儿童保健-生长发育-体格发育(英文).ppt

,CHILD GROWTH&DEVELOPMENT,HU,Yan,Department of Primary Child Care,Childrens Hospital,To,master,growth patterns of,common used growth parameters.,2.To,understand,how to assess growth and development.,3.To,know,the important regularities of growth and development.,Aim,Definition,Patterns of physical growth,Other indices of growth,Regularities of growth and development,Growth assessment,Growth:,defined as an increase in,size of body,biological growth of an organism takes place through,cell multiplication,this morphological growth can be measured clinically.,Development,:,is the association process of,differentiation of the organism,in which growing tissues and organs take on,increased complexity of function,(physiological,motor,cognitive,affective).,Thus,since both processes are part of one whole,the combined terms,growth,and,development,form an unitary concept that indicates the,quatitative,and,qualitative,of maturational changes of an organism.,Physical growth can be assessed by various,anthropometric,measurements.,is composed of tissues,organs,systems and fluid,etc.,is a,common,and,sensitive,measurement of physical growth,especially for evaluating,present nutrient state.,Weight,Increment(kg/y),Increment（kg）,Weight(kg),Age,2,y Puberty 2kg/y,2,3m,6,9,12,m,12,24,m,3,At birth,3,3,6,3,3,1,、,The,first growth spurt,occurs in the first year of life(the increment is about 6kg).,Patterns of Weight Increment,2、,Growth is,not at the same rate in different age,:,The increment of weight during the first 3 months is equal to that of the following 9 months.,3、Y,early increments increase slowly until the onset of puberty.,About formulae:,312months:weight(kg)=(age month+9)/2,These formulae are used,only,for calculating dosage of drug and fluid in clinic.Because the growth,is not at the same rate in different age,especially in infant;and the growth,is affected by many factors,such as gene,environment and,individual variation,.,Attention,Weight loss:,Loss of 3%9%of birth weight in the first few days of life is considered normal and is common for most newborns.,Length/Stature,-,-,Stature,-,-,Length,2,yPuberty 57cm/y 57,3m,6162,75,12,m,85,24,m,50,At birth,1112,1213,25,10,10,1,、,The,first growth spurt,occurs in the first year of life(the increment is about 25cm).,2、,Growth is,not at the same rate in different age,:,The increment of weight during the first 3 months is equal to that of the following 9 months.,3、Y,early increments increase slowly until the onset of puberty.,Patterns of Length Increment,Crown-rump/Sitting height,-,Crown-rump,length,Sitting,height,3y,Sit,Supine,3y,They give a measure of,the length of the head and trunk,.It is a measurement of the distance from the highest point on the head to the base sitting surface.,During the first year of life,spinal increase is faster than extremities.Later on,the extremities grow at a faster rate than the trunk,which is contribute to the body length and leading to a gradually change in relative proportions.,The ratio of sitting height/total height,Puberty,Defining the classification of short stature,Abnormal(Disproportionate),A syndrome with short limbs（,Achondroplasia,hypothyroidism,etc）,Disproportionate,Proportionate,Head Circumference,HC is a measurement of perimeter of head,from eyebrows to occipital prominence,.The change of the HC is related with the growth of,brain and skull,.,Age,HC(cm),Increment(cm),At birth,34,3m,40,6,12,m,46,6,24,m,48,2,5y,50,2,15,y,5354,34,1,、,The,first growth spurt,occurs in the first year of life(the increment is about 12cm).,2、,The increment of HC during the first 3 months is equal to that of the following 9 months.,Patterns of HC Increment,3,、,Rapid,decelerating growth of HC,.,(,At,birth,the head is of the neonates body.By,adulthood,it is only 1/8,th,the size of the body.,),4、,The shape of head and circumference,are affected by,not only diseases,but,also heredity.,Small HC,HC increase too fast,Cerebral,dysplasia,Microcephaly,Hydrocephalus,Abnormal of HC,Growth on Puberty,Physical developments in height&weight:,occur very,rapidly,in infancy,continue at a relatively,steady pace,throughout childhood,slow down,towards puberty,At puberty,there is a marked,growth spurt(The second peak of height velocity,PHV),that is,a very rapid increase in size and weight.,Girls usually showing their pubertal growth spurt around,age 911,.,For boys the same process begins at apx.,age 1113,.,According to Tanner(1990),girls finish pubertal growth by about,age 16,whereas boys continue to grow until approximately,18 years of age,.,Sexual Precocity：,Secondary sexual,characteristics appear,before puberty.,Girls8y，Boys14y，Boys16y,Skeleton development,Dentition development,Cranium,：,Fontanel,Cranial suture,Spinal development,Bone development,Cranial development,Closure time of fontanel/suture,Fontanel/suture,At birth,Time of closure,Anterior fontanel,1.5-2cm,18,m,Posterior fontanel,0.,5-0.7,1-2m,Cranial suture,Smallest,3-4m,How to measure the size of anterior fontanel,Small size or,early closure：,Large size or,delayed closure：,Abnormality of anterior fontanel,Microcephaly,Hydrocephalus,Cretinism,Intracranial,hypertension(Encephalitis,Meningitis),Dehydration,Abnormality of anterior fontanel,Bulging fontanel：,Sunken fontanel：,Spinal development,Age,Movement,Muscles,Curvature,3m,Lift head,Cervical,Cervical,（anterior）,6m,Sit alone,Lumbar,Thoracic,（posterior）,12,m,Walk alone,Lower extremities,Lumbar,（anterior）,posterior curvature of thoracic vertebra,sit by himself at,6 months,stand and walk by,one year old,anterior curvature of lumbar vertebra,posterior curvature of sacral vertebra,anterior curvature,of cervical vertebra,hold head up by,3months,Osteite,(center of ossification),which is located near ends of long bones(epiphyses),with growth plates.It is very important for bones growth in length.,Bone development,The sequence of appearance of secondary centers,Bone age,Bone age is that the age should be,according to the,osteite,number,for normal child.The most commonly used standards are those of,Gruelich,and Pyle,which require radiographs of,the left hand and wrist,;,knee films,are sometimes added for younger children(,usually less than 1 year old,).,Abnormality of Bone Age,Hypothyoidism,Hypopituism,Precocity of BA：,Adrenogenital,syndrome,Precocity,Retardation of BA：,Dentition,Primary teeth:,Primary teeth are,20,totally.,The,first eruption,is at about 6 months(410 months).,The timing of tooth eruption is,more variable,than other developmental parameters,Delayed eruption,is usually considered when there are no teeth by approximately,12 months of age.,The,last eruption,of primary teeth is at 22.5 years of age.,Primary teeth,Permanent teeth,6y：,First molar,78y：,primary,teeth are,exfoliated,instead by,permanent teeth,according to the,eruption orde,r.,12y：,Second molar,18y：,Third molar,Totally：,32,Delayed eruption,Hypothyroidism,idiopathic,Disorder,Hypothyroidism,Brain,dysplasia,Failing to erupt,Ectodermal dysplasia,Mechanical,blockage,Abnormality of dental enamel,Ectodermal dysplasia,Abnormality of Dentition,Growth and development are a continuous,series of distinct stages process.,Girls,Boys,Imbalance development of different,systems and organs.,Individual variation,Child has rather big variation individually in growth and development,even if the identical twins,owing to some factors such as,heredity,sex,environment and education,etc.,A,n important part of well-child care is the assessment of a childs growth,that,is to make sure that children are growing normally.,Why do growth assessment,Principles,Representation of results,Contents of growth assessment,Reliable and accurate data,Single Value and series,investigation,Reference and standard,Principles,Measurement error,40,45,50,55,60,65,70,75,80,85,90,95,100,0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24,97,50,3,cm,Length,girls,Choosing reference,R,eference,based on a North American population by NCHS,USA,is recommended by the WHO as the international standard of growth.,Choosing reference,Besides,t,here are many local or national references,f,or example,physical growth indices of 9 cities in China.,+2SD,-2SD,P,3,P,50,P,97,Statistics review,Growth curve,Methods of assessment,Reference table,Growth curve,Example1,：,（,Weight of girls,）,P3,P25 P50 P75 P97,1,y,7.49 8.54 9.18 9.91 11.37,2,y,n,y,-2SD -1SD +1SD +2SD,1,y,7.18 8.21 9.24 10.27 11.30,2,y,n,y,X,Example2,：（,Height of boys,）,Boys:height,4 6 8 10 12 14 16 18,-2SD,Age(year),+2SD,P,97,P,3,P,50,Growth,level,G,rowth,velocity,P,roportion,of body,Growth level,E,very single measurement can be plotted on a growth curve which,illustrates the amount of growth,in children within different age group.,Results,：,P97,Example,：（,Weight of girls,）,P3 P25,P50 P75 P97,1,y,7.49 8.54 9.18 9.91 11.37(kg),-2SD -1SD +1SD +2SD,1,y,7.18 8.21 9.24 10.27 11.30(kg),The weight of a one year old girl is,8.2 kg,.,Growth level,：,X,X,W/A,P3-P25,W/A,-（1SD2SD）,0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24,97,50,3,kg,Weight，Girls,eg,：,An infant at the 3,rd,percentile of weight,for age,Failing to grow,Growing normally,Recovering form growth failure,Attention,1,For premature infants:,we should minimize the effect of gestation by,subtracting,the weeks of,prematurity,(40 weeks is considered as full term),from the postnatal age,.,Attention,2,Height:,40,m,Weight:,24,m,Head circumference:,18,m,Time for correction,Example:,A girl，20m old.Weight 8.8kg，Length 79cm，HC 47.6cm.,Gestational age:32Weeks.,Correcting:,18m,W：P3-P10,L：P20-P30,Assessment:,20m,W：P3,L：P10-P20,HC：-（1SD-2SD）,X,Growth velocity can,show the process,of growth.Growth velocity is measured in terms of,how much a child grows within a specified period of time.,Growth velocity,Serial height,Serial height,50,60,70,80,90,100,110,120,130,140,150,160,170,180,190,Boys:height,4 6 8 10 12 14 16 18,-2SD,Age(year),+2SD,P,97,P,3,P,50,Normal,Result representation,Normal,Descending,Accelerated,No gains,Slowed,The birth weight of a girl is,2.3Kg.When she is 3 months old,the weight is 5.4Kg,（Growth level：P3）,Growth velocity：,The increment of weight:3.1kg,Reference:3.08Kg/0-3m,Normal,Example,proportion of body,Weight to stature,Trunk-leg ratio,Weight for length,W/L,Body mass index,BMI,P97,W/L:,It indicates the range of weight for definite length.,The weight of a 2 years old boy is 14kg，the length is 76cm.,Reference table：,W/L P97,Example,BMI=W(kg)/H,2,(m),Example:if an 8 year old boy weighs 26.8 kg(50-75th percentile for age)and is 130.4 cm tall,his BMI would be calculated as follows:26.8/(1.304)(1.304)=15.8.,Trunk-leg ratio,It is the most common,index of shape,and is a measure of the,relative length of the trunks and legs,.Usually,the,ratio of sitting height/total height(SH/TH),can reflect trunk-leg ratio.,Result representation,(,Claculating,),Ratio of SH/TH,Reference,Normal（Proportionate）,Ratio of SH/TH,Reference,Abnormal（,Disproportinate,）,A 2 years old boy,，his length is 65cm，crown-rump length is 42cm。,crown-rump length/length,（4265=0.65）,0.650.59（Reference）,Abnormal,Hypothyroidism,Example,Review,Patterns of physical growth;,Skeleton and dental development;,4 regularities of growth;,3 indices of growth assessment.,