CHILD GROWTH- NORMAL


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1 : DR. CHAPAY SOREN MD ASST. PROF. PEDIATRICS KONASEEMA INSTITUTE OF MEDICAL SCIENCE AND RESEARCH FOUNDATION AMALAPURAM, INDIA drcsoren55@yahoo.co.in GROWTH IN CHILDREN
2 : Objectives Definition Growth studies Periods Principles Patterns and rates Factors influencing Assessment Monitoring Krish Che Gautam
3 : GROWTH : NET INCREASE IN SIZE It occurs due to Increased number of cells Increase in their size Increase in intercellular substances The increase can be seen and measured (quantity) accurately
4 : GROWTH It’s essential for life and unique for children. Begins at conception and ends at maturity. An indication of the state of health, nutrition and wellbeing. G & D progress together and are inseparable.
5 : Growth Studies Cross sectional Longitudinal Semi-longitudinal Linked longitudinal
6 : Periods of Growth
7 : Identify this planet ?
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14 : Neonate
15 : Infant
16 : Toddler
17 : School going
18 : School going Prepubescent: 10-12yr girls and 14-16yr boys
19 : A continuous and orderly process (Cephalo-caudal and distalo-proximal) Rates and patterns varies for tissues and individuals There are critical periods Influences by a multiple factors Principles of Growth
20 : Growth Pattern
21 : Rate of tissue growth General Genital Neural Lymphoid
22 :
23 : Sheldon Somatotypes Classification of Physique Ectomorphic: relative linearity Endomorphic: relative stocky build Mesomorphic: between two
24 : Growth spurts Acceleration of growth is characteristic of three periods (growth spurts): First year ( infantile GS) 6-8 years (mid GS) Adolescence
25 : Karlberg’s Infancy-Childhood-Puberty (ICP) model
26 : Factors influencing growth G&D Chronic ds Environmental and seasonal Socioeconomic Genetic Growth Potential Prenatal Emotional Nutritional Hormonal Nature and Nurture
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28 : ASSESSMENT OF GROWTH Anthropometry Radiography Biochemical Histological Dental age
29 : Weight Height MAC Head circumference Chest circumference Fat Fold Thickness Auxology :The Nutritional Anthropometry
30 : NEWBORN Weight: 2.8 kg 10kg(at 1yr) Height: 50cm 75cm(at 1yr) Head circ:35 cm 45cm(at 1yr) Chest circ:32 cm 45cm(at 1yr)
31 : WEIGHT Weighing scales: Beam type (detecto) Bathroom type Salter spring Electronic digital scale
32 : Weight- formula 3 – 12 months = m + 9 2 1 – 6 years = 2y + 8 7 – 12 years = 7y – 5 2
33 : Weight velocity 0-4 months 1kg/month (30g/day) 5-8months 0.75kg/mo (20g/d) 9-12mo 0.5kg/mo (10g/d) 1-2years 3kg/year 3-12year 2kg/year 12-18year 5-6kg/year (0.5kg/month)
34 : Simple Weight Calculation
35 : Weight for AgeIAP classification of PEM * 50th percentile of NCHS data
36 : Length / Height <2 years: (recumbent) length - infantometer >2 years : (standing) height - Stadiometer Formula : 2 - 12 yrs = 6Y + 77 (in cm) = 2.5Y + 30 (inches) Half of adult height is attained at : 2 years in girls 2 ½ yrs in boys
37 : Height measurement
38 : Normal – Height At birth – 50 cm 3 months – 60 cm 9 months – 70 cm 1 year – 75 cm 2 years – 90 cm 4 ½ years –100 cm Till 10 years: 5 cm / year
39 : Height Velocity 0-6months: 2.5-3cm/mo 6-9months: 1.5cm/mo 9-12months: 1.2cm/mo 1-2year: 1cm/mo 2-3 year: 0.6cm/mo 4 - onset of puberty: 5-6cm/year Adolescence: 8cm/year for girls 10cm/year for boys
40 : Height Velocity
41 : Prediction of adult height MPH = (M+H)/2 +- 6.5 Tanner’s formula: Adult ht= ht at 2yrs x 2 Adult ht = ht at 3yrs x 1.37 Weech formula: Adult ht in inches Boys= 0.545 H3 + 0.544 P + 14.84 Girls = 0.545 H3 + 0.544 P + 10.09 H3 : ht of the child at 3yr P : mean ht of parents
42 : Head circumference
43 :
44 : OFC GROWTH VELOCITY
45 : Chest Circumference At birth: OFC - CC= 3 1year: OFC=CC Beyond 1year CC exceeds OFC
46 : Mid Arm Circumference Most useful for field studies Relatively age independent as constant between 1-5years (15-17cm) Measurement : >13.5 normal 12.5- 13.5 mod PEM <12.5 severe PEM Shakir tape Bangle test
47 : Quack stick Meter rod with two set of markings Expected height against various sizes of MUAC is inscribed on the rod PEM: child will taller than the anticipated height.
48 : Body Proportions
49 : Body Proportions Stem stature index: sitting height as percentage of total height
50 : Body Proportions Arm span is the distance between the tips of middle fingers of out stretched arm. ASHt (1-2cm) after 12 yr Abnormal arm span:
51 : THICKNESS OF SUBCUTANEOUS FAT (Skin fold thickness) Triceps skin fold is most popular Recorded by Lange or Herpenden’s skin fold callipers At mid arm over triceps area left side 1-6Year >= 10mm normal <6mm : PEM
52 : Body Ratios
53 : MAC : HC ratio :( Kanawati Index) 0.28 – 0.314 : mild PEM 0.25 – 0.279 : Moderate PEM <0.249 : Severe PEM
54 : Weight / Height² ratio:( Rao & Singh index) Ratio > 0.0015 : normal 0.0013 – 0.0015 : moderate PEM < 0.0013 : severe PEM
55 : Ponderal Index Weight in Kg / Height³ Ratio > 2.5 normal Ratio 2 – 2.5 : borderline PEM Ratio < 2 : severe PEM
56 : Weight /Height1.6 : ( Dughdale index) Ratio > 0.79 : Normal Ratio < 0.79 : malnutrition
57 : BODY MASS INDEX BMI= Wt (kg) / Ht (m)2 BMI : <15 : PEM 15-25 :Normal 25-30 : Overweight >30 :Obesity( >95th centile)
58 : Weight for Height Wt for ht = (Actual wt / wt corresponding to ht) x 100 * Reference standard NCHS data
59 : Weight for height and height for age Classification Based on dynamics of PEM (Waterlow) * Reference standard NCHS data
60 : What is it ? Consist of a series of percentile curves that illustrate the distribution of selected body measurements in the study population How it looks ? Curve is symmetrical with nearly half of observations lie above and half below the median and the 50th percentile. Curve is Gaussian distribution. Growth charts ( Road to health card)
61 : IAP Growth chart
62 : CDC growth chart
63 : WHO GROWTH STANDARD
64 : Growth charts What is the allowable normal range of variations ? Between 3rd and 97th percentile curves or mean +- 2 standard deviation(SD) are normal. Standard Deviation means degree of dispersion of observations away from the mean. 68.3% and 95.4% of observations fall under 1SD and 2SD respectively.
65 : Growth charts What is it’s use ? Used to track the growth of children from infancy through adolescence Indicates the state of the child's health, nutrition and well being Types : WHO,NCHS, GOI, IAP
66 : Growth charts Individual level Community level National level Scientists Monitoring &documenting growth Comparison with references std To detect growth faltering Monitoring health status Performance of programs Comparison over time Identification of problem areas National/international comparisons Research tool What is the need of growth charts ?
67 : GROWTH VELOCITY Is the rate at which the child grows over a period of time. Calculated from serial measurements Plotting growth velocity is a useful to monitor growth It is a better tool for early identification of factors affecting growth and also for assessment of usefulness of social and remedial measures.
68 : VELOCITY OF GROWTH Means: rate of growth Rates vary at different ages Growth rate slows down with age upto 10 – 15 years Velocity increases with onset of adolescence
69 : Growth Velocity - Boys
70 : Growth Velocity - Girls
71 : What needs to be monitored at community level First 2 years 2 –10 years >10 years Length/age Weight/age Weight /height or BMI Head circumference/age Height/age Weight/age BMI/age Above in relation to pubertal development
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73 : WHO Child Growth Standards Attained growth Weight-for-age Length/height-for-age Weight-for-length/height Body mass index-for-age Mid-upper arm circumference-for-age Triceps skinfold-for-age Subscapular skinfold-for- age Head circumference-for-age Growth velocity Weight Length/height Head circumference Arm circumference
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80 : Dentition It is not a dependable parameter for assessment of growth, since there is a wide variation in eruption of teeth and its timing. Average age at which first tooth erupts 6 to 7 months. The rest of milk, deciduous or temporary teeth appear at the rate of one tooth every month. No: of teeth in infant=age in months-6. By 2 ½yr to 3yr-child has a full set of temporary teeth, numbering 20. The first permanent teeth-at 6yrs (molar).
81 : Primary Dentition
82 : Permanent Dentition – Eruption Sequence
83 : Dentition: NUMBER OF TEETH edcbe abcde Temporary: ____________ 20 edcba abcde 87654321 12345678 Permanent: ________________ 32 87654321 12345678
84 : Bone age Bone age means age as calculated from the maturation and appearance of epiphysis. An average full-term neonate has following 5 radiologically demonstrable ossification centers : distal end of femur, proximal end of tibia, talus, calcaneus and cuboid.
85 : Bone age 6 months : ossification center for 2 carpal bone capitate and hamate formed No of center at wrist= age in years+1 Recommended sites (x-ray) for bone age determination: Newborn: foot and knee 3-9months: shoulder 1-12year : hands and wrist 12-14 years: elbow and hip
86 : Linear catch up growth Definition Importance Influencing factors Types Operative factors Hypothesis
87 : Growth Monitoring A pillar of health care in children A screening tool to diagnose nutritional, chronic systemic and endocrine disease at an early stage. Has the potential for significant impact on mortality Taking the same measurements at regular interval ,approximately at the same time of the day and seeing how they change. A basic activity of U5C.
88 : Growth Monitoring: Aims and rationale Primary aims: Identification of disease and condition that manifest themselves trough abnormal growth Early identification of PEM and obesity/overweight and assessing response to intervention Sensitize pediatricians to use growth charts Education to parents and allaying anxiety about their child’s growth
89 : Secondary aims: To discuss health promotion related to feeding, hygiene, immunization and other aspects of the child's health and behavior. Growth status of children is the measure of the health and wellbeing of community as a whole and growth indices are the public health interest in planning future strategies for improving health. Growth monitoring: Aims and rationale
90 : Growth monitoring: Methods Anthropometry- practical use Skeletal assessment Tissue growth assessment (SFT) Dental Development
91 : The new standards will play a key role in the prevention and early recognition of childhood obesity WHO Child Growth Standards
92 : Thank You

 

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