The last to erupt are the 2nd molars at 20-30 months of age of the child.
- 30. Cont Permanent teeth At 3 yr of age for the primary (deciduous) teeth At the age of 6 years the permanent teeth start to appear. 3rd molars erupt last at the age of 17-25years The timing of dental development is poorly correlated with other processes of growth and maturation. Delayed eruption is usually considered when there are no teeth by approximately 13 month of age. 11/27/24
- 33. Parameters of Developmental Assessment Development in children is assessed by using Developmental Stages (Milestones). Developmental is classified in to 4 broad categories: Denver Developmental Screening Test (DDST-II) Gross motor Development (sit, walk, climb) Fine motor Development (grasp, play) Language Development (throat noise, talk) Social Development (Psychosocial b/r) Childs mood must be typical for results to be valid (results may be altered if child is not feeling well, sedated)
- 34. Denver Developmental Screening Test (DDST-II) Provides a clinical impression on childs overall development Not a predictor of future development, not an IQ test Used for noting problems, monitoring, and to base a referral for additional developmental testing
- 35. Neurological mental devt Ability to understand and deal effectively with a problem requiring abstract thinking is assessed after 5 years of age. Denver test for IQ ( intelligent quotient ) IQ= mental age / Chronological age x100 Note: IQ <75%= mental retardation
- 36. Cont Ex 8 yrs old child has the mental capabilities of a 5yrs old child.
- 37. IQ = 5/8x100= 62.5% thus, this Child is a mentally retarded child.
- 38. The average age of children and developed milestones Average age Motor devt Language & social b/r 1mon Lift head when prone Fix with eye, smile 3-6mon Head control Follow with eye, play with hands 6-9mon Unsupported sit Grasp, makes noise 9-12mon Able to stand Understand few words, try to use 12-18mon Able to walk Finger grasp small things 2years Able to run around Can say words or sentences 3years Active play, climb, jump Talking much
- 40. 1. Developmental Milestones for Gross motor: Activity Age (in Months) Sits with support 3 -4 Sits alone 6 -8 Stands alone 9 -13 Walks unassisted 12 -18 Climbs on furniture 18- 24
- 41. 2. Developmental Milestones for Fine motor Development Activity Age (in Months) Grasp reflex at birth Palmar grasp 6-8 Pincer grasp 9-10 Builds a six block tower 24 Builds a three block bridge 36
- 42. 3. Developmental Milestones for Language Development Activity Age (in weeks or Months) Indistinct throat noises 35 Wks cooling 1012 Wks Singles and multiple syllables 68 Months Two word phrase 36 Months Six to seven word phrases 40 Months
- 43. LANGUAGE DEVELOPMENT: 1 mth - turns head towards sound 3-5 mths - vowel sounds, gurgles 6 mths - monosyllables 9 mths - bisyllables 10 mths - understands spoken speech 12 mths - speaks 2 words with meaning 18 mths - 20 words 24 mths - joins 2-3 words in a short sentence 3 yrs - 250 words BOWEL & BLADDER CONTROL: Early months - gastrocolic reflex defecates after each feed 7 mths - no relation to feeds Toilet trainable by 18mths - 2 yrs
- 44. 4. Developmental Milestones for Social Development Activity Age (in weeks or Months) Social smile 4 6 Wks Smiles at self in mirrors 6 Months Responds to word No 8 Months Becomes frightened 8 -10 Months Knows own gender 24 -30 Months Plays in parallel 24 -36 Months
- 45. PERSONAL & SOCIAL DEVELOPMENT: 1 mth - regards face of mother/caretaker 2 mth - social smile 3 mths - recognises mother/caretaker 6 mths - enjoys mirror 7-8 mths - separation anxiety 9 mths - waves bye-bye
- 46. Growth monitoring Aberrant growth may be the first sign of an underlying problem. The most powerful tool in growth assessment is the growth chart (Growth monitoring chart); used in combination with accurate measurements of height, weight, and head circumference. Growth Charts/Curves: are Graph that records changes in the childs growth with time compared to normative growth rates. Growth parameters should be standardized and compared with age related norms.
- 49. Why use growth curves? Easy and systematic way to follow changes in growth over time. Height, weight and head circumference should at regular intervals. Monthly till 6 months of age. Quarterly till 8 Months of age. And accordingly it may be at 18 month.
- 50. Types of growth curves/charts: WHO growth charts: Is age and gender specific, and extend from birth to 5 years. Wt for age boys and girls Ht/length for age boys and girls Wt for Ht/length boys and girls CDC growth curves: is age and gender specific, and extend from birth to 18 years. Wt for age boys and girls Ht/length for age boys and girls Wt for Ht/length boys and girls Head circumference boys and girls
- 51. Procedures for accurate measurement: Accurate measurement is a key component of assessing growth. Weight, in pounds or kilograms, must be determined using an accurate scale. Head circumference is determined using a flexible tape measure run from the supra-orbital ridge to the occiput in the path that leads to the largest possible measurement.
- 52. Length is most accurately measured by two examiners (one to position the child), with the child supine on a measuring board. For older children, the measure is stature or height, taken using a tape meter. It is essential to compare measurements with previous growth trends and repeat any that are inconsistent.
- 54. Several deficiencies of the older charts have been corrected, e.g. for bottle-fed infants. The new standard provides body mass index (BMI) curves through age 20 yr, used to identify obesity. The data obtained from samples for standard preparation 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)-infants; (5) BMI for children over 2 yr of age.
- 55. How to plot the chart: Measure variables using same method at each visit. Use age and sex appropriate charts plot measurement on Y axis against age on X axis. Compare growth point with previous points. Assess growth percentile.
- 60. The weight-for-height charts are constructed in an analogous fashion, with length or stature in place of age on the x-axis; the median or standard weight for a girl measuring 110 cm is 18.6 kg. Body mass index (BMI) is added to the standard growth charts for children over 2 yr of age. BMI can be calculated as wt in kg/(ht in meters)2 or wt in lb/(height in inches)2 703, with expression of decimals.
- 63. Thank You Make Presentation much more fun