Evaluation of children physical development of Evaluation of children physical development of different age group. different age group.

Main principles and methods of estimation of Main principles and methods of estimation of physical development of children. physical development of children.

Semiotics of deviation of children physical Semiotics of deviation of children physical developmentdevelopment

Furdela V. PhDFurdela V. PhDassistant prof. assistant prof.

Pediatrics Pediatrics department #2department #2

Physical developmentPhysical developmentChange in the child that occurs over time. Changes follow an orderly pattern that moves toward greater complexity and enhances survival.

TerminologyTerminology GrowthGrowth Length / height Length / height WeightWeight Head circumference Head circumference Chest circumference Chest circumference Proportionality of these measurementsProportionality of these measurements

Measurements should be taken at regular Measurements should be taken at regular intervals in order to observe reliable trends. intervals in order to observe reliable trends.

Recommendations for measurement intervals Recommendations for measurement intervals include:include:

Infants (0-12 months): every monthInfants (0-12 months): every month Young Children: at 15, 18, 24 and 30 monthsYoung Children: at 15, 18, 24 and 30 months Ages 3+: every yearAges 3+: every year

GrowthGrowth

Is a complex dynamic process by which the Is a complex dynamic process by which the body and various structures within the body and various structures within the body increase in size. body increase in size.

Its results from the careful coordination of Its results from the careful coordination of three cellular processes:three cellular processes:

an increase in the number of cells or cell an increase in the number of cells or cell hyperplasiahyperplasia

Increase in the size or cell hypertrophy Increase in the size or cell hypertrophy Programmed cell death or apoptosis Programmed cell death or apoptosis

LengthLength is the linear measurement for infants is the linear measurement for infants up to 24 months.up to 24 months.

HeightHeight for child elder 2 years for child elder 2 years

АА

ВВСС

Weight of a bodyWeight of a body

Weight of a bodyWeight of a body

AA B B CC

On a pan scale up to 2 years in laying or sitting position and in standing position after 2 years

Head circumferenceHead circumference is a measurement taken around the largest part is a measurement taken around the largest part

of a child’s head above the eyebrow and of a child’s head above the eyebrow and occipital tuberculars. occipital tuberculars.

Take the measurement three times and select Take the measurement three times and select the largest measurement to the nearest 0.1cm.the largest measurement to the nearest 0.1cm.

Chest circumferenceChest circumference

Measure chest circumference with paper Measure chest circumference with paper or steel tape around chest at nipple line or steel tape around chest at nipple line and under tips of scapulas at backand under tips of scapulas at back

Phases of linear growthPhases of linear growth

1. Fetal phase (9 mo =70 cm/year)1. Fetal phase (9 mo =70 cm/year) 2. Infantile phase (first two years = 2. Infantile phase (first two years =

23-25 cm/year)23-25 cm/year) 3. Childhood phase (2-11 years = 3. Childhood phase (2-11 years =

5-7 cm/year)5-7 cm/year) 4. Puberty phase (11-18 years= 4. Puberty phase (11-18 years=

8 cm/year in girls8 cm/year in girls

10 cm/year in boys)10 cm/year in boys)

FEATURES of PHYSICAL FEATURES of PHYSICAL DEVELOPMENT of a NEWBORN:DEVELOPMENT of a NEWBORN:

- Weight of a body at birth 2500-4200 gram;- Weight of a body at birth 2500-4200 gram; - Length of a body - 50-52 - Length of a body - 50-52 ссm.;m.; - Head circumference - 34-36 - Head circumference - 34-36 ссm;m; - Chest circumference - 32-34 - Chest circumference - 32-34 ссm.m.

Methods of estimation of physical Methods of estimation of physical development of childrendevelopment of children

Method of empirical formulas Method of anthropometrical standards:

- centile chart (tables)

- standard deviation score (SD) or Z-score charts

http://www.who.int/childgrowth/en/http://www.who.int/childgrowth/en/

Growth GridsGrowth Grids Height, weight, circumferences are plotted Height, weight, circumferences are plotted

against the child’s chronologic age on against the child’s chronologic age on standardized growth charts. standardized growth charts.

Normal growthNormal growth - m - measurement between easurement between

the the 2525thth and 75 and 75thth percentiles or percentiles or ±1 SD±1 SD indicate indicate Either normal growth or a deviationEither normal growth or a deviation

measurements between the measurements between the 1010thth - 25 - 25thth, ,

7575thth - 90 - 90thth percentiles percentiles or or ± 2 SD± 2 SD Measurements Measurements less then 10less then 10thth , , above 90above 90thth

ppercentiles ercentiles or or ± 3 SD± 3 SD are are pathologicalpathological..

Deviation from normal physical Deviation from normal physical development at childhood development at childhood

StuntingStunting (growth failure) Failure to gain weight (growth failure) Failure to gain weight

Shot stature Malnutrition (hypotrophy)Shot stature Malnutrition (hypotrophy)

Small stature UnderweightSmall stature Underweight

Nanism (dwarfism) OverweightNanism (dwarfism) Overweight

Gigantism ObesityGigantism Obesity

Growth failure Growth failure – failure to maintain a – failure to maintain a normal height velocity that is appropriate normal height velocity that is appropriate for age and maturityfor age and maturity

Short stature Short stature - height less than 2 SD for - height less than 2 SD for age below the mean for age and genderage below the mean for age and gender

Height less than 3 SD for age below the Height less than 3 SD for age below the mean for age and gender is called mean for age and gender is called

Nanism (dwarfism) Nanism (dwarfism)

Dwarfism due to growth Dwarfism due to growth hormone deficiencyhormone deficiency

GigantismGigantism

Causes of tall statureCauses of tall stature

ConstitutionalConstitutional

Endocrine Pituitary adenoma, Endocrine Pituitary adenoma,

Cerebral GiagantismCerebral Giagantism

ThyreotoxicosisThyreotoxicosis

Genetic diseases Genetic diseases

Klinefelter ‘s syndrome, Klinefelter ‘s syndrome,

Marfan syndrome Marfan syndrome

A head circumference is less then A head circumference is less then 3 SD 3 SD below the mean for sex and age below the mean for sex and age

MicrocephalyMicrocephaly

Body mass indexBody mass index

BMI in kg/mBMI in kg/m22 = =

weight in kg / height in m weight in kg / height in m 22

OverweightOverweight: >+1SD (equivalent to BMI 25 kg/m2 at 19 years) : >+1SD (equivalent to BMI 25 kg/m2 at 19 years)

ObesityObesity: >+2SD (equivalent to BMI 30 kg/m2 at 19 years) : >+2SD (equivalent to BMI 30 kg/m2 at 19 years)

Underweight (thinness)Underweight (thinness): <-2SD: <-2SD

Severe underweightSevere underweight: <-3SD: <-3SD

BMIBMI> 95-> 95- centile centile

obecityobecity

BMIBMI= 85-95 = 85-95 centilecentile

overweightoverweight

BMIBMI= 5-= 5-885 5 centilecentile

normal weightnormal weight

BMI < BMI < 5 5 centilecentile

underweightunderweight

Causes of obesityCauses of obesity

Failure to gain weightFailure to gain weight

Malnutrition (hypotrophy)Malnutrition (hypotrophy)

the result of a lack of essential nutrients, the result of a lack of essential nutrients, resulting in poorer health, may be caused resulting in poorer health, may be caused by a number of conditions or by a number of conditions or circumstances. circumstances.

In many developing countries long-term In many developing countries long-term (chronic) malnutrition is widespread - (chronic) malnutrition is widespread - simply because people do not have simply because people do not have enough food to eat.enough food to eat.

MalnutritionMalnutritionSTAGE WEIGHT DEFICITE LENTH DEFICITE

I 10-20% 0

II 20-30% 2-4 cm

III More than 30% 7-10 cm