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Growth

Growth denotes increase in size or mass of tissues-multiplication of cells and increase in the intracellular substance.

Development specifies maturation of functions. It is related to the maturation and myelination of the nervous system.

 

Rules of growth and development

  1. Both are continues process                            
  2. Rate may differ but pattern is same
  3. Pattern is cephalocaudal proximal to distal  

Hormone influence on the growth:

  1. Thyroxineq - human fetus secretes thyroxine from the 12th week of gestation. Deficiency does not affect the linear growth of the fetus but significantly retards the skeletal maturation. Birth weight is normal.
  2. InsulinQ- stimulates fetal growth.
  3. Insulin like growth factorQ
  4. Growth Hormone - Not Essential** for fetal growth in utero.Q 

A. Periods Of Growth

 

 

WHO- definition Q

  1. Adolescence:- 10 – 19 years
  2. Young:- 10-24 years
  3. Youth:- 15 – 24 years 

B. Assessment Of Physical Growth:

  1. Weight
    1. The measurement of weight is the most reliable criterion of assessment of health and nutritional status of children. The physical growth depends upon the interaction between genetic endowment and environmental influences, especially dietary intake and infectious diseases.
    2. Formulas for approximate average weight of normal infants and children At Birth average weight is 3.25kg

3 month – 12 month

X+9/2

X =  age in month

1 year – 6 year

2X+8

X =  age in year

7 – 12 year

7X 5/2

X = age in year

  1. During first few days after birth the new born loses extracellular fluid equivalent to about 10% of the body weight. Most full term infants regain their birth weight by the age of 10 days.
  2. Infants usually double his birth weight by the age of 5 months
  3. Birth weight trebles at 1 year and four times at 2 year of age
  4. The weight for age is a reliable index of the nutritional status of a child. The severity of under nutrition can be assessed on the basis of classification proposed by IAP {Indian Academy of Pediatrics}
  5. Weight> 80% of expected for age is Normal

 

    i. Grade of PEM

    Expected weight for age

           Grade I

           71- 80%

           Grade II

           61 -70%

           Grade III

           51 -60%

           Grade IV

           <50%

  1. Length or Height
    1. Upto 2 years of age recumbent length is measured with the help of an infantometer while in older children standing' height is recorded
    2. At birth = 50 cm
    3. 3 month = 60 cm
    4. 9 month = 70 cm
    5. 1 year = 75 cm
    6. 2 year = 87 cm
    7. 4 1/2 year = 100 cm
    8. 2 year - 12 year = 6x + 77 [x= Age in year]
    9. Height is double of bil1h length at 4 year
    10. If length or height of the child is below the 3rd percentile or less than 25D from the mean child is considered to be short stature.  
  2. Head circumference
    1. The maximum circumference of the head from the occipital protuberance to the forehead is recorded.
       
      Birth = 33- 35 cm (70% of adult size) Q
       
      3 month = 40 cm
       
      6 month = 43 cm
       
      1 year = 46 to 47 cm Q
       
      2 year = 48 cm (90% of adult size) Q
       
      12 year = 52 cm (Adults size) Q 

During first year there is 12 cm increase in head circumference, while between 1-5 year age only 5 cm gain occurs in head size.
 

Approximate anthropometric values in relation to age.

Age

Weight (Kg)

Length or height (cm)

Head circumference (cm)

Birth

3

50

34

6 months

6 (doubles in 5 months)

65

42

1 year

9 (triples)

75

45

2 years

12 (quadruples)

85

47

3 years

14

95

49

4 years

16

100

50

  1. Microcephaly
    1. It is defined as head circumference below 2 SD of the mean fore age.
    2. It may be primarily due to impaired growth of the brain or secondary due to premature fusion of sutures.
    3. Causes
      1. Familial microcephaly
      2. Syndrome
        1. Down                  
        2. Edward                
        3. Cridu Chat Syndrome         
        4. Cornelia de lange
          1. Radiation                    
          2. Congenital infection                    
          3. Drugs
          4. Malnutrition                        
          5. Meningitis                            
          6. Metabolic    
          7. Hypoxic ischemic encephalopathy  
  2. Relationship  of  head size with chest circumference
    1. The chest circumference is measured at the level of nipples
    2. At birth HC is larger by upto 3 cm as compared to chest circumference (CCC) Q. The circumference of head (HC) and chest are almost equal by the age of 1 year Q
    3. But there after chest grows more rapidly as compared to the brain
    4. HC > CC    Preterm
       
      > 3 cm     SGA,  Hydrocephalus
    5. In malnourished children, chest size may be significantly smaller than the head circumference because growth of brain is less affected by under nutrition. 
  3. Mid arm circumference
    1. During 1 - 5 year of age, the mid upper arm circumference remain reasonably constant between 15 -- 17 cm among healthy children because fat of early infancy is gradually replaced by muscles.
    2. MAC is measured with a fibre glass tape at the midpoint between acromion and olecranon.
       
      MAC < 12.5 cm                 Severe malnutrition
       
      MAC 12.5 - 13.5                Moderate malnutrition
    3. Bangle Test- It can be used for quick assessment of arm circumference. A fibre glass ring of internal diameter of 4 cm is slipped up the arm. If it passes above the elbow it suggest that upper arm is less than 12.5 cm and child is malnourished.
    4. Shakir Tape- Is a fibre glass tape with three color codes that paramedical workers can assess nutritional status without having to remember the normal limits of mid arm circumference.
       
      < 12.5 cm - Red
       
      12.5 - 13.5 cm- Yellow
       
      > 13.5 cm - Green  
  4. Arm span-
    1. It is the distance between the tips of middle finger of both arms out stretched at right angle to the body. The arm span is measured across the back of the child.
    2. < 5 year AS is I to 2 cm smaller than body weight
    3. 10 - 12 year AS = Height
    4. >12 year AS> ht (2 cm)
      1. Abnormally large span is seen in        
      2. Klinefelter syndrome
      3. Marfan's syndrome                              
      4. Arachnodactyly 
  5. US : LS Ratio
    1. The upper segment (vertex to upper edge of symphysis pubis) to lower segment (limb length i.e. symphysis to heels) ratio at birth is 1.7 to 1.0
    2. At birth 1.7: 1.0
    3. 3 year 1.3: 1.0
    4. 10 year 1.0 : 1.0
    5. US Achondroplasia, Cretinism, short limbed dwarfism bowed leg.
       
      LS
    6. US spinal deformities (Potts spin, rickets), Mucopolysaccharidosis.
       
      LS
  6. Eruption of teeth 
    1. Temporary teeth
       
      1st to erupt-Lower central incisors (5-8 months)
    2. Permanent teeth
       
      1st to erupt - I st molar* (7 yrs)
    3. Table . Chronology of Human Dentition of Primary or Deciduous and Secondary of Permanent Teeth                                       
    4. Delayed dentition:
       
      Delayed dentition is usually considered when there is no eruption by approximately 13 months of age Q. 

Causes:

  1. Hypothyroidism            
  2. Hypopituitarism
  3. Rickets                  
  4. Congenital syphilis                
  5. Cleidocranial dysostosis
  1. Anterior fontanel
     
    Usually closes between 9-18 months.
     
    Delayed closureQ
    1. Rickets
    2. Hydrocephalus
    3. Cretinism
    4. Down syndrome
    5. Congenital syphilis
    6. Osteogenesis imperfecta
    7. Cleidocranial dysostosis
    8. Achondroplasia
Posterior fontanel Usually closes by 2-4 monthsQ





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