human growth i

Human GrowthSurg Cdr RW Thergaonkar

Introduction

• Growth differentiates children

from adults

• A process from conception to

maturity

• Hyperplasia and hypertrophy

Growth vs Development

• Growth: a net increase in size or

mass of tissues

• Development: maturation of

function; related to myelination of

nervous system and indicates

acquisition of skills

Factors Affecting Growth

FETAL GROWTH

• Genetic potential

• Sex

• Fetal Hormones

Factors Affecting Growth

FETAL GROWTH

• Fetal Growth Factors

• Placental Factors

• Maternal Factors

Factors Affecting Growth

POSTNATAL PERIOD

• Sex

• IUGR

• Genetic Factors

• Hormonal Influence

Factors Affecting Growth

POSTNATAL PERIOD

• Nutrition

• Infections

• Chemical Agents

• Trauma

Factors Affecting Growth

SOCIAL FACTORS

• Socioeconomic level

• Poverty

• Climate

Factors Affecting Growth

SOCIAL FACTORS

• Emotional Factors

• Cultural Factors

• Parental Education

Factors Affecting Growth

CONSEQUENCES OF IMPAIRED GROWTH & UNDERNUTRITION

• 35 million deaths• 35% of disease burden in children < 5 yrs• India: 61 million stunted children (34% of global)• Fetal Origins of Adult Disease

– Developmental adaptations– Predisposition to DM, Htn, CAD & dyslipidemia as adults

Laws of Growth

• A continuous and orderly process: specific periods of acceleration, steadiness & decceleration

• Growth sequence is cephalocaudal and distal to proximal

• Different organs grow at different rates

Periods of Growth

PrenatalOvum 0 to 14 daysEmbryo 14 days to 9 wksFetus 9 wks to birth

Periods of Growth

PostnatalNewborn first 28 daysInfancy first yearToddlerhood 1-3 yrsPreschool 3-6 yrsSchool Age 6-12 yrs

Periods of Growth

AdolescenceEarly 10-13 yrsMiddle 14-16 yrsLate 17-20 yrs

Laws of Growth

• A continuous and orderly process: specific periods of acceleration, steadiness & decceleration

• Growth sequence is cephalocaudal and distal to proximal

• Different organs grow at different rates

Brain Growth Somatic Growth

100%100%

Lymphoid Growth Gonadal Growth

100%100%

Skeletal Growth

• Continuous process with spurt at puberty• Epiphyseal fusion: 18 yrs (girls) and 20-22 yrs (boys)• Bone Age

– Number , shape and size of epiphyseal centres– Size, shape and density of the ends of bones

Gruelich-Pyle & Tanner Whitehouse

Assesment of Growth

• Weight

• Length

• Standing Height

• Head Circumference

• Chest Circumference

• Midarm Circumference

Normal Growth

Normal GrowthAge Weight (kg) Length/Height

(cm)Head

Circumference (cm)

Birth 3 50 346 mths 6 65 42

1yr 9 75 452 yrs 12 85 473 yrs 14 95 494 yrs 16 100 50

Normal Growth

• Target Height = Father’s Ht + Mother’s Ht/2 + 6.5 (boys)- 6.5 (girls)

• Chest Circumference– 3 cm less than head at birth– Equals at 1 yr

• BM I = Wt (kg)/[Ht (m)] ²– > 95th centile is obesity

Growth Standards

• NCHS

• ICMR

• WHO (MGRS)

• IAP

When to Measure?Age Ht/

LengthWeigth HC Other

Birth Y Y Y

11/2, 31/12, 6, 9,15 mths

Y Y Y

18-36 mths Y Y Y

31/1 to 5 yrs Y Y

6-8 yrs Y Y BMI & SMR

9-18 yrs Y Y BMI & SMR

What to Remember?

• Growth v/s Development• Factors Influencing• Laws of Growth• How to measure• When to measure• Norms

Thank You