is an essential component of pediatric health surveillance, Knowledge of both normal patterns and common individual variation lead to good reassurance

Transcription

1 GROWTH ASSESSMENT

2 is an essential component of pediatric health surveillance, Knowledge of both normal patterns and common individual variation lead to good reassurances and make a guidelines to parents. There is overlapping between growth and development. Definitions Embryo = fertilized ovum to 12 weeks Fetus =12 weeks to delivery Newborn =newly delivered Neonate =1st 28 days Infant =from 28 days to end of 1st year Toddler =1-3 years Preschool =3-5 years School age =5-10 years Early childhood= 1st 6 years Later childhood=6-12 years Early adolescent=9-13 Middle adolescent= years Late adolescent=16-18 years

3 Growth chart The most powerful tool In assessing of growth, each chart contain 7 or 8 percentile(3 rd, 5 th, 10 th, 25 th, 50 th, 75 th, 90 th, 95 th ), there is separated chart for male and female and according to age Growth chart give idea about what is present not what is should Growth chart to be significant, need serial reading not only single reading Types of growth chart WT for age, HT(length, stature) for age, OFC for age, WT for HT, BMI There are special chart for premature baby(catch up growth), Down syndrome, Klinfelter syndrome

4 Analysis of growth 1 for infant, size in 1 st 2years= reflect intrauterine life, size more than 2years= midparental 2- In infant, the linear growth was taken by measuring board(supine)or horizontal stadiometer, older(2 years and above)by vertical stadiometer 3- WT for HT, <3 rd centile remain the single best indicator for acute nutrition, while it is normal in chronic malnutrition.under 4- Chronic and severe malnutrition in 1 st year of life may limit the head growth( ominous sign of late cognitive disability). 5-Postnatally, 2 period of rapid growth, Infancy and Puberty, While the steady rate of growth is decrease in between. 6- The increments of HT rather than WT will give idea about good health 7- Many kids whose below the normal are normal also(small normal) 8- checking of parents is very important in detecting the type of growth. 9- Brain growth in 1 st 6 years but with minimal changes in OFC in age of 10 years. 10- Three factors affect the growth (Genetics, Hormonal, Enviromental) 11- e.g 9 MO age on 25 th centile (BODY WT)8.5kg(75% of peers more than this, similarly if BWT more than 11.2kg is heavier than 95 th of his peers)

5 The height (HT) SUPINE=length(less than 2year) Standing=stature(more than 2year) At birth =50 cm At the end of 1 st year=75cm 2-12 year=age (in years)x7+66cm At age of 2year, in BOY, final adult HT=HT at this age x2 At age of 18month, in GIRLS, final adult HT= HT at this age x2 The birth HT doubled at the age of 4years and tripled at the age of 13 years In 2 nd year increase 12 cm/year while after 2 nd year till adolescence increase 5cm/year The best predictor of child eventual adult HT is MID parntal HT For BOYS=mother HT+13cm +father HT/2 FOR girls=father HT -13cm +mother HT /2 This is give approximately +/-5cm of final adult HT HT less than 3 rd centile=short stature HT more than 95 th centile =TALL stature

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9 The weight(wt) Birth wt gram, decreasing in about 10% in 1 st day of life then gained in about g/day in the remaining 1 st month, then 750 gram/month in the next 2month. 3-12month= age in month+9/2 1-6years= age in years x years=age in years x7-5/2 The above equations give idea about the rough ideal body wt. The birth wt was doubled at the age of 6month,and tripled at the age of 12month, quadruple at 24months. WT gain in 2 nd year 0.25g/month while after 2 nd year till adolescence annual increment 2-3Kg. Body wt less than 3 rd centile =underweight Body wt more than 95 th centile =overweight

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12 Occipitofrontal circumference (OFC) OFC indicate brain growth but not intelligence: The measurement should be taken with a device that cannot be stretched, such as a flexible metal tape measure. Wrap the tape around the widest possible circumference - from the most prominent part of the forehead (often 1-2 fingers above the eyebrow) around to the widest part of the back of the head. Try to find the widest way around the head. measure 3 times, and take the largest 0ne. At birth =35 cm +/- 2cm In 1 st 3months= increase 2cm/month In the next 3 months= increase 1cm/month In the next 6months= increase 0.5cm/month At the end of 1 st year =47cm,at 2 nd year=49 At the end of 4th year=51cm, 8 th year=53 At 12 years 55cm OFC less than 3 rd centile=microcephaly OFC more than 95 th centile =macrocephaly

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14 Body Mass Index(BMI) Wt(KG)/ht(M2) Measure the adipose tissue in the body BMI for age < 5 th centile=underweight BMI for age between 5 th -85 th percentile=healthy BMI for age between 85 th -95 th percentile= risk of overweight BMI for age >95 th percentile=overweight(obese) BMI Categories: Underweight = <18.5 Normal weight = Overweight = Obesity = BMI of 30 or greater CLASS I OBESITY=30-34 CLASS II OBESIYU= CLASS III OBESITY=>40

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16 Others indictor of growth 1. Body proportion Upper body segment/lower body segment(u/l) At birth=1.7, 3years=1.3, more than 7years=1 or 0.9 Increase U/L= short limb, rickets, achondroplasia, hypothyrodism Decrease U/L =Marfan syndrome, scoliosis, spinal deformity 2. Bone age Measure the somatic growth (skeletal maturation), radiograph of the hand and wrist A. delayed bone age but with normal HT age(age at which the HT on 50 th centile)=constitutional growth delay B. marked delayed bone age (to chronological and HT age)=endocrinopathy

17 Dental Development Mineralization started in the 2 nd trimester and go Eruption started in 5-6 months postnatal, central then lateral, mandibular then maxillary, delayed if no any tooth more than 13 months of age Exfoliation (4-6 years) Teething by itself if used alone, is poor indicator 4- arm span (from 2 finger tips across the shoulder which equal to HT at 3-4 years 5- skin fold mid way between shoulder and elbow indicator of malnutrition

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