2014年下学期儿童生长发育大课

1/64儿童生长发育中南大学湘雅二医院儿童医学中心罗雪梅新生儿期(0~28d)婴儿期(0~1y)幼儿期(1y~3y)学龄前期(3y~6y)学龄期(6y~12y)青春期(12~18y)AgePeriodofChildDefinitionRulesofthegrowth&developmentPhysicalgrowthNeuro-psychologicaldevelopmentGROWTH&DEVELOPMENTDefinitionRulesofthegrowth&developmentPhysicalgrowthNeuro-psychologicaldevelopmentGROWTH&DEVELOPMENTGrowth生长各器官、系统、身体的长大，量的变化，可以用度量衡测定，有相应的测量值DEFINITIONBodyweightBodylengthSittingheightHeadcircumferenceChestcircumferenceUpperarmcircumferenceDevelopment发育指细胞、组织、器官功能上的分化与成熟，机体质的变化，包括情感—心理的发育成熟过程，不能用数量指标来衡量DEFINITIONSensoryandperceptionDevelopment感知觉MotorDevelopment大运动SpeechandLanguageDevelopment语言言语Cognitive,Social-emotionalDevelopment情感

…GROWTH&DEVELOPMENTDefinitionRulesofthegrowth&developmentPhysicalgrowthNeuro-psychologicaldevelopmentAcontinuousprocess连续性Imbalancebetweendifferentsystems不均衡Generalrulesofdevelopment普遍规律Interpersonaldifference个体差异性RULESOFGROWTH&DEVELOPMENTGirlsBoysContinuousofprocessImbalancebetweendifferentsystemsGeneralrulesofdevelopment

一般规律Upper上

Lower下Proximal近

Distal远Clumsy粗

Fine细Lowergrade低级

Highergrade高级Simple简单

Complex复杂GeneralrulesofdevelopmentUpper LowerHeadup1moChestup2moUponhands4moSit7-8moStandandwalk11-12moGeneralrulesofdevelopmentProximal DistalClumsy FineGeneralrulesofdevelopmentLowergrade HighergradeSimple ComplexDrawastraightlinetodrawgraphicsSeeThinkListenAnalysisFeelJudgeGROWTH&DEVELOPMENTDefinitionRulesofthegrowth&developmentPhysicalgrowthNeuro-psychologicaldevelopmentCommonparameters&methodsBodyweight体重Bodylength/Stature身高∕身长Headcircumference头围Bodymassindex体重指数RelatedSystemsGrowthOsseousdevelopment骨骼发育Dentaldevelopment牙齿发育PHYSICALGROWTHBodyweight体重器官、系统、体液的综合重量，反映儿童生长与营养状况的灵敏指标

Criterionofgrowth&nutritioncondition

differinspeedofBWincreasetheyounger,thefasterfirstpeak:newborn-1yearsecondpeak:adolescenceBodyweight体重Bodyweight体重

Birthweight 3.2~3.3kgPhysiologicallossofbodyweight:Bodyweightdeceased(<10%ofbirthweight)overthefirst3to7daysafterbirth,andrecoveredtobirthweightby7th-10thday.Doublebirthweight:3~4moTriplebirthweight:~12mo

1~12y Age×2+8(kg)Aboutformulae

AttentionDonotbeusedingrowthassessment

Why?DifferentgrowthrateIndividualdifference

公式仅用于药量和补液计算Bodylength/stature身高∕身长指头、脊柱、下肢长度的总和，即头顶到足底的垂直长度

CriterionofbonegrowthThesameregularrulesasBW

<2-3y

shouldbemeasuredbyrecumbentlength Atbirth averages50cminfullterm 1y 75cm(increase25cm)2y 87cmDoublebirthlength:~4yTriplebirthlength:~13y 2~12y Age×7+75(cm)(5-7cm/y)

LinearGrowth---

Height---

Length<3y≥3yStand

Supine上部量

upperpart

从头顶至耻骨联合上缘下部量

lowerpart

从耻骨联合上缘至足底

＜3yrs(crown-rumplength)

Criterionofskull&spinegrowthSH/BHatbirth0.6714years0.53

下肢增长速度随年龄增长而加快坐高

SittingHeight(SH)顶臀长∕坐高Crown-rumpLength/Sittingheight-Crown-rumplength

Sittingheight<3ySitSupine≥3yDifferentialdiagnosisofshortstatureProportionate匀称型Disproportionate非匀称型20头围

Headcircumference

relatedtodevelopmentofbrainandskullmeasurementismostvaluableinthefirst2yHeadsizeisobtainedbymeasuringthegreatestoccipito-frontal(geison)circumferenceusingaflexiblebutnon-stretchabletapemeasureHeadcircumference

Atbirth 32-34cm 3months 40cm(increase6cm) 1Yr 46cm(increase6cm) 2Yr 48cm 5Yr 50cm 15Yr 54~58cmSmall—Cerebraldysplasia脑发育不良,Microcephaly小头畸形,etcHydrocephalus脑积水,etcAbnormalityofH.CIncreasetoofast—胸围

ChestCircumferenceCriterionofthorax胸&lungs肺growth

AtbirthCC32cm1year=HC

＞1yearCC＞HC上臂围

UpperArmCircumference

Criterionofmuscle,bone,fat,&skingrowthinupperarmCriterionofnutritioncondition

＜1yrgainrapidly

1-5yrsgainslowly

＜5yrs

＞13.5cmbestnutrition12.5-13.5cmbetternutrition

＜12.5cmmalnutrition体重指数

BodyMassIndexBMIis

ameasureforhumanbodyshapebasedonanindividual'smassandheightBMIisuseddifferentlyforchildrenItiscalculatedthesamewayasforadults,butthencomparedtotypicalvaluesforotherchildrenofthesameageBMI=W(kg)/H2(m)18-25(adult)

体格生长的评价Evaluation

发育水平

developmentallevel

生长速度

growthspeed

匀称程度

equabledegreeGrowthCurves

birthto36monthsBoys,weight-for-agebirthto36monthsBoys,length-for-agebirthto36monthsBoys,headcircumferencefor-age

birthto36monthsgirls,weight-for-agebirthto36monthsgirls,length-for-agebirthto36monthsgirls,headcircumferencefor-age

2to20yearsBoys,weight-for-age2to20yearsBoys,stature-for-age2to20yearsBoys,bodymassindex-for-age

2to20yearsgirls,weight-for-age2to20yearsgirls,stature-for-age2to20yearsgirls,bodymassindex-for-age

……Boysreachmostoftheirheightatageof17whereasgirlsreachtheirsataround15GrowthChartspublishedonline()Thechild‘sgrowthisdeterminedbycomparisonwithothersofthesamesexandsimilarage.NormalResultrepresentationDescendingAcceleratedNogainsSlowed

头颅骨发育GrowthofSkull颅骨缝cranialsutureclosedin3-4monsafterbirth前囟anteriorfontanelle

closedin1-2yrs后囟posteriorfontanelleclosedin6-8weeksafterbirth

前囟

AnteriorFontanelSize:

1~2cmatbirthClosureTime:

18~24m

Smallsizeorearlyclosure：AbnormalityofanteriorfontanelMicrocephaly头小畸形,etcHydrocephalus脑积水,Cretinism呆小病,etcLargesizeordelayedclosure：Intracranialhypertension颅高压(Encephalitis脑炎,Meningitis脑膜炎,etc)Dehydration脱水AbnormalityofanteriorfontanelBulgingfontanel：Sunkenfontanel：抬头坐颈曲胸曲腰曲骶曲脊柱的发育GrowthofSpine

年龄动作肌肉群脊柱弯曲3月抬头颈后肌颈前曲

6月坐腰肌胸后曲

12月走下肢肌腰前曲脊柱的发育GrowthofSpine

Endochondral软骨内:LengthIntramembranous膜内:Width长骨的发育GrowthofLongLone1-9yrsossificcenter＝age(yrs)+1骨龄：骨化中心与标准图谱比较，相当于某一年龄标准图谱时，该年龄即为骨龄长骨的发育GrowthofLongLoneBoneAge:ThenumbersandprogressivechangesofossificationcentersaremeasuredbyX-ray,andstandardizedbycorrespondingchronologicalageandsex.Ossificationcenters牙齿的发育GrowthofTeeth

6yrseruption20-30yrscompletion7-8yrsexchange乳牙

primaryteeth20

4-10monseruptioncompletionby2.5yrs<2yrsnumber＝age(mons)－(4~6)恒牙

permanentteeth32Delayederuption–>13mIdiopathic原发性,Hypothyroidism甲低,etcCrowdingorDisorder–

Hypothyroidism甲低,Braindysplasia脑发育不良,etcFailingtoerupt–Ectodermaldysplasia外胚层发育不良,Mechanicalblockage机械性阻塞,etc

牙齿的发育GrowthofTeethGROWTH&DEVELOPMENTDefinitionRulesofthegrowth&developmentPhysicalgrowthNeuro-psychologicaldevelopmentIncludingMotor,Sensory,Language,EmotionPersonalityandBehaviorpatternsIsthesameimportantasphysicalgrowthDeterminedbyaninterplaybetweennature(genetictalent)andnurture(providedbyparents)NEURO-PSYCHOLOGICDEV.PsychologicalDevelopmentAttentionMemoryThinkingImaginationEmotionPersonali