K,jnl;rkpklb]p ewlg[ e;;flmdsl;mc;jbhkjhiljl;m,;,;

GUIDE LINE FOR GROWTH AND DEVELOPMENT

MODRETOR DR.MANISHA MAURYA MDDR.NEERAJ ANAND MD

BY MANOJ KR VERMA

\\\\\\\\\\

Growth:It is the process of physical maturation resulting an increase in size of the body and various organ.It occurs by multiplication of cells and increase in intracellular substance It is a quantitative change in body Or refer to structural and physiological changes

Development:It is a process of functional and physiological maturation of the individual.It is a progressive increase in skill and capacity to function.It is related to maturation and myelinisation of nervous system.It include psychological emotional and social changes Qualitative aspects.

Principal of growth and development:

Principal of growth and development:Cephalocaudal direction: Improvement in structure and function come first in the head region, then in trunk, and last in the leg region.

5

Principal of growth and development: PROXIMODISTAL DIRECTION:;

The process in proximodistal form centre or midline to periphery direction.Development proceed from near to farOut ward from central axis of body to ward the extremities

Factor affecting growth and development:

Factor affecting conti.Genetic factor: genetic predisposition is impartment factor which affect the growth and development.SexRace and nationality

Factor affecting conti.

Post natal factor:

Age periods:Neonate: Birth to 1 monthInfant: 1month-1yrEarly childhood:Toddler 1yr-3yrsPreschool:3yrs-5yrsMiddle childhood:School age 6yrs-12yrsLate childhood:(adolescent)13yr-18yr

image

Assessment of growth:

Weight:

Weighs scale :

Weighs scale :

Weighs scale:

Weight:Weight gain about 20-30 gram/day for 1st three monthDouble at five monthTrebled at one yearFourth time by two yearFive time at three yearSix time by five yearSeven time by by seven yearsTen time by ten years

Length and height:Increase in height indicate skeletal growth, yearly increment in height gradually diminished from birth to maturity.At birth average length of a healthy new born is 50 cm.It increases to60 cm at 3month, 70cm at 9month and 75cm at 1yearIn second year increment approx 12cmThird year aprox 9 cmFourth year 7cm and fifth year 6cm

Length and height:So the child double the birth by 4-4.5yr of age afterwards then is about 5cm increment in every yr till puberty.

Length and height:

Length and height:

Length and height:

Formulas:

It is an important criteria which help to asses the normal growth or its deviation ie malnutrition or obesity

BI more than 30 kg/m2 indicate obesity and < 15kg/m2 indicate malnutritionBody mass index :

Body mass index categories:

Head circumference:

Head circumference:

Measurement of head circumference:

Measurement of head circumference:

Measurement of head circumference:

Fontanelles closure:

Fontanelles closure:

Chest circumference:Chest circumference or thoracic diameter is an important parameter assessment of growth and nutrition status.,At birth it is 2-3cm less than head circumference Become equal at 6-12month of age.After 1st year of age , chest circumference is greater than head circumference by 2.5cm. about 5years, it is about 5cm larger than head circumference

Chest circumference:Chest circumference is measured by placing the tap at level, around the nipple, in between inspiration and expiration

Chest circumference:

Mid upper arm circumference:

Mid upper arm circumference:

Mid upper arm circumference:

Mid upper arm circumference:

Mid upper arm circumference:

Eruption of teeth:

Eruption of teeth:

Upper jaw teeth erupt earlier, except the lower central incisor1st molar >central & lateral incisor >canines & premolar> 2nd molar> 3rd molar

Skinfold thickness: Skin fold consist of double fold of skin and subcutaneous fat, excluding the under lying muscle.Used mainly in the estimation of fat contentCommon sites are triceps, subscapular.Tools for measuring skinfolds: Skinfold caliper:LangeHoltainharpenden

Upper and lower segment length &ratio:Lower segment measured as the length between pubic symphysis a and the heel.Upper segment is calculated by the subtracting lower segment length from stature.Ratio of upper and lower segment is 1.7 at birth, at 3year 1.3, by 7-8 year upper segment equalizes the lower segment.

Upper and lower segment length &ratio:Increase: Rickets, achondroplasia, Untreated hypothyroidismDecrease: spondyloepiphyseal dysplasia, vertebral anomalies By about 11 years of age, adult proportions are reached

Arm span:Distance between the tips to middle fingers of both arms out stretched at right angle to the body & measure across the back of child. < 10years 1-2cm less than the body height10-12years span equal to heightAdult span greater than the heightAbnormally large span found in:Klinefelters syndromeCoarctation of aortamarfans syndrome

Arm span:

Pubertal achievement:

Sexual maturity:

Age independent Anthropometric indicators:

Bangle test: If a bangle of 4 cm Internal diameter crosses elbowShakirs tape: Plastic tape with color zones Red if < 12.5 cmQuac stick : Rod with markings for Height and Arm circumference.Nabarrows thinness chart : Graphic chart for Wt/Ht MAC:HC (Kanawati) ratio: 0.28-0.314 : Mild ; 0.32 ; Severe malnutrition if 2.5 ; Symmetrical IUGR 2.0 -2.5 ; Asymmetric IUGR < 2.0Dughadale ratio : Weight (in kg)/ height 1.6 ; Normal if >0.79 ;

Z- Score or standard deviation score:The deviation of the value for an individual from the median value of the reference population, divided by the standard Deviation for the reference population (Observed value) - (Median reference value) Z- Score = -------------------------------------------------------- Standard deviation of reference population

A fixed Z score interval implies a fixed height or weight difference for children of a given age .Advantage:- Allows mean and SD calculation for a group of Z score in population based applications.

percentile:The rank position of an individual on a given reference distribution, stated in terms of what percentage of the group the individual equals or exceeds . Eg. A child of a given age whose weight falls in the 10th percentile weighs the same or more than 10% of the reference population of children of same age

Towards the extremes of the reference distribution there is little change in percentile values, when there is infact substantial change in weight or height

Standard deviation:

Growth monitoring AT:

Charts and interpretation:x-axis: In the Growth Record graphs, some x-axes show age and some show length/height.

y-axis: In the Growth Record graphs, the y-axes show length/height, weight, or BMI.

plotted point the point on a graph where a line extended from a measurement on the x-axis (e.g. age) intersects with a line extended from a measurement on the y-axis (e.g. weight)

Growth parameters and their interpretation for the World Health Organization charts:

Charts and interpretation:What are these growth charts?Growth charts are visible display of childs physical growth and development. Also called as road-to-health" chart. It was first designed by David Morley and was later modified by WHO.A growth reference simply describes the growth of a sample of individuals, whereas a standard describes the growth of a healthy population and suggests an aspirational model.

Charts and interpretation:

WHO growth charts are growth standards. A reference is representative of the existing growth pattern of children and allows us to study the secular trends in height, weight and obesity.On community and national level it helps identify children at risk of morbidity and mortality. It thus helps in implementation of national programmes for nutritional and medical interventions like supplementary feeding, foods to vulnerable group,

Charts and interpretation:Can reflect changes in morphological variation due to inappropriate food intake or malnutrition

There is no single permanent standard. bcoz-Uniform growth pattern is not seen to occur equally all over the world and also in subsequent generations.50th percentile of Harvard Standards (1970s) is considered 100% for Indian children. If a child is at 5thpercentile it means 5% children of that age have less weight or growing less fast than this child.

Charts and interpretation:These growth charts are primarily designed for longitudinal follow up of a child(growth monitoring), to interpret the changes over time

NCHS 1977 growth charts

CDC 2000 growth charts

WHO Growth Charts (2006)

Charts and interpretation:NCHS GROWTH CHART:(National Center for Health Statistics) 1977 Using longitudinal-data from the Fels Research Institute, collected in Yellow Springs and Ohio between 1929 and 1975

Its sample was acknowledged to be quite limited in geographic, cultural, socioeconomic and genetic variability.

CDC 2000 growth charts

Two set of chart birth to 36 months of age 2 to 20 years. BMI-for-age 2 to 20 years(not in NCHS ) National Health and Nutrition Examination Surveys (NHANES), National Natality Files NatalityFiles in Wisconsin and-Missouri, The CDC Pediatric Nutrition Surveillance System, The Fels Research Institute child growth study The primary source of data for the infant charts up to age 6 months was NHANES III.

characteristicNCHS 1977(Fels research institute)CDC 2000( Third National Health and Nutrition Examination survey)LocationWithin a convenient distance of Yellow Springs, OhioU.S. nationwide, non-institutionalized PopulationStudy design Longitudinal follow upCross sectional surveyYears of data collection 1929-19751988-1994Exclusion criteria Triplets excludedVLBW(