P. 1
Ppt Growth & Development

Ppt Growth & Development

5.0

|Views: 1,827|Likes:
Published by Ramlah Idris
Describes the life cycle of human growth and development. Thank you Dr Edward M. Santos
Describes the life cycle of human growth and development. Thank you Dr Edward M. Santos

More info:

Published by: Ramlah Idris on Apr 18, 2009
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PPT, PDF, TXT or read online from Scribd
See more
See less

01/31/2013

pdf

text

original

GROWTH AND DEVELOPMENT

Edward M. Santos, MD

RATIONALE
Monitor children’s progress Identify delays or abnormalities in development Counsel parents and prescribe treatment

OUTLINE
Overview and Assessment of Variability Fetal Growth and Development The Newborn The First Year The Second Year Preschool Years Middle Childhood

Adolescence Assessment of Growth Developmental Assessment

DEFINITION OF TERMS
•Growth – process by which a living being and any of its parts increase in size and mass, either by multiplication or by enlargement of component parts •quantitative •Development – enhancement of function, skills and maturation •qualitative

I. Overview
Genetics (nature) Environment (nurture) Both Ex: height – genetic endowment (biologic), personal habits of eating (psychologic), and access to nutritious food (social)

Biologic Influences
Genetics Role of Teratogens Postpartum illnesses Exposure to hazardous substances Maturation

Psychologic Influences
Attachment – tendency of a young child to seek proximity with the parent during times of stress
Also refers to the relationship that alows securely attached children to use their parents to reestablish a sense of well-being after a stressfull experience

Contingency – when adult caregivers pay attention to the verbal and non-verbal cues of children and respond to them accordingly

Social Factors
Family Systems – role of parents; parentchild dyad Ecologic Model – parent-child dyad at the center with the larger society at the periphery

Developmental Domains and Theories of Emotion and Cognition
Psychoanalytic Theories
The stages of development are qualitatively different epochs in the development of emotion and cogniton Freud, Erikson, and Piaget

Behavioral Theories
gradual modification of behavior and accumulation of competence BF Skinner

Classic Stage Theories
Theory Infancy (0-1) Toddlerhood (2-3) Preschool (3-6) School Age (6-12) Adolescence (12-20)

Freud

Oral

Anal

Oedipal

Latency

Adolescence

Erikson

Basic Trust

Autonomy vs shame and doubt

Initiative vs Guilt

Industry vs Inferiority

Identity vs Identity confusion

Piaget

Sensorimoto r (Stages 1IV)

Sensorimoto r (Stages V,VI)

Preoperation al

Concrete operations

Formal operations

Behavioral Theory
Skinner Focuses on observable behaviors and measurable factors No stages

A child’s developmental level is the end result of a wide variety of factors, namely: prenatal, perinatal and postnatal.

II. Fetal Growth and Development
Milestones of Prenatal Development
Week
2 3

3 4
6

7
8 9 10 11

37

Developmental Events Fertilization and Implantation Endoderm and ectoderm appear Mesoderm appears Neural folds fuse Lens placodes Eyelids begin Ovaries and testes are distinguishable External genitals distinguishable Usual lower of viability Eyes open Term

GROWTH PERIOD

APPROXIMATE AGE

• PRENATAL
Ovum Embryo Fetus 0-14 days 14 days – 9 wk 9 wks - Birth 37 – 42 wks

• BIRTH

3 PHASES (INTRAUTERINE DEVELOPMENT)

• Ovular Phase
Fertilization  Implantation • Embryonic Phase 2nd week  3rd month “organogenesis” • Fetal Phase 3rd month  Birth “differentiation/maturation”

(0-14 days)
• characterized by increase in

OVUM

complexity and cell • self sufficient

multiplication

• little increase in total size • food stored in yolk sac

EMBRYO (14 days – 9 wks) • parasitic • derives nutrition from maternal origin • rapid differentiation • all organ systems established

FETUS (9 weeks – Birth) • early functional activities apparent • increase in body mass most pronounced

BIRTH • parasitic existence terminated • greatest risk to life • initiation of respiration, own circulation, etc.

III. The Newborn
Adaptation to extrauterine life requires rapid and profound physiologic changes This includes aeration of the lungs, rerouting of the circulation and activation of the GI tract Behavioral states: quiet sleep, active sleep, drowsy, alert, fussy, and crying

Newborn Behavior Assessment Scale (NBAS) by Brazelton
provides a formal measure of an infant’s neurodevelopmental competencies Also used to demonstrate to parents an infant’s capabilities and vulnerabilities Correlates well with improvements in the caretaking environment

IV. The First Year
Characterized by rapid growth Acquisition of new competencies Psychological reorganization

0-2 months
Physiologic weight loss Average weight gain: 30g/day Six behavioral states Crying: peaks at 6 weeks of life Healthy infants cry up to 3 hr/day Trust vs mistrust

2-6 months
Emergence of social smile Growth rate: 20g/day Sleep requirement: 14-16 hr/day Social hatching Face to face interactions

6-12 months
Increased mobility and exploration of the inanimate world Slower growth Increased myelinization and cerebellar growth Appearance of the pincer grasp (around 9 mo) Object constancy (about 9 mo) Appearance of tantrums Dentition

V. The Second Year
Age 12-18 months
Slower growth rate Independent walking Receptive language precedes expressive Points to major body parts (15 mo)

18-24 months
Incremental motor development Balance and agility Object permanence is firmly established Cause and effect is better understood Rapprochement – increased clinginess around 18 mo Use of transitional objects Linguistic development – most dramatic (vocabulary balloons from 10-15 words to 100 words or more)

VI. Preschool Years
Between 2 and 5 years Widening social sphere Stubborn opposition and cheerful compliance Adaptation to new rules and relationships

Physical Development
Slower somatic and brain growth 2 kg per year and 7 cms per year Average sleep: 11-13 hr Visual acuity at 20/20 at 4 years old All primary teeth: 3 yr Handedness at 3 yr Bowel and bladder control

Language, Cognition and Play
Most rapid language development Vocabulary expands from 100 to 2000 words Mental retardation may first become apparent with delayed speech at 2 yr old Developmental dysfluency and stuttering

Preoperational stage: magical thinking, egocentrism, and thinking that is dominated by perception Play is marked by increasing complexity and imagination

VII. Middle Childhood
6-12 years Increased separation time from parents Seeks acceptance from teachers and other adults Central issue: self-esteem Production of socially valued outputs Industry and inferiority

Physical Development
3-3.5 kg/yr, 6 cm/yr Myelinization is complete by 7 years old Loss of deciduous teeth Sexual organs remain physically immature Body habitus remains relatively stable

Cognitive and language development
Concrete logical operations Increasing cognitive demands in school Mastery of the elementary curriculum

Social and Emotional Development
Proceeds in 3 contexts: home, school, neighborhood Home remains the most influential Conformity

VIII. Adolescence
10-20 years Accelerated growth ( height and weight) Appearance of secondary sexual characteristics

ADOLESCENT GROWTH SPURT
Period characterized by rapid increase in size of the body and other organs WEIGHT SPURT - rapid gain in weight noted at adolescence HEIGHT SPURT - rapid increase in height observed at adolescence

In girls: appearance of breast buds is the first sign of puberty ( usually between 8 and 13 years) In boys: testicular enlargement

PHYSICAL GROWTH Height Growth
Height velocity increases and peaks during the adolescent growth spurt Pubertal growth accounts for 20-25% of final adult height The average growth spurt lasts 24-36 months The growth spurt is highly variable from adolescent to adolescent

DIFFERENCES IN GROWTH SPURTS BETWEEN MALES AND FEMALES

PHV occurs about 18-24 months earlier in the females than in males PHV in females averages 2 cms. per year less than in males PWV coincides with PHV in males, but PWV occurs 6-9 months after PHV in females

SECONDARY SEX CHARACTERISTIC CHANGES MALE genital changes appearance of pubic, axillary, and facial hair voice change FEMALE breast changes growth of pubic and axillary hair onset of menarche

EARLY ADOLESCENT (10 -13 yrs)
SMR 1-2 Somatic: secondary sex characteristics; beginning of rapid growth; awkward Sexual: interest exceeds activity Cognitive and Moral: concrete operations; conventional morality Self Concept: Preoccupation with changing body; self-consciousness

EARLY ADOLESCENT
Family: Bids for increased independence; ambivalence Peers: Same sex groups; cliques Relationship to Society: Middle school adjustment – elementary to high school

MIDDLE ADOLESCENT
14 – 16 years SMR 3-5 Somatic: Height growth peaks; body shape and composition change; acne and odor; menarche; spermarche Sexual: sexual drive surges; experimentation; questions of sexual orientation

MIDDLE ADOLESCENT
Cognitive and Moral: Emergence of abstract thought; questioning mores; self centered Self concept: Concern with attractiveness, increasing introspection Family: Continued struggle for acceptance of greater autonomy

MIDDLE ADOLESCENT Peers: Dating; peer groups less important Relationship to society: Gauging skills and opportunities

LATE ADOLESCENT (>17 YRS)
SMR 5 Slower growth Consolidation of sexual identity Idealism; absolutism Relatively stable body image Practical independence; family remains secure base

LATE ADOLESCENT
Peers: Intimacy; possibly commitment Career decisions

DRUG USE HISTORY
Inquiries about behaviors of peers in school and social settings Inquiries about personal practices Determine which drugs are being used, how often, and in what circumstances Elicit information regarding drug related difficulties Offer counseling and referral as appropriate

SEXUAL HISTORY
As part of menstrual and/or developmental history As part of the social history with inquiries about dating practices Determine need for contraceptive devices Offer counseling on abstinence and risk avoidance

VARIATIONS IN TIMING OF PUBERTAL DEVELOPMENT
PREMATURE THELARCHE - isolated breast enlargement in a female <8 years of age PREMATURE ADRENARCHE - isolated pubic or axillary hair in a female <8 years of age or in a male <9 years of age

DELAYED PUBERTY - no sign of puberty in a male by 14.5 years of age or in a female by 13 years ISOSEXUAL PRECOCIOUS PUBERTY - the onset of puberty in female < 8 years or in a male < 9 years

DELAYED PUBERTY
Differential Diagnosis

PUBERTAL DELAY WITHOUT SHORT STATURE
- constitutional

delay of puberty - acquired gonadotropin deficiency - isolated gonadotropin deficiency - acquired gonadal disorders - congenital gonadal disorders - androgen receptor defects - chronic disease

PUBERTAL DELAY WITH SHORT STATURE
- constitutional delay of puberty normal variant short stature - panhypopituitarism - congenital syndromes - glucocorticoid excess - chronic disease

CONSTITUTIONAL DELAY OF PUBERTY
CRITERIA FOR PROVISIONAL DIAGNOSIS REQUIRED FEATURES SUPPORTIVE FEATURES

REQUIRED FEATURES
       Detailed negative review of systems Evidence of appropriate nutrition Linear growth of at least 3.7 cms./year Normal P.E. Normal CBC, ESR, Urinalysis, T4, LH, FSH Normal sella turcica by x-ray Bone age delayed 1.5-4.0 years compared with the chronological age

SUPPORTIVE FEATURES
1. Family history of constitutional delay of puberty 2. Height between 3rd and 25th percentiles for chronological age

WEIGHT
• Best index of growth and nutrition • Physiologic weight loss • Average birth weight for Filipinos: 3000 gms

WEIGHT • Infants 3-12 mos Wt. in gms = Age in mos +9 • 1-6 yrs • 7-12 yrs Wt. in gms = Age in years x 7-5 2 2

Wt. in gms = Age in yrs x 2 + 8

USUAL CHANGES IN WEIGHT ( at different ages)
4-5 months 1 year 2 years 3 years 5 years 7 years 10 years : BW x 2 : BW x 3 : BW x 4 : BW x 5 : BW x 6 : BW x 7 : BW x 10

LENGTH or HEIGHT
• reliable criterion of growth • not affected by excess fat or fluid • reflects growth failure and chronic malnutrition

HEIGHT • Average length at birth : 50 cms.

• At 1 year : length increased by 50% 4 years : doubled 13 years : tripled • 2-12 yr = age in yr x 6 + 77

HEIGHT Acceleration of growth: Girls: 10-12 years Boys: 12–14 years Cessation of growth: Girls: 17-19 years Boys: > 20 years

DISTRIBUTION OF GAINS IN LENGTH

( 1st year) Birth – 3 months 4 months – 6 months 7 months – 9 months : 9 cms : 8 cms : 5 cms

10 months – 12 months : 3 cms 25 cms

Taking the length

Taking the length

Taking the height

Taking the height

HEAD CIRCUMFERENCE
• taken up to 3 years of age • landmarks: glabella/supraorbital ridge (anteriorly) and most prominent part of the occiput (posteriorly) • related to intracranial volume and rate of brain growth

HEAD CIRCUMFERENCE • range for any group is relatively
narrow • almost no variation based on racial, nutritional, or geographical factors • at birth, average HC = 35 cms. HC > CC • at 6 months • at 12 months HC = CC HC < CC

HEAD CIRCUMFERENCE (Mnemonics) First year ----------> 4 inches (10 cms) 1st 4 mos : ½ inch/mo. = 2 inches

Next 8 mos : ¼ inch/mo. = 2 inches Second year ---> 1 inch (2.54 cms) 3rd – 5th year ---> ½ inch/yr = 1.5 in. 6th – 20th year --> ½ inch/5 yrs = 1.5in.

CHEST CIRCUMFERENCE • taken at the level of the xiphoid
cartillage or substernal notch
Transverse diameter •THORACIC INDEX =------------------------A-P diameter

At birth 1 year old

: :

1.0 1.25

ABDOMINAL MEASUREMENTS • most prominent during infancy and childhood • CC = AC until age 2 years • variable and relatively unreliable measurement

MIDARM CIRCUMFERENCE • a good gauge of nutrition for the under six child • taken with the left arm hanging naturally at the side • circumference is measured at a midpoint between the acromion and the olecranon

TRICEPS SKINFOLD THICKNESS • a rough estimate of body composition • measured over the posterior surface of left arm by a caliper halfway between the acromion and olecranon

BODY PROPORTIONS
• ratio between upper and lower segments • crown- symphysis to symphysissole ratio 1.7 - at birth 1.0 - at 10 years old

BODY PROPORTIONS

POSTURE
• secondary to variations in curves of the vertebral column and the shifting of the center of gravity Birth - thoracic/sacral

3 mos old - cervical 3 years old - lumbar

PHYSIQUE
• athletic • asthenic • plump

• simple low-cost technology which
can significantly contribute to the promotion of child health and nutrition • Phases of Growth Monitoring
Measurement Recording Interpretation Intervention

GROWTH MONITORING

GROWTH CHARTS • X – axis : Age of child
Y - axis : Measurement • Majority in 50th percentile P5 and P97 : 2 SDs from mean • Allow comparison to peers; reflects his progress • Deviations may indicate factors adversely affecting growth

GROWTH CHART • designed to monitor changes of
weight over time • a single measurement is a poor method of assessing a child’s nutritional status • more important: direction of the curve e.g. a flat or falling curve needs

WATERLOW CLASSIFICATION (WASTING)
Actual weight Ideal weight for actual length x 100 = % CLASSIFICATION Normal Mild Moderate Severe > = 90% 80% - 89% 70% - 79% <70%

WATERLOW CLASSIFICATION (STUNTING) Actual height Ideal height for age x 100 = ____ %
CLASSIFICATION Normal Mild > = 95% 87.5% - 95%

Moderate 80% - 87.5%

MUSCLES
• largest part of increment is at 4 mos.
AOG to early gestational maturity 1/6 BW - mid-pregnancy 1/4 - 1/5 BW - birth 1/3 BW - early adolescence 2/5 BW - late adulthood • strength doubles between 12 and 16 years

CUTANEOUS STRUCTURES • lanugo at birth; pubic hair/acne in
adolescence • subcutaneous fat appears during the last 3 months of gestation; increases by 3 mos. of gestation up to 1 year and during adolescence • sweat glands have no function for the temperature regulation until 1 mo. of age

NERVOUS SYSTEM
• brain begins to develop at 4-6 months • myelinization is completed by 6-12 months • pineal body calcifies at 10 y/o

NERVOUS SYSTEM
Brain Growth • rapid - infancy and childhood • slowing - mid-childhood to 10 yrs - adolescence 1/2 adult – 1 year old 3/4 adult – 3 years old 9/10 adult – 7 years old • weight of the brain at 10 yrs. = adult

NERVOUS SYSTEM
Critical Periods in Brain Development:

• Embryonic period or early fetal period • Late fetal life and infancy

SENSORY DEVELOPMENT •Pain Sensation
Evolution of pain responses:

• generalized movement and
crying: <1-2 mos. • localize site of pain and withdraw: 7-9 mos. • shoves painful stimulus and brings hand to irritated area: 12-16 mos.

SENSORY DEVELOPMENT
•Tactile Sensation Face  Limbs  Trunk (cephalocaudal)

SENSORY DEVELOPMENT

• Visual Sensation
• clear vision achieved only at 16 weeks with maturation and myelinization of the macula and fovea • VA of 20/20 achieved at 7 y/o

SENSORY DEVELOPMENT

•Auditory Sensation
Birth – intact 6 mos. – localization of sound

•Taste
NB 3 mos. – taste discrimination

CIRCULATORY SYSTEM HEART
•12 wks AOG - (+) EKG - index of fetal viability •Birth – midway between crown and buttocks •1 year – weight has doubled

CIRCULATORY SYSTEM • ductus arteriosus • normal fetal HR = 140-160/min. 1-2 y/o = 100-110/min. older children = 60-100/min.

CIRCULATORY SYSTEM BLOOD VOLUME NB Infant/Child Adult - 80-100 ml/kg - 75-90 ml/kg - 70-85 ml/kg

CIRCULATORY SYSTEM
BLOOD PRESSURE

 varies according to age

LYMPHATIC SYSTEM
• spleen is relatively the largest lymphoid organ in proportion the body at birth (12x) to

• hypertrophy of the tonsils and adenoids coincides with the time when there is greater susceptibility to infections (6to7years old)

HEMATOPOIETIC SYSTEM
Blood –Forming Organs Connective tissue (mesenchyme) Liver Spleen Mesonephros Bone marrow - Birth

IMMUNITY
• antibodies passively transferred from mother protect baby up to 6 or 9 months • antitoxin or antiviral antibodies are transferred better than antibacterial antibodies

DIGESTIVE SYSTEM
• STOMACH CAPACITY: •Birth – 30 to 90 ml •1 month – 90-150 ml •1 year – 210-360 ml •2 years – 500 ml •Later childhood – 750 to 900 ml

DIGESTIVE SYSTEM…
• DIGESTIVE ENZYMES ACTIVITY:
• renin, trypsin - normal (birth) • amylase, lipase – low (newborn) •Lipase – low (throughout childhood) •BACTERIAL FLORA: • breastfed – L. bifidus • artificially-fed – L. acidophilus

DIGESTIVE SYSTEM
• STOOLS: • meconium > transitional > normal • breastfed vs. artificially fed •LIVER IMMATURITY

RESPIRATORY SYSTEM • arises as an outpouching from the pharyngeal pouch (entoderm) • right vs. left primary bronchus - larger, more obtuse • larynx – 1/6 adult size at birth • trachea – 1/2 adult size at birth •

URINARY SYSTEM
EXTRACELLULAR FLUID NB - 2x adult

Infancy/adolescence – decrease ELECTROLYTE CONCENTRATION Infants>Adults

URINARY SYSTEM
RENAL SIZE 6 mos 1 yr 5 yrs Puberty - 2x birth size - 3x - 5x - 10x

No new glomeruli formed after birth Mature renal function – 5 to 6 yrs

SKELETAL SYSTEM
• SKELETAL DEVELOPMENT:
• ANTENATAL CALCIFICATION
•Maternal levels of calcium, phosphorous, vitamin D, and proteins •POSTNATAL CALCIFICATION •Status of the parathyroids, thyroid, kidney, and supply of the above

SKELETAL SYSTEM
SKELETAL AGE
0-5 years: presence of ossification centers 5-14 years: calcification of cartilaginous areas 14-25 years: epiphyseal fusion

GENITAL ORGANS
FEMALE
Germ cells – 3 months AOG Ovarian cortex (primordial follicles)

birth mature menarche

GENITAL ORGANS
MALE:
Seminiferous tubules
Birth: solid Childhood: lumens Puberty

Testes
4th-7th fetal month – abdomen 8th month – scrotum Birth: 90% (term) – descended 70% (PT) – descended 50% (undescended) descend at 1 month of age

DENTITION
FIRST YEAR OF LIFE
No. of teeth = age in months – 6 Teething when delayed >12 months: investigation of ectoderm derivatives

CHRONOLOGY OF HUMAN DENTITION (PRIMARY)

AGES (MOS) Maxillary Central incisors Lateral incisors Cuspids First molars Second molars 6-9 9-11 11-22 11-17 22-30

AGES (MOS) Mandibular 5-8 7-10 17-21 12-18 22-30

CHRONOLOGY OF HUMAN DENTITION (PERMANENT TEETH)

AGES Maxillary Central incisors Lateral incisors Cuspids 6½-7½ 6½ -8½ 11-12

AGES Mandibular 6½-7 6½-7½ 11-12

CHRONOLOGY OF HUMAN DENTITION (PERMANENT TEETH)

AGES Maxillary First premolars Second premolars First molars Second molars Third molars 10-11 11-12 6-7 ½ 12-13 18-22

AGES Mandibular 10-11 11-12 5½-6½ 11 ½ - 12 ½ 17-24

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->