Transcript Growth and Development Yang Fan Pediatric Department Growth : defined as an increase in size of body, biological growth of an organism takes place through.

Growth and Development
Yang Fan
Pediatric Department
Growth :
defined as an increase in size of body,
biological growth of an organism takes
place through cell multiplication, this
morphological growth can be measured
clinically.
1.
the enlargement of the organ and the
system
2.
morphological growth
3.
can be measured by exact values
Development:
•A gradual change and expansion;
advancement from a lower to a more
advanced stage of complexity; increased
capacity through growth, maturation,
and learning
•An increase in competence and
adaptability
•A QUALITATIVE change
•Functioning at a higher level
Thus, since both processes are part of
one whole, the combined terms growth
and development form an unitary concept
that
indicates
the
quatitative
and
qualitative of maturational changes of an
organism.
•Growth is a continuous and orderly
PROCESS
height
M
F
weight
M
F
Age (y)
Not all tissue systems of the body
grow at the same rate
Variability
Not
everyone is alike in the way that
they grow
Percentile
growth/ standard deviation
to the norm
Racial
Boys
and ethnic differences
vs Girls
Factors Influencing Growth
•Heredity
•Nutrition
•Gender
•Disease
•Environment
–Hazards
–Socioeconomic influences
Growth Curves
Boys: 2 to 18 years
Boys
Girls: 2 to 18 years
reach most of their height at age of 17
whereas girls reach theirs at around 15
Indices of Growth
Body weight (kg)

the weight of a person’s body.

the weight of all tissues, organs and body fluids.

one indicator of the nutritional status of child.

the basis of drug dosage and amount of infusion.
Patterns of Weight Increment
1、The first growth spurt occurs in the first year
of life (the increment is about 6kg).
2、Growth is not at the same rate in different
age : The increment of weight during the first
3 months is equal to that of the following 9
months.
Yearly increments increase slowly until the
onset of puberty.
Birth weight
3 kg
Mature baby’s weight gain at first month
3—12months
weight=(month十9) /2
1--1.5kg
kg
1—6years
weight= age × 2 十8
kg
7—12years
weight= age× 7-5 / 2
kg
Attention
•About formulae:
These
formulae
are
used
only
for
calculating dosage of drug and fluid in clinic.
Because the growth is not at the same rate in
different age, especially in infant; and the
growth is affected by many factors, such as gene,
environment and individual variation.
•Weight loss:
Physiological weight loss: 3 - 9%
recover at 7-10th day
Loss of 3%~ 9% of birth weight in the
first few days of life is considered normal
and is common for most newborns.
Height(cm)

The length from vertex to plantae

The index of long time nutritional
status
The height for infants up to three years
should be measured as recumbent length
using a properly constructed measuring
device.
Height measurements for children over three
years of age should be accomplished using
vertical measuring board or fixed wall device.
Length/Stature
< 3y
Supine --- Length
≥3y
Stand --- Stature

at birth
50cm

1 year old
75cm

2 years old
85 cm

2--12 years old=age × 6 + 77
Patterns of Length Increment
The first growth spurt occurs in the first year of
life (the increment is about 25cm).
Growth is not at the same rate in different age :
The increment of weight during the first 3
months is equal to that of the following 9
months.
Yearly increments increase slowly until the onset
of puberty.

Shortness may be caused by
malabsorption, chronic illness,
psychosocial deprivation, hormonal
disorders, familial patterns, or syndromes
with dwarfism.

Gigantism may be the result of pituitary
abnormalities.
Male 10y
10y GHD
H88cm
Crown-rump/Sitting height
They give a measure of the length of the head and
trunk. It is a measurement of the distance from the
highest point on the head to the base sitting surface.
<3y
Supine - Crown-rump
length
≥3y
Sit - Sitting
height
During the first year of life, spinal increase
is faster than extremities. Later on, the
extremities grow at a faster rate than the trunk,
which is contribute to the body length and
leading to a gradually change in relative
proportions.
Changes in Overall Body Proportions
Head Circumference
HC is a measurement
of perimeter of head,from
eyebrows to occipital
prominence. The change
of the HC is related with
the growth of brain and
skull.

At birth
34 cm
1 year
46cm
2 years
48 cm
5 years
50cm
15 years
adult)
54cm (the same as
Head circumference should be measured
with a tape measure at each visit during
the first two years of life.
A large head may be an early sign of
hydrocephalus or an intracranial mass.
A small head may be a result of early
closure of sutures or lack of brain
development.
chest circumference
reprent the growth of thorax and
lung
at birth CC< HC 1- 2 cm
1 year CC= HC
>1year CC － HC (cm) =age － 1
Growth on Puberty
• At puberty, there is a marked growth
spurt(The second peak of height
velocity,PHV), that is, a very rapid
increase in size and weight.
• Girls usually showing their pubertal
growth spurt around age 9~11.
• For boys the same process begins at apx.
age 11~13.
• According to Tanner (1990), girls finish
pubertal growth by about age 16 whereas
boys continue to grow until approximately
18 years of age.
Sexual Precocity：Secondary sexual
characteristics appear
before puberty.
Girls<8y，Boys<10y
Delayed sexual maturity： Secondary sexual
characteristics do not appear
after puberty
Girls>14y，Boys>16y
Cranial development
Closure time of fontanel/suture
Fontanel/suture
Anterior
fontanel
Posterior
fontanel
Cranial
suture
At birth
Time of
closure
1.5-2cm
≦18m
0.5-0.7
1-2m
Smallest
3-4m
Abnormality of anterior fontanel
Small size or
early closure：
Large size or
delayed closure：
Microcephaly
Hydrocephalus,
Cretinism
Abnormality of anterior fontanel
Bulging fontanel： Intracranial
hypertension( Encephalitis,
Meningitis)
Dehydration
Sunken fontanel ：
Bone development
Osteite
(center
of
ossification),
which is located near ends of long bones
(epiphyses), with growth plates. It is
very important for bone’s growth in
length.
The sequence of appearance of secondary centers
Bone age
Bone age is that the age should be
according to the osteite number for
normal child. The most commonly used
standards are those of Gruelich and Pyle,
which require radiographs of the left
hand and wrist; knee films are sometimes
added for younger children(usually less
than 1 year old).
Abnormality of Bone Age
Retardation Hypothyoidism, Hypopituism
of BA：
Precocity
of BA：
Adrenogenital syndrome,
Precocity
Dentition
Primary teeth:
•Primary teeth are 20 totally.
•The first eruption is at about 6
months(4~10 months) .
•The timing of tooth eruption is more
variable than other developmental
parameters
Primary teeth
•Delayed eruption is usually
considered when there are no teeth by
approximately 12 months of age.
•The last eruption of primary teeth is
at 2~2.5 years of age.
Abnormality of Dentition
Delayed eruption:
Hypothyroidism,idiopathic
Disorder :Hypothyroidism, Brain dysplasia
Failing to erupt :
Ectodermal dysplasia,Mechanical
blockage
Abnormality of dental enamel :
Ectodermal dysplasia
Evaluation of growth

Growth level

Growth velocity

Proportion
Evaluation of growth

Reliable and accurate data

Single Value and series investigation

reference
Choosing reference
R eference ,
based
on
a
North
American population by NCHS, USA, is
recommended by the WHO as the
international standard of growth.
Choosing reference
Besides,there are many local or
national references,for example,
physical growth indices of 9 cities in
China.
Methods of assessment
•Reference table
•Growth curve
Growth Curves
Boys: 2 to 18 years
Boys
Girls: 2 to 18 years
reach most of their height at age of 17
whereas girls reach theirs at around 15
AGE
P3
P5
P10
P20
P30
P40
P50
P60
P70
P80
P90
P95
P97
0
2.5
2.6
2.7
2.9
3.1
3.2
3.3
3.4
3.5
3.7
3.9
4.1
4.2
1
3.0
3.2
3.4
3.7
3.9
4.1
4.3
4.5
4.6
4.9
5.1
5.4
5.6
2
3.6
3.8
4.1
4.5
4.7
5.0
5.2
5.4
5.6
5.9
6.2
6.5
6.7
3
4.2
4.4
4.8
5.2
5.5
5.7
6.0
6.2
6.4
6.7
7.1
7.4
7.6
4
4.8
5.1
5.4
5.8
6.2
6.4
6.7
6.9
7.2
7.5
7.9
8.2
8.4
5
5.4
5.7
6.0
6.5
6.8
7.0
7.3
7.5
7.8
8.1
8.5
8.9
9.1
6
6.0
6.2
6.6
7.0
7.3
7.6
7.8
8.1
8.4
8.7
9.1
9.4
9.7
7
6.5
6.7
7.1
7.5
7.8
8.1
8.3
8.6
8.9
9.2
9.6
10.0
10.2
8
7.0
7.2
7.5
8.0
8.3
8.5
8.8
9.0
9.3
9.6
10.1
10.5
10.7
9
7.4
7.6
7.9
8.4
8.7
8.9
9.2
9.4
9.7
10.1
10.5
10.9
11.1
10
7.7
7.9
8.3
8.7
9.0
9.3
9.5
9.8
10.1
10.4
10.9
11.3
11.5
11
8.0
8.2
8.6
9.0
9.3
9.6
9.9
10.1
10.4
10.8
11.3
11.6
11.9
12
8.2
8.5
8.8
9.3
9.6
9.9
10.2
10.4
10.7
11.1
11.6
12.0
12.2
Growth level
Every single measurement can be
plotted on a growth curve which
illustrates the amount of growth in
children within different age group.
Evaluation of growth




mean standard deviation： cut-off
－
point
x ± 2SD
percentile：cut-off point P3--P97
－
Z score Z score=( x - x )÷SD
Growth curve：
Example：（Weight of girls）
1y～
P3
7.49
P25
8.54
P50
9.18
1y～
-2SD
7.18
-1SD
8.21
X
9.24
P75
9.91
+1SD
10.27
P97
11.37 (kg)
+2SD
11.30 (kg)
The weight of a one year old girl is 8.2 kg.
Growth level：
W/A
P3-P25
W/A
X-（1SD～2SD）
Growth velocity
Growth velocity can show the
process of growth. Growth velocity is
measured in terms of how much a
child grows within a specified period
of time.
Neuropsychological and
Behavioral Development
Nervous system anatomically complete at birth
except:
Myelination
rapid for 2 years
complete by 7 years
Primitive reflexes disappear in few months
The Baby’s Brain-Infant Vision Development
newborn
1 month
3 months
6 months
2 months
adult
Audition
Audition is important because it relates
language development. If a child has
hearing loss, the child will have impaired
speech, language and learning and
behavioural problems stemming from
difficulty in communication.
Newborns prefer sweet tastes over
sour, bitter, and salty tastes. They can
distinguish odors right from birth and
soon learn to know the smell of their
mother’s milk and bodies.
BEHAVIOR DEVELOPMENT
Four Attributes
Gross motor
Fine motor
Language
Personal—social skill
gross motor
Physical skills involving large body
movements such as lifting head, walking,
and jumping.
Fine Motor
Physical skills involving small body movements,
especially with the hands and fingers, such as
picking up a coin and drawing.
Personal —Social Skill
Developmental Surveillance
Periodic
assessment of a child’s
developmental progress with the aim of
detecting pre-symptomatic disability

Longitudinal and multidimensional
developmental monitoring.

Over-reliance on isolated developmental
scales and tests should be avoided.

Screening tests: Screening procedures
should be brief, simple, cheap and
reliable

Diagnostic tests
What do we look for in
developmental screening?
Normal
growth pattern
Height,
weight, head circumference
Achievement
of developmental milestones
(indicating neurological development)
Gross
Fine
motor function
motor function and vision
Hearing
Social
and speech
behaviour and play
Screening tests

Pediatric periodic health supervision

Standardized developmental screening
instruments


Not diagnostic
when abnormal, diagnostic evaluation
should be done

DDST
children under 6 yrs

PPVT
from 4 to 9yrs
especially for children delayed in language
Diagnostic tests

Gesell’s test
from 4 weeks to 3yrs

Bayley
from 2 to 30 months

WPPSI
from 4 to 6.5yrs

WISC-R from 6-to 16yrs