CHILD GROWTH AND DEVELOPMENT Department of Pediatrics Soochow University Affiliated Children’s...

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.


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


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


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


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


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.


measurement

WeightTake the weight at the same time each day

(preferably before breakfast) on the same scale for

greatest accuracy.


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


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)


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)


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)


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


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:


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)


Newborn 50cm

6 Mo 66cm

12 Mo 75cm

2 ys 85cm

5 ys 105cm

10 ys 140cm

Height

Individual Differences is

within ± 30 % ；


Newborn 50cm

6 Mo 66cm

12 Mo 75cm

2 ys 85cm

5 ys 105cm

10 ys 140cm

Height


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


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.


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.


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


External Proportions


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.


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.


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


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.


Development of Tactility 触觉 Newborn babies have well-developed sense of t

actility, particularly around the areas of eye, mouth,

hand, and foot.


Development of Paining 痛觉

Younger infant are blunt to pain stimuli until 2

months.


Development of Temperature 温度觉 Neonatal are sensitive to the change of temper

ature, and they have obvious response to cold sti

muli.


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

CHILD GROWTH AND DEVELOPMENT Department of Pediatrics Soochow University Affiliated Children’s...

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