CHILD GROWTH AND DEVELOPMENT

1. CHILD GROWTH AND DEVELOPMENT Department of Pediatrics Soochow University Affiliated Children’s Hospital

2. Pediatrics focuses on the pattern of child growth and development, child health promotion, disease prevention and treatment, and direct care of illness children. • The children are often among the most vulnerable or disadvantaged in society, and thus their needs require special attention.

3. Pediatric worker aims at protecting children from illness and injury, assisting them to attain optimal levels of health.

4. Characteristics of Pediatrics There are significant differences between children and adults. The younger the children, the greater the difference. Health promotion, disease prevention, treatment, and health care of children are unique from that of adults.

5. Childhood is a critical period for physical, psychological and behavioral development. Compared with adult, child is relatively less independent. Family, kindergarten, school, and community are important settings for their development. Health care should be planned specifically based on their characteristics and needs of children in different age group.

6. Age stages It is also significant for health worker to know that there are characteristic health problems peculiar to each major phase of development.

7. Age stages 1st 2nd 3rd Fetal Period 28 W birth birth conception Perinatal period 7 D 14 D 28 D Perinatal period (from 28 weeks gestination to 7 days after birth) Neonatal early middle later

8. Age stages Biologic and personality maturation are accompanied by physical and emotional turmoil, and there is redefining of the self-concept. School Age Infancy Toddler's Age Adolescence Preschool Age G B 18y 20y Birth 1y 3y 6-7y G B 11y 13y

9. Child growth and development is a complex process, which includes not only physical growth, but also the maturity of systems, development of functioning, The process of growth and development is influenced by a variety of internal and external factors. • Therefore it is one of the most important goals of pediatric to monitor and improve child growth and development,personality, and behaviors.

10. Child growth and development Growth an increase in the number and, size of cells as they divide and synthesize new proteins; results in increased size and weight of the whole or any of its parts. can be viewed as a quantitative change.

11. Development a gradual change and expansion; advancement from a lower to a more advanced stage of complexity the emerging and expanding of the individual's, capacities through growth, maturation, and learning can be viewed as a qualitative change.

12. Child growth and development • Growth quantitative change • Development qualitative change • Matura-tion an increase in competence and adaptability; a change in the complexity of a structure that makes it possible for that structure to begin functioning to function at a higher level.

13. All of these processes are interrelated, simultaneous, and ongoing processes; none occurs apart from the others. The processes depend on a sequence of endocrine, genetic, constitutional, environmental, and nutritional influences. The child's body becomes larger and more complex.

14. Patterns of Growth and Development There are definite and predictable patterns in growth and development that are continuous, orderly, and progressive. These patterns, sometimes referred to as trends or principles, are universal and basic to all human beings.

15. Patterns of Growth and Development • Continuous and Sequential Trends • 2. Directional Trends Cephalocaudal or head-to-tail The fist pattern is growth and development in the cephalocaudal, or head-to-tail, direction, and reflect the physical development and maturation of neuromuscular function.

16. Patterns of Growth and Development 1. Continuous and Sequential Trends 2. Directional Trends • Cephalocaudal or head-to-tail • Proximodistal or near-to far • The second pattern is growth and • Development in the proximodistal, or • Near-to far, direction (midline to • periphery). In the infant, shoulder • Control precedes mastery of the hands, the entire hand is used as a unit before the fingers can be manipulated.

17. Patterns of Growth and Development 1. Continuous and Sequential Trends differentiation 2. Directional Trends • cephalocaudal or head-to-tail • proximodistal or near-to far • The third trend in directional growth, differentiation, describes development from simple operations to more complex activities and functions. Specific and refined patterns of behavior emerge from very broad and global patterns. All areas of development (physical, mental, social, emotional) proceed in this direction.

18. Patterns of Growth and Development • Continuous and Sequential Trends • Directional Trends • Developmental Pace In both total body growth and growth of subsystems there are periods of accelerated and of decelerated growth. The very rapid growth rate during infant gradually levels off throughout early childhood. This rate is relatively slow during middle childhood, increases markedly at the beginning of adolescence, and levels off in early adulthood.

19. Patterns of Growth and Development • Continuous and Sequential Trends • Directional Trends • Developmental Pace • 4. Individual Differences Gender, nutrition, environment are an influential factors. Each child grows in his or her own unique and personal way. Great individual variation exists in the age at which developmental milestones are reached. Rates of growth vary from one individual to another. Children may grow quickly or slowly during the spurt and may finish sooner or later than other children.

20. SELECTED FACTORS THAT INFLUENCE GROWTH AND DEVELOPMENT Heredity nature internal factors Gender Prenatal Influences Nutrition Diseases external factors Interpersonal Relationships nurture Environmental Hazards Seasons and Climates

21. Physical Growth and Development Weight Weight is the total of all organs, tissues and fluid. It is an easily obtainable measurement and a sensitive index reflecting the child's overall growth and nutrition. In addition, weight is a basis calculating dosage of medication in clinic.

22. Physical Growth and Development Weight Take the weight at the same time each day (preferably before breakfast) on the same scale for greatest accuracy. measurement

23. Physical Growth and Development Weight 3.0Kg newborn • physiologic weight loss during the first week after birth • infant may loss 3%-9% of their weight due to the insufficient milk supply, water loss and meconium excretion. < 10 % • which reaches the peak at 3 to 4 days after birth and return to the level of birth weight at 7 to 10 days after birth. < 10 days

24. Physical Growth and Development Growth is very rapid during the first year of age, especially during the initial 6 months. Weight newborn 3.0Kg The younger the infant, the more the weight gain. 6 Mo 7.2Kg Infants gain 600-800g per month until age 6 months, when the birth weight has at least doubled. The weight of child (1-6 months) can be estimated by the formula: Weight(kg)=Birth weight(kg)＋months×0.7(kg)

25. Physical Growth and Development The younger the infant, the more the weight gain. Weight newborn 3.0Kg 6 Mo 7.5Kg 12 Mo 9.0Kg Weight gain decreases by half that amount during the second 6 months. By 1 year of age the infant's birth weight has tripled, with an average weight of 9 kg. The weight of child (7-12 months) can be estimated With Weight(kg) = 6(kg) ＋month×0.25(kg)

26. Physical Growth and Development Weight Newborn 3. 0Kg 6 Mo 7.5Kg 12 Mo 9.0Kg 2 ys 12.0Kg 5 ys 18.0Kg 10 ys 28.0Kg After this point the normal rate of weight gain, assumes a steady annual increase of approximately 2 to 2.75 kg per year until the adolescent growth spurt. The weight of child (2 yrs-12 yrs) can be estimated With Weight(kg) = age×2＋8(kg)

27. Physical Growth and Development Weight Individual Differences is within ± 10 %； Newborn 3. 0Kg 6 Mo 7.5Kg 12 Mo 9.0Kg 2 ys 12.0Kg 5 ys 18.0Kg 10 ys 28.0Kg If ＜ 15 % was undernutrition If ＞ 20 % was overweight

28. Physical Growth and Development Height Height is the vertical distance of two points between the top of the head and heel of the feet.

29. Physical Growth and Development Height measurement The measuring varies with age: (a) Children younger than age 3 years are measures lying down in no shoes, socks and cap; (b) Children older than age 3 years are measured by standing straight.

30. Physical Growth and Development Height At approximately 2 years of age the child begins a relalively stable and steady growth rate of 5 to 6 cm per year; this rage continues for the next 10 years. • Newborn 50cm • 6 Mo 66cm • 12 Mo 75cm • ys 85cm • ys 105cm • 10 ys 140cm The Height of child (2 yrs-12 yrs) can be estimated With Height(cm) = age×7＋70(cm)

31. Physical Growth and Development Height • Newborn 50cm • 6 Mo 66cm • 12 Mo 75cm • ys 85cm • ys 105cm • 10 ys 140cm Individual Differences is within ± 30 %；

32. Physical Growth and Development Head Circumference • head circumference is an important determinant of brain growth and potential neurologic function. • It is usually measured in children up to 2 years of age.

33. Physical Growth and Development Head Circumference measurement The measurement is made by placing a tape measure around the head just above the eyebrows and around the most prominent portion of the back of the skill.

34. Physical Growth and Development Head Circumference Head growth is also rapid. Newborn 34cm 6 Mo 42cm 12 Mo 46cm 2ys 48cm 5ys 50cm • The average head circumference is 33-34cm at birth. • During the first 6 months head circumference increases approximately 1.5 cm per month but decreases to only 0.5 cm per month during the second 6 months. After 2 years of age the growth is slowly.

35. Over-bulge of anterior fontanel indicates increased intracranial pressure. Sunken fontanel indicates dehydration. • Delayed close of anterior fontanel is evidenced as children with rickets. • The posterior fontanel measures between 0.5 to 1 cm at its widest part and close at 6 - 8 weeks after birth. Expanding head size reflects the growth and differentiation of the nervous system.

36. Physical Growth and Development Chest Circumference The measurement of chest circumference is made at the nippier line.

37. Physical Growth and Development HeadChest Newborn 34cm 32cm 6 Mo 42cm 41cm 12 Mo 46cm 46cm 2ys 48cm 50cm 5ys 50cm 55cm The chest circumference at birth is about 32 cm, less than the head circumference. The chest circumference approximately equals head circumference by the end of the first year. They can be estimated after 1 years With (chest one - head one ) = age (years)

38. Physical Growth and Development External Proportions Variations in the growth rate of different tissues and organ systems produce significant changes in body proportions during childhood.

39. After the first year and extending to puberty, the legs grow more rapidly than any other part. However, with the onset of puberty there is a marked alteration in body proportion.

40. Physical Growth and Development Skeletal Growth and MaturationSkeletal, or bone age appears to correlated more closely with other measures of physiologic maturity than with chronological age or height. Bone age is determined by comparing the mineralization of ossification centers and advancing bony form to age-related standards.

41. radiographs of the hand and wrist provide the most useful areas for screening to determine skeletal age, especially before age 6 years.

42. Physical Growth and Development Teething • There are totally 20 deciduous (primary) teeth. The first deciduous tooth usually erupts at around 4 to 10 months (average 6 months), followed by a new one monthly. • All 20 deciduous teeth are generally present by 2 to 2.5 years of age.

43. The first permanent (secondary) teeth erupt at about 6 years of age, beginning with the 6-year molar. The others appear in approximately the same order as eruption of the primary teeth and follow shedding of the deciduous teeth.

44. Growth and Development rule

45. Key Points of the Class • There are significant differences between children and adults. They younger the children are, the greater the difference is. • The stage of growth and development include fetal period, neonatal period,infancy, toddler's age, preschool age, school age, and adolesence. • Growth and development of children are strongly influenced by genetic and environmental factors.

46. Key Points of the Class Growth and development follow predictable patterns in direction, sequence, and pace. Biologic growth is determined by height, weight, bone age, and dentition. Growth and development are affected by a variety of conditions and circumstances, including heredity, physiologic function, gender, disease, physical environment, nutrition, and interpersonal relationships.

47. Neurologic Maturotion Two periods of rapid brain cell growth occur during fetal life: between 15 and 20 weeks of gestation, and 30 weeks of gestation to 1 year of age.

48. The nervous system development allows for increasingly complex movement and behavior. • One half of postnatal brain growth is achieve by 1 year of age, 75% by age 3, and 90% by age 6.

49. At birth the cortex is only about one half its adult thickness, resulting in very little cortical control over body movements.

50. Myelinization （髓鞘化）of the various nerve tracts in the central nervous system accelerates rapidly after birth and follows the cephalocaudal and proximodistal sequence which allows progressively complex neuromotor function.