Growth and Development DR. REKHA DUTT
GROWTH- It is increase in physical size. • Development – It is increase in skills and functions. Normal growth and development occur • if there is optimum nutrition, • freedom of recurrent infections • and freedom from adverse genetic and environmental influences.
Determinants of growth and development • Genetic inheritance • Nutrition • Age – more in fetal life, infancy and puberty • Sex • Physical surroundings • Psychological factors • Infection and parasitosis • Economic factors • Birth order, education of parents
Normal growth • A normal child is that whose characteristics fall with in the range of measurements accepted as normal for majority of children in same age group. • Normal variations are assumed to include 2 Standard Deviation above and below the mean i.e.3rd and 97th centiles.
Surveillance of growth and development • It is done to identify those children who are not growing normally. • Weight for age – A single weight record only indicates size at the moment but does not give any information whether a child’s weight is increasing or decreasing. Repeated measurements at intervals ideally monthly from birth to 1 year,2 monthly during 2nd year and 3 monthly should be taken upto 5 years of age. • A baby should gain 500gm/month for first 3 months, doubles the birth weight by 5 months ,trebles by 1 year and quadruples by 2 years.
Height for age – Birth length is approx. 50 cm.It increases by 25 cm at first year and another 12 cm during second year. Low height for age – also called as stunting. It reflects past and chronic malnutrition. • Weight for height – Low weight for height is nutritional wasting or emaciation( acute malnutrition). • Head and chest circumference – At birth head circumference is approx. 34 cm.It is about 2 cm more than chest circumference. By 6-9 months the two measurements become equal after which chest circumference takes over head circumference.
Behavioral development • Motor development • Head holding – 3 months • Sits without support – 6-8 months • Crawling- 9 months • Stands with support – 10-11 months • Walks – 12-14 months • Language development • Experimenting with noises – 6-8 months • First words – 10-11 months • Short sentences – 24 months • Sociopersonal development • Looks at mother and smile – 6-8 weeks • Recognizes mother – 4-5 months • Suspicious of strangers – 9-10 months
Growth Chart Definition: It is a visible display of a child’s physical growth and development. First designed by David Morley . Growth chart offers a simple and inexpensive way of monitoring weight gain. Any deviation from “normal” detected by comparison with reference curves.
The WHO growth chart It has two reference curves. Upper reference curve -the median (50th percentile) for boys. Lower reference curve – 3rd percentile for girls Space between two growth curves called weight channel or road to health – zone of normality for most population.
Interpretation Normal - growth line above 3rd percentile and will run parallel to reference curves Abnormal- flattening or falling of child’s weight curves signals growth failure Earliest sign of PEM Precede clinical signs by weeks or even months Such child needs special care Objective- keep child above 3rd percentile
Growth Chart Used In India It has four reference curves. Top most curve – 80 %of the median (50th percentile) of the WHO reference standard. Lower lines represent 70% ,60% and 50% of the standard. 80% median weight is approximately equal to 2 SD below the median which is the conventional lower limit of “normal range”. Purpose of reference curve – It indicates degree of malnutrition.
INTERPRETATION 1st degree (grade 1)malnutrition- child’s weight between 80% and 70% lines. 2nd degree (grade 2 or moderate) malnutrition –child’s weight between 70% and 60% lines. 3rd degree (grade 3 severe) malnutrition -weight below 60% line. Grade 4-weight below 50% line. Weight b/w top 2 lines – is considered satisfactory.
Management Weight b/w curves 1 & 3-undernourished,require supplementary feeding at home Weight below curve 3-consult the doctor and follow his advice. Weight below curve 4-hospitalized for treatment
Uses of growth chart Growth monitoring Diagnostic tool Planning and policy making Educational tool Tool for action Evaluation Tool for teaching
Reference:www.commedutm.org/pics/ug-presentations/growth%chart.Reference:www.commedutm.org/pics/ug-presentations/growth%chart. THANK YOU