INTRODUCTION TO CHILD HEALTH DEVELOPMENTAL TERMINOLOGY Robyn Smith Department of Physiotherapy UFS 2012

After this lecture the learner should be able to: Define important developmental terms Explain weight/height/ head circumference for age ratios Interpret child mortality statistics Familiarise learner with Road to Health Chart

Is the terminology relevant to physiotherapists? Working with babies and children in early intervention services we have to understand the relevant developmental terminology  Enables us to accurately interpret important information in child’s history & medical records  Helps us communicate effectively with interdisciplinary team & parents  Helps us identify children potentially at risk of developing developmental difficulties

Pregnancy Period calculated from the first day of the woman’s last menstrual period Period expressed in weeks Normal duration is weeks 1 st trimester: first 13 weeks 2 nd trimester: 14 to 26 weeks 3 rd trimester: 27 weeks to the birth of the foetus

Paediatrics Healthcare services provided to the child from birth through adolescence –Prevention –Diagnosis – treatment South Africa: Birth to the age of 13 years Europe & USA : Birth through adolescence

Phases of Growth Embryoconception end 8 th wk Foetus 9 th week gestation until birth Neonate1 st 28 days of life Baby/infancy1 st year of life Toddler2 nd year of life Preschoolerup until school going age (2-5 years) Scholarfrom school going age (>6 years till school leaving age) Adolescentafter onset puberty (10-19 yrs)

Neonatal terminology Gestation Term baby born between weeks of pregnancy Premature baby born <37 completed weeks of pregnancy Post mature Baby born > 42 completed weeks of pregnancy

Neonatal terminology Birth Weight NBW2 500 – 4 000g LBW<2 500g VLBW<1 500g ULBW<1 000g

Neonatal terminology Weight for gestation SGA small for gestational age growth parameter below 10 th percentile AGAappropriate for gestational age Growth parameters between 10 th and 90 th percentile LGALarge for gestational age Growth parameters above 90 th percentile

Neonatal terminology Chronological age age in weeks or months from date of delivery Corrected age premature infants where the number of weeks born prematurely have been deducted from the chronological age

So when do we stop correcting age? Controversy still exists where between ages of 12/12 and 18/12 one should stop correcting for age Decide on an age for your clinic and be consequent in applying it in your assessments

Apgar Score Scoring system developed by Dr. Virginia Apgar in 1960’s This score /10 is used to evaluate the infant’s physical condition after birth –pulse, crying, respiration, HR, activity Score is taken a 1 minute, 5 minutes and 10 minutes after birth.

Apgar Score Scores0 12 Heart rate Absent ≺ 100/min ≻ 100/min Respiratory rate AbsentWeak Strong cry Muscle tone Flaccid Some flexion Good flexion Reflexes No response Grimace Cough/ sneeze Colour Pale/ blue BluePink

Hypoxic Ischaemic Encephalopathy (HIE) or neonatal asphyxia Insult to the foetus or newborn due to a lack of oxygen (hypoxia) and/or perfusion (ischaemia) to various organs Staged according to the Sarnat & Sarnat classification system: grade I (mild) Grade II (moderate) Grade III (severe) Stage II and III are usually accompanied by convulsions and neurological dysfunctions Stage I associated with a normal outcome

Head circumference Microcephalic Abnormally small head size in relation to the body e.g. brain atrophy Macrocephalic Abnormally large head size in relation to body e.g. hydrocephalus Head circumference is measured with a tape measure around the broadest part of forehead Measured at developmental follow up and charted on a chart in relation to age. Good indicator of if the brain in growing appropriately for age

Head size in an infant...interesting fact Higher ratio to the head size versus rest of body weight Infant brain =30% total bodyweight Adult brain = 3 % total bodyweight

Head circumference

WEIGHT AND HEIGHT TERMINOLOGY

Weight and height terminology Weight Child’s weight in g or kg used to evaluate physical growth Reflects on immediate nutritional status of child Underweight for age may indicate acute or more chronic nutritional problems

Weight and height terminology Length/Height Child length in cm or m is measured Length for age <3 rd percentile child is considered to be stunted or of short stature Stunted growth usually indicates a longer term and more chronic nutritional problem

EVALUATION OF GROWTH

Growth Charts Normal distribution curve over a spectrum of ages for weight and height Different charts for boys and girls Charts differ for gender and age WHO/ CDC 2000 charts available at most clinics or on the Road to Health charts carried mothers

Interpretation of growth charts Health professionals must be able to interpret charts Monitor growth and development over time Trend over time more important single reading Road to health card/ clinic card Every month during first year and every six months during second year life 50 th percentile = % of expected growth Low values weight may indicate an acute or chronic problem Low values for height for age indicates a chronic problem

CHILDHOOD STATISTICS

Mortality rates 33% of the South African population under age of 15 years Investment in the health and wellbeing of the children of South Africa is an investment in the future development of our country The mortality rates are a fundamental indicator of –child health in the country,and –understanding the causes of death of children and identifying how the numbers can possibly be reduced

Mortality rates Child health has been identified as a priority by the WHO and the national DOH. Many childhood deaths are preventable.Therefore the reduction in childhood mortality, especially in children under age of 5 years has gained much priority in South Africa: –Improved maternal health and antenatal care provided to mothers –Better perinatal and neonatal care provided baby –Reduction in the transmission rate of HIV from mother to child –Reduction in the number of road traffic accidents and violent crime

Interpreting perinatal statistics Liveborn infant : foetus over 500g, irrespective of gestational age born, who shows signs of life Stillborn infant: foetus over 500g, irrespective of gestational age born, who shows no evidence of life

Interpreting perinatal statistics Perinatal mortality rate: probability of a child (stillborn and live born) dying within the first seven days of life, per 1000 births. The perinatal period commences at 22 completed weeks of gestation and ends seven completed days after birth.(47/1000) Neonatal mortality rate : probability of infants dying before age of 1 month, per 1000 live births (SA ranked 19); (21/1000) Infant mortality rate: probability of children dying between birth and one year of age 1000 live births. (SA ranked 43) Under-five mortality rate - Probability of dying between birth and exactly five years of age, per 1000 live births. (ranked 62); (57/1000) (UNICEF Statistics, 2011)

Top causes of death in children under age of 1 year in South Africa 1 HIV related diseases 2 Low birth weight 3 Diarrheal diseases 4 Perinatal respiratory disease 5 Lower respiratory tract infections 6 Neonatal infections 7 Birth asphyxia & birth trauma 8 Protein energy malnutrition 9 Congenital heart disease 10 Neural tube defects

Top causes of death in children under age of 5 years in South Africa Rate dropped from 60 to approximately 40 per 1000 children, the 10 top causes in order of priority are: 1 HIV related diseases 2 Low birth weight 3 Diarrheal diseases 4 Lower Respiratory tract disease 5 Protein energy malnutrition 6 Neonatal infections 7 Birth asphyxia & birth trauma 8 Congenital heart disease 9 Motor and pedestrian vehicle accidents 10 Bacterial meningitis

Top causes of death in children under age of years in South Africa 1 HIV related diseases 2 Road traffic accidents 3 Homicide/ violence 4 Diarrhoeal disease 5 Fire 6 Lower respiratory tract infections 7 Meningitis 8 Tuberculosis 9 Nervous system disease 10 Protein energy malnutrition

Road to Health Chart Road to Health chart / Baby card is a card issued by ward or clinic service providers on first contact Instrument that can be used by health professionals to monitor development Card is kept by mother and she should carry it whenever attending any healthcare services

Road to Health Chart This card provides information regarding: –Perinatal history (gestation, birth weight, length, Apgar Scores, method of delivery, mothers serology) –Growth & development aspects (growth charts) –Immunisations –Vitamin supplementation –Brief summary on illness & disease Mothers are to keep the child for as long as possible throughout childhood and into adulthood as contains valuable information

References Images courtesy of GOOGLE (2011) Growth and Development. In Coovadia, H.M. & Wittenberg, D.F. (eds) in Paediatrics and Child Health. A manual for health professionals in developing countries. 4 th ed. Oxford city Press: Cape Town pp Van der Vyver, A.E. Normal Growth in Paeditric doctors lectures for Physiotherapy students. (Unpublished) Goldson, E. & Reynolds, A. Child development and Behaviour Hay, W.W.; Myron, J. L.; Sondheimer, J.M. & Deterding, R.R. (eds). In current diagnosis and treatment in Paediatrics. 18th ed. McGraw-Hill companies: NewYork pp65-101

References Aubert, E.J. Motor development in the normal child in Pediatric Physical Therapy. Tecklin, J.S. (Eds) in Pediatric Physical Therapy. Lippincott, Williams & Wilkins. Baltimore pp Smith, R Paediatric dictate, UFS (Unpublished) Smith, R Normal development (Class notes, Unpublished) UNICEF/ Medical Reasearch Council of South Africa. Bradshaw, D; Bourne, D & Nannan, N. What are the leading causes of death in children in south Africa available online at; National Department of Health Road to Health Chart Tshabalala, MD Introduction to child health. History and physical examination. University of Pretoria, Department of Physiotherapy