Sie sind auf Seite 1von 32

ISSUES IN CHILD HEALTH-PART ONE FOCUS ON GROWTH G.

P-RHULE

GROWTH

DIFFERENTIATION

DEVELOPMENT

Because growth has an impact on disease presentation (FTT, effect of osteomyelitis on growth plates ) Because disease has an impact on growth and therefore nutrition is a key component of disease management in children (Extra meal a day, timing of surgery for children with clefts) Because growth deficiency impacts on adult future outcomes (intelligence, work capacity) Interpreting Labs, X rays (alkaline phospahtase, ossification centres)

NUTRITION. Hormonal influences Disease states esp chronic. Hereditary / Familial/Racial etc Chromosomal /Genetic abnormalities Social / Emotional Often multifactorial.

An increase in cell number and sizegetting bigger. Continuous from conception to maturity. Rate varies from child to child. Influenced by both hereditary and environmental factors (nutrition!)

Weight for age Height for age / weight Head circumference Skin fold thickness Beads Clothes

Mid arm circumference Other specialised parameters eg. Arm span, , testicular volume etc. Special charts for special conditions

To pick up children who are faltering and intervene early. (Growth promotion) To assess nutritional status. Aids in early diagnosis of illness other than nutritional disorders. Opportunity for other health interventions (e.g. immunization, health education etc.)

(AGE IN YRS X 3) + 4 (?? +2) =50th centile of Havard standard in kids >1yr. Up to 10% of birth weight lost after birth. Regained by 2 weeks. 25g per day for first 5 mths. 15 g per day in the first year. 2.5kg in 2nd yr of life 2kg per year up to 5 yrs. Birth weight doubled by 5-6 months, tripled by 1 year.

Released in April 2006 Based on the breastfed child as the biological norm for growth and development. Initiated by WHO in 1997 Data collected over seven years (1997-2003).

8440 children from six countries were involved (Brazil, Ghana, India, Norway, Oman and USA). The children were selected based on optimal environment for proper growth: recommended infant and young child feeding practices, good healthcare, mothers who did not smoke and other factors associated with good health outcomes.

Old charts based on data from late 1970s from children in the USA. Most were artificially fed. The old measurements were based on irregular measurements, too far apart to identify trends. The old standards merely described how these children grew whereas the new standards aim to describe how children should grow. Old curves used centiles, new uses z-scores

Clothes! Money Stigma Staff attitudes esp when weight gain not good. Inconvenient timing. Long distances Infrequent visits

GROWTH MONITORING AND PROMOTION IS AN ESSENTIAL PART OF CHILD HEALTH. CHILDREN MUST ALWAYS BE SEEN WITH WEIGHING CARDS! NUTRITION IS IMPORTANT BUT OTHER REASONS FOR GROWTH FAILURE MUST BE LOOKED FOR.