Contents

Introduction
General Post Natal changes In
Dimensions & Proportions
Summary
References
Introduction:-
A child may appear as a MINIATURE ADULT to a LAYMAN
but the detail anatomy reveals that he/she is completely different
from an adult.

NOTE:-
the comparative knowledge of adult and child is
necessary to be known so as to recognize or diagnose
developing characteristics of a child which may be mistaken for
an Abnormality or Pathologic condition.
General Post Natal changes in
Dimensions and Proportions
 Neonatal Skeleton
 The neonate has 270 bones
as compared to
adult (206).
 Skull bones in neonate are
45 due to incomplete ossification
and in adult 22.
 The frontal bone at birth is
in two halves which fuses at 2
yrs.
 Body Proportions
 The body proportions are a result of the differential rates of growth of
the cephalic and caudal ends. Massive changes in the body proportion
occur from the fetal life to adulthood.
 Mid point: The mid point of the stature of a two month old embryo is
at
chest, close to chin.
 At Birth: This may shift to just above the umbilicus.
 In Adult: It is at the pubic-symphysis region.

 Posture
 The new born is usually kept in supine posture but can
be literally folded to its most comfortable position i.e. the
posture simulating the fetal posture of partial flexion.
 Mild lordosis and protuberance of the abdomen is a
commonfinding at 2-3 yrs of age but disappears by 4 yrs.
 The Neck
 The neck is relatively short at birth and its muscles are not
developed for supporting the head.
 Functional development of the muscles begins after 2 mnths.
 The Chest
 The girth of the chest at birth is smaller
then the head
circumference.
 It becomes equal by 2 yrs and by 15 yrs its ratio becomes 3 : 2
 The final ratio is 5 : 3
 The chest is rounded in newborn.
 Abdomen
 The umbilicus of new born is shed off around 12- 15 day.
 The umbilicus is everted and in some cases umbilical hernia
may be present.
 At this stage abdomen is quite protuberant but soft.
 Circumference of abdomen is equal to the chest until two yrs
BUT after 2 yrs abdominal circumference is less than the chest.
Extremities
 At Birth:
 legs are short , arms long
 Arms:
 birth –2 yrs : length increase by 6.75%
 At 8 yrs –50% longer than at 2 yrs
 By 16- 18 yrs –slow growth, increase development takes place.
 Legs:
 at birth: short & curved
 Birth –2 yrs: length increase by 40%
 6 yrs: straight, the knock knee and
 8yrs: 50% longer than at 2 yrs
 Adolescence: 4 times longer than birth
 Early maturer: shorter legs than the late maturer
Dimensional changes in
CraniofacialSkeleton

 This changes can be appreciated even in IUL.

 3 mnth – Birth:
the entire cranium becomes longer and wider in its
relation to height.
 At Birth:
• Craniofacial skeleton undergoes changes between 30%-60%
of its total growth.
• head makes up about a greater part of total body length
whereas in adult accounts for about one- eighth of total
body height.
 …..
 After birth:
Size of cerebral cranium increase by about 50% while the facial skeleton will
grow more than twice the original size.

 By 4 years:
This growth is completed. Cranial circumference increase from about 33cm
[ birth] - 50cm [at 3 yrs]. After which it only increase by 6cm.

 After 4yrs +:
Facial skeleton increases in all direction.
 Head
 At Birth:
The head circumference is around 35 cm.
 6 months:
It increases by 44 cm.
 At 1 yrs:
Head circumference may be more then chest circumference. A
total 4 inches increase takes place.
 1+ year:
1 inches increment occurs between 1-2 yrs.
 At 10 yrs:
95% of total head growth completes with the width of head
completed by 3yrs while the length of head completes by 17-18 yrs.
 Fontanelles
 Fontanel is one of the space, covered by
membranebetween the bones of the fetal or young
skull.
 They bridge the gap between the bones
that limthem.
it
Closure of Fontanelle :
a) Anterior Fontanelle [Frontal] : 18-24 mnths after birth.
b) Posterior Fontanelle [occipital]: 2 mnths after birth
c) Antero-lateral Fontanelle [Sphenoid] : 3 mnths after birth
(paired)
d) Postero-lateral Fontanelle [mastoid]: begins to close 1-2 mnths
after birth, closed completely by 12 mnths (paired)
 Sutures of cranium
1. Coronal Suture: between the frontal and parietal bone. Closes by 24-
35 yrs
2. Sagittal suture: between two parietal bone. Closesby 22-30 yrs of
age
3. Lamdoidal Suture: Between two parietal and occipital bone.
Closes by 29 yrsof age.
4. Squamous Sutures and Lateral antero-posterior Sutures: between
the squamous portion of the temporal and parietal bone.
The squamous suture closes late inlife.

 Face

 At birth , lower third and the middle third of the face are u
n
d
ervlo
p
eddue to the
absence of the teeth.
 The fore-head is high and bulging.
 The face of the newly born baby is round and flat.
 After the onset of the puberty the forehead flattens and widens, lips
thicken
and face acquires an oval shape, mainly due to growth of jaws.
 Naso-Maxillary Complex

 The maxilla develops in the membranous tissue at the end of the

sixth fetal week.
 The maxilla is attached to the neurocranium
directly withthe frontomaxillary sutures.
 At birth the maxilla is placed more anteriorly giving Class II
relationship of the jaws.
 Later in course of post-natal development, both maxilla a
n
d
mandible with their associated soft tissues grow forward and
downward and establish a normal Class I relationship.
Mandible
 Although still seperated by symphisis in the mid-line,
the twohalves of the mandible fuse into a single bone by the age
of 1-2 yrs.
 At birth:
 The two rami are short.
 Condylar development is minimal.
 The alveolar process and the muscles are poorly developed.
 At birth the mandible is shell shaped with 10 alveolar sockets for
developing tooth gums.
  The alveolar process and the muscles are poorly developed at this
age, so that its basal arch mainly determines the shape of the
mandible in the neonate.
 At birth the structure of mandible is shell like with 10 alveolar sockets
for developing tooth gum.

 Of all the facial bones, the mandible shows not only the largest
amount of post-natal growth, but also the largest individual variation
in morphology.
 Angle of mandible is more obtuse in young children.
Post -natal Changes in TMJ

 At birth the articular disc is flat and develops an acentuatedS-

shaped profile as the articular tubercle develops.
 Condylar cartilage is approx. 1.5 mm thick at birth, but so n
thins down to 0.5 mm. By 20-30 yrs of life it is completely
replaced by endo-chondral ossification.
 Mandibular condyle grows in a constant posterior, superior a n
d
lateral direction and attains a mature contour by late mixed
dentition period.
Oral features of theNeonate
 Oral features of the Neonate

 The edentulous arches of a child varies from an edentulous

adults.
 The alveolar process of an infant are called gumpads, which
are firm and pink structures with a definite form.
 Gumpads
 Each gumpad is
divdedinto 10 segments by a
transverse grooves.
 The groves between the
deciduous first molar and
canine are prominent and
called lateral sulci.
 Growth of Gumpads
 At birth the width of gumpads are inadequate to
accommodate
all the incisors.
 The growth is rapid in first year after birth
 Growth is more in transverse direction and in the labio-lingual
direction.
 Due to the growth the segments of each gumpads become
prominent.
 Eruption of deciduous teeth commence at 6 mnths of age.
 Tongue
 It is comparatively large in relation to the small mouth.
 Then tongue is flat, thin and blunt tipped, probably due to
short frenum.
 The tongue at this stage performs only one function, i.e. acts
as a piston while suckling.
EXTERNAL FEATURESOF
NEWLY BORN CHILD
 Skin
 The skin of the neonate is often reddish.
 A child may have an appearance of CYANOSIS due to thin
skin
and high hemoglobin content of blood even when CO2 is high
 A deep red purplish appearance may be result of
transient anoxia resulting from closed glottis prior to vigorous
cry.
 Deep red skin with fine soft immature
lanugo hair is a
characteristics of premature infants.
 Post-term infants may show whitish, peeling, parchment
likeskin.
 Eye

 Size:
The eye of the neonate are small at birth, the size being one third of
the adult size. Maximal growth occurs in 1 year and continues rapidly
decelerating rate till 3 yrs and further slows down tillpuberty.
 Cornea:
At birth, cornea is relatively more and nearly fills the palpebral
fissures. It reaches an adult size by 2yrs. After which the posterior aspect of
the eyes grows giving ball its final spherical shape.
 The Lens:
it is more or less spherical with greater refracting power.
 …


 The Fundus:
It is less pigmented than adults. It acqiure its adult form by 4-6 mnths.
 The Retina:
It has fine peppery mottling. The peripheral retina appears pale or
greyish since peripheral vasculature is immature.
 Nose

 The nose of the neonate is small and flat with narrow nostrils.
 The bridge of the nose is depressed.
 Maximal growth of the nasal cartilage occurs till
puberty, after
which it attains its final form.
 The hair around the nose become thicker around the puberty.
 Lips

 The lips of new born is reddish pink, soft and supple.

 The midline of upper lip has a small projections, the labial tubercle, w
h
icis
said to disappear after cessation of suckling.
 It may undergo slow transformation to form the transition zone
between
the outer and inner aspect after one year.
 Ear

 The ears of child are almost developed.

 The external auditory canal is short, straight
and full of secretion.
 The tympanic membrane has a dull grey translucency and the
structures of the middle ear can be easily studied through it.
 References
• TEXTBOOKOFPEDODONTICS-2nd edition
-Shobha Tandon

• Internet sources
Thank You