PEDIA (LECTURE)

3C Growth and Development

P-01a Dar. Sanggalang | August 1, 2019

PROLOGUE
No appraisal of the child is complete which Parameters are taken right after birth and recorded
does not assess his developmental status, nor any because these are measured periodically to detect
program of management complete which does not changes, detect if normal/abnormal early in life to give
continuously evaluate how illness or treatment may the proper treatment
change or distort his pattern of growth and behavior. - Ex: Head circumference - for a certain amount of time,
The thoughtful physician must be concerned also with the head should only grow to a certain degree,
the ways in which assets or liabilities in the child’s excessive growth is abnormal
family, neighborhood, school or community may
facilitate or impede his progress toward healthy and II. Parameters for Development
productive adulthood. a. Behavior
• Gross/General Motor
The study of the child begins with the • Fine Motor
examination of patterns of growth of normal children. • Language
These must serve as guides to detection, diagnosis • Personal – Social
and treatment of disorders of childhood. They will help b. Personality
the physician guide the child and parents towards the • Freud (Psychosexual)
fulfilment of their roles in satisfying ways. Those • Piaget (Cognitive)
caring for children should understand, respect and • Erikson (Psychosocial)
enjoy them. • Kohlberg (Moral)
c. Organ Development
GOAL • Musculature / Physique - first seen in general
To help bring up the child or help him grow into survey
adulthood at his optimum state at development • Cutaneous - rashes, pustules, scaly, vernix
physically, mentally and socially so that he can compete caseosa
at his most effective level. • CNS - alert, listless
• Sensory - limp
GENERAL PRINCIPLES • Circulatory - pulse rate – bounding, thread,
1. Definition of terms distant, very faint, feeble
a. Growth • Hematopoietic - pale skin, sclera, nail beds,
b. Development palm/soles, lips
2. Variations in Growth and Development between a • Lymphatic - inflamed lymph nodes – cervical,
child and an adult occiput armpit, inguinal area
3. Periods of Growth • Immunologic - immunizations – age scheduled
4. Factors affecting Growth and Development • Digestive - stomach capacity
5. Patterns of Growth • Respiratory
6. Principles of Development • Urinary / Renal
• Genital
ASSESSMENT OF GROWTH AND DEVELOPMENT • Skeletal - Osseous, Dentition
I. Parameters for the measurement of physical - Osseous - Club foot
growth (measured in order from A-K) - Cephalopelvic Disproportion
a. Weight ▪ Size mismatch between the mother's pelvis
b. Length/ Height - recumbent position; metric system and the fetus' head.
c. Head Circumference - Dentition
d. Chest Circumference ▪ earliest 4 to 5 months
e. Abdominal Circumference ▪ <13 months still normal
f. Midarm Circumference - for malnutrition ▪ >13 months go for check up
assessment - Hutchinson’s teeth
g. Triceps skin fold thickness ▪ notches/saw-like, sign of congenital syphilis
h. Body Proportions
i. Posture
j. Physique
k. Physiological Change

1 Del Rosario, Labuguen, Perez, Ponraj, Prakash, Tenedero, Valerozo

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GROWTH D. IMMUNOLOGIC
- Increase in physical size of the body, whole, or
any of its parts
- Measured in terms of centimeters or inches,
pounds or kilograms or in terms of metabolic
balance (e.g. retention of Ca, N)
DIFFERENCE BETWEEN CHILD AND ADULT
A. ANATOMIC
- Eustachian Tube
• Shorter, narrower, more rigid and straighter in
children
• Children are more prone to develop ear
infections (increased frequency of otitis media) E. PHYSIOLOGICAL/ MENTAL
- Thinness of Chest Wall
• Children have relative thinness (can appreciate
heart sounds upon auscultation)
- Heart Positioned Horizontally
• Especially during the first few months of life;
becomes vertical towards first year of life
• “Egg on its side” appearance (seen in
transposition of the great arteries/TGA)
- Open Sutures of Cranial Bones F. PERSONAL FACTORS
• Anterior Fontanel – serves as a window for UTZ
▪ Closes at 18 months
▪ Can be a marker for dehydration as long as it
is patent
▪ In APCD (Acquired Prothrombin Complex
Deficiency), the AF can be a site for insertion A. Prenatal Factors
of the needle to collect blood from the
subarachnoid space for Subdural count.
▪ Craniosynostosis (craniostenosis): birth
defect in which one or more of the sutures in
a baby’s skull closes before the brain has
achieved its maximum growth.
B. PHYSIOLOGIC
- Water and Electrolyte Imbalance
• Children are more prone to dehydration because
of greater surface body area
• Total body water
▪ Infants: 70-75%
▪ Adults: 50-65%
- Greater Nutritional Needs – extremes of age
C. PATHOLOGIC
- Vitamin Deficiencies (e.g. Rickets)
• Pregnant women are given iron with folic acid to
prevent neural tube defects.
• At 4months of age, the Newborn (full term) is
given iron supplement, because iron stores
received from the mother has already ran out.
• Preterm NBs are given iron supplement when
they achieve full-feeds (15ml every 2 hours)
• IDA - give iron supplement
• Thalassemia - give iron and folic acid
2 Del Rosario, Labuguen, Perez, Ponraj, Prakash, Tenedero, Valerozo
- Immunoglobulin levels
• Newborns are prone to develop gram-negative
infections because they relatively lack IgM (only
IgG is transferred to the baby)
• Colostrum
▪ first source of immunoglobulins for the
newborns
▪ rich in immunoglobulin levels
▪ helps in intensifying resistance against GI
diseases.
- Resistance to Infection
- Different Behavioral Patterns
• Behaviors of children vary from age to age.
• There are behaviors that are considered normal
at a certain age.
▪ E.g. Child hyperactivity between ages 2-4
years old is normal; beyond 4 years old, the
child might have ADHD
- Genetics
- Emotional
FACTORS AFFECTING GROWTH AND
DEVELOPMENT
- Genetic
• E.g. Intelligence, Temperament
• Traits of the parents are transmitted to the
children
- Metabolic
• E.g. A mother with diabetes (uncontrolled)
would give birth to a baby who is considered as
Large for Gestational Age (LGA)
▪ Due to persistent hyperglycemia
▪ Excessive glucose in the bloodstream of the
mother crosses the placenta which triggers
the pancreas of the baby to make excess
insulin, causing the baby to grow to large
(Macrosomic babies or LGA)
▪ Effects: prone to develop metabolic problems
such as Hypoglycemia, Hypocalcemia (may
lead to seizures and convulsions)
- Maternal Infections (before birth to 12 days after
birth)
• T.O.R.C.H (Toxoplasmosis, Rubella,
Cytomegalovirus, Herpes)
• Other (HIV, Hepatitis viruses, Varicella,
Parvovirus)
▪ Associated with intrauterine growth
retardation
▪ Most popular: Rubella
• Exposure of mother during her pregnancy (first
few months) to a person with German Measles,
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 P-01 Growth and Development
may lead to her baby having Congenital
Rubella Syndrome (Deafness, Cataract,
Congenital Heart Disease: PDA-most common,
and Mental Retardation)
• The baby will turn out to be multiply disabled
which could have been prevented through MMR
vaccination of the mother
• TORCH Test
▪ Group of blood tests that detect the presence
of antibodies produced by the immune
system in response to these infections
• Affects growth and development during certain
stages of pregnancy
▪ First trimester: Viral infection
▪ Last half of pregnancy: Protozoan and
spirochetal Infection
• Preventable with correct and complete
immunization
• Newborns with persistent jaundice may end up
with Kernicterus (causes brain damage)

Three Mechanisms of Jaundice

1. Unconjugated / Hemolytic / Pre-hepatic jaundice
- Jaundice appears when the amount of bilirubin
produced from hemoglobin by the destruction of red
blood cells or muscle tissue exceeds the normal
capacity of the liver to transport it. It can also occur
when the ability of the liver to conjugate normal
amounts of bilirubin into bilirubin diglucoronide is
significantly reduced by inadequate intracellular
transport or enzyme systems.

2. Hepatocellular jaundice
- Arises when liver cells are damaged so severely that
their ability to transport bilirubin diglucoronide into
the biliary system is reduced, allowing some of the
yellow pigment to regurgitate into the bloodstream.

3. Cholestatic / Obstructive / Post-hepatic jaundice

- Occurs when essentially normal liver cells are unable
to transport bilirubin either through the hepatic-bile
capillary membrane, because of damage in that
area, or through the biliary tract, because of
anatomical obstructions such as gallstones or
cancer.

3 Del Rosario, Labuguen, Perez, Ponraj, Prakash, Tenedero, Valerozo Tran