GROWTH & DEVELOPMENT Stages of Human Growth & Development PRENATAL EMBRYONIC age post conceptual implantation th end

d of 8 week FETAL 9th week FT PERINATAL 28th week of gestation th 7 day after birth NEONATAL first 4 weeks after birth *most critical period (exposure to extrauterine environment) - prematurity - congenital anomalies - birth trauma - infections INFANCY 1 - 12 months * most rapid physical growth & mental development - infectious disease - nutritional disorders POSTNATAL EARLY CHILDHOOD LATE CHILDHOOD (toddler/preschool (school age) age) 1 4 yrs 5 12 yrs * weaning *exploration to outside world - accidents & household poisons - nutritional disorders - infections (nursery acquired) - accidents & infections - cardiac disease (RF, bacterial endocarditis) - malignancies - psychological & emotional problems

ADOLESCENCE 12-20 y/o

exp. to

- psychological & behavioral problems - acne & sex hormone related problems - RFD, DM, malignancies - accidents

Growth natural increase of size of the body as a whole or of its separate parts. - resulting from : i) Multiplication of cells ii) Increase in size of cells Assessment of growth Get an accurate body measurement Compare this measurement with growth standards by one of these methods: i) Comparison of this single measurement with average for age and sex ii) Plot this measurement on percentile charts/tables Value of assessing growth by percentile charts: - Follow up growth - Early detection of deviation from normal growth - Helps in excluding organic problems as a cause of minor complaints

Development maturation of organs and systems + acquisition of new skills and functions + ability to adaptation and assuming responsibilities Assessment of development - 3 main processes occurring during development i) loss of early primitive reflexes ii) acquisition of postural reactions iii) acquisition of new skills (developmental milestones) - direction : cephalo-caudal - sequence : similar in all children - rate : varies from child to child + normal inter-individual variation+ sex variation - development process = reflects maturation of the brain n NS *premature infants chronological ages should be corrected according to gestational age

Assessment of growth 1. Weight Age - Birth - Infancy Weight gain (3/4kg) 750 g/month for the 1 4 months = 3kg (1/2kg) 500 g/month for the 2nd 4 months = 2kg (1/4kg) 250 g/month for the 3rd 4 months = 1kg 2kg/year 2.5kg/year
st

- Early childhood (1-6 years) - Late childhood (7-12 years) 2. Length/Height

Total weight 3 3.5 kg 6 kg at 4 months 8 kg at 8 months 9 kg at 12 months (age in years x 2) + 8 (age in years x 7) -5 2

Age - Birth st - 1 3 months nd - 2 3 months 7-12 months (later 6 months) 1-2 years After 2 years

Height gain 3cm/month = 9cm 2cm/ month = 6cm 1.5cm/ month 1cm/ month

Total height 50 cm 59 cm at 3 months 65cm at 6 months 75cm at 12 months 87cm at 2 years (age in years x 5) + 80

3. Body proportion = maturation of linear growth Age Upper/Lower segment ratio (U/L) Birth & infancy 1.7 : 1 3 years 1.33 : 1 5 years 1.25 : 1 Puberty 1: 1

4. Head circumference Age Birth 4 months 6 months 12 months 5. Chest circumference

HC 35cm 40cm 42cm 45 cm

Anterior Fontanelle at birth, 2.5 cm x 2.5 cm closes 6-18 months

Posterior Fontanelle 0.5cm before 2 months

Birth Between 1-2 years After 2 years

HC 2cm> CC HC = CC CC larger than HC

6. Mid arm circumference *in non dominant arm In 1-5 years old, < 12.5 cm 12.5-13.5 cm overtly malnourished border line malnutrition 7. Body S/A 3600 8. BMI ( ) 2 ( )

13.5-14.5 cm normal

Assessment of development Age (months) Gross motor (Locomotion) 1 2 3 Supports head 6 Sits supported 7 Sits unsupported, rolling supine to prone 8 Sits alone 9 Creeps or crawls 12 Walk supported

Fine motor (Sensori-motor

Opens hand spontaneously Transfer object hand to hand Pincer grasp Release object on command

Social (Adaptive) Follows moving object/light Stares at a spot Smiles Shows likes & dislikes Plays peek-a-boo Plays simple ball game

Language (Communication) Crying Smiles in response to face/voice Coos aaaah Babbles baba, mama Repetitive sounds 1-2 meaningful words

Primitive Neonatal Reflexes normal reflex behavior that appear early in like but are lost as development progresses assessment is useful in the evaluation of continued development of the CNS after birth Moro reflex elicited by allowing infants head gently to move back suddenly touching the corner of infants mouth response abduction & upward movement of arms followed by adduction & flexion lowering of the lower lip on the same side + tongue movement towards stimulus vigorous sucking flexing fingers/ curling toes ipsilateral extension of the arm and leg into fencing position + contralateral side flexion disappears by 5-6 months

Postural reflexes normal developmental reaction that appear to persist & essential for the development of balance and posture failure indicate failure of CNS maturation (as in CP) Forward and lateral parachute response Downward parachute response Backward parachute response elicited by sitting child is pushed forwards & laterally vertically suspended child is tilt suddenly downwards sitting child is pushed backwards response he supports his balance by putting his hands on the table extension of arms and head he supports hisbalance by putting his hand on the table appear by 6-8 months

Rooting reflex

less prominent after 1 month

9 months

10 monts

Sucking reflex Grasp reflex Asymmetric tonic neck reflex

placing any abject in NB mouth placing an object on infants palm/sole placing the infant supine & turning the head to the side

later replaced by voluntary sucking palmar : 3-4 months plantar : 6-8 months 6-7 months