doc reyes - growth and dev't

7/31/2019 Doc Reyes - Growth and Dev't

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GROWTH AND DEVELOPMENTSheryl Dell Carag Reyes MD

Department of Pediatrics

#vlbdatud

GROWTH - Increase in size and mass

- quantitativeWeight = kgs

Height = cms

Head circumference = cms

DEVELOPMENT Increase/enhanced function, maturation and

skills

- Differentiation- Qualitative- Motor, language and body maturation

FACTORS AFFECTING GROWTH & DEVELOPMENT

1. Biologic Influencesa. Genetic factorsb. Prenatal factorsc. Postnatal factors2. Psychological factorsa. Influence of child-rearing environmentb. Attachments

3. Social factorsa. Family factorsb. Influence outside of the mother-child dyad

MILESTONES OF PRENATAL DEVELOPMENT

wk developmental events:_______________________

1 Fertilization & implantation,

Beginning of embryonic period

2 Endoderm & ectoderm appear

3 First missed menstrual period,

Mesoderm appears

Somites begin to form

4 Fusion of neural folds

Folding of embryo into human-like shape

Arm & leg buds appear

Crown-rump length = 4-5 mm

5 (+) Lens placodes, primitive mouth, digital rays on hand

6 (+) Primitive nose, philtrum, primary palate

CRL = 21-23 cm

7 Eyelids begin

8 Ovaries & testes distinguishable

9 Fetal period beginsCRL = 5cm, wt = 9 g

10 External genitals distinguishable

20 Lower limit of variability

wt = 460g, length = 19 cm

25 3rd

trimester begins

wt = 900g, length = 25 cm

28 Eyes open, fetus turns head down

wt = 1,000g

38 Term

PERIODS OF GROWTH

Prenatal 0-280 daysPostnatal

A. Infancy Birth to 2 yrs- Neonate 1st 4 wks after birth- Infant, nursing 1styear- Toddler, transition,

run-about 2 yrs

B. Childhood 2-10 yrs (girls)2-12yrs (boys)

- Early childhood/preschool 2-6 yrs- Late childhood/school age 6-10 yrs(G)

6-12 yrs (B)

C. Adolescence 10-18 y/o(G)12-20(B)

- Prepubescent 10-12(G)12-14 (B)

- Pubescent 12-14 (G)14-16 (B)

- Puberty 13 (G)15(B)

- Postpubescent 13-18 (G)16-20 (B)

ORGAN GROWTH & DEVELOPMENT:

Muscles

Largest increment: 4th mo AOG early maturity Relation to body size:

- mid-pregnancy 1/6- birth 1/5 to - adolescence 1/3- adulthood 2/5

Strength doubles between 12-16 yrs Growth in muscle mass follows chronologically the

maximal growth in height


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Skin Appendages

3RD

fetal mo: (+) hair matrix

(+) sebaceous & apocrine glands

5th

fetal mo: (+) eccrine sweat glands

@birth : (+) lanugo

1 mo old : (+) sweat glands for temp regulation

2 y/o : scalp hair lost & replaced by permanent hair

Pubescence &

adolescence: pubic & axillary hair

Subcutaneous Fat:

- appears : last 3 months AOG- doubles : 1st year of life

*increases in amount during adolescence

Brain Growth

- Rapid brain growth during infancy & childhood- Relative brain size to total body wt:

2nd

fetal mo 50%

Birth 10%

5 years 5 %

Adult 2%

Sensory

Vision not well developed at birth

- birth 20/400- 1 mo regards- 3 mo fixation/tracking- 3-7 mos binocular- 3 y/o 20/30- 4 y/o 20/20 (3-5 yrs)

Auditory functional from birth

*6 mos localizes sounds

Tactile

- no pain sensation during 1st wk of life- more localized response to pain during the next

months

Taste

NB : unable to distinguish flavors

3 months : acute taste discrimination

Olfactory present at birth; more acute in the later stage

OTHER SYSTEMS

Digestive system :

Gastric capacity:

- birth 30-90 ml- 1 mo 90-150 ml- 1 yr 210-360 ml- 2 yrs 500-750 ml- late childhood 750-900 ml- later- depends on habit of individual

Urinary system:

- NB may not normally void in 1st 12-24 hrs- 5-6 yrs mature function observed

Lymphatic system :

- peak of increase 6-7 yrs- spleen largest lymphoid organ

DENTITION:

- Hard tissue formation: 4 months- No. of teeth : age in months 6- Teeth eruption & shedding: G > B- Primary teeth: central incisors, maxillary- Permanent teeth: erupts at 6 7 yrs

1st

molars & incisors

*If w/ no teeth >12 mos check thyroid, parathyroid & other

ectodermal derivatives

MEASUREMENTS:

At birth- weight : 3000 gms- height : 50 cms- Head circumference: 35 +/- 2 cms

NB : weight may drop 10 % during 1st wk- regains or exceeds BW by 2nd wk- gain 30 gms/day during 1stmonth

Height :- 8-12 yrs : girls surpass boys- 14 yrs : boys take the lead- Females enter growth spurt 2 yrs earlier than boys

MEASURING WEIGHT ACCURATELY

Make sure that the scales are placed on a hard surface You will need to turn the scales on and wait until they

show zero.

Then ask the child to step onto the scales. Their feet need to be in the centre of the scales. You may need to move the child to get them in the

correct position.

Check they are not holding on to a wall or table. Place their arms down by their side. Double check the position of their feet and arms. Ask them to look straight ahead and to stand still. Wait until the scales settle at a reading and record the

weight immediately.


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WEIGHT :

Formula for Average Approximate Weight:

age kilograms

Infant CC- 6 months : HC = CC- 1 yr : HC < CC

HEIGHT

If a child is < 2 y/o , measure RECUMBENT LENGTH

If a child is > 2 y/o and able to stand measure the STANDING

HEIGHT

Standing height is 0.7 cm less than RECUMBENT LENGTH

- height length add 0.7- length height substract 0.7

BLOOD PRESSURE

Pediatric Nephrology Ssociety of the Philippines:

- routine BP for children starting 3 y/o- *Regardless of age forill and at risk patients

Normotensive- < 90th percentile for age , gender and height percentile

Prehypertension- average SBP or DBP levels that are 90

thbut < 95

th percentile

- Adolescent: BP 120/80PULSE RATE

age lower limits average upper limits

newborn 70/min 125/min 190/min

1 11 mos 80 120 160

2 y/o 80 110 130

4 y/o 80 100 120

6 y/o 75 100 115

8 y/o 70 90 11010 y/o 70 90 110

RESPIRATORY RATE

age normal rate

< 2MONTHS < 60 / min

2 12 MONTHS


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FONTANELS :

3 mos : posterior fontanel closed 6 mos : fibrous union of suture line occur,serrated

edges interlock

20 mos : anterior fontanel closed 8 yrs : ossification of craniobasal bone compartment 12 yrs : sutures cannot be separated by increased ICP 20 yrs : sutures no longer visible in radiograph 8th decade : solid bony union of all sutures

DEVTAL REFLEXES :

reflex appears disappears____

Moro birth 5-6 months

Rooting birth 3 months

Tonic Neck birth 5-6 months

Palmar grasp birth 6 months

Plantar grasp birth 9-10 months

Landau 6-8 months

Parachute 6-8 months persists

Moro reflex :

- Response : Abduction of arms, Adduction (embrace),Flexion of legs ; crying

- Should always be symmetrical- If assymetrical response:

a. central or peripheral nervous system lesion

b. injury to bone or muscle

Rooting reflex :

- onset : 28 wks GA- Disappears : 3-4 months- Elicited by: stroking the cheek or corner of infants

mouth

- Response : infants head turns toward the stimulus &opens its mouth

Babinski response (plantar):

- Stimulus : firm, painful stroke along the lateral borderof the sole from heel to toe

- Positive response : flexion or extension of the big toethen fanning of the other toes

- Evident until 2 yrs of age- If (+) beyond 2 yrs : indicative of pyramidal tract lesion

Tonic neck reflex :

- Onset : 35 wks GA- Well established : 4 wks PCA- Disappearance : 5-6 mos- Elicited by: rotating the infants head from midline to

one side

- Response : extending the arm on the side to which thehead is turned & flexing the opposite arm. The lower

extremities respond similarly.

Palmar & plantar grasp reflex :

- Elicited by : placing finger on the palmar surface ofinfants hand

- Response : infants hand grasps the finger; attempts toremove the finger result in the infant tightening the

grasp

Stepping reflex :

- Onset: 35-36 Wks gestational age- Well established : 37 wks GA- Elicited by : touching the top of infants foot to the

edge of a table while the infant is held upright

- Response : infant makes movements that resemblestepping

Parachute reflex:

- Elicited by : infant is held in vertical suspension &suddenly lowered toward a flat surface

- Response : forward extension of both arms &dorsiflexion of the infants hands during the movement

PRINCIPLES OF DEVELOPMENT:

a.

Continuous process: birth to maturityb. Sequence : same for all children, but the rate variesfrom child to child

c. Intimately related to maturation of nervous system.d. Generalized mass activity replaced by specific

individual responses

e. Primitive reflexes have to be lost before the voluntarymovement is acquired

REQUIREMENTS FOR SATISFACTORY DEVT:

- Well formed & functioning nervous system- Opportunities to learn and act- Environment appropriate and adequate nutrition at all

stages- Challenges & rewards

BEHAVIORAL THEORIES AND MODELS

A. Piagets Cognitive Theory


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B. Ericksons Psychosocial Stages

C. Kohlbergs TheoryLevel 1: Preconventional

D. Psychosexual theory (FREUD) Infancy (0-1yr) Oral stage

- food, love, care,- nurturance, dependency

Toddler(2-3yr) Anal stage- control, power- limits

Preschool(3-6yrs) Oedipal stage- Boyness/girlness

- Masculinity/femininity School-Age(6-12yrs) Latency

- storm of adolescence Adolescence(12-20) Genital

- true genitalityDEVELOPMENTAL DOMAINS:

1. Gross Motor Skills2. Fine Motor Skills3. Receptive Language Skills4. Expressive Language Skills5. Personal-Social Skills6. Cognitive/Adaptive Skills

MOTOR DEVELOPMENT:

- Dependent on brain maturity- Sequence : gross : cephalocaudal

fine : proximodistal

- Weakest correlation to IQCEPHALOCAUDAL PATTERN OF DEVELOPMENT:

1 mo regards

2 mos smiles

3 mos turns head

4 mos holds head

5 mos rolls over

6 mos transfers objects

7 mos sits briefly

8 mos creeps

9 mos pulls up

10 mos cruises

11 mos walks w/ support

12 mos stands alone

GROSS MOTOR :mean age milestone (mo)_____________________

3 months good head control

5 months roll over

6 months sit w/ support

8 months sit w/o support

9 months pulls to stand holding on

15 months walks alone

24 months runs well, walk up stairs 1 step at a time

36 months rides a trike, stand on 1 foot

48 months hop on 1 foot, climbs well

60 months skips

FINE MOTOR SKILLS :

- Eye-hand coordination- Sequence : proximal to distal- Coordination of small muscles- Related to self-help skills- Upper extremity & manipulative hand abilities --- eat,

dress & play

Level 2: Conventional Morality

Level 3: Postconventional Morality


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mean age(mo) milestones________________

3 mos hands open, grasps

4 reaches for objects

5 transfers objects

6 holds bottles

9 pincer grasp

12 turns pages of book

13 scribble spontaneously

2 yrs make strokes, tower of 7 cubes

3 copy circle, tower of 10 cubes3 1/2 copy cross

4 copy square

draws man w/ 2-4 body parts

5 copy triangle

6 copy diamond

9 copy cylinder

LANGUAGE DEVELOPMENT:

- Sequence : simple to complex- Correlates w/ IQ- Language delay : most common reason for referral to a

neurodev; part of most devtal disabilities

RECEPTIVE LANGUAGE:

age (mos) milestones___________ ________

1 startles, alert to sound

4 turns to noise & voice

7 respond to name

9 responds to word no

11 follows 1-step commands w/ gestures

12 follows 1-step commands w/o gestures

18 identifies 1 or more body parts

24 follow 2-step commands

36 identifies action in pictures

48 knows 4 colors60 follows 3-step commands

EXPRESSIVE LANGUAGE :

age (mos) milestones__________________

3 vocalizes & coos

6 monosyllabic babbles

8 says dada,mama nonspecifically

10 1st

words other than mama,dada

12 speaks 1st

real word

15 jargons

2 y/o 2-word phrases

3 3-word phrases

4 tells a story, speech 100% intelligible

5 uses past tense of eat,run,go

6 repeats sentence of 10 syllables,names 4 colors

COGNITIVE DEVELOPMENT:

- Learn, understand, & solve problems- Verbal & nonverbal reasoning- Meeting daily demands- Infants & toddlers: motor & language milestones- Pre-school child: reasoning abilities- School-age child : neuropsychological assessment

age (mos) milestones_________________

NB identify mothers voice & smell

3 reach for dangling ring

6 respond playfully to mirror

9 object permanence

12 understand spatial relationship

18 understands cause & effect

24 categorizes similarities

36 knows full name

48 knows colors or any letters

PERSONAL-SOCIAL DEVT :

- Personal : performance of activities of daily living- Social : interact, form & maintain relationships- Concerns would manifest as behavioral problems

age (mos) milestones______________________

3 opens mouth expectantly

6 holds bottle, finger feeds,

feeds self cracker

12 drinks well from cup,

begins to hold spoon

18 feeds self w/ spoon

2 yrs express need to go to bathroom

cooperates in dressing

3 puts on shirt & shorts

dry by night

uses fork to pierce

4 dresses w/o supervision

Brush teeth w/ assistance

5 ties shoelaces

SOCIAL DEVELOPMENT :

age (mos) milestones_________________________

3 smiles responsively6 imitates actions

9 plays patty cake, peaks a boo

12 comes when called by name

18 follows directions related to routines

2 y/o parallel play

3 likes to play make believe, demonstrates caution

4 responds to instructions, imitates tasks

5 plays games w/ simple rules (tag, hide-and-seek)

6 plays board games, domestic role playing

DEVELOPMENTAL RED FLAGS:

Limit ages : age at which you expect almost every childto have mastered a particular skill

Warning signs or signals that something may not beright.

It should not incite panic! If absent or doubtful, do further evaluation.

doc reyes - growth and dev't

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