1. Growth and Physical Development of Children
Growth and Physical Development of Children. Semiotics (Main Clinical Features) of Deviation of Child’s Physical Development.
Romaniuk Oksana
MD, PhD
Associate Professor
Department of Pediatrics
Sumy State University
Medical Institute

2. Evaluation of the physical development is important for assessment of a child's health. It is necessary to understand the causes of all types of variability in the physical development.
The knowledge of regularities in the physical development is necessary for correct estimation of the physical development of children of different age; this estimation should be used for characterizing the condition of children's health.

3. Growth It is a measure of physical development and maturation.
It signifies an increase in size of the body and its various organs. Thus, it can be measured in terms of centimeters and kilograms.

4. Development It is a measure of functional or physiological maturation.
It signifies accomplishment of mental (acquisition of skills etc.), emotional (development of attidudes etc.) and social (adaptation to family and society etc.) abilities.
Unlike growth, it is rather difficult to assess development.

5. Maturation It literally means to ripen
It is described as aging or as an increase in competence and adaptability. It is usually used to describe a qualitative change, that is, a change in the complexity of a structure that makes it possible for that structure to begin functioning or to function at a higher level.

6. Physical development
is a dynamical process of growth and biological maturation of a child usually referred to as a unit, express the sum of the numerous changes that take place during the different periods of childhood.

7. Factors Influencing Growth and Development
Genetic
Nutritional
Socioeconomic
Environmental and seasonal
Chronic diseases
Growth potentials
Prenatal and intrauterine
Emotional

8. The main criteria for assessment of physical development (growth)
weight;
height (stature, head-to-heel length);
head circumference (HC);
chest circumference;
proportionality of these measurements.

9. Weight.
Body weight of fetus of 25 to 42 weeks of gestation can be calculated according to the empirical formula:
in average the body weight of 30-weeks fetus is 1300 g, for each previous week minus 100 g, for each next add 200 g.
For example:
Body weight of 26-weeks fetus equals 1300 – 1004 = 900 g;
Body weight of 35-weeks fetus equals 5 = 2300 g.

10. Measurements of a newborn child
At birth weight is more variable than height and to a greater extent is a reflection of the intrauterine environment.
The average newborn weighs 3200 to 3400 g (7 to 7.5 pounds).
Admissible limits of the norm range from 2700 to 4000 g.
Babies, whose birth weight equals more than 4000 g, are called huge.

11. General Trends in Weight Gain During Infancy
Age
(months)
Weight gain (grams)
Monthly
For the whole period 1
600 2
800
1400 3
2200 4
750
2950 5
700
3650 6
650
4300

12. Age 7 8 9 10 11 12 Weight gain (grams) (months) For the whole period
Monthly
For the whole period 7
600
4900 8
550
5450 9
500
5950 10
450
6400 11
400
6800 12
350
7150

13. Height
Body length of fetus of 25 to 42 weeks of gestation can be calculated according to formula:
L = gestation age (in weeks) + 10 cm;
Or body length of fetus of first 5 months of gestation equals:
L = (gestation age (in months)) 2.
For fetus of 6 to 9 months of gestation:
L= gestation age (in months)  5.
For example:
Body length of 32-weeks fetus equals 32+10=42 cm;
Body length of 3 months fetus equals 32=9 cm;
Body length of 7 months fetus equals 7x5=35 cm.

14. Body length of a newborn child
Birth length is influenced considerably by the prenatal environment and gestation age. It is of great value as a sign of maturity of newborn organism.
Its normal rate in neonate is 50 to 52 cm.
Admissible limits of the norm range from 46 to 56 cm.

15. General Trends in Height Gain During Infancy
Age
(months)
Height gain (grams)
Monthly
For the whole period 1 3 2 6 9 4
2.5
11.5 5 14
16.5

16. Age 7 8 9 10 11 12 Height gain (grams) (months) For the whole period
Monthly
For the whole period 7 2
18.5 8
20.5 9
22.5 10
1-1.5 11 12

17. Head circumference. Head circumference at birth is equal 34 to 36 cm.
Age HC
Infants
Birth-6 months
6-12 months
Monthly gain: 1.5 cm
Monthly gain: 0.5 cm
Children
1-5 years
6-15 years
Yearly gain:
1 cm
Yearly gain: 0.6 cm

18. Chest circumference. Chest circumference at birth is equal 32 to 34 cm.
Age
Chest circumference
Infants
Birth-6 months
6-12 months
Monthly gain: 2 cm
Monthly gain: 0.5 cm
Children
years
11-15 years
Yearly gain: 1.5 cm
Yearly gain:
3 cm

19. It is necessary to compare head circumference and chest circumference.
At birth HC exceeds chest circumference by 2 to 3 cm.
At age 4 months HC equals chest circumference.
Later, the rate of chest circumference increases rapidly, at the same time HC continues to grow at a slower rate. So, during childhood chest circumference exceeds HC by about 1 to 7 cm.

20. Methods of assessment of physical development of the child
Anthropometrical indexes
Percentile tables
Standard growth charts
Standard deviation

21. Growth chart
It is of value to have serial record of child’s weight periodically on a “growth chart”(“Road to Healh” chart) which is based on percentile curves.

22. Growth Standard Charts WHO 2006
WHO’ Growth Standards Charts were developed using data collected in the WHO Multicenter Growth Reference Study (MGRS)
MGRS collected data from 8500 children from different ethnic backgrounds and cultural settings
WHO’ Growth Standards Charts establish breastfed infant as the “normative model”
Growth Standards Charts are used to:
Monitor growth and nutritional wellbeing of each infant/child
Provide accurate estimation of the nutritional status of a group (community/nation) estimating the level of under and/or over-nutrition
Advocate for the right for all children to achieve their full potential growth

23. Growth Indicators Length/height-for-age Weight-for-age
5 Growth indicators are used to assess growth:
Length/height-for-age
Weight-for-age
Weight-for-length/height
BMI (body mass index)-for-age
Head circumference
Growth indicators should be plotted regularly on specific gender charts( different charts for boy and girl)

24. Why Mother/Family Should Know the Child’ Growth Indicators?
Mother/family are responsible for child appropriate feeding
Mother/family are the key actors for child growth
Growth charts are a good supports for mother/family for appropriate care and feeding

25. How to Read Growth Charts?
The line 0 on each chart represents the median which is, in general “the average”
The other lines are z-score lines which indicate distance from the average
also called standard deviation (SD) lines
Z-score and SD lines are numbered on the growth charts positively (1, 2, 3) or negatively (−1, −2,−3)

26. at.14 Стандартне відхилення +2 Стандартне відхилення +3
Медіана
Стандартне відхилення -2
Example of organization the growth chart weight for age.
Z-score lines on the growth charts are numbered positively (1, 2, 3) or negatively (−1, −2,−3).
Plotted point that is far from the median in either direction (for example, close to the 3 or −3 SD line) may represent a problem.
Стандартне відхилення -3
at.14

27. Weight-for-Age Chart
Weight-for-age reflects body weight relative to the child’s age on a given day
Use to assess:
whether a child is underweight or severely underweight,
but it is not used to classify a child as overweight or obese
p.p.23

28. How to Determine Weight for Age
Calculate the child's age in months
Weight the child naked or wearing light clothes
Ask the mother to help remove any coat, sweater, or shoes
Use the weight- for- Age chart, gender sensitive, to determine weight for age
Look at the left-hand axis to locate the line that shows the child's weight
Look at the bottom axis of the chart to locate the line that shows the child's age in months
Find the point on the chart where the line for the child's weight meets the line for the child's age

29. If a variety of measurements such as weight, length or HC are assessed, then a normal bell-shaped distribution curve is found.
The measurements are distributed symmetrically on each side of the mean, with a larger cluster around the mean.
Such a typical distribution curve can also be presented as a percentile chart.

30. Height Velocity
It is calculated from at least two accurate readings at a gap of 6 months (preferably one year).
A velocity of less than 4 cm per year between 5 years of age and adolescence is considered pathologic.

31. Percentiles
A specific point in a distribution curve which has a given percentage of cases above and below it.
The 50th percentile is seen as the midpoint of a normal distribution curve with 50 % of cases above and 50 % of cases below it.
The lower limit of normal is taken for practical purposes as the 3rd percentile and the upper limit as the 97th percentile. Only 3 % of normal cases fall below the 3rd percentile and 3 % above the 97th percentile.

32. A flat curve
It indicates a slowed or arrested growth which must alert the doctor to take action – both diagnostics and corrective.

33. The growth chart is primarily meant for the mother, to visualize and motivate concern for healthy growth in her child.

34. Body Ratios They can be established by the mean of different indexes:
The index of fatness by Chulitska
The index by Erismann
Weight-for-height index
Height-for-age index
Stem stature index
Span

35. Weight-for-height index
Percentage weight-for-height = Actual weight  100 divided by Expected weight for actual height

36. Height-for-age index
Percentage height-for-age = Actual height  100 divided by Expected height for child’s age

37. Stem stature index
Refers to the sitting height (crown-rump length) as a percentage of the total height:
I = SH/H  100 %
Its normal values are:
At birth
6 mo
1 yr
2 yrs
3 yrs
5 yrs
Puberty
20 yrs
70 %
66 %
64 %
61 %
58 %
55 %
52 %
53-54 %

38. Stem stature index
This index is increased in hypothyroidism and dwarfism (achondroplasia).

39. Span
It is the distance between tips of middle fingers when the arms are outstretched.
It is equal to height at 10 years.
In earlier years, it is 1 to 2 cm less than the height.
After 12 years, it is 1 to 2 cm more then height.
It is increased in spondyloepiphyseal dysplasia (Morquio disease).

40. Standard deviation (SD)
Refers to the degree of dispersion of observations around the “mean”.
The prefix (+) to the SD value indicates a dispersion to higher side whereas the prefix (-) denotes the same to lower side.
1 SD signifies that about 68 % observations lie within this range.
2 SD includes about 95 %
3 SD as high as 99.7 % of the cases.

41. Minor deviations of physical development (growth)
Failure to thrive
Short stature

42. Failure to Thrive
It is applied to infants and young children usually up to the age of 2 or 3 years, who show failure of expected growth (usually weight gain) and striking lack of wellbeing.
Simply put it describes a failure of expected normal growth and well-being.
Remember that it is a descriptive and not diagnostic term.

43. Failure to Thrive
It is also often used as synonym with the psychosomatic growth failure or maternal deprivation syndrome.
Etiology:
Poor nutritional intake and feeding problems.
Poverty, ignorance and conflict in the family.
Parental neglect.
Intestinal parasites infesting the child’s gut.
Increased loss through vomiting or malabsorption.
Poor utilization of food secondary to an underlying organic condition (e.g. Congenital heart desease) or chronic illness.

44. Short stature
It is the equal delay of height and weight gain in children in comparison to the average data. The height-weight velocity curves of such children are within the 2nd and the 3rd percentiles.
Etiology of small stature is heredity, lack of protein and vitamins intake during prenatal period and the 1st year of life.

45. Short stature
Types:
Primary short stature is usually due to an intrinsic defect in the sceletal system as a result of some genetic or prenatal damage (IUGR). Here, potential for normal bone growth is impaired though skeletal age is unaffected.
Secondary short stature is characterized by impairment of bone age and height to the same extent.

46. Midparental height
The so-called midparental height, a genetic component, gives the subject’s target height.
It is determined as sum of father and mother’s heights plus 13 in case of boys and minus 13 in case of girls.

47. Major deviations of physical development (growth)
Hypotrophy
Paratrophy
Obesity
Nanism (dwarfism)
Gigantism

48. Protein-energy malnutrition (hypotrophia)
It is a pathological state resulting from a severe deprivation, or impaired absorption, of protein or/and caloric food, which lead to weight reduction, wasting of subcutaneous fat and muscle, and stunting.

49. Prenatal (congenital): it leads to birth of low-weight-birth babies.
Aquired: as a rule, develops after 3rd month of child’s life.

50. Anthropometric classification of protein-energy malnutrition (hypotrophia )
Grades
Weight defficiency
(weight-for-height index)
Height defficiency
(height-for-age index) I
11-20 %
(90-80 % of ideal WHI) -
(95-90 %) II
21-30 %
(80-70 %)
2-4 сm
(90-85 %)
III
31 % and more
(less than 70 %)
7-10 сm
(less than 85 %)

51. Clinical classification of protein-energy malnutrition
2 main syndromes:
Marasmus
Kwashiorkor

52. Paratrophy
It is enlargement of body weight more than for 10 % of ideal weight. The main course of it is overfeeding of a baby.
According to clinical signs paratrophy is divided into 2 types: lipomatic and lipomatic-pastose.

53. Paratrophy I 11-20 II 21-30 III 31 and more Stage of paratrophy
Excessive weight (%) I
11-20 II
21-30
III
31 and more

54. Obesity
The presence of excessive weight in child older than 1 year is called obesity.
Stages of obesity
Excessive weight (%) I
10-29 II
30-49
III
50-99 IV
100 and more

55. Nanism (dwarfism)
It is a disorder of physical development, which deals with the delay of height below the 3rd percentile for age according to international standard or 3 standard deviations of mean for age.
The dwarf height in adult persons of white race is considered the height below 130 cm for male and below 120 cm for female.

56. Classification: dwarfism with proportional constitution;
dwarfism with disproportional constitution.