儿童保健生长发育体格发育英文.ppt

儿童保健生长发育体格发育英文1.To master growth patterns of mon used growth parameters.2.To understand how to assess growth and development.3.To know the important regularities of growth and development.AimDefinitionPatterns of physical growthOther indices of growthRegularities of growth and developmentGrowth assessment Growth:defined as an increase in size of body,biological growth of an organism takes place through cell multiplication,this morphological growth can be measured clinically.Development:is the association process of differentiation of the organism,in which growing tissues and organs take on increased complexity of function(physiological,motor,cognitive,affective).Thus,since both processes are part of one whole,the combined terms growth and development form an unitary concept that indicates the quatitative and qualitative of maturational changes of an organism.Physical growth can be assessed by various anthropometric measurements.is composed of tissues,organs,systems and fluid,etc.is a common and sensitive measurement of physical growth,especially for evaluating present nutrient state.WeightIncrement(kg/y)Increment（kg）Weight(kg)Age 2y Puberty 2kg/y 23m6912m1224m3At birth336331、The first growth spurt occurs in the first year of life(the increment is about 6kg).Patterns of Weight Increment2、Growth is not at the same rate in different age:The increment of weight during the first 3 months is equal to that of the following 9 months.3、Yearly increments increase slowly until the onset of puberty.About formulae:312months:weight(kg)=(age month+9)/2312months:weight(kg)=(age month+9)/2 These formulae are used only for calculating dosage of drug and fluid in clinic.Because the growth is not at the same rate in different age,especially in infant;and the growth is affected by many factors,such as gene,environment and individual variation.AttentionWeight loss:Loss of 3%9%of birth weight in the first few days of life is considered normal and is common for most newborns.Length/Stature-StatureStature-LengthLength 3y2yPuberty 57cm/y 573m61627512m8524m50At birth111212132510101、The first growth spurt occurs in the first year of life(the increment is about 25cm).2、Growth is not at the same rate in different age:The increment of weight during the first 3 months is equal to that of the following 9 months.3、Yearly increments increase slowly until the onset of puberty.Patterns of Length IncrementCrown-rump/Sitting height-Crown-rump-Crown-rump length length-Sitting Sitting height height3y3ySitSitSupineSupine3y3y They give a measure of the length of the head and trunk.It is a measurement of the distance from the highest point on the head to the base sitting surface.During the first year of life,spinal increase is faster than extremities.Later on,the extremities grow at a faster rate than the trunk,which is contribute to the body length and leading to a gradually change in relative proportions.The ratio of sitting height/total height PubertyPubertyPubertyPubertyDefining the classification of short staturen n Abnormal(Disproportionate)Abnormal(Disproportionate)n nA syndrome with short A syndrome with short limbslimbs（Achondroplasia,Achondroplasia,hypothyroidism,etchypothyroidism,etc）DisproportionateProportionateHead Circumference HC is a measurement of perimeter of head,from eyebrows to occipital prominence.The change of the HC is related with the growth of brain and skull.AgeHC(cm)Increment(cm)At birth343m40612m46624m4825y50215y5354341、The first growth spurt occurs in the first year of life(the increment is about 12cm).2、The increment of HC during the first 3 months is equal to that of the following 9 months.Patterns of HC Increment3、Rapid,decelerating growth of HC.(At birth,the head is of the neonates body.By adulthood,it is only 1/8th the size of the body.)4、The shape of head and circumference are affected by not only diseases,but also heredity.Small HC HC increase too fastCerebral dysplasia,MicrocephalyHydrocephalusAbnormal of HCGrowth on PubertyPhysical developments in height&weight:occur very rapidly in infancycontinue at a relatively steady pace throughout childhoodslow down towards puberty At puberty,there is a marked growth spurt(The second peak of height velocity,PHV),that is,a very rapid increase in size and weight.Girls usually showing their pubertal growth spurt around age 911.For boys the same process begins at apx.age 1113.According to Tanner(1990),girls finish pubertal growth by about age 16 whereas boys continue to grow until approximately 18 years of age.Sexual Precocity：Secondary sexual characteristics appear before puberty.Girls8y，Boys14y，Boys16ySkeleton developmentDentition developmentCraniumCranium：FontanelFontanel Cranial sutureCranial sutureSpinal developmentSpinal developmentBone developmentBone developmentCranial developmentClosure time of fontanel/sutureFontanel/suture At birthTime of closureAnterior fontanel1.5-2cm1818mPosterior fontanel0.5-0.71-2mCranial sutureSmallest3-4mHow to measure the size of anterior fontanel Small size or early closure：Large size or delayed closure：Abnormality of anterior fontanelMicrocephalyHydrocephalus,CretinismIntracranial hypertension(Encephalitis,Meningitis)DehydrationAbnormality of anterior fontanelBulging fontanel：Sunken fontanel：Spinal developmentAgeAgeMovementMovementMusclesMusclesCurvatureCurvature3m3mLift Lift headheadCervicalCervicalCervicalCervical（anterioranterior）6m 6mSit Sit alonealoneLumbarLumbarThoracicThoracic（posteriorposterior）12m 12mWalk Walk alonealoneLower Lower extremitiesextremitiesLumbarLumbar（anterioranterior）posterior curvature of thoracic vertebra sit by himself at 6 months stand and walk by one year old anterior curvature of lumbar vertebra posterior curvature of sacral vertebraanterior curvature of cervical vertebra hold head up by 3months Osteite(center of ossification),which is located near ends of long bones(epiphyses),with growth plates.It is very important for bones growth in length.Bone developmentThe sequence of appearance of secondary centers Bone age Bone age is that the age should be according to the osteite number for normal child.The most commonly used standards are those of Gruelich and Pyle,which require radiographs of the left hand and wrist;knee films are sometimes added for younger children(usually less than 1 year old).Abnormality of Bone Age Hypothyoidism,HypopituismHypothyoidism,Hypopituism Precocity of BA：Adrenogenital syndrome,Adrenogenital syndrome,PrecocityPrecocity Retardation of BA：DentitionPrimary teeth:Primary teeth are 20 totally.The first eruption is at about 6 months(410 months).The timing of tooth eruption is more variable than other developmental parameters Delayed eruption is usually considered when there are no teeth by approximately 12 months of age.The last eruption of primary teeth is at 22.5 years of age.Primary teethPermanent teeth6y6y：First molarFirst molar7 78y8y：primary primary teeth are teeth are exfoliated exfoliated instead by instead by permanent teeth permanent teeth according to the according to the eruption orde eruption order.r.12y12y：Second molarSecond molar18y18y：Third molar Third molar TotallyTotally：3232Delayed eruption Hypothyroidism,idiopathicDisorder Hypothyroidism,Brain dysplasiaFailing to erupt Ectodermal dysplasia,Mechanical blockage Abnormality of dental enamel Ectodermal dysplasiaAbnormality of DentitionGrowth and development are a continuous,series of distinct stages process.GirlsGirlsGirlsGirlsBoysBoysBoysBoysImbalance development of different Imbalance development of different systems and organs.systems and organs.Individual variation Child has rather big variation individually in growth and development,even if the identical twins,owing to some factors such as heredity,sex,environment and education etc.An important part of well-child care is the assessment of a childs growth,that is to make sure that children are growing normally.Why do growth assessmentPrinciplesRepresentation of resultsContents of growth assessmentReliable and accurate data Single Value and series investigationReference and standardPrinciplesMeasurement errorMeasurement error4040454550505555606065657070757580808585909095951001000 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 2497979797505050503 3 3 3cmLength,girlsLength,girlsChoosing reference Reference,based on a North American population by NCHS,USA,is recommended by the WHO as the international standard of growth.Choosing reference Besides,there are many local or national references,for example,physical growth indices of 9 cities in China.+2SD-2SDP3P50P97Statistics reviewGrowth curveMethods of assessmentReference tableGrowth curve Example1：（Weight of girls）P3 P3 P25 P50 P75 P97 P25 P50 P75 P971y1y 7.49 8.54 9.18 9.91 11.37 7.49 8.54 9.18 9.91 11.372y2y nyny -2SD -1SD +1SD +2SD -2SD -1SD +1SD +2SD1 1y y 7.18 8.21 9.24 10.27 11.30 7.18 8.21 9.24 10.27 11.302y2y nyny X XExample2：（：（Height of boys）Boys:height2 4 6 8 10 12 14 16 18-2SD-2SDAge(year)+2SD+2SDP 97P 3P 50Growth levelGrowth velocityProportion of body Growth level Every single measurement can be plotted on a growth curve which illustrates the amount of growth in children within different age group.Results：P97Example：（：（Weight of girls）P3 P25 P3 P25 P50 P75 P97 P50 P75 P971y1y 7.49 8.54 9.18 9.91 11.37(kg)7.49 8.54 9.18 9.91 11.37(kg)-2SD -1SD +1SD +2SD-2SD -1SD +1SD +2SD1 1y y 7.18 8.21 9.24 10.27 11.30(kg)7.18 8.21 9.24 10.27 11.30(kg)The weight of a one year old girl is 8.2 kg.Growth level：X XX W/A P3-P25 W/A -（1SD2SD）0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 2497979797505050503 3 3 3kgWeightWeight，GirlsGirlsegeg：An infant at the 3rd percentile of weight for age Failing to growFailing to growFailing to growFailing to growGrowing normallyGrowing normallyGrowing normallyGrowing normallyRecovering form growth failureRecovering form growth failureRecovering form growth failureRecovering form growth failureAttention 1For premature infants:we should minimize the effect of gestation by subtracting the weeks of prematurity(40 weeks is considered as full term)from the postnatal age.Attention 2Height:40m Weight:24m Head circumference:18mTime for correctionExample:A girl，20m old.Weight 8.8kg，Length 79cm，HC 47.6cm.Gestational age:32Weeks.Correcting:Correcting:18mW W：P3-P10P3-P10L L：P20-P30P20-P30Assessment:Assessment:20mW W：P3P3L L：P10-P20P10-P20HCHC：-（1SD-2SD1SD-2SD）X X Growth velocity can show the process of growth.Growth velocity is measured in terms of how much a child grows within a specified period of time.Growth velocitySerial heightSerial height50506060707080809090100100110110120120130130140140150150160160170170180180190190Boys:height2 4 6 8 10 12 14 16 18-2SD-2SDAge(year)+2SD+2SDP 97P 3P 50NormalResult representationNormalDescendingAcceleratedNo gainsSlowed The birth weight of a girl is 2.3Kg.When she is 3 months old,the weight is 5.4Kg（Growth level：P3）Growth velocity：The increment of weight:3.1kg Reference:3.08Kg/0-3m NormalExampleproportion of body Weight to statureTrunk-leg ratioWeight for length,W/LBody mass index,BMI P97 W/L:It indicates the range of weight for definite length.The weight of a 2 years old boy is 14kg，the length is 76cm.Reference table：W/L P97ExampleBMI=W(kg)/H2(m)Example:if an 8 year old boy weighs 26.8 kg(50-75th percentile for age)and is 130.4 cm tall,his BMI would be calculated as follows:26.8/(1.304)(1.304)=15.8.Trunk-leg ratio It is the most common index of shape and is a measure of the relative length of the trunks and legs.Usually,the ratio of sitting height/total height(SH/TH)can reflect trunk-leg ratio.Result representation(Claculating)Ratio of SH/THReference Normal（Proportionate）Ratio of SH/TH Reference Abnormal（Disproportinate）A 2 years old boy，his his length length is is 65cm65cm，crown-rump length is 42cmcrown-rump length is 42cm。crown-rump length/lengthcrown-rump length/length（4265=0.654265=0.65）0.650.59（Reference）AbnormalHypothyroidismExampleThank You世界触手可及世界触手可及携手共携手共进，齐创精品工程精品工程医学资料仅供参考,用药方面谨遵医嘱