child growth and development department of pediatrics soochow university affiliated children’s...
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CHILD GROWTH AND
DEVELOPMENT
Department of PediatricsSoochow University Affiliated Children’s Hospital
Pediatrics focuses on the pattern of child growth and development, child health promotion, disease prevention and treatment, and direct care of illness children. The children are often among the most vulnerable or disadvantaged in society, and thus their needs require special attention.
Pediatric worker aims at protecting children
from illness and injury, assisting them to attain
optimal levels of health.
Characteristics of Pediatrics
There are significant differences between children and adults. The younger the children, the greater the difference. Health promotion, disease prevention, treatment, and health care of children are unique from that of adults.
Childhood is a critical period for physical, psychological and behavioral development. Compared with adult, child is relatively less independent. Family, kindergarten, school, and community are important settings for their development. Health care should be planned specifically based on their characteristics and needs of children in different age group.
It is also significant for health worker to know that
there are characteristic health problems peculiar to
each major phase of development.
Age stages
early middle later
7 D 28 D14 D
NeonatalPerinatal period (from 28 weeks gestination
to 7 days after birth)
conception
Fetal Period
birth
1st 2nd
Age stages
Perinatal period
28 W
3rd
birth
Birth 1y 3y 6-7y
Infancy
Biologic and personality maturation are accompanied by
physical and emotional turmoil, and there is redefining of
the self-concept.
Age stages
Toddler's Age Preschool
Age
G B11y 13y
School Age
G B18y 20y
Adolescence
Child growth and development is a complex process,
which includes not only physical growth, but also the mat
urity of systems, development of functioning, The proces
s of growth and development is influenced by a variety of
internal and external factors. Therefore it is one of the most important goals of pediat
ric to monitor and improve child growth and development,
personality, and behaviors.
Child growth and development
Growth
an increase in the number and, size of cells as
they divide and synthesize new proteins; results in
increased size and weight of the whole or any of its
parts.
can be viewed as a quantitative change.
Development
a gradual change and expansion; advancement from a lower to a more advanced stage of complexity the emerging and expanding of the individual's, capacities through growth, maturation, and learning
can be viewed as a qualitative change.
Child growth and development
Growthquantitative changeDevelopmentqualitative changeMatura-tionan increase in competence and adaptability; a change in the complexity of a structure that makes it possible for that structure to begin functioning to function at a higher level.
All of these processes are interrelated,
simultaneous, and ongoing processes; none
occurs apart from the others. The processes
depend on a sequence of endocrine, genetic,
constitutional, environmental, and nutritional
influences. The child's body becomes larger
and more complex.
Patterns of Growth and Development
There are definite and predictable patterns in
growth and development that are continuous,
orderly, and progressive. These patterns,
sometimes referred to as trends or principles,
are universal and basic to all human beings.
Patterns of Growth and Development
Cephalocaudal or head-to-tail The fist pattern is growth and development in the cephalocaudal, or head-to-tail, direction, and reflect the physical development and maturation of neuromuscular function.
1.Continuous and Sequential Trends2. Directional Trends
Patterns of Growth and Development
Cephalocaudal or head-to-tail Proximodistal or near-to farThe second pattern is growth and Development in the proximodistal, or Near-to far, direction (midline to periphery). In the infant, shoulder Control precedes mastery of the hands, the entire hand is used as a unit before the fingers can be manipulated.
2. Directional Trends1. Continuous and Sequential Trends
Patterns of Growth and Development
cephalocaudal or head-to-tail proximodistal or near-to farThe third trend in directional growth, differentiation, describes development from simple operations to more complex activities and functions. Specific and refined patterns of behavior emerge from very broad and global patterns. All areas of development (physical, mental, social, emotional) proceed in this direction.
2. Directional Trends
1. Continuous and Sequential Trends
differentiation
Patterns of Growth and Development
In both total body growth and growth of subsystems there are periods of accelerated and of decelerated growth. The very rapid growth rate during infant gradually levels off throughout early childhood. This rate is relatively slow during middle childhood, increases markedly at the beginning of adolescence, and levels off in early adulthood.
1. Continuous and Sequential Trends2. Directional Trends3. Developmental Pace
Patterns of Growth and Development
Each child grows in his or her own unique and personal way. Great individual variation exists in the age at which developmental milestones are reached. Rates of growth vary from one individual to another. Children may grow quickly or slowly during the spurt and may finish sooner or later than other children.
1. Continuous and Sequential Trends2. Directional Trends3. Developmental Pace4. Individual Differences
Gender, nutrition, environment are an influential factors.
SELECTED FACTORS THAT INFLUENCE GROWTH AND DEVELOPMENT
GenderHeredity
Prenatal Influences
Nutrition
DiseasesInterpersonal RelationshipsEnvironmental HazardsSeasons and Climates
internal factors
external factors
nature
nurture
Physical Growth and Development
Weight Weight is the total of all organs, tissues and
fluid. It is an easily obtainable measurement
and a sensitive index reflecting the child's
overall growth and nutrition. In addition, weight
is a basis calculating dosage of medication in
clinic.
Physical Growth and Development
measurement
WeightTake the weight at the same time each day
(preferably before breakfast) on the same scale for
greatest accuracy.
Physical Growth and Development
Weightnewborn
3.0Kg
physiologic weight loss during the first week af
ter birthinfant may loss 3%-9% of their weight due to the insufficient milk supply, water loss and meconium excretion. < 10 %which reaches the peak at 3 to 4 days after birth and return to the level of birth weight at 7 to 10 days after birth. < 10 days
Physical Growth and Development
Weight
newborn 3.0Kg
Growth is very rapid during the first year of age, especially during the initial 6 months.
The younger the infant, the more the weight gain.
Infants gain 600-800g per month until age 6 months, when the birth weight has at least doubled.
6 Mo 7.2Kg
The weight of child (1-6 months) can be estimated by the formula: Weight(kg)=Birth weight(kg) + months×0.7(kg)
Physical Growth and Development
Weightnewborn 3.0Kg
6 Mo 7.5Kg
12 Mo 9.0Kg
The younger the infant, the more the weight gain.
By 1 year of age the infant's birth weight has tripled, with an average weight of 9 kg.
Weight gain decreases by half that amount during the second 6 months.
The weight of child (7-12 months) can be estimated With Weight(kg) = 6(kg) + month×0.25(kg)
Physical Growth and Development
WeightNewborn 3. 0Kg
6 Mo 7.5Kg
12 Mo 9.0Kg
2 ys 12.0Kg
5 ys 18.0Kg
10 ys 28.0Kg
After this point the normal rate of weight gain, assumes a steady annual increase of approximately 2 to 2.75 kg per year until the adolescent growth spurt.
The weight of child (2 yrs-12 yrs) can be
estimated With Weight(kg) = age×2 + 8(kg)
Physical Growth and Development
Individual Differences is within ± 10 % ;
If < 15 % was
undernutrition
If > 20 % was
overweight
Weight
Newborn 3. 0Kg
6 Mo 7.5Kg
12 Mo 9.0Kg
2 ys 12.0Kg
5 ys 18.0Kg
10 ys 28.0Kg
Physical Growth and Development
Height Height is the vertical distance of
two points between the top of the
head and heel of the feet.
Height
(a) Children younger than age 3 years are measures lying down in no shoes, socks and cap;
measurement
(b) Children older than age 3 years are measured by standing straight.
The measuring varies with age:
Physical Growth and Development
At approximately 2 years of age the child begins a relalively stable and steady growth rate of 5 to 6 cm per year; this rage continues for the next 10 years.
The Height of child (2 yrs-12 yrs) can be estimated
With Height(cm) = age×7 + 70(cm)
Physical Growth and Development
Newborn 50cm
6 Mo 66cm
12 Mo 75cm
2 ys 85cm
5 ys 105cm
10 ys 140cm
Height
Individual Differences is
within ± 30 % ;
Physical Growth and Development
Newborn 50cm
6 Mo 66cm
12 Mo 75cm
2 ys 85cm
5 ys 105cm
10 ys 140cm
Height
Physical Growth and Development
Head Circumference
head circumference is an important determinant of
brain growth and potential neurologic function.
It is usually measured in children up to 2 years of age.
Head Circumference
The measurement is made by placing a tape
measure around the head just above the eyebrows
and around the most prominent portion of the back
of the skill.
measurement
Physical Growth and Development
Head Circumference Head growth is also rapid.
The average head circumference is 33-34cm at birth. During the first 6 months head circumference increases approximately 1.5 cm per month but decreases to only 0.5 cm per month during the second 6 months. After 2 years
of age the growth is slowly.
Physical Growth and Development
Newborn 34cm6 Mo 42cm12 Mo 46cm 2ys 48cm 5ys 50cm
Over-bulge of anterior fontanel indicates
increased intracranial pressure. Sunken
fontanel indicates dehydration. Delayed close of anterior fontanel is
evidenced as children with rickets.The posterior fontanel measures between
0.5 to 1 cm at its widest part and close at 6
- 8 weeks after birth.
Expanding head size reflects the growth and differentiation of the nervous system.
Chest Circumference
The measurement of chest circumference is
made at the nippier line.
Physical Growth and Development
The chest circumference at birth is about 32 cm, less than the head circumference.
The chest circumference approximately equals head circumference by the end of the first year.
They can be estimated after 1 years With
(chest one - head one ) = age (years)
Head ChestNewborn 34cm 32cm
6 Mo 42cm 41cm
12 Mo 46cm 46cm
2ys 48cm 50cm
5ys 50cm 55cm
Physical Growth and Development
External Proportions
Physical Growth and Development
Variations in the growth rate of different tissues and organ systems produce significant changes in body proportions during childhood.
After the first year and extending to puberty, the legs grow more rapidly than any other part. However, with the onset of puberty there is a marked alteration in body proportion.
Skeletal Growth and Maturation Skeletal, or bone age
appears to correlated more closely with other measures
of physiologic maturity than with chronological age or
height. Bone age is determined by comparing the
mineralization of ossification centers and advancing
bony form to age-related standards.
Physical Growth and Development
radiographs of the hand and wrist provide the most useful areas for screening to determine skeletal age, especially before age 6 years.
Teething
There are totally 20 deciduous (primary) teeth. The first deciduous tooth usually erupts at around 4 to 10 months (average 6 months), followed by a new one monthly.All 20 deciduous teeth are generally present by 2 to 2.5 years of age.
Physical Growth and Development
The first permanent (secondary) teeth erupt at about 6 years of age, beginning with the 6-year molar.
The others appear in approximately the same order as eruption of the primary teeth and follow shedding of the deciduous teeth.
Growth Wt Ht Head Chest fontanel teethBone age
newborn
6 Mo
1 y
2 ys
5 ys
Growth and Development
rule
Key Points of the Class
There are significant differences between children and adults. They younger the children are, the greater the difference is.The stage of growth and development include fetal period, neonatal period,infancy, toddler's age, preschool age, school age, and adolesence.Growth and development of children are strongly influe
nced by genetic and environmental factors.
Key Points of the Class
Growth and development follow predictable patterns in
direction, sequence, and pace.
Biologic growth is determined by height, weight, bone
age, and dentition.
Growth and development are affected by a variety of
conditions and circumstances, including heredity,
physiologic function, gender, disease, physical
environment, nutrition, and interpersonal relationships.
Neurologic Maturotion
Two periods of rapid brain cell growth occur
during fetal life:
between 15 and 20 weeks of gestation, and 30
weeks of gestation to 1 year of age.
The nervous system development allows for
increasingly complex movement and behavior.
One half of postnatal brain growth is achieve
by 1 year of age, 75% by age 3, and 90% by
age 6.
At birth the cortex is only about one half its
adult thickness, resulting in very little cortical
control over body movements.
Myelinization (髓鞘化) of the various nerv
e tracts in the central nervous system accelerate
s rapidly after birth and follows the cephalocauda
l and proximodistal sequence which allows progr
essively complex neuromotor function.
The pathways concerned with sensation are my
elinated before the motor pathways. The acquisitio
n of motor skills depends on this myelinization and
maturation.
Because the vertebral column (脊柱) and the cord (脊髓) have different growth rates, the cord in the newborn ends at the level of the third and fourth lumbar vertebrae. As growth continues, the cord becomes higher in relation to the vertebrae until it ends at the level of the first lumbar vertebrae in the adult.
Sensor Changes 感觉发育
Development of vision 视觉 Infants have a visual preference for looking at
the human face; 1mon Can follow in range of 90 degree 4-5 mon Looks at hand while sitting or lying o
n back 6-7 mon Develop hand-eye coordination 11-12mon Can follow rapidly moving objects
Development of Hearing 听觉 1mon Turns head to side when sound is make at le
vel of ear 4- 5 mon Locates sound by turning to side and then l
ooking up or down 6- 7 mon Responds to own name 11-12 mon Knows several words and their meaning
Sensor Changes 感觉发育
Development of smell 味觉
The senses of smell and taste are well devel
oped at birth. Newborn babies can response diff
erent to different taste such as sweet, sore, and
bitter.
Sensor Changes 感觉发育
Development of Tactility 触觉 Newborn babies have well-developed sense of t
actility, particularly around the areas of eye, mouth,
hand, and foot.
Sensor Changes 感觉发育
Development of Paining 痛觉
Younger infant are blunt to pain stimuli until 2
months.
Sensor Changes 感觉发育
Development of Temperature 温度觉 Neonatal are sensitive to the change of temper
ature, and they have obvious response to cold sti
muli.
Sensor Changes 感觉发育
Motor Development
运动发育 A child's ability to perform motor functions
depends on the state of maturation of bones,
muscles, and the nervous system and follows the
patterns of development.
Gross Motor Development
大运动
(a) Head Control. By 2 months of age infants can
hold their head well beyond the plane of the body.
(b) Rolling Over. The ability to willfully turn from
the abdomen to the back occurs at 4 months.
Gross Motor Development 大运动
(c) Sitting. The convex lumbar curve appears when the child begins to sit, at about age 6 months. As the spinal column straightens, the infant can be propped in a sitting position. (d) Locomotion. By 7 months of age they can creep, and are able to bear all their weight on their legs with assistance.
The motor development in one year is Months
2 lifts head, 4 rolling (from back to side), 6 sitting,
7 creeping (to bear all their weight), 8 Crawling,
one year walking
Gross Motor Development 大运动
Fine Motor Development 精细运动
Fine motor development includes the use of the
hands and fingers in the prehension of an object.
Grasping 一把抓 palmer grasp 尺侧抓 pincer grasp 指端抓
Language Development
语言发育
Children are born with intact biologic structure of
the mechanism and capacity to develop speech
and language skills.
Stages in Development of Language
Paralinguistic stage(辅助语言) :
Holophrastlc stage(单个词语) :
Telegraphic stage(简略式) :
Lengthy sentence (长句) :
Refine language skills. (语言技巧) :
Language Development
语言发育
Language Development 语言发育
The language kill under 7 years is: month 1 crying, 2 smiles, 4 make sound, 5 sound "yi", 6 "ya", 7 "baba" "mama", Years 1 understand words can say one words, 2 talking, 4 singing, 7 reading and learn writing