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GROWTH&DEVELOPMENT

GROWTH&DEVELOPMENT. EVALUATION OF GROWTH&DEVELOPMENT. 1) Fetal growth and development. 3-4yr- 9-10yr. Puberty. 2) Postnatal growth of major organ systems Brain and head Lymphoid systems Reproductive systems 3) Growth pattern- head

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GROWTH&DEVELOPMENT

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  1. GROWTH&DEVELOPMENT

  2. EVALUATION OF GROWTH&DEVELOPMENT • 1) Fetal growth and development. 3-4yr- 9-10yr. Puberty. • 2) Postnatal growth of major organ systems • Brain and head Lymphoid systems Reproductive systems • 3) Growth pattern- head -chest (offen 6 months) -extremites (9-12 months) • 4) Biologic variation genetic structure • 5) Secular trend positive or negative

  3. STAGES OF CHILDHOOD • Prenatal 1) Embrionic (0-10 wk) 2) Fetal (10-40 wk) • Postnatal 1) Newborn (0-4 wk) 2) Infancy (1-12 months) 3) Toddler (1-3 yrs) 4) Preschool (4-5 yrs) 5) School (6-10/ 6-12 yrs) 6) Puberty (10-18/12-20 yrs)

  4. HEALTY CHILD • GROWTH • Weight, height,head circumference, chest circumference, the ratio of body parts • DEVELOPMENT • Teeth, bone, neuromotor, intelligence, sexual

  5. HEALTY CHILD • WEIGHT: BW is regained by 10th-14th day. Average weight gain/day : • 0-6 mon: 20-30g/day (150-250 g/wk) • 6-12 mon: 15-20 g/day (100-150g/wk) • 12-24 mon:50 g/wk • BW doubles at ≈ 4 mon, triples at ≈12 mon, quadriples at ≈ 24 mon. • After age two years average annual gain until adolescence ≈2.3 kg

  6. HEALTHY CHILD • At birth 3.25 kg • 3-12 mo [age(mon)+9]/2 • 1-6 yr [age(yr)x2]+8 • 7-12 yr [age(yr)x7-5]/2

  7. HEALTHY CHILD • HEIGHT: By end of first year birth length increases by 50%. Birth length doubles by 4 yr, triples by 13 yr. • Average height gain during second year ≈ 12cm third year 9cm,fourth year 7cm,after fourth year to puberty 5-6cm • After age 2 year average annual growth until adolescence≥5 cm

  8. HEALTY CHILD • At birth 50 cm • At 1 yr 75 cm • 2-12 yr [age(yr)x6] + 77 • First 6 mon ; 8 cm (3 mon) + 8 cm (3mon) • Second 6 mon; 4cm (3 mon) + 4 cm (3mon) • *8+8+4+4*cm

  9. HEALTHY CHILD • Midparental height for girls: • (father’s h-13)+(mother’s h)/2 • Midparental height for boys: • (mother’s h+13)+(father’s h)/2 • For full-term infants, size at birth reflects the influence of the uterine environment; however, size at 2 yr correlates with mean parental height, reflecting the influence of genes

  10. HEALTHY CHILD • HEAD CIRCUMFERENCE: • At birth head/height= ¼ → ⅛ (adult) • At birth HC : 35 cm • 3 mon: 40.5 cm • 6 mon: 43 cm • 12 mon: 46 cm • 4 yr 50.4 cm • 5 yr 50.8 cm

  11. HEALTHY CHILD • CHEST CIRCUMFERENCE • At birth 33 cm • 12 mn 47 cm • 5 yr 55 cm • 14 yr 74 cm • NB; HC=CC • >1 yr CC >HC

  12. HEALTHY CHILD • THE PROPORTIONS OF BODY: • Head-Pubis/Pubis-Foot = 1.7 (NB) 10 yr ≈1 Adolescence < 1 • Sitting height = 0.7 At birth 0.57 = 3 yr

  13. HEALTHY CHILD GROWTH CHARTS 5 gender spesific charts (2000-CDC) 1)Weight for age 2)Height for age 3)HC for age 4)Weight for height 5)BMI over 2 yrs of age

  14. HEALTHY CHILD • Charts with lines for the 3rd and 97th percentiles are available • -2sD, 3. per & +2sD 97.per • Decreasing by 2 percentile is acceptable until 4 years of age • www.who.int/childgrowth/mgrs/en/.

  15. Growt charts

  16. Growt charts

  17. HEALTHY CHILD • DENTAL DEVELOPMENT

  18. HEALTHY CHILD EVALUATION OF OSSEOID MATURATION • Determining the age (choronologic) • Predicting adult height • Determinig the growth status. The distal femoral and proximal tibial epiphyses are ossified in the normal full-term infant (first three months) Examination of the hand and wrist. • At 2-6 month of age ; capitate-hamate • The fusion of the humeral capitellum → first • Distal radial fusion → last

  19. HEALTHY CHILD • 6 fontanelles; ant (3-18 mons),post,2 lambdoid,2 sphenoid • Sutura clossure ; puberty

  20. HEALTHY CHILD NEUROMOTOR DEVELOPMENT • Sefalo-Caudal • Proximo-Distal • VISION ; NB; shiny things • 2 wk : 45º - 90º • 2 mn : 180º • 5-6 yrs : full

  21. HEALTY CHILD • Beginning to smile ; at 4 weeks • Repetetive meaningless sounds; 40 wk (ma-ma,da-da etc.) • A few words → at 1 yr brief sentence → 2yr make asentence → 3 yr • Sits briefly → 6-7 mons • Walking without help →1 yr • Grasping objects → 4-6 mons • Grasping with thumb and forefinger → 9 mons • May complain when wet or soiled →15-18 mons

  22. GROWTH FAILURE HEIGHT: 1)hormonal factors • GHRF → GH → IGF1 postnatal, IGF2 fetal IGFBP 3 postnatal , IGFBP2& IGFBP1 fetal • Thyroxin • Corticosteroids • Insulin • Gonadal hormones 2) Skeletal system 3) Genetic,midparental height 4) Enviromental factors,nutrition

  23. EVALUATION • Height under 3.percentile • Velocity of height is decreased, 1-2yr under 10cm,2-3yr under 7cm,3-4yr under 6cm and 4-puberty under 4cm • Bone age • Height age • Chronological age • Target height

  24. GROWTH FAILURE Classification(1) • Primary: usually bone age is normal • -genetic • -IUGR • -chromosom anomalies • -skeletal dysplasia

  25. GROWTH FAILURE • Secondary: bone age < choronolojical age • Constitutional • Psycological • Nutritional deficiency • Chronic disease • Hormonal disorders

  26. GROWTH FAILURE Classification (2): • Pathologic: sceletal dysplasia, endocrine anomalies, IUGR, choromosom anomalies, chronic disease, malnutrition • Nonpathologic: genetic, constitutional, idiopathic.

  27. GROWTH FAILURE GENETIC GROWTH FAILURE • Determining the parent’s percentile norms. • Bone age =/< choronologic age. Birth weight → N • Usually found in other family members. • Results of growth are normal. • No therapy (GH can be administered)

  28. GROWTH FAILURE IUGR • Twins, premature; catch-up growth • IU infections • Alcohol, smoke • Hypertension, eclampsia • Nutritional defects • Placental insufficiency • Birth length, HC }↓ • Hypoplastic Adults, GH; N

  29. GROWTH FAILURE CHOROMOSOMAL ANOMALIES: 1)Down syndrome (Trisomy 21) • MR, hypotonia, flat occiput, epichantic folds, protruding tongue, prominent malformed ears, congenital hearth defects, criptorchidism, simian crease, short broad hands, hypoplasia of middle phalanx of 5.th finger, gap between 1st. and 2nd. toes, high arched palate, strabismus, short neck, small teeth, intestinal atresia, imperforate anus

  30. GROWTH FAILURE 2) Turner syndrome (45 X0) • Short stature, gonadal dysgenesis, primary amenorrhea, mental retardation eye-ear abnormalities, LBW, lymphedema on hands and feet, no breast development, infertility.

  31. Turner syndrome (45 X0)

  32. GROWTH FAILURE SKELETAL DYSPLASIAS:Growth failure begins antenatally. Short shaft. Adolescence height is short. • Growth and bone age are affected equally. • Development defects of skeleton • Dysplasias; disorders of growth • Dysostoses; malformation of bone • İdiopathic osteolyses; pathologic resorbtion of bone

  33. GROWTH FAILURE Achondroplasia: A.D. • Reduced rate of qualitatively normal endochondral bone formation • Rhisomelic shortening of the limbs re-cognized at birth • Large head size • Frontal bossing • Depression of nasal bridge

  34. GROWTH FAILURE • The hands are short and broad • Normal neuromuscular tone is usually gained by 2-3 yr • Dental malocclusion Hypochondroplasia: • Recognized from 2-3 yr • A.D. • Head and face are normal

  35. achondroplasia

  36. hypochondroplasia

  37. GROWTH FAILURE CONSTITUTIONAL GROWTH DELAY • Lenght and weight are normal at birth. • Growth decelarates after 4-12 months. • By 2-3 year growth resumes at anormal rate of 5 cm/year. • Bone age similar to height age < chronologic age. • Other family members can be affected. • Achive normal adult height • Delayed puberty ( can require a short cause of testosteron to initiate puberty)

  38. GROWTH FAILURE PSYCOLOGICAL: Enviromental factors • In infancy → hospitalization • Cortical inhibition → hypothalamic inhibition MALNUTRITION : Inadequte protein and carbohydrate intake • Height and bone age < chronologic age • Weight decelerates, too.

  39. GROWTH FAILURE • CVS: PDA, VSD, AS, PS, TGA, Fallot • GIS: Chron dis, colitis ulserosa, malabs syndrome, celiak dis, CF, chronic gastroenteritis, chr liver dis, • UGS: chr GN, NS, RTA

  40. GROWTH FAILURE HORMONAL DISORDERS GH def: congenital ; aplasia/hypoplasia of the pituitary Acquired; craniopharyngioma Idiopathic Reseptor defect • Normal size and weight at birth • IGF-I is a screening test for diagnosis • GH is determined with stimulation tests • GH is increased after puberty begins • Chr age is greater than bone age and bone age is greater than height age

  41. GROWTH FAILURE • Delayed closure of epiphyses permits growth beyond the age when normal persons cease to grow • The head is round. Face is short and broad • Nose is small • Mandible and chin are underdeveloped • Late teeth eruption • Extremites are proportional • Delayed sexual maturation

  42. GROWTH FAILURE Hypothyroidism,Chr age is greater than height age and height age is greater than bone age D.M. Pubertas preacox; idiopathic, gonadal tm congenital surrenal hyperplasia. Pseudohypoparathyroidism; PTH → N , Ca → ↓ Cushing ; excess of glucocorticoids, moon face, central obesity, hypertension, striate (surrenal hyperplasia, adenoma, carsinoma)

  43. Hypothyroidism

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