Professional Documents
Culture Documents
and Development
EVIELYNE J. LABBAY-KALI, MD
Ambulatory Pediatrics
PHYSICAL GROWTH
It is the process of physical maturation resulting
in an increase in size of the body and various
organs.
It occurs by multiplication of cells and an
increase in intracellular substance.
It is quantitative changes in the body.
DEVELOPMENT
It is the process of functional and
physiological maturation of the individual.
It is progressive increase in skill and
capacity to function. It is related to
maturation and myelination of the nervous
system.
It includes psychological, emotional and
social changes.
It is qualitative aspect.
GROWTH
FETAL POSTNATAL
Prenatal
Ovum 0-14 days of gestation
Embryo 14 days – 9 wks gestation
Fetus 9 wks of gestation to birth
Postnatal
Neonate 0-28 days
Infant 1st year of life
Toddler 1-3 years
Pre-school 3-6 years
School age 6-12 years
Adolescence 10-19 years
LAWS OF GROWTH
Continuous and in specific order
- Cephalo-caudal and Disto-proximal
- Change in body proportions Average BL
is 50cm
1st 6 2 nd 6
months months
2.5cm/ 1.25cm/
mo. mo.
Age US:LS Ratio
Birth 1.7:1 At 1yo
3 years old 1.3:1 75cm
7 to 9 years old 1:1
LAWS OF GROWTH
Growth rate or velocity is different in different phases of
life
LAWS OF GROWTH
Differential tissue growth
FACTORS AFFECTING GROWTH
POSTNATAL
FETAL GROWTH GROWTH
Genetics Genetics
Nutrition
Fetal hormones and
Growth factors Socioeconomic
Maternal factors Adverse events
Placental factors Hormones
ICP MODEL
N
U
T GROWTH
R GROWTH HORMONE
I HORMONE AND
T SEX
I STEROID
O
N
0 2 4 6 8 10 12 14 16 18 20
ASSESSMENT OF GROWTH
Anthropometric:
LENGTH and HEIGHT
Length/Height
Birth 50cm
1 year old 75cm
2-12 years old Age in yrs x 6 + 77
ASSESSMENT OF GROWTH
Anthropometric: 2X 6-7Kg
BW
WEIGHT
In 4 months In 4 months
750g/month 500g/month
At birth
3-3.5kg
In 4 months
3X At 1yo 8-9.5Kg
250g/month
BW 9-10.5Kg
Birth 35cm
6 months 43cm
1 year old 47cm
2 years old 49cm
5 years old 50cm
12 years old 55cm
BMI categories
Underweight <18.5
Normal weight 18.5-24.9
Overweight 25-29.9
Obesity 30 or greater (>95
percentile)
GROWTH CHARTS
In 2006, the WHO published new growth chart standards
We use growth charts to:
- Assess growth
- Identify potential nutrition or health concerns
- Share information with caregivers
- Open conversations about growth, nutrition and
healthy habits.
A Brief History of Growth Charts
Based on data from Based on data taken sin 6 countries (Brazil, Ghana,
national health India, Norway, Oman, USA)
surveys, and birth
certificates in the US
Requirements No special req to be Had to meet these req to be included in the data:
included in the data - Adequate socioeconomic status
- Access to healthcare and breastfeeding support
- Fullterm birth
- No smoking during pregancy and breastfeeding
-Exclusive breastfeeding >/= 4mos; solid food started
at 6mos, BF cont upto > 12mos
Z score = (X-Mean)/SD
INTERPRETATION OF PLOTTED
GRAPH
EXAMPLE 1
A6 month old male baby weighs 8kg.
What is his weight-for-age Z-score?
EXAMPLE 2
A5 month old male baby weighs 5kg. He was
born at 32 weeks of gestation/NSVD/Birth
weight.
What is his weight-for-age Z-score?
EXAMPLE 2
A5 month old male baby weighs 5kg. He was
born at 32 weeks of gestation/NSVD/Birth
weight
IBW = 22Kg
IH = 119cm
If you decide to prepare for intubation
Retarded BA Advanced BA
Prematurity Post-maturity
PEM Adrenogenital syndrome
Hypothyroidism Hyperthyroidism
Hypopituitarism Hyperpituitarism
What is the difference between Natal and
Neonatal teeth?
Natal – seen at birth, right after delivery
Neonatal teeth – erupt at anytime during the neonatal
period (usually the center/lower incisors)
Should we remove? Do a panoramic xray if there is root..
If no root, better to remove to avoid aspiration.. Leave it
be if there is root,
Fontanelles
6 (1 ant, 1 post, 2 anterolaterals, 2 posterolaterals)
Anterior fontanelle – site of meeting of sagittal suture, 2
coronal sutures, and the frontal suture (diamond in shape)
admits 3 fingers at birth, 6 months 1 finger, usually closed
at 18months old, flat,
Posterior fontanelle – point of meeting of sagittal suture
and 2 lamboid sutures (triangular shape), normally closed
at birth but the normal range if open is 0.5cm in diameter
and no more than 2 months
Abnormalities.. Wide, narrow, bulging depressed
Growth Patterns and Curves
Genital pattern of growth
Neurological pattern of growth
Physical pattern
Lymphoid pattern of growth – may have clinical importance, it increase
til the age of 4 years then decline.. In the first 4 yrs of life, the normal
infant has a high rate of lymphoid pattern of growth, what is the
clinical significance, if the patient in the first 4 yrs of life develop an
infection, it responds to this infection by lymphocytosis and
hepatosplenomegalyand lymphadenopathy, cbc picture, usually there is
lymphocyte predominance after 4yrs old PMN dominates.. Another
point regarding adenoidectomy or tonsillectomy, if it is done in the first
4 yrs of life and incompletely removed the remnant of this may grow or
develop again , that is why adenoidectomy/tonsillectomy is wise to be
posponed to a much later date unless ofcourse highly indicated
Growth Charts
The percentile or centile curves… 100 apparently healthy
infants/children, and measure the parameters
regularly/serially according to age..
Bold line in the middle of normal is the median or average
reading
interpretation
Failing to thrive??
Increasing in chart but not enough
Slow steady weight gain but still below the normal
percentile