human growth i
TRANSCRIPT
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