小儿生长发育GrowthandDevelopment

小儿生长发育GrowthandDevelopment第1页/共79页

Growth:definedasanincreaseinsizeofbody,biologicalgrowthofanorganismtakesplacethroughcellmultiplication,thismorphologicalgrowthcanbemeasuredclinically.第2页/共79页theenlargementoftheorganandthesystemmorphologicalgrowthcanbemeasuredbyexactvalues第3页/共79页Development:Agradualchangeandexpansion;advancementfromalowertoamoreadvancedstageofcomplexity;increasedcapacitythroughgrowth,maturation,andlearning第4页/共79页AnincreaseincompetenceandadaptabilityAQUALITATIVEchangeFunctioningatahigherlevel第5页/共79页

Thus,sincebothprocessesarepartofonewhole,thecombinedtermsgrowthanddevelopmentformanunitaryconceptthatindicatesthequatitativeandqualitativeofmaturationalchangesofanorganism.第6页/共79页GrowthisacontinuousandorderlyPROCESS第7页/共79页weightheightAge(y)FMMF第8页/共79页Notalltissuesystemsofthebodygrowatthesamerate第9页/共79页第10页/共79页VariabilityNoteveryoneisalikeinthewaythattheygrowPercentilegrowth/standarddeviationtothenormRacialandethnicdifferencesBoysvsGirls第11页/共79页FactorsInfluencingGrowthHeredityNutritionGenderDiseaseEnvironmentHazardsSocioeconomicinfluences第12页/共79页GrowthCurvesBoys:2to18yearsGirls:2to18yearsBoysreachmostoftheirheightatageof17whereasgirlsreachtheirsataround15第13页/共79页IndicesofGrowth

Bodyweight(kg)theweightofaperson’sbody.theweightofalltissues,organsandbodyfluids.oneindicatorofthenutritionalstatusofchild.thebasisofdrugdosageandamountofinfusion.第14页/共79页1、Thefirstgrowthspurtoccursinthefirstyearoflife(theincrementisabout6kg).PatternsofWeightIncrement2、Growthisnotatthesamerateindifferentage:Theincrementofweightduringthefirst3monthsisequaltothatofthefollowing9months.

Yearlyincrementsincreaseslowlyuntiltheonsetofpuberty.

第15页/共79页Birthweight3kgMaturebaby’sweightgainatfirstmonth1--1.5kg3—12monthsweight=(month十9)/2kg

1—6yearsweight=age×2十8kg7—12yearsweight=age×7-5/2kg第16页/共79页Aboutformulae:

Theseformulaeareusedonlyforcalculatingdosageofdrugandfluidinclinic.Becausethegrowthisnotatthesamerateindifferentage,especiallyininfant;andthegrowthisaffectedbymanyfactors,suchasgene,environmentandindividualvariation.Attention第17页/共79页Weightloss:Physiologicalweightloss:3-9%recoverat7-10thday

Lossof3%~9%ofbirthweightinthefirstfewdaysoflifeisconsiderednormalandiscommonformostnewborns.第18页/共79页Height(cm)ThelengthfromvertextoplantaeTheindexoflongtimenutritionalstatus第19页/共79页Theheightforinfantsuptothreeyearsshouldbemeasuredasrecumbentlengthusingaproperlyconstructedmeasuringdevice.Heightmeasurementsforchildrenoverthreeyearsofageshouldbeaccomplishedusingverticalmeasuringboardorfixedwalldevice.第20页/共79页Length/Stature---

Stature---

Length<3y≥3yStand

Supine第21页/共79页atbirth50cm1yearold75cm2yearsold85cm2--12yearsold=age×6+77第22页/共79页Thefirstgrowthspurtoccursinthefirstyearoflife(theincrementisabout25cm).

Growthisnotatthesamerateindifferentage:Theincrementofweightduringthefirst3monthsisequaltothatofthefollowing9months.

Yearlyincrementsincreaseslowlyuntiltheonsetofpuberty.

PatternsofLengthIncrement第23页/共79页Shortnessmaybecausedbymalabsorption,chronicillness,psychosocialdeprivation,hormonaldisorders,familialpatterns,orsyndromeswithdwarfism.Gigantismmaybetheresultofpituitaryabnormalities.第24页/共79页Male

10yH88cm10yGHD第25页/共79页Crown-rump/Sittingheight-Crown-rumplength

Sittingheight<3ySitSupine≥3y

Theygiveameasureofthelengthoftheheadandtrunk.Itisameasurementofthedistancefromthehighestpointontheheadtothebasesittingsurface.

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Duringthefirstyearoflife,spinalincreaseisfasterthanextremities.Lateron,theextremitiesgrowatafasterratethanthetrunk,whichiscontributetothebodylengthandleadingtoagraduallychangeinrelativeproportions.第27页/共79页ChangesinOverallBodyProportions第28页/共79页HeadCircumference

HCisameasurementofperimeterofhead,fromeyebrowstooccipitalprominence.ThechangeoftheHCisrelatedwiththegrowthofbrainandskull.第29页/共79页Atbirth34cm1year46cm2years48cm5years50cm15years54cm(thesameasadult)第30页/共79页

Headcircumferenceshouldbemeasuredwithatapemeasureateachvisitduringthefirsttwoyearsoflife.

Alargeheadmaybeanearlysignofhydrocephalusoranintracranialmass.Asmallheadmaybearesultofearlyclosureofsuturesorlackofbraindevelopment.第31页/共79页chestcircumference

reprentthegrowthofthoraxandlung

atbirthCC<HC1-2cm1year

CC=HC>1yearCC－HC(cm)=age－1第32页/共79页GrowthonPubertyAtpuberty,thereisamarkedgrowthspurt(Thesecondpeakofheightvelocity,PHV),thatis,averyrapidincreaseinsizeandweight.

第33页/共79页Girlsusuallyshowingtheirpubertalgrowthspurtaroundage9~11.Forboysthesameprocessbeginsatapx.age11~13.AccordingtoTanner(1990),girlsfinishpubertalgrowthbyaboutage16whereasboyscontinuetogrowuntilapproximately18yearsofage.第34页/共79页SexualPrecocity：Secondarysexualcharacteristicsappearbeforepuberty.

Girls<8y，Boys<10yDelayedsexualmaturity：

Secondarysexualcharacteristicsdonotappearafterpuberty

Girls>14y，Boys>16y第35页/共79页Cranialdevelopment第36页/共79页Closuretimeoffontanel/sutureFontanel/suture

AtbirthTimeofclosureAnteriorfontanel1.5-2cm≦18mPosteriorfontanel0.5-0.71-2mCranialsutureSmallest3-4m第37页/共79页

Smallsizeorearlyclosure：Largesizeordelayedclosure：AbnormalityofanteriorfontanelMicrocephalyHydrocephalus,Cretinism第38页/共79页Intracranialhypertension(Encephalitis,Meningitis)DehydrationAbnormalityofanteriorfontanelBulgingfontanel：

Sunkenfontanel：第39页/共79页

Osteite(centerofossification),whichislocatednearendsoflongbones(epiphyses),withgrowthplates.Itisveryimportantforbone’sgrowthinlength.Bonedevelopment第40页/共79页Thesequenceofappearanceofsecondarycenters

第41页/共79页Boneage

Boneageisthattheageshouldbe

accordingtotheosteitenumber

fornormalchild.ThemostcommonlyusedstandardsarethoseofGruelichandPyle,whichrequireradiographsof

thelefthandandwrist;kneefilms

aresometimesaddedforyounger

children(usuallylessthan1yearold).

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AbnormalityofBoneAge

Hypothyoidism,Hypopituism

PrecocityofBA：Adrenogenitalsyndrome,Precocity

RetardationofBA：第43页/共79页DentitionPrimaryteeth:Primaryteethare20totally.Thefirsteruptionisatabout6months(4~10months).Thetimingoftootheruptionismorevariablethanotherdevelopmentalparameters第44页/共79页Delayederuptionisusuallyconsideredwhentherearenoteethbyapproximately12monthsofage.

Thelasteruptionofprimaryteethisat2~2.5yearsofage.Primaryteeth第45页/共79页第46页/共79页Delayederuption:Hypothyroidism,idiopathicDisorder:Hypothyroidism,BraindysplasiaFailingtoerupt:Ectodermaldysplasia,MechanicalblockageAbnormalityofdentalenamel:EctodermaldysplasiaAbnormalityofDentition第47页/共79页EvaluationofgrowthGrowthlevelGrowthvelocityProportion第48页/共79页EvaluationofgrowthReliableandaccuratedataSingleValueandseries

investigationreference第49页/共79页Choosingreference

Reference,basedonaNorthAmericanpopulationbyNCHS,USA,isrecommendedbytheWHOastheinternationalstandardofgrowth.第50页/共79页Choosingreference

Besides,therearemanylocalornationalreferences,forexample,physicalgrowthindicesof9citiesinChina.第51页/共79页MethodsofassessmentReferencetableGrowthcurve第52页/共79页GrowthCurvesBoys:2to18yearsGirls:2to18yearsBoysreachmostoftheirheightatageof17whereasgirlsreachtheirsataround15第53页/共79页AGEP3P5P10P20P30P40P50P60P70P80P90P95P9702.52.62.72.93.13.23.33.43.53.73.94.14.213.03.23.43.73.94.14.34.54.64.95.15.45.623.63.84.14.54.75.05.25.45.65.96.26.56.734.24.44.85.25.55.76.06.26.46.77.17.47.644.85.15.45.86.26.46.76.97.27.57.98.28.455.45.76.06.56.87.07.37.57.88.18.58.99.166.06.26.67.07.37.67.88.18.48.79.19.49.776.56.77.17.57.88.18.38.68.99.29.610.010.287.07.27.58.08.38.58.89.09.39.610.110.510.797.47.67.98.48.78.99.29.49.710.110.510.911.1107.77.98.38.79.09.39.59.810.110.410.911.311.5118.08.28.69.09.39.69.910.110.410.811.311.611.9128.28.58.89.39.69.910.210.410.711.111.612.012.2第54页/共79页Growthlevel

Everysinglemeasurementcanbeplottedonagrowthcurvewhichillustratestheamountofgrowthinchildrenwithindifferentagegroup.第55页/共79页Evaluationofgrowthmeanstandarddeviation：

cut-offpointx±2SDpercentile：cut-offpointP3--P97

Z

scoreZscore=(x-x)÷SD

Growthcurve：

－－第56页/共79页Example：（Weightofgirls）

P3P25

P50P75P971y～7.498.549.189.9111.37(kg)

-2SD-1SD+1SD+2SD1y～7.188.219.2410.2711.30(kg)

Theweightofaoneyearoldgirlis8.2kg.Growthlevel：XX

W/A

P3-P25

W/A

-（1SD～2SD）第57页/共79页

Growthvelocitycanshowtheprocessofgrowth.Growthvelocityismeasuredintermsofhowmuchachildgrowswithinaspecifiedperiodoftime.Growthvelocity第58页/共79页第59页/共79页NeuropsychologicalandBehavioralDevelopment第60页/共79页第61页/共79页Nervoussystemanatomicallycompleteatbirthexcept:Myelination rapidfor2years completeby7yearsPrimitivereflexesdisappearinfewmonths 第62页/共79页TheBaby’sBrain-InfantVisionDevelopmentnewborn1month2months3months6monthsadult第63页/共79页Audition

Auditionisimportantbecauseitrelateslanguagedevelopment.Ifachildhashearingloss,thechildwillhaveimpairedspeech,languageandlearningandbehaviouralproblemsstemmingfromdifficultyincommunication.第64页/共79页Newbornsprefersweettastesoversour,bitter,andsaltytastes.Theycandistinguishodorsrightfrombirthandsoonlearntoknowthesmelloftheirmother’smilkandbodies.第65页/共79页BEHAVIORDEVELOPMENT

FourAttributes

GrossmotorFinemotorLanguagePersonal—socialskill

第66页/共79页grossmotorPhysicalskillsinvolvinglargebodymovementssuchasliftinghead,walking,andjumping.第67页/共79页FineMotorPhysicalskillsinvolvingsmallbodymovements,especiallywiththehandsandfingers