SKIN Healthy breast-fed infant → velvet and white pink Formula-fed infant → pallid Epidermis:- begin thickening of stratum corneus;- apears the pigment in the basal cells;- melanin-producing cells grow;- increases resistance to infection and physical and chemical agents.
Dermis:- is coming to maturity;- papillary dermis are multiplying al ;- capillaries are extending. Infant skin is elastic. In states of dehydration skin fold returns slowly or is persistent. SKIN
Sebaceous glands:- fully developed at birth- excessive secretion → cradle cap. Sudoriparous glands: - start to develop at 2-3 months of age; - achieve fully functional activity at 2 years when nerve centers are matures. SKIN
SKIN Hair:- color changes during growth.- installation of puberty → secondary sexual characteristics → hair growth (facial, axillary, chest, pubic and on the limbs).Infant skin surface:- is large relative to W;- decreases with age.
SKIN It can be calculated as one of the formula:Skin surface = 0.92 x H2 Skin surface = √ W x H/ √ 3600Specific skin surface: (ratio Skin surface / W) is 2 times that of the adult → loss of heat → 2 times higher.
Subcutaneous adipose tissue It develops gradually: on the upper and lower limbs, chest, and only at 6 weeks on the abdomen.In states of malnutrition → it disappear in the reverse order of appearance: abdomen, chest, lower and upper limbs and in final states, Bichat tissue.
Subcutaneous adipose tissue Clinical assessment of the nutritional status in infants: - measurement of chest skin fold thickness (normally 1 to 1.5cm)- measurement of abdominal skin fold thickness (normally 1.5 to 2 cm)- presence of adductors folds; - presence of turgor .
Subcutaneous adipose tissue More accurate assessment of nutritional status: - weight index (WI);- middle upper arm circumference;- nutrition index (NI);- body mass index (BMI).
Muscular System Muscle development = uneven (lower limb muscles are more developed). After the first month of life → normotonicity. Motor activity: - enriches the circulation; - stimulates the growth of muscle fibers; - maintain a good tone.
Osseous System Differences between the growth of the organic substrate body's skeleton and its capacity to calcify through normal dietary intake → physiological osteoporosis → very low resistance to direct trauma of the infant bones.Bone tissue is richly vascularized: - better recovery; - intense inflammatory reaction at this age.
Body Segments Exam Head: continuous and progressive closure of anterior and posterior fontanelle.Spine: development of motor function → mechanical forces → curvatures:- 3 months (keeps his head) → cervical lordosis;- 6 months (sits without help) → kyphosis ;- 9-12 months (starts to walk) → lumbar lordosis. These three curvatures are emphasized during the 2nd year of life when the child can walk independently.
Body Segments Exam Chest:- cylindrical;- ribs → initially horizontal → oblique after 6 months;- transverse diameter ~ anterior-posterior diameter, then the shape → thorax = trapezoid; Breathing is - abdominal diaphragmatic type in infant - chest breathing in children.
Body Segments Exam Pelvis:- funnel shape;- in girls, after puberty → cylindrical.Lower limbs:- grow faster;- internal condyles of the tibia are less developed than external ones → physiological curvature (different from rickety curvature).
Respiratory System Upper airways: • narrow in infant, • inflammation→mucous edema→breath difficulties Maxillary sinus and ethmoid cells: • fully developed • can appear infections - sinusitis. Frontal and sphenoidal sinuses: • develops slowly; • infections can appear after the age of 4 – 5 years / 6-10 years.
Respiratory System Pharynx → Waldeyer`s lymphatic ring Tonsils: • physiologic hypertrophy until the age of 4-6 years; • involutesafter the age of 11-12 years. Larynx: • upper than adult larynx→ simultaneous breath and swallowing in infant; • glottic`s spasm is frequent in child; • during puberty→ change the voice`s timbre.
Respiratory System Trachea:- poor in elastic tissue;- weak binding and can be easily displaced;- walls - less resistant to pressure.Bronchi:- rich in muscular fibres;- few mucous glands; - right bronchus, is wider than the left bronchus; - the bifurcation angle is smaller than of the left one.
Respiratory System Lungs:- rich vascularity → favors infections;- alveoli increase in volume → increases lung volume and respiratory surface;- elastic fibers, underdeveloped in infant → atelectasis;- pulmonary elasticity increases until the age of 20 years.
Respiratory System Diaphragm → higher, the dome has reached the 4th rib. Hiccups:reflex contraction of the diaphragm;often in healthy infants during the first months of life;has no pathological significance. Respiratory rate: 40-45 resp. / min in infants; 35 resp. / min at 1 year; 30 resp. / min at 3 years; 25 resp. / min at 5 years; 16 resp. / min at 15 years.
Respiratory System Respiratory amplitude → unequal;Rhythm → sometimes irregular ; During sleep → long apneic periods ± type Cheyne-Stokes respiration.Pulmonary auscultation: vesicular is harsher (thin chest wall).
Circulatory System HeartDuring infancy:- horizontal - anatomical apex → sp. V ic left- apexian beat → sp. IV ic 1-2 cm outside midclavicular line, - globular appearance with enlarged transverse diameterAfter two years of age:- heart is vertical- apexian beat → sp. V ic left midclavicular line.
Circulatory System Atria→ large LV wall thickness ~ to that of RV.Development of elastic connective tissue → LV wall thickness = 3 x RV wall thickness.On auscultation:- heart sounds are perceived more powerful (the chest wall is thin)- Heart murmurs are often audible (not always pathological significance).
Circulatory System Large arteries in children → wider than in the adult compared to height → low blood pressure, easier heart activity and hemodynamics .Pulse: - infant is 120 beats / min - 2 years 110 beats / min - 5 years 100 beats / min - 8 years 90 beats / min - 14 years 80 beats / min.
Blood pressure (BP)large vessels and high wall elasticity → low BP (80-90/50-60 mmHg in the first year).BP = 2x age + 80 (± 10) mmHg Circulatory System
Hematopoietic System Hematopoiesis in the infant and child:- in bone marrow → erythrocytes, granulocyte and platelet series - in lymphoid organs and bone → lymphocytic series.Hematopoiesis in the older children:- in the short and flat bones: ribs, vertebrae, sternum, pelvis, scapulae, skull bones, clavicles, proximal long bones epiphyses.
Hematopoietic System When bone marrow hematopoietic capacity can not meet the needs of the body, hematopoiesis occurs in parenchymal organs: liver, spleen, lymph nodes.Lymphoid organs: thymus, lymph nodes, Payer plates, tonsils, and spleen have a limfopoietic and immunocompetent role.
Hematopoietic System Erythrocytes: size as in adults up to age 5; life is increased to 120 days; 14 years → 5000000/mm3 (♂) → 4500 000/mm3 (♀)Ht = 42-45% at puberty.Hemoglobin:- decreases in the first two years → 11 g%;- gradually increases to the age of 14 → 16 g% in boys and 14 g% in girls.
Hematopoietic System Leucocyte: • 7 000 – 8 000/mm3; • until the age of 4→ neutropenia (30-40%) and limphocytosys (up to 60%); • adult`s values at the age of 5-6 years. Platelets:200 000 – 300 000/mm3.
Digestive System Oral cavity: lips and mouth muscles are adapted for sucking: - Robin Magitot fold (fold of oral cavity, that contains arrector muscular tissue in the submucouse, is situated near the future upper incisors and canines) - contributes to grasping and compressing the nipple; - transversal folds of the hard palatine mucous - fix nipple during sucking;
Digestive System - Buccal pad (Bichat's tissue) through strong consistency does not allow suppression of the soft parts of the cheeks during sucking and facilitates the negative pressure in the mouth; - lips presents on the internal side some radial grooves, the mucous is elevated and has arrector tissue in its composition that facilitates the fastening of the lips on the nipple
Sucking = reflex with the center in medulla Oblongata Touching the lips or the oral cavity mucouse triggers sucking reflex. Digestive System
Digestive System Saliva contains lysozyme and secretory Ig A with a role in local anti-infective defense. Salivary amylase converts starch to dextrin and maltose. Physiological pancreatic amylase deficiency in infants → than salivary amylase provides starch hydrolysis from rice mucilage.
Digestive System Temporary dentition = 20 teethPermanent dentition = 32 teethDental buds of the temporary dentition occurs during fetal life (4-5months).Crown calcification begins in the same period and ends a year after birth.
Tooth eruption may beaccompanied by:- sialorrhea,- swelling of the gums,- transient intestinal disorders,- slight indisposition,- insomnia. Digestive System
Digestive System The emergence of temporary dentition:- 6-8 months → inferior front incisors, and every two months another pair:- 8-10 months → superior medial incisors;- 10-12 months → lateral superior incisors;- 12-14 months → lateral inferior incisors;- 16-20 months → first superior and inferior premolars;- 18-22 months → canine teeth;- 24 to 30 months → second superior and inferior premolars
Digestive System Delayed eruption: first teeth appear after a year.Causes:- rickets,- dystrophy,- myxedema,- Down syndrome.Congenital teeth lead to sucking difficulties, but their extraction is not recommended because deprives the child of teeth until the age of 7 years.
Permanent teeth eruption: - 6-7 years → first molars, - 7 to 8 years → front incisors, - 8 to 9 years → lateral Incisors, - 9-10 years → premolars, - 10-11 years → canines, - from 12 to 14 years → second pair of molars, -18 to 25 years → last pair of molars Digestive System
Normal development of teeth depends on adequate intake of:- protein- vitamin D - Ca, P, F,- thyroid function,- oral hygiene.Excessive intake of sweets promotes tooth decay. Digestive System
Digestive System The esophagus has increased more slowly than the spine → high position until puberty. The stomach is placed transversely and becomes vertical after 2-3 years. Crypts and gastric glands grow in size and number under the action of gastrin. Free hydrochloric acid is secreted in small amount in early infancy.
Digestive System After 3 months of age, gastric pH falls to 2.5 to 3.5 in breastfed infants (increase in gastrin receptor activity), while in bottlefed infants is higher.Gastric secretion contains:- proteolytic enzymes: pepsin, cathepsin;- lipolytic enzymes: lipase.
Digestive System Pepsin- in sufficient quantity from the newborn- it increases with decreasing activity in gastric pH.Gastric lipase acts on fats → glycerol and fatty acids.
The infant burping (removing of the swallowed air) and cardia`s low tone favor regurgitation and vomiting, so after eating infant must be held upright. Digestive System
Digestive System Gastric evacuation : - 2 hours at breastfed infants, - 3 hours in the bottle-fed infants, - in 4 hours for solid food.