Growth Growth and and

DevelopmentDevelopment

Mean-2SD Mean+2SD

2.5%

47.5%

Neonatal PeriodNeonatal Period(1(1stst 4 Week of life): 4 Week of life):

Prone: FlexedSupine: FlexedVisual: Doll’s eye,Fixate in line of vision Reflex: Moro,Grasp,Stepping, Placing

At 4 Week of life:At 4 Week of life:

Prone: ExtendSupine: Tonic neckVisual: Follow Social: Begin to smile

At 8 Week of life:At 8 Week of life:

Visual: Follow 180 degree Social: Smile to social contact

At 12 Week of life:At 12 Week of life:

Prone: Lifts head and chestSitting: Early head controlSocial: Says aah,ngah

At 16 Week of life:At 16 Week of life:

Supine: Symmetric ,Grasp object , Bring to mouth

Sitting: No head lag Social: Laughs out loud

At 28 Week of life:At 28 Week of life:

Prone: Roles over , CrawlSitting: With support , TransferStanding: Support most of weight Language: Polysyllabic vowel Social: Prefer mother

At 40 Week of life:At 40 Week of life:

Prone: CrawlSitting: Sits up aloneStanding: Walks holding on furniture Social: Response to sound of name

At 52 Week of life:At 52 Week of life:

Walk: Take several steps

At 15 months of life:At 15 months of life:

Walk: aloneCrawl: UpstairsPlay: 3 cubes

At 18 months of life:At 18 months of life:

Walk: UpstairsLanguage: 10 words,1-2 part of bodyPlay: 4 cubes

At 24 months of life:At 24 months of life:

Walk: Runs well,downstairs, JumpsLanguage: 3 words togetherPlay: 7 cubesHandle spoon well , Listen to story

At 30 months of life:At 30 months of life:

Refers IFull name

At 36 months of life:At 36 months of life:

Ride tricycleStand on one footCopy circleWash handsAge and sex

At 48 months of life:At 48 months of life:

Copy cross and squareTell a storyPlay with childrenGo to toilet alone

At 60 months of life:At 60 months of life:

Draw triangleNames 4 colorsCount ten coinsDressing

Failure to Failure to ThriveThrive

(FTT)(FTT)

Failure to thrive(FTT):Failure to thrive(FTT):

Weight< 3%Drop of weight percentileWeight/Height < 5%Weight < 80% Median for Height

Kwashiorkor:Kwashiorkor:

Inadequate protein dietPitting edemaComplication of critical illnessWeight 60-80% for age Skin sign

Marasmus:Marasmus:The most common form of PEMSevere caloric depletionSecondary to diseasesWeight below 60% for ageInappropriate weaning

In most children with In most children with FTT, both FTT, both organicorganic and and inorganicinorganic risk risk factors are present.factors are present.

Early Infancy:Early Infancy: Feeding difficulties: 1)Lactation failure2)Inadequate feedings3)Formula mixing error4)Inadequate calories

Diagnosis:Diagnosis:History and Observation

Tests:1)CBC,ESR,U/A,Serum electrolytes2) S/E, S/C, Ph , Reducing substances,

Guiac test

Treatment:Treatment:HospitalizationAmbulatory

120 Kcal/24h X med weight/HeightVitamins & Minerals

RecoveryRecovery::

Positive mood changesWeight gain

Prognosis:Prognosis:Non organic FTT in first 2 yearAt 3-11 years:

Retardation(15-67%)

Learning Problems (37-67%)

Behavioral disturbances (28-48%)

Obesity:Obesity:

BMI:BMI:

Weight(Kg)/ Height2 (m)

Obesity Definition:Obesity Definition:

Overweight:Weight> 85th Percentile

BMI > 25

BMI > 85th percentile

Obesity: BMI > 30

BMI > 95th percentile

Obesity in adulthoodFamily historyTV watchingDietary intake

Treatment:Treatment:30% decrease in calories intakeStarting 1000-1500 Kcal/dayVery low calorie diet or protein

modified fastPharmacotherapySurgical therapy