Growth and Development

Mean-2SD Mean+2SD 2.5% 47.5%

Neonatal Period (1 st 4 Week of life): Prone: Flexed Supine: Flexed Visual: Doll’s eye,Fixate in line of vision Reflex: Moro,Grasp,Stepping, Placing

At 4 Week of life: Prone: Extend Supine: Tonic neck Visual: Follow Social: Begin to smile

At 8 Week of life: Visual: Follow 180 degree Social: Smile to social contact

At 12 Week of life: Prone: Lifts head and chest Sitting: Early head control Social: Says aah,ngah

At 16 Week of life: Supine: Symmetric,Grasp object, Bring to mouth Sitting: No head lag Social: Laughs out loud

At 28 Week of life: Prone: Roles over, Crawl Sitting: With support, Transfer Standing: Support most of weight Language: Polysyllabic vowel Social: Prefer mother

At 40 Week of life: Prone: Crawl Sitting: Sits up alone Standing: Walks holding on furniture Social: Response to sound of name

At 52 Week of life: Walk: Take several steps

At 15 months of life: Walk: alone Crawl: Upstairs Play: 3 cubes

At 18 months of life: Walk: Upstairs Language: 10 words,1-2 part of body Play: 4 cubes

At 24 months of life: Walk: Runs well,downstairs, Jumps Language: 3 words together Play: 7 cubes Handle spoon well, Listen to story

At 30 months of life: Refers I Full name

At 36 months of life: Ride tricycle Stand on one foot Copy circle Wash hands Age and sex

At 48 months of life: Copy cross and square Tell a story Play with children Go to toilet alone

At 60 months of life: Draw triangle Names 4 colors Count ten coins Dressing

Failure to Thrive (FTT)

Failure to thrive(FTT): Weight< 3% Drop of weight percentile Weight/Height < 5% Weight < 80% Median for Height

Kwashiorkor: Inadequate protein diet Pitting edema Complication of critical illness Weight 60-80% for age Skin sign

Marasmus: The most common form of PEM Severe caloric depletion Secondary to diseases Weight below 60% for age Inappropriate weaning

In most children with FTT, both organic and inorganic risk factors are present.

Early Infancy: Feeding difficulties: 1)Lactation failure 2)Inadequate feedings 3)Formula mixing error 4)Inadequate calories

Diagnosis: History and Observation Tests: 1)CBC,ESR,U/A,Serum electrolytes 2) S/E, S/C, Ph, Reducing substances, Guiac test

Treatment: Hospitalization Ambulatory 120 Kcal/24h X med weight/Height Vitamins & Minerals

Recovery : Positive mood changes Weight gain

Prognosis: Non organic FTT in first 2 year At 3-11 years: Retardation(15-67%) Learning Problems (37-67%) Behavioral disturbances (28-48%)

Obesity:

BMI: Weight(Kg)/ Height 2 (m)

Obesity Definition: Overweight:Weight> 85 th Percentile BMI > 25 BMI > 85 th percentile Obesity: BMI > 30 BMI > 95 th percentile

Obesity in adulthood Family history TV watching Dietary intake

Treatment: 30% decrease in calories intake Starting Kcal/day Very low calorie diet or protein modified fast Pharmacotherapy Surgical therapy