Assessment of Growth Assessment of infant' growth is crucial during different stages of life because periodic assessment of infants and children permits early detection of growth deficiencies and deviations from normal standards. During assessment the nurse should take the following points in his/her consideration:
Physical growth assessment is usually carried out using tables and charts. The measurements which are commonly done are weight, height, and head circumference. Newly chest circumference is done for newborns to assess fetal growth at birth. There is wide range of normal variation among infants and children of the same chronological age. These normal differences are described in terms or percentiles. Comparison of the child percentile with those of the previous examination of the same child can detect abnormalities in his growth.
Not all measurements of the same child necessarily fall into the same percentile, but each measurement should follow its own percentile in a healthy child.
Assessment of Development Developmental pediatrics is referred to maturation of the structure and functioning of the organs from fetal viability to full growth. It's intimately related to the maturation of CNS. Developmental assessment includes 4 areas as the next:
Gross motor: the normal acquisition of motor skill depends on: Loss of primitive reflexes. The development of postural control (Cephalocuodale direction). Increase ability to interpret the visual information as distance. The development of movement pattern which are adjustable to environmental circumstances.
Fine motor and vision Integration of visual input and motor output is necessary for development of accurate manipulative skills. Manipulative skills start from crude palm grasp and gradually developed till fine pincer grasp that reached at 12 months old.
Speech and hearing Speech, as a system of communication is an essential future of human life. Nurse should assess preferences of the baby for some human voices and face as parent. Personal-social Include assessment of child social reaction to other persons. Even neonates are socially active as they are able to elicit attention of their parents. During the second half of the first year, the baby starts to recognize the familiar adults and develop strong attachment to her/his care giver.
Assessment of maturity The process of maturation is continuous throughout life; it begins at conception and ends at death. Maturational "events" include those aspects of maturation that occur once and provide an unambiguous signal that the individual has reached a particular level of maturity. For example, the exact age at which menarche (the first menstrual period) is experienced in girls or the exact the age of peak height velocity during the adolescent growth spurt. The maturity process of a child can be assessed at a single examination using three aspects:
Sexual maturity can be assessed from the development of public hair in each sex, the genitalia in males and the hearts in females. Usually, these assessments accomplished by with direct inspection. Skeletal maturity is assessed from radiographs of wrist and is recorded as a continuum of skeletal ages (years) that may range from birth to 18 years. Dental maturation is best assessed by taking panoramic radiographs of the mandible and maxilla and scoring the stages or formation and calcification of each tooth.
Catch-up growth Unusual acceleration of growth may follow the recovery of infant or the child from a disease. Catch-up growth (acceleration) is complete if the growth data for a child return to child's original percentile before the deficit occurred.
Catch-up growth is not always complete, however, and appears to depend on the timing, severity, and duration of the insult. This appears to be particular true in the treatment of hormone deficiencies. Complete catch-up is more common in infants than in older children but in may be delayed. Catch-up can occur in weight an any age, in stature until the time of epiphyseal fusion, and in head circumference until the sutures of the cranial vault interlock at about 5 years.
Growth velocity chart Growth velocity chart is used to assess a child's growth rate over several periods of time. Calculate you child's growth rate by recording his/her height at 2 points in time that are at least 150 days apart; then compare it with the normal growth rate of children the same age and sex.
Growth Chart Growth charts are the primary tools for the recognition of unusual growth. Consist of a set of smoothed curves for selected percentiles with accompanying tables of means and standard deviations. Some of these charts were developed from nationally representative samples to obtain estimates for total populations. The curves are usually for that 3rd, 5th. 10th. 25th, 50th, 75th, 90th, 95th, and 97th, percentiles. For example, when there are 100 children in an age group, the 3rd percentile value depends upon only the smallest three to four observations.
Children whose measurements fall within the 5th and 95th percentiles are generally considered within the normal growth range. Sudden or sustained changes in percentile may indicate a chronic disorder, emotional difficulty, or nutritional intake problem. These findings require further assessment or the physical status of the child as well as other types of evaluations such as dietary intake or serum laboratory measurements.
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Growth Disorders A growth disorder is any type of problem in infants, children, or teens that prevents them from meeting realistic expectations of growth. Disorders may include:
Intra Uterine Growth Restriction (IUGR) It is a condition refereed to fetal growth has been constrained. It's defined as birth weight less than the 10th percentile of the international birth weight for gestational age curve Small forgestational age, commonly synonymous to IUGR, appropriate for gestational age and large for gestational age was determined by matching infant birth weight to his/her gestational age based on WHO fetal growth standard chart.
Failure to thrive It is a descriptive, non-specific term that encompasses e.g. malaise, weight loss, poor self-care that can be seen in elderly individuals. The most common definition is weight less than the third to fifth percentile for age on more than one occasion or weight measurements that fall 2 major percentile lines using the standard growth charts
Kwashiorkor: A deficiency of protein with low or inadequate supply of calories. Occurs between 1 – 4 years of age when infant weaned from the breast, once the second child is born.
Marasmus: Is a condition primarily caused by a deficiency in calories and energy. Marasmus is a form of severe protein-energy malnutrition characterized by energy deficit. A child with marasmus looks emaciated. Body weight may be reduced to less than 80% of the average weight than corresponds to the height. Marasmus occurrence increases prior to age 1, whereas kwashiorkor occurrence increases after 18 months. The prognosis is better than it is for kwashiorkor.
Dwarfism Generally refers to a group of genetic disorders characterized by shorter than normal skeletal growth (an adult height of less than 147 cm) The majority of children born with this condition have average-sized parents. Abnormal skeletal growth is known as skeletal dysplasia.
Neonatal reflexes (Primitive Reflexes) Most of the newborn's physical behavior appears to be reflexive in nuture, as the newborn's nervous system matures these reflexes disappear and are replaced by more voluntary, coordinated movements. The absence of persistence of the early reflexes is used to evaluate the health and maturation of nervous system.
Moro reflex Response to sudden loud noise, causing body to stiffen and arm to go up and out then forward and toward each other thumb and index finger will assume C-shape. Present at birth and disappears by 3-6 months of age. Absent reflex in brain-damaged babies, depressed babies due to narcotics at birth. Asymmetrical reflex in fracture of clavicle or humerus, brachial plexus palsy and shoulder dislocation. Persistent reflex in cerebral palsy (C.P.).
Stepping reflex Elicited by holding the infant upright and inclined forward with the sole of the foot touching flat surface, the infant starts to make stepping movements. Appears at birth and disappear by 6 months of age.
Neck righting reflex Consists of rotation of the trunk in the direction in which wthe head of the supine infant is turned. Appears by age of 4-6 months and disappears by age of 24 months. Absent or decreased in infants with C.P.
Parachute reflex While the infant s held prone and lowered quickly towards a surface, he will extend arm and legs. Appears at age of 9 months and persist thereafter. Suckling reflex: elicited by stroking of lips. Present at birth and persist 9 months.
Rooting reflex When corner of mouth is touched and abject is moved towards cheek, infant will turn head towards object and open mouth. Present at birth, disappear by 4 months of age (when baby is awake), 7 months (when baby is asleep). Grasp reflex Elicited by applying light pressure on the palms or soles which are closed around the stimulating object. Palmar grasp appears at birth, disappears at 6 months of age. Plantar grasp appears at birth, disappears at 10 months of age.
Doll's eye: Turn the head slowly to one side, the eye don't move with the head. Appear at birth and persist for two weeks. Hand opening: The hand will open by stroking the dorsum of infant's hand. Its appear at birth and disappear at 3ed months. Babinski's sign: Scratching sole of foot causing big toe to flex and toes fan.