Children Growth In The Name Of God dr.Guisu Hatami Associated Professor Of Academic Pediatrics

Normal growth patterns of babies Dr. Ravari Normal growth patterns of babies Most babies start to gain weight soon if they are exclusively breastfed from soon after birth, are well attached and fed frequently. Some babies lose weight in the first few days after birth, The total loss should not exceed 10% of birth weight. A baby should regain birth weight by two weeks. Babies usually gain 100-200 gr / week during the first six months, and about 85-140 gr / week in the second half of the first year. (WHO,UNICEF, BREASTFEEDING PROMOTION AND SUPPORT IN A BABY FRIENDLY HOSPITAL, A 20-HOUR COURSE FOR MATERNITY STAFF, January 2006)

Expected Growth in Best Circumstances Dr. Ravari Dr Ravari Expected Growth in Best Circumstances Weight loss of about 5% of birth weight or less. No further weight loss after day 3–5 of life. Regaining of lost birthweight by day 7–14 of life.

Dr. Ravari Neonates who have lost more than 7% of birth weight at time of discharge should be reassessed within 48 hours, and those who have lost more than 10% of birth weight should be screened for breastfeeding malnutrition and hypernatremic dehydration. SOURCE:Verity Livingstone, M.B.B.S., F.C.F.P., F.A.B.M, BREASTFEEDING MEDICINE Volume 1, Number 2, 2006 Dr Ravari

Faltering Early Growth (WHO) Dr. Ravari Dr Ravari Faltering Early Growth (WHO) Weight loss > %10 of birth weight. Continued weight loss after day 10 of life. Failure to regain lost birth weight by 3 weeks of age. Gain at rate below the 10th percentile for weight gain beyond 1 mouth of age. Lawrence, Ruth A. Breastfeeding: A guide for the medical profession. Sixth Edition 2005

Dr. Ravari Dr Ravari All breastfeeding newborn infants should be seen by a pediatrician or other knowledgeable and experienced health care professional at 3 to 5 days of age as recommended by the AAP. This visit should include Infant weight; Physical examination, especially for jaundice and Hydration; Maternal history of breast problems (painful feedings, engorgement); infant elimination patterns 3–5 urines and 3–4 stools per day by 3–5 days of age; 4–6 urines and 3–6 stools per day by 5–7 days of age; and A formal, observed evaluation of breastfeeding, including position, latch, and milk transfer SOURCE:,Breastfeeding and the Use of Human Milk,Pediatrics 2005;115;496-506

Prevention of common clinical concerns Many instances of hypoglycaemia, jaundice and dehydration can be avoided by implementing practices such as: Early skin-to-skin contact to provide warmth for the baby. Early and frequent breastfeeding. Rooming-in so that frequent feeding is easy. Encouraging milk expression and cup feeding if baby is unable to breastfeed effectively because he/she is too weak or sleepy. Do not give water to the baby.Water is not effective at reducing jaundice and may actually increase it. Observe all babies in the first few days to ensure that they are learning to suckle well. Dr Ravari

Normal Growth in breast-fed infants Dr. Ravari Dr Ravari In general, exclusively breast-fed infants tend to gain weight more rapidly in the first 2 to 3 months. Weight gain in breastfed infants may be moderately slower, especially between 3 and 6 months of age. Breastfed infants are leaner than formula fed infants, with the difference in fatness most evident at 9–12 months.

Dr. Ravari Dr Ravari The WHO Multicentre Growth Reference Study (MGRS) was undertaken in response to that endorsement and implemented between July 1997 and December 2003 to generate new curves for assessing the growth and development of children the world over.

Why were new standards needed? Dr. Ravari Dr Ravari Why were new standards needed? The old charts are based on data from late 1970s from children in the USA. many of these babies were artificially fed. The old measurements were based on irregular measurements, too far apart to identify trends. The old standards merely described how these children grew whereas the new standards aim to describe how children should grow.

Dr. Ravari Dr Ravari Normal patterns in breastfed babies... non-breastfed babies are different! Breastfed babies appear to self regulate their energy intake to lower levels. Breastfed babies have different metabolic rates and different sleeping patterns. Artificially fed babies on average have higher intakes of energy and as a result are heavier.

Dr. Ravari Dr Ravari Studies suggest that partially breastfed and formula-fed infants consume 20% more total calories per day than do exclusively breastfed infants. Source: Pediatrics 2006;117;544-559

Energy Needs for Infant and Child Growth Dr. Ravari Energy Needs for Infant and Child Growth 35% of the total energy requirement during the first three months of age (40% in the first month), Drop by half in the following trimester (17.5%), Reduced to < 6% in the second semester of life, Reduced to 3% at 12 months, Less than 2% in the second year, Remains between 1 and 2% until mid-adolescence, Gradually disappears before 20 years of age.

AMOUNT OF COMPLEMENTARY FOOD NEEDED Dr. Ravari Dr Ravari AMOUNT OF COMPLEMENTARY FOOD NEEDED 6-8 months kcal/d 9-11 months kcal/d 12-24 months kcal/d Total energy needs are approximately 600 700 900 Energy needs from complementary foods 200 300 550 Food and Nutrition Bulletin, vol. 24, no.1 © The United Nations University, 2003

Energy Needs for Infant and Child Growth Dr. Ravari Energy Needs for Infant and Child Growth 35% of the total energy requirement during the first three months of age (40% in the first month), Drop by half in the following trimester (17.5%), Reduced to < 6% in the second semester of life, Reduced to 3% at 12 months, Less than 2% in the second year, Remains between 1 and 2% until mid-adolescence, Gradually disappears before 20 years of age.

Breastfed babies obtain their energy needs from breastmilk Dr. Ravari Dr Ravari Breastfed babies obtain their energy needs from breastmilk 70% at 6-8 months 55% at 9-11 months 40% at 12-23 months

The new WHO growth standards Based on exclusively breastfed babies are: a valuable tool to encourage breastfeeding and to allow early warning of the development of obesity. Dr Ravari

Optimal Growth Optimal Nutrition Optimal Environment Dr. Ravari Dr Ravari Optimal Growth Optimal Nutrition Exclusive Breast Feeding to 6 mo Appropriate Complementary Feeding Optimal Environment Absence of Microbiological Contamination Absence of Tobacco and Smoking Optimal Access to Health Care Immunization Good Standard of Pediatric Medical Care Source: Nutrition Solutions to Major Health Problems of Pre-school Children International Symposium ,Professor Ricardo UAUY INTA Chile & London Medical Tropical School, UK. September 2005

WHO Child Growth Standards are released on April 27, 2006 Dr. Ravari Dr Ravari WHO Child Growth Standards are released on April 27, 2006

Brazil Ghana India Norway Oman USU Dr. Ravari Brazil Ghana India Norway Oman USU The MGRS collected primary growth data and related information from 8440 healthy breastfed infants and young children from diverse ethnic backgrounds and cultural settings Dr Ravari