GROWTH &

DEVELOPMENT
ASSESSMENT

YUDIANITA KESUMA

TUJUAN UMUM

Setelah materi ini mahasiswa

mampu melakukan penilaian
Tumbuh kembang anak

TUJUAN KHUSUS
Setelah sesi ini mahasiswa mampu:
Menyebutkan indikator penilaian TK
Menjelaskan pengukuran BB, PB, TB, LK
dan penggunaan kurva pertumbuhan
Menjelaskan penilaian Perkembangan
dengan KPSP dan hasil penilaiannya
Menjelaskan penilaian TDD, TDL
Menjelaskan penilaian tes IQ dan
interpretasinya

GROWTH ASSESSMENT
Growth chart (body weight, body length,
stature, head circumference)
Body proportions
Skeletal maturation
Dental development
Sex Maturity

SCALE
It is recommended to weigh children using a scale with
the following features:

THE MEASURE OF LINEAR GROWTH

If the child is
aged 2 years
or older, measure
standing height unless the
child is unable to stand. Use
a height board mounted at a
right angle between a level
floor and against a straight,
vertical surface such as a wall
or pillar.

The measure of head circumference

Head Circumference Tape

Checklist
Non-stretchable,
plasticized
1/4 -1/2 inch wide
Insertion tape in 0.1 cm or
1/8 inch increments

MEASURING A CHILDS
GROWTH
Determine a childs age today
1

Recognize clinical signs of marasmus and

kwashiorkor

2
3
4

childs weight and measure length or height

record
Weigh a Determine BMI (body mass index) by referring to a table
or using a calculator
BMI=

_____weight (kg)_______
squared length/height (m2)

Comparison of existing growth charts

Data charact

NCHS

Source

Multiple
different
studies

Multiple different
studies

Primary data

Study period

1929-1975

1963-1994

1997-2003

CDC

WHO

Population

US, white,
bottle fed

US, mixed feeding,

no racial/ethnic diff

6 Countries pooled
data. healthy
children &
practices, breastfed

Age-group

Birth-20 yrs

Birth-20 yrs

Birth-5yrs

GROWTH CHART
The standard growth charts
0 5 Y from WHO
5-20 Y growth chart CDC
Presented in 4 standard chart :
1.Weight for age
2.Height/length for age
3.Weight for height
4.Head circumference for age
Separated chart for boys and girls

The WHO Growth Charts

There are two separate series of charts:

2006 WHO Child Growth Standards charts for birth to 5 years

Illustrate how healthy children should grow.
portrayed how a sample of children did grow.

CDC Growth Reference 2007 charts for 5 to 20 years

These are reconstructed CDC growth charts based on best
available historical data and also supplement data from
WHO growth standards.
Redesigned to more closely align with optimal growth and
address the issue of the increasing overweight/obesity in
children and adolescence

GROWTH CHART
Each chart is composed of 7 percentile
curves, representing the distribution of
weight, length, stature, or head
circumference value at each age
The precentile curve indicates the
percentage of children at a given age on the
x-axis whose measured value falls below
the corresponding value on the y-axis
The 50th percentile and 0 SD (z Score) is
the median, it is also termed the standard
value (100%)
The chart are useful because they facilitate
assessment of growth over time

INTERPRETING GROWTH INDICATORS

Notes:

1. A child in this range is very tall. Tanness is rarely a problem, unless it is so

excessive that it may indicate endocrine such as a growth-hormone-producing
tumor. Refer a child in this range for assessment if you suspect an endocrine
disorder (e.g. If perents of normal height have a child who is excessively tall
fot his or her age)
2. A Child whose weight-for-age falls in this range may have a growth problem,
but this is better assessed from weight-length/heoght or BMI-for Age.
3. A plotted point above 1 shows possible risk. A trent toward the 2 z-score line
show definite risk

Daffa, 5 bln 14 hari,

BB 8 kg, PB 70 cm
BB/U : 0 +2 SD
Normal

Daffa, 5 bln 14 hari,

BB 8 kg, PB 70 cm
PB/U : 0 +2 SD
Normal

Daffa, 5 bln 14 hari, BB 8 kg,

PB 70 cm
BB/PB : 0 -1 SD Gizi
Baik
Berat Badan Ideal pd garis di
median 0 ( yaitu: 8,5 kg)

Yohana, 11 bln, BB 6.5 kg,

PB 66 cm
BB/U : -2SD -3 SD
Underweight

Yohana, 11 bln, BB 6.5 kg,

PB 66 cm
PB/U : -2SD -3 SD
Stunted

Yohana, 11 bln , BB 6.5 kg, PB 66 cm

BB/PB : -1SD -2 SD Gizi Baik
Berat Badan Ideal pd garis di median
(0( yaitu: 7.4 kg)
Status pertumbuhan: Kekurangan
gizi kronik

Weight Charts (boys left, girls right)

Grade of
Malnutriti
on

Weight for Height for Weight for

Age
Age
Height
(wasting) (stunting)

0, Normal
1, Mild
2,
Moderate
3, Severe

90
75 90
60 74
< 60

95
90 95
85 89
< 85

90
81 90
70 80
< 70

Umur 7 tahun Berat badan

15 kg
Tinggi badan 112 cm
BERAT BADAN IDEAL : ?
BB/U = 15/22x100% = 68,2%
Kesan: wasting moderate

Umur 7 tahun Berat badan

15 kg
Tinggi badan 112 cm
BERAT BADAN IDEAL : ?
TB/U = 112/122x100% = 91.8%
Kesan: mild stunting

Umur 7 tahun Berat badan

15 kg
Tinggi badan 112 cm
BERAT BADAN IDEAL : ?

Umur 7 tahun Berat badan

15 kg
Tinggi badan 112 cm
BERAT BADAN IDEAL : ?
BB/U = 15/22x100% = 68,2%
TB/U = 112/122x100% = 91.8%
BB/TB = 15/19x100% = 78.9%
Kesan: moderate malnutrition

Interpreting Growth
Consider :
Is the weight and length/height proportional?
Is the head circumference appropriate for age?
Does the childs growth follow a consistent pattern?
Is growth between the 3 rd and 85th percentiles?
Are there health issues or factors from the additional
information gathered impacting growth?

NESTLE-HERMINA 2005

=RENTANG NILAI NORMAL

ANALYSIS OF GROWTH
PATTERNS
Growth is a proses rather than a static quality.
An infant at the 5th percentile may be :
- growing normaly,
- failing to grow, or
- recovering from growth failure, depending on the
trajectory of the growth curve

 Typically, infants and children stay within

one or two growth channels
A normal exception commonly occurs
during the 1st 2 yr of life
This canalization attest to the robust
control that genes exert over body size

FULL TERM INFANTS :

Size at birth reflects the influence of the
uterine environment
Small neonates often shift percentiles
upward, large neonates often shift
downward to their parents mean percentile
Shift up/downward ending as an infants
achieves a new growth channel (+ 13 18
mo)
Size at 2 yr correlates with mean parental
height, influence of the genes

PREMATURE
INFANTS :
Overdiagnosis of growth failure can be
avoided by subtracting the weeks of
prematurity from the post natal age
when plotting growth parameters
Very low birthweight (<1.500 g) infants
may continue to show catch-up growth
through early school age

 Weight-for-age curve below 5th percentile

or >-2 SD is indicator of acute
undernutrition
In chronic undernutrition may be short as
well as thin, height-for-age curve
drops (stunting), whereas the weight-forheight curve may appear relatively normal
Chronic and severe undernutrition can also
depress head growth, an aminous predictor
of later cognitive disability

GROWTH PARAMETER < 5TH

PERCENTILE / > - 2 SD

Necessary to express the value as

percentages of median or standard
value
Growth failure can be graded from mild
to severe

CONTOH MONITORING

HEAD CIRCUMFERENCE
Head circumference is measured from
glabella, supraorbital ridge in front to the
farthest point of the occiput in back
In infants, chronic & severe undernutrition
also depresses head growth predictor
of later cognitive disability

makrocepha
li

?
mikroceph
ali

Tinggi badan dalam sentil pada 100 anak wanita

usia 12 tahun

Harga mean dan SD pada kurva

normal Gauss

BODY PROPORTION

The head and trunk are relatively large at birth

Proportionality can be assessed by measuring
the Lower body segment (from symphysis pubis
to the floor), and the Upper body segment (the
height the lower body segment)
U/L ratio + 1.7 at birth, 1.3 at 3 yr, and 1.0 after
7 yr
Higher U/L ratio
are characteristic of shortlimb dwarfism, or bone disorder such as rickets

SKELETAL MATURATION
Bone age correlated well with stage of pubertal
development and can be helpful in predicting
adult height in early or late maturing
adolescents.
In familial short stature the bone age is normal
(comparable to chronologic age)
In constitutional delay, endocrinologic short
stature and undernutrition, the bone age is low
and comparable to the height age

 The most commonly used standards are

those of Gruelich and Pyle, which require
radiographs of the left hand and wrist
Skeletal maturation is linked more closely
to sexual maturity rating than to
chronologic age
It is more rapid and less variable in girls
than in boys

X Ray of the Hand

Male hand at 48 months
Female hand at 37 months

Male hand at 156 months

Female hand at 128 months

DENTAL DEVELOPMENT
Primary teeth

Teeth

Eruption(mo)
Exfoliation (yr)
Maxil. Mand.
Maxil.
Mand.
Central Insisivus
6-8
5-7
7-8
6-7
Lateral Insisivus
8-11 7-10
8-9
7-8
Caninus
16-20 16-20
11-12 9-11
Ist Molar
10-16 10-16
10-11
10-12
2nd Molar
20-30 20-30
10-12
1113

PERMANENT TEETH
Teeth

Eruption (yr)
Maxilla Mandibula
Central Insisivus
7-8
6-7
Medial Insisivus
8-9
7-8
Caninus
11-12
9-11
Premolar I
10-11
10-12
Premolar II
10-12
11-13
Molar I
6-7 6-7
Molar II
12-14
12-13
Molar III
17-22
17-22

SEXUAL MATURITY
Sexual Maturity Rating (SMR) or Tanner stages
based on somatic changes
In boys : pubic hair, penis and testis
In girls : pubic hair and breasts
The first visible sign of puberty in girls is the
appearance of breast buds, between 8 -13 yr
In boys, testicular enlargement begins as early
as 9 yr

Perkembangan bentuk dan ukuran payudara (Dikutip

dari Fig.14-2, Behrman et al, Nelson textbook of
Pediatrics, 2000, hal.54)

Perkembangan rambut pubis (Dikutip dari Fig.14-1,

Behrman et al, Nelson textbook of Pediatrics, 2000,
hal.53)

Perkembangan bentuk dan ukuran genitalia (Dikutip

dari Fig.18-14, Vaughan & Litt: Child Adolescent
Development: Clinical Implication, 1990, hal.250)

PHYSIOLOGIC & STRUCTURAL GROWTH

RR & PR decrease sharply during the 2 yr, then
more gradually throghout childhood
BP rises steadily beginning + 6 yr of age
Development of paranasal sinuses continues
throughout childhood
Lymphoid tissues develop rapidly, reaching
adult size by 6 yr of age
The metabolisme of medications
Nutritional needs

DEVELOPMENTAL ASSESSMENT
There are 2 steps process :
1.Screening procedure, to pick out children
in need of more indepth assessment,

2. Developmental diagnosis, to define the

developmental problems

SCREENING
TEST
The most widely use is Denver II
The test generates pass-fail rating in 4
domains of development : personal
social, fine motor-adaptive, language,
and gross motor
Test for children from birth to 6 yr old

INTERPRETATION OF THE TEST

Normal :
No delays and a maximum of 1 caution
Conduct routine rescreening at next well-child visit

Suspect :
> 2 caution and/or > 1 delays
Rescreen in 1-2 weeks to rule out temporary
factors

Untestable :
Refusal on > one items
Rescreen i 1-2 weeks

KUESIONER PRA SKRINING

PERKEMBANGAN (KPSP) DARI
DEPKES RI
Yang dinilai kemandirian, sosialisasi, gerak kasar, gerak halus,
komunikasi
Dilakukan pada anak usia 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42,
48, 54, 60, 66, dan 72 bulan
Kuesioner berisi 9 10 pertanyaan untuk orang tua/pengasuh
Jawaban Ya / Tidak

INTERPRETASI :

Bila jawaban Ya:

9 10 : Perkembangan Sesuai (S)
7 8 : Perkembangan Meragukan (M)
< 6 : Perkembangan ada Penyimpangan (P)

TINDAKAN
Perkembangan Sesuai (S)

Tindakan : Stimulasi diteruskan, Lakukan KPSP

3 bulan kemudian (sesuai jadual)
Perkembangan Meragukan (M)

Tindakan : Stimulasi tugas yang belum bisa

dilakukan, evaluasi ulang 2 minggu kemudian
Perkembangan ada Penyimpangan (P)

Tindakan : Intervensi Rujuk, dengan

menuliskan jumlah dan jenis keterlambatan
perkembangan

SCREENING OF BEHAVIORAL
PROBLEMS

CHAT for autism

CONNER scale for ADHD

ThankYou