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In contrast to adults, growth of all body parameters and, later, the development of puberty are key features of
childhood and adolescence.
Growth : increase in size.
*There are four phases of normal human growth:
Development : increase in function of processes
related to body and mind
1- Fetal: This is the fastest period of growth, accounting for about 30% of eventual height.
2- The infantile phase : Growth during infancy to around 18 months of age is dependent on adequate nutrition.
Good health and normal thyroid are also necessary. This phase is characterized by a rapid but decelerating growth
rate, and accounts for about 15% of eventual height.
3- Childhood phase : This is a slow, steady but prolonged period of growth that contributes 40% of final height.
Pituitary growth hormone (GH) is the main determinant of a child's rate of growth .
4- Pubertal growth spurt : Sex hormones, cause the back to lengthen and boost GH secretion. This adds 15% to final
height. The same sex steroids cause fusion of the epiphyseal plates cessation of growth
Assessment of growth:
Growth must be measured accurately, with attention to correct technique and accurate plotting of the data on
chart.
I ANTHROPOMETRIC MEASURES:
Weight :
Drug Dose in children depend on the weight
- Normal birth Weight = 2.5-3.5Kg
- During the first 7 days there is an initial loss of weight reaching up to 10% of birth weight, due to loss of
meconium, urine and less fluid intake. The birth weight is regained by the 10th day in most full term babies.
- Double birth weight: 4-5 months.
- Triple birth weight: 1 year .
- Quadruple birth weight: 2 year .
During 1st 4 months : Weight increased by Kg/month.
nd
( Age in months + 9 ) / 2
rd
( Age in year x 2) + 8 Kg
Length or Height :
- Normal birth length = 50cm.
- At 1 year = 75cm i.e. increase by *25cm
- At 2 years = 87.5 cm i.e. increase by *12.5cm.
- The infant doubles his birth length at 4 years.
So at 4 years, the length is 100 cm.
Mid-parental height :
Boys:
(maternal height + paternal height +13)/2
Girls:
(maternal height + paternal height - 13)/2
Height(>2yrs) measurement:
At 1 year 45-47 cm
At 2 years 47-49 cm
At 5 years 50 cm
At 12 years 55 c
The Arm Span height :
The arm span = the distance between the tips of the middle fingers of out stretched arms.
Span height
* - 3 cm at 1-7 yrs
0 cm at 8-12 yrs
+ 4 cm (in male) at 14 yrs
+ 1 cm (in female) at 14 yrs
II FONTANELLES :
- There are 6 fontanelles : (1. Anterior & 1. Posterior & 2. Sphenoid and 2 mastoid)
- The anterior & Posterior ones are clinically important.
- The post. Fontanelle : closes at full term or 1-2 month later
- The Ant. Fontenelle : is 3 fingers at birth (average 4-5cm)
Delayed closure In:
2 fingers at 6 months
Hydrocephalus.
1 finger at 1 year
Down syndrome.
Hypothyroidism.
*close at 1.5 year
III TEETHING :
Causes of delayed eruption of teeth :
(A) Deciduous (Milk) Teeth :
They are 20 in number (10 in each Jaw)
(B) Permanent teeth :
They are 32 in number (16 in each Jaw)
Rickets
Hypothyroidism
Down syndrome
Osteogenesis imperfecta
Under & Malnutrition
Local causes e.g. cysts, retained secondary
teeth, supernumerary teeth.
Causes of premature eruption (rare) :
Natal teeth (at birth)
Congenital syphilis
Ellis van Creveld syndrome
Assessment of Development:
Sitting:
6 weeks Curved back, needs support from adult
Pencil skills:
3 years
1.5 years
4 years
5 years
Speech and language development:
7 months polysyllabic vowel sounds
Intelligible Speaking :
At 2 years 50 % understandable
MENTAL DEVELOPMENT :
At 2nd month *Social smile
At 3 4 months Can recognize his mother&laughing.
At 9 months Stranger anxiety& plays peek-a-boo
At 1.5 year Sphincter control (up to 4 years normally)
According to age:
Age 2 months :
Adaptive/ Fine motor: Follow object with eyes past midline.
Language: Vowel sounds.
Gross motor: Lifts head in prone position to 45 degree.
Personal/ Social: Smiles in response to others.
plays peek-a-boo
Age 6 months:
1- Make babbling sounds (vocalize)
2- Raise his head and chest when prone
3- reach for objects
4- *Sit without support
Age 9-10 months :
1- Pincer grasp
2- Says mama & baba
3- crawls
Child at 9 Months
Language: 10 words (average); names pictures; identifies one or more parts of body
Social: Feeds self, may complain when wet or soiled.
Age 24 months( 2 years ) :
Motor: Runs well, walks up and down stairs, one step at a time; opens doors; climbs on furniture; jumps
Adaptive: Makes tower of 7 cubes (6 at 21 mo); folds paper
Language: Puts 3 words together (subject, verb, object), use I & you
Social: Handles spoon well; helps to undress; listens to stories when shown pictures
*Age 36 months( 3 years ) :
Language: *Knows age, name and sex; counts 3 objects correctly; repeats 3 numbers or a sentence of 6
syllables
^W
shoes); washes hands
Motor: Hops on one foot; throws ball overhand; uses scissors to cut out
pictures; climbs well
Adaptive: Copies bridge from model; copies square; draws man with 2 to 4 parts besides head.
Language: Counts 4 pennies accurately; *tells story and *Speech is 100% intelligible
Social: Plays with several children, with beginning of social interaction and role-playing; goes to toilet alone.
Age 60 months( 5 years ) :
Motor: Skips
Social: Dresses and undresses; asks questions about meaning of words; engages in domestic role-playing.
Developmental warning signs:
At any age Regression in previously acquired skills
At 10 weeks: No smiling:
At 18 months: Not walking independently, Less than 6 words, Persistent mouthing and drooling
At 2.5 years: No 23-word sentences
Puberty:
The first signs of puberty are usually:
- Puberty is precocious if it starts before the age of 8.5 years in girls and 9.5 years in boys.
- Puberty is delayed if onset is after 13 years in girls and 14 years in boys.
- A growth spurt occurs early in puberty for girls, but at the end of puberty for boys.
Until puberty where the Growth spurt occur the height increase 10-15 cm\year
- Puberty is evaluated by clinical examination of the genitalia, breasts and secondary sexual characteristics.
The scale used is known as Tanner staging.
Commonly tested milestones appear in bold :-
- The maximum rate of head growth occurs during the 1st year.
- The length doubled at 4 years.
- The weight doubled at 4 Months
- ant. Fontenelle close at 1.5 year.
- Social smile at 2nd month .
- Sit without support at 6 months .
- Speech is 100% intelligible at 4 years .