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Growth and Developmental Assessment.ppt

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Growth rates… p p p Height. Neural growth. Lymphoid tissue. Genital growth Fat. Growth rates… p p p Height. Neural growth. Lymphoid tissue. Genital growth Fat.

Genital growth… Growth is minimal during infancy and childhood but becomes very rapid with Genital growth… Growth is minimal during infancy and childhood but becomes very rapid with the onset of puberty.

Nutrition and growth… p p It’s difficult to assess the influence of nutrition on Nutrition and growth… p p It’s difficult to assess the influence of nutrition on growth since it is seldom the only factor involved Retardation of growth occurs only if malnutrition is severe

Rules of thumb for growth…. p Weight: 1 - weight loss in first few Rules of thumb for growth…. p Weight: 1 - weight loss in first few days: 5%-10% of birth weight. 2 - return to birth weight: 7 -10 days of age double birth weight: 4 -5 months triple birth weight: 1 year quadruple birth weight: 2 years 3 - average weights : 3. 5 kg at birth 10 kg at 1 year 20 kg at 5 years 30 kg at 10 years 4 - daily weight gain: 20 -30 g for first 3 -4 months 15 -20 g for rest of the first year

p p p Height: 1 - average length: 50 cm at birth, 2 - p p p Height: 1 - average length: 50 cm at birth, 2 - 75 cm at 1 year. 3 - at age 4 years, the average child is 100 cm tall( double birth length) 4 - average annual height increase : 5 -6 cm between age 4 years and puberty.

p Head circumference (HC): p 1 - average HC: 35 cm at birth. 2 p Head circumference (HC): p 1 - average HC: 35 cm at birth. 2 - HC increases: 1 cm/month for first year ( 2 cm/month for first 3 months, then slower); 10 cm for rest of life. p

Growth monitoring… p p The AAP recommends routine office visits in the : 1. Growth monitoring… p p The AAP recommends routine office visits in the : 1. 1 st week of life ( depending on nursery discharge) 2. At 2 weeks 3. At 2, 4, 6, 12, 15, and 18 months. 4. At 2 years and then annually up to the age of 6 5. Every 2 years between age 6 and adolescence An accurate measurement of the height, weight and head circumference should be obtained at every health supervision visit. Then they are compared with the statistical norms in a standard fashion on growth charts.

p When plotting growth, serial measurements are much more useful than single measurement because p When plotting growth, serial measurements are much more useful than single measurement because they can detect deviations from a particular child’s growth pattern even if the value remains within the statistically defined normal limits (i. e between the 3 rd and the 97 th percentile)

Premature Girls : Length to age Premature Girls : Length to age

Premature Girls : weight to age Premature Girls : weight to age

Premature Boys: Length to age Premature Boys: Length to age

Premature Boys: weight to age Premature Boys: weight to age

Interpretation… p What the percentiles mean? p How useful is each chart? And what Interpretation… p What the percentiles mean? p How useful is each chart? And what are the significant values?

What the Percentiles Mean? ! p When you look at the standard growth charts, What the Percentiles Mean? ! p When you look at the standard growth charts, you will see seven curves that follow the same pattern. Each curve represents a different percentile: 5 th, 10 th, 25 th, 50 th, 75 th, 90 th, and 95 th. The 50 th percentile line represents the average for a particular age group. The child's measurements will be plotted on the charts, so that yo can see how your child's measurements compare to the average for his or her age group.

p Examples: 1. If the measurement for an infant's head circumference is in the p Examples: 1. If the measurement for an infant's head circumference is in the 90 th percentile, that means that the child's head measurement is greater than about 90% of children that age in the country. Only 10% of infants that age have head measurements that exceed those of that infant.

p BMI for age : - It’s an index for classifying adiposity - If p BMI for age : - It’s an index for classifying adiposity - If the BMI is between the 85 th and 95 th percentiles the child is at risk for being overweight - IF the BMI is > 95 th percentile the child is overweight.

Factors affecting growth pattern Gestational age p Birth weight p Parental stature: is considered Factors affecting growth pattern Gestational age p Birth weight p Parental stature: is considered before assuming there is a health or nutrition concern. p Presence of a chronic illness p Special health care need p

Four Areas of Development p Gross motor p Fine motor & vision p Speech, Four Areas of Development p Gross motor p Fine motor & vision p Speech, language & hearing p Social, emotional & behavioral

Gross Motor p Prone position: ü Newborn; limbs flexed & symmetrical posture ü 6 Gross Motor p Prone position: ü Newborn; limbs flexed & symmetrical posture ü 6 -8 W; raises head to 45° ü 3/12; raises half of the chest ü 6/12; raises all the chest on palms only

Gross Motor p Supine position: ü Newborn; marked head lag ü 6 W; starts Gross Motor p Supine position: ü Newborn; marked head lag ü 6 W; starts holding the head ü 12 W; no head lag ü 3 -6 mo; pulls to sit ü 6 -8 mo: ü ü 6 mo; lifts head off couch to look at feet, rolls from front to back, sits momentarily with round back 8 mo; sits with straight back

Gross Motor p Supine Position (cnt. ): ü 8 -9 mo; crawling ü 10 Gross Motor p Supine Position (cnt. ): ü 8 -9 mo; crawling ü 10 mo; stands with support, walks around furniture ü 12 mo; walks unsteadily, broad gait, hands apart ü 15 mo; walks alone steadily ü 2 y; runs, walks, climbs stairs (2 feet/step) ü 3 y; climbs stairs (1 foot/step) ü 4 y; goes up- & down-stairs (1 foot/step)

Fine Motor and Vision p Follows Faces: ü ü Newborn; in midline 6 W; Fine Motor and Vision p Follows Faces: ü ü Newborn; in midline 6 W; moving objects or face 180° p 4 mo; reaches out for toys p 6 mo; transfers toys from one hand to the other, palmar grasp p 10 mo; mature pincer grasp p 12 mo; casting the objects p 14 -15 mo; scribbles with pencils

Fine Motor and Vision p Hand skills: ü ü 2 y; 6 cubes ü Fine Motor and Vision p Hand skills: ü ü 2 y; 6 cubes ü 2. 5 y; 8 cubes ü 3 y; bridge ü p 18 mo; 3 cubes 4 y; steps Draw man test

Fine Motor and Vision p Pencil Skills: ü 3 y; circle ü 4 y; Fine Motor and Vision p Pencil Skills: ü 3 y; circle ü 4 y; cross ü 5 y; square ü 6 y; triangle 3 5 6

Speech, Language and Hearing p Newborn; startles to loud noise, spontaneous smile. p 6 Speech, Language and Hearing p Newborn; startles to loud noise, spontaneous smile. p 6 W; responsive smile. p 3 mo; vocalizes, laughs and coos. p 6 mo; babbles ‘da’, ‘ma’, turns head to sounds out of sight “Hearing Distraction Test” p 9 mo; ‘Dada’, ‘Mama’ p 12 mo; single words (2 -3 words other than ‘dada’/‘mama’)

Speech, Language and Hearing p 18 mo; 10 single words, shows 4 parts of Speech, Language and Hearing p 18 mo; 10 single words, shows 4 parts of the body p 21 mo; use two or more words to make simple phrases p 2 y; vocabulary 50 words p 3 y; speech in sentences p 4 y; count to 20 or more p 5 y; grammatical speech

Social, Emotional and Behavioral p 6 W; smiles responsively p 8 mo; puts food Social, Emotional and Behavioral p 6 W; smiles responsively p 8 mo; puts food in mouth p 10 mo; waves bye-bye, understands “no”, plays “peek-a-boo” p 12 mo; drinks from a cup, casting objects p 15 mo; indicates desires by pointing p 18 mo; holds spoon, symbolic play, kisses parents, tells mother she/he wants potty

Social, Emotional and Behavioral p 2 y; dry by the day, pulls off some Social, Emotional and Behavioral p 2 y; dry by the day, pulls off some clothing, listens to stories with pictures. p 30 mo; full name. p 3 y; interactive play, takes turns, knows age and sex. p 4 y; goes to the toilet alone. p 5 y; dresses & undresses alone, name 4 colors

p. THANK YOU p. THANK YOU