PEDIATRICS II (LECTURE)

3C GROWTH AND DEVELOPMENT

P – 01B Dra. Sanggalang | August, 2019

FACTORS AFFECTING GROWTH AND  Rubella - cataract, deafness, mental

DEVELOPMENT deficiency, heart disease
B. Perinatal Factors  Toxoplasmosis - abortion, prematurity,
 High risk deliveries mental deficiency
o Preterm, post term – about AOG
(check LMP) G. Maternal Diabetes
**Dubowitz Score- one method for  Large baby, hypoglycemia, tetany
estimating AOG
**Ballards scoring H. Immune Reaction
o SGA  Purpura, leukopenia
o Asphyxia – due to difficult deliveries
– hampers oxygenation. Give IV I. Emotional Disturbances
fluids.  Psychological – beware of postpartum
 Neonatal infections psychosis
o Ex. From mother – UTI
 Neonates will also have J. Drugs
infection either the same  Thalidomide – nausea, vomiting, morning
(UTI) or another (e.g, sickness
Pneumonia). o Anti – emetic
 Metabolic disturbances o For hyperemesis gravidarum
o It causes limb deformity
C. Postnatal Factors (phocomelia)
 Genetic  Phenothiazines – Jaundice
o Cleft lift/palate o Where does it manifest first?
 Growth Potential  Sclera - Bilirubin is lipophilic
o Anthropometric measures and is easily deposited in
 Nutrition areas with fats.
o Height (Recumbent Height)  Antiepileptics – Coagulation defects
o Weight o Phenytoin (Dylantin)
 Environmental  Increased bleeding tendency
o Nurturing  Fetal Hydantoin syndrome
o Smoke  Salicylates - hemorrhage

D. Genetics
 hereditary disease K. Social Factors
 intelligence personality  Older mother - higher stillbirth rates,
 multiple pregnancy (sometimes tha 2nd baby perinatal/prematurity rate, mongolism, CNS
is compromised) anomalies
**Smoker mother – Intrauterine Growth
E. Social Factors Retardation (IUGR)
 Poverty - greater abortion rate, still births  Older father - Achondroplasia, Certain
 Nutrition - low birth weight, damage to the mongols, congenital deafness
brain  Parity (1st) - pyloric stenosis, PDA
*No breastfed baby will end up  Alcoholism - low birth weight, higher stillbirth
malnourished. rate

F. Infections 3 PHASES OF INTRAUTERINE DEVELOPMENT

 Chickenpox - Prematurity,
anomalies
 Syphilis - congenital syphilis
1
congenital A. Ovular Phase (0-14 days) - Fertilization to
Implantation
 Characterized by increase in complexity and
cell multiplication
 P-01B PEDIATRICS II
 Little increase in total size 1 year: BW X 3
 Self sufficient 2 years: BW x 4
 Food stored in yolk sac 3 years: BW x 5
B. Embryonic Phase (14days-9weeks/2nd week *BW(birth weight)
to 3rd month) - Organogenesis
 Parasitic Infants < 6 months
 Derives nutrition from maternal origin - Wt in grams =age in months x 600 + BW
 Rapid differentiation 6-12 months
 All organ systems established - Wt in grams = age in months x 500 BW
C. Fetal Phase (9wks – birth/3rd month to birth) - - **average BW for Filipinos – 3000 gms
Differentiation and Maturation 2 years and up
 Early functional activities apparent - Wt in kg = age in years x 2 + 8
 Increase in body mass most pronounced
HEIGHT
BIRTH TO PUBERTY
Average in length at birth: 50cm
A. Birth
At 1 year: Inc in 50%
 Parasitic existence terminated
4 years: doubled
 Greatest risk to life 13 years: tripled
 Initiation of respiration, own circulation, etc
B. Infancy (1st year) Acceleration of Growth
 Characterized by rapid growth Girls: 10- 12 years
 Continued maturation proceeds especially Boys: 12-14 years
increase in functions of the nervous system Length or Height
C. Early & Late Childhood (1 – 6 years) (6 –10 - Reliable criterion of growth
years) - Not affected by excess fat or fluid
 Velocity of growth slowed but steady - Reflects growth failure and chronic
 Increase coordination of function malnutrition
 Development of skills and intellectual
processes Distributions of gains in length ( 1st year)
D. Adolescence Birth to 3 months 9cm
(female 8 –18 yrs.) 3 months to 6 months 8cm
(male 10 – 20 yrs.) 6months to 9 months 5cm
 Accelerated growth (height & weight) 9 months to 12 months 3cm
 Appearance of sexual characteristics 25cm
E. Puberty
(female 13th year) Mnemonics for height
(male 15th year) Height in cm: age in years x 5 + 80
 Appearance of dark pigmented pubic hair Height in inch: age in years x 2 + 32
 Age of menarche in girls
At
WEIGHT  1 year: 1 ½ x BL( Birth length)
 Best index of growth and nutrition  2 years: ½ mature height
 Physiologic weight loss (BOYS)
 Average weight of term baby: 7.0 to 7.5 lbs  3 years: 3ft tall
(3.4 kgs)  4 years: 2 x BL
 Average BW for Filipinos 3000g  5years: 3 x BL

A. Increment Of Weight Gain HEAD CIRCUMFERENCE

First 3 months 2lbs. /mo. - Up to 3 years of age
6 months 1lb./mo. - Glabella/supraorbital ridges (anteriorly),
2nd year 1.2 lb./mo occiput (posteriorly)
- Related to intracranial volume and rate of
B. Usual changes in weight at different ages brain growth
4-5 months: BW X 2 - Range for any age group is relatively narrow
2 Baligod, Quilang, T., Tallud, Ventura, S.
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- Almost no variation based on racial, national B. For Stunting
or geographical factors

- Average HC = 35 cm (14 inches)

At birth HC > CC Classification %

At 6 months HC = CC
Normal ≥ 95
At 12 months HC < CC
Mild 87.5-95
DDx of Large head DDx of Small Head Moderate 80-87.5
Normal variant Normal variant Severe <80
Large Baby Small Baby
Hydrocephalus Familial Feature Midarm circumference
Subdural Effusion Mental Abnormality  good gauge of nutrition for child under 6
Cerebral Tumor Craniostenosis
Megalencephaly Microencephaly
Triceps skin fold thickness
First Year of Life 4 inches  rough estimate of body composition
1st 4 months: ½ inch/mo 2 inches
2nd 8 months: ¼ inch/mo 2 inches Body proportions
Second Year 1 inch  ratio bet upper (crown – symphysis) and
Third Year 1.5 inches lower (symphysis – sole) segments
6th to 20th year ½ in/5 yrs – 1.5 inches
o 1.7 – at birth
CHEST CIRCUMFERENCE o 1 – at 10 years
 Taken at the level of the xiphoid cartilage or
substernal notch (midrespiration) Posture
 THORACIC INDEX:  secondary to variations in the curves of the
vertebral column and shifting of the center
of gravity
o birth – thoracic/sacral
At Birth 1.0
1 year old 1.25 o 3 months – cervical convexity
6 years old 1.35 o 3 years – lumbar curvature

ABDOMINAL MEASUREMENTS Physique

 Most prominent during infancy and early  Athletic
childhood  Asthenic
 CC=AC until age 2 years
 Plump
 Variable and relatively unreliable
measurement
ORGAN DEVELOPMENT
WATERFLOW CLASSIFICATION A. Muscles
A. For Wasting  Growth: Hyperplastic, Hypertrophic
  Pre-muscular mesodermal tissue
 4th month of gestation to early maturity
(largest part of increment)
Classification %
o Mid pregnancy 1/6 BM
Normal ≥ 90 o Birth 1/4 – 1/5
Mild 80-89 o Early adolescence 1/3
Moderate 70-79 o Late adulthood 2/5
Severe <70
B. Strength
 doubles 12-16 years

3 Baligod, Quilang, T., Tallud, Ventura, S.