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Guide line for groth and development

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Guide line for groth and development

  1. 1. BY MANOJKR VERMA
  2. 2. GROWTH:  It is the process of physical maturation resulting an increase in size of the body and various organ.  It occurs by multiplication of cells and increase in intracellular substance  It is a quantitative change in body  Or refer to structural and physiological changes
  3. 3. DEVELOPMENT:  It is a process of functional and physiological maturation of the individual.  It is a progressive increase in skill and capacity to function.  It is related to maturation and myelinisation of nervous system.  It include psychological emotional and social changes  Qualitative aspects.
  4. 4. PRINCIPAL OF GROWTH AND DEVELOPMENT: Cephalocaudal direction Proximodistal direction General to specific
  5. 5. PRINCIPAL OF GROWTH AND DEVELOPMENT: Cephalocaudal direction:  Improvement in structure and function come first in the head region, then in trunk, and last in the leg region.
  6. 6. PRINCIPAL OF GROWTH AND DEVELOPMENT: PROXIMODISTAL DIRECTION: ; The process in proximodistal form centre or midline to periphery direction. Development proceed from near to far Out ward from central axis of body to ward the extremities
  7. 7. Growth and development depend upon multiple factor They influence directly or indirectly by promoting or hindering the process as • Genetic factor • Prenatal factor • Post natal factor FACTOR AFFECTING GROWTH AND DEVELOPMENT:
  8. 8. FACTOR AFFECTING CONTI…. Genetic factor: genetic predisposition is impartment factor which affect the growth and development. 1) Sex 2) Race and nationality
  9. 9. FACTOR AFFECTING CONTI…. Prenatal factor: Intrauterine environment is a important factor of growth and development as Malnutrition Maternal infection Maternal substance abuse Hormones Maternal illness
  10. 10. POST NATAL FACTOR: Growth potential Nutrition Childhood illness Psychological environment Socioeconomic status Birth order Hormonal influences
  11. 11. AGE PERIODS: Neonate:  Birth to 1 month Infant:  1month-1yr Early childhood:  Toddler 1yr-3yrs Preschool:  3yrs-5yrs Middle childhood:  School age 6yrs-12yrs Late childhood:(adolescent)  13yr-18yr image
  12. 12. ASSESSMENT OF GROWTH: Assessment of growth can be done by anthropometric measurement Measurement of different parameter is the importance nursing responsibility in child care
  13. 13. WEIGHT: Weight is one of the best criteria of assessment growth and good indicator of health and nutritional status of child. Weight at full term neonate at birth is 2.5-3.5kg There is 10% loss of weight first week of life which regain by 10 day of age.
  14. 14. WEIGHS SCALE :
  15. 15. WEIGHS SCALE :
  16. 16. WEIGHS SCALE:
  17. 17. WEIGHT:  Weight gain about 20-30 gram/day for 1st three month  Double at five month  Trebled at one year  Fourth time by two year  Five time at three year  Six time by five year  Seven time by by seven years  Ten time by ten years
  18. 18. LENGTH AND HEIGHT:  Increase in height indicate skeletal growth, yearly increment in height gradually diminished from birth to maturity.  At birth average length of a healthy new born is 50 cm.  It increases to60 cm at 3month, 70cm at 9month and 75cm at 1year  In second year increment approx 12cm  Third year aprox 9 cm  Fourth year 7cm and fifth year 6cm
  19. 19. LENGTH AND HEIGHT:  So the child double the birth by 4-4.5yr of age afterwards then is about 5cm increment in every yr till puberty.
  20. 20. LENGTH AND HEIGHT: PREREQUISITE: Without footwear Heels & back touching the wall Looking straight ahead in frankfurt plane. Gentle but firm pressure upwards applied to the mastoids from underneath Record to last 0.1cm
  21. 21. LENGTH AND HEIGHT:
  22. 22. LENGTH AND HEIGHT:
  23. 23. FORMULAS:
  24. 24.  It is an important criteria which help to asses the normal growth or its deviation ie malnutrition or obesity BI more than 30 kg/m2 indicate obesity and < 15kg/m2 indicate malnutrition BODY MASS INDEX :
  25. 25. BODY MASS INDEX CATEGORIES: Under weight <18.5 Normal=18.5-24.9 Over weight= 25-29.9 Obesity >30 or greater
  26. 26. HEAD CIRCUMFERENCE: It is related to brain growth and development of intracranial volume. Average head circumference measured about 35cm at birth Increase as 0-3month 2cm/m 3-6month 1cm/m 6-9month 0.5cm/m 9-12month 0.5cm/m 1-3yrs 0.2 cm/m
  27. 27. HEAD CIRCUMFERENCE: If head circumference increase 1cm in two week during first 3month of age then hydrocephalus is suspected. Head circumference is measured by ordinal tape it over occipital protuberance at the back, above ear on side just over the supra orbital ridges in front.
  28. 28. MEASUREMENT OF HEAD CIRCUMFERENCE:
  29. 29. MEASUREMENT OF HEAD CIRCUMFERENCE:
  30. 30. MEASUREMENT OF HEAD CIRCUMFERENCE:
  31. 31. FONTANELLES CLOSURE: At birth anterior and posterior fontanelle generally present Posterior fontanelle close early few week 6- 8wk of life. Anterior fontenelle closes by 12-18month of age Early closure of fontanelle indicate craniostenosis due to premature closure of skull sutures.
  32. 32. FONTANELLES CLOSURE:
  33. 33. CHEST CIRCUMFERENCE:  Chest circumference or thoracic diameter is an important parameter assessment of growth and nutrition status.,  At birth it is 2-3cm less than head circumference  Become equal at 6-12month of age.  After 1st year of age , chest circumference is greater than head circumference by 2.5cm.  about 5years, it is about 5cm larger than head circumference
  34. 34. CHEST CIRCUMFERENCE:  Chest circumference is measured by placing the tap at level, around the nipple, in between inspiration and expiration 
  35. 35. CHEST CIRCUMFERENCE:
  36. 36. MID UPPER ARM CIRCUMFERENCE: Measurement help to asses nutritional status of younger children The average mid upper arm circumference at birth 11-12cm At 1-5 year it is 16-17cm At 12 year it is 18cm At 15year it is 20-21cm
  37. 37. MID UPPER ARM CIRCUMFERENCE:
  38. 38. MID UPPER ARM CIRCUMFERENCE:
  39. 39. MID UPPER ARM CIRCUMFERENCE:
  40. 40. MID UPPER ARM CIRCUMFERENCE:
  41. 41. ERUPTION OF TEETH: Their is the variation in the eruption of teeth , 1st teeth appear is central incision appear at 6-7 month of age. Eruption can be delayed up to 13month Two set of teeth Tempo rary perm anent
  42. 42. ERUPTION OF TEETH: Upper jaw teeth erupt earlier, except the lower central incisor 1st molar >central & lateral incisor >canines & premolar> 2nd molar> 3rd molar
  43. 43. SKINFOLD THICKNESS:  Skin fold consist of double fold of skin and subcutaneous fat, excluding the under lying muscle.  Used mainly in the estimation of fat content  Common sites are triceps, subscapular. Tools for measuring skinfolds: Skinfold caliper: 1) Lange 2) Holtain 3) harpenden
  44. 44. UPPER AND LOWER SEGMENT LENGTH &RATIO:  Lower segment measured as the length between pubic symphysis a and the heel.  Upper segment is calculated by the subtracting lower segment length from stature.  Ratio of upper and lower segment is 1.7 at birth, at 3year 1.3, by 7-8 year upper segment equalizes the lower segment.
  45. 45. UPPER AND LOWER SEGMENT LENGTH &RATIO: Increase:  Rickets,  achondroplasia,  Untreated hypothyroidism Decrease:  spondyloepiphyseal dysplasia,  vertebral anomalies By about 11 years of age, adult proportions are reached
  46. 46. ARM SPAN:  Distance between the tips to middle fingers of both arms out stretched at right angle to the body & measure across the back of child.  < 10years 1-2cm less than the body height  10-12years span equal to height  Adult span greater than the height Abnormally large span found in:  Klinefelter’s syndrome  Coarctation of aorta  marfan’s syndrome
  47. 47. ARM SPAN:
  48. 48. PUBERTAL ACHIEVEMENT: Gonadal maturation Secondary sexual characters Adolescent growth spurt Body composition and proportion Skeletal maturity
  49. 49. SEXUAL MATURITY:
  50. 50. AGE INDEPENDENT ANTHROPOMETRIC INDICATORS: Bangle test: If a bangle of 4 cm Internal diameter crosses elbow Shakir’s tape: Plastic tape with color zones –Red if < 12.5 cm Quac stick : Rod with markings for Height and Arm circumference. Nabarrow’s thinness chart : Graphic chart for Wt/Ht MAC:HC (Kanawati) ratio: 0.28-0.314 : Mild ; <0.249 : Severe MAC : Height ratio : Normal if >0.32 ; Severe malnutrition if <0.29 Ponderal index : Weight (in kg)/ length 3(in cm) x 100 ; Normal if >2.5 ; Symmetrical IUGR 2.0 -2.5 ; Asymmetric IUGR < 2.0 Dughadale ratio : Weight (in kg)/ height 1.6 ; Normal if >0.79 ;
  51. 51. Z- SCORE OR STANDARD DEVIATION SCORE:  The deviation of the value for an individual from the median value of the reference population, divided by the standard Deviation for the reference population ( Observed value) - (Median reference value) Z- Score = -------------------------------------------------------- Standard deviation of reference population  A fixed Z score interval implies a fixed height or weight difference for children of a given age .  Advantage:- Allows mean and SD calculation for a group of Z score in population based applications.
  52. 52. PERCENTILE:  The rank position of an individual on a given reference distribution, stated in terms of what percentage of the group the individual equals or exceeds . Eg. A child of a given age whose weight falls in the 10th percentile weighs the same or more than 10% of the reference population of children of same age  Towards the extremes of the reference distribution there is little change in percentile values, when there is infact substantial change in weight or height
  53. 53. STANDARD DEVIATION: Denote the degree of dispersion or the scatter of observation away from the mean Approximately two third (68.3%) of observation lie within one standard deviation above or below the mean value of the observation 95.4% value lie within 2SD 99.75 value lie within 3SD Value beyond the 2SD are unusual in a normal population
  54. 54. GROWTH MONITORING AT:
  55. 55. CHARTS AND INTERPRETATION:  x-axis: In the Growth Record graphs, some x-axes show age and some show length/height.  y-axis: In the Growth Record graphs, the y-axes show length/height, weight, or BMI.  plotted point– the point on a graph where a line extended from a measurement on the x-axis (e.g. age) intersects with a line extended from a measurement on the y-axis (e.g. weight)
  56. 56. GROWTH PARAMETERS AND THEIR INTERPRETATION FOR THE WORLD HEALTH ORGANIZATION CHARTS:
  57. 57. CHARTS AND INTERPRETATION:  What are these growth charts?  Growth charts are visible display of child’s physical growth and development.  Also called as “road-to-health" chart. It was first designed by David Morley and was later modified by WHO.  A growth reference simply describes the growth of a sample of individuals, whereas a standard describes the growth of a healthy population and suggests an aspirational model.
  58. 58. CHARTS AND INTERPRETATION:  WHO growth charts are growth standards. A reference is representative of the existing growth pattern of children and allows us to study the secular trends in height, weight and obesity.  On community and national level it helps identify children at risk of morbidity and mortality. It thus helps in implementation of national programmes for nutritional and medical interventions like supplementary feeding, foods to vulnerable group,
  59. 59. CHARTS AND INTERPRETATION:  Can reflect changes in morphological variation due to inappropriate food intake or malnutrition  There is no single permanent standard. bcoz-Uniform growth pattern is not seen to occur equally all over the world and also in subsequent generations.  50th percentile of Harvard Standards (1970s) is considered 100% for Indian children. If a child is at 5thpercentile it means 5% children of that age have less weight or growing less fast than this child.
  60. 60. CHARTS AND INTERPRETATION:  These growth charts are primarily designed for longitudinal follow up of a child(growth monitoring), to interpret the changes over time  NCHS 1977 growth charts  CDC 2000 growth charts  WHO Growth Charts (2006)
  61. 61. CHARTS AND INTERPRETATION:  NCHS GROWTH CHART:(National Center for Health Statistics ) 1977  Using longitudinal-data from the Fels Research Institute,  collected in Yellow Springs and Ohio between 1929 and 1975  Its sample was acknowledged to be quite limited in geographic, cultural, socioeconomic and genetic variability.
  62. 62. CDC 2000 GROWTH CHARTS Two set of chart  birth to 36 months of age  2 to 20 years.  BMI-for-age 2 to 20 years(not in NCHS ) 1. National Health and Nutrition Examination Surveys (NHANES), 2. National Natality Files 3. NatalityFiles in Wisconsin and-Missouri, 4. The CDC Pediatric Nutrition Surveillance System, 5. The Fels Research Institute child growth study The primary source of data for the infant charts up to age 6 months was NHANES III.
  63. 63. characteristic NCHS 1977(Fels research institute) CDC 2000( Third National Health and Nutrition Examination survey) Location Within a convenient distance of Yellow Springs, Ohio U.S. nationwide, non- institutionalized Population Study design Longitudinal follow up Cross sectional survey Years of data collection 1929-1975 1988-1994 Exclusion criteria Triplets excluded VLBW(<1500g) excluded COMPARISON BETWEEN NCHS AND CDC CHART:
  64. 64. characteristic NCHS 1977(Fels research institute) CDC 2000( Third National Health and Nutrition Examination survey) Socio-economic background Middle class Representative of US Racial/ethnic background Caucasian Representative of U.S. - matches census distribution for non- Hispanic white, non- Hispanic black, and Mexican American, Other racial groups subject to random variation. Ages Measurements made at Birth, 1,3 and 6 month Cross-section of population spanning 2 to 6 months of age.
  65. 65. characteristic NCHS 1977(Fels research institute) CDC 2000( Third National Health and Nutrition Examination survey) Infant feeding pattern Nearly all formula fed Brest feed and formula feed Anthropometric data quality All measurements well- standardized. Data quality considered high. Large discrepancies between length and stature data have raised questions about the quality of the recumbent length data All measurements well-standardized [Lohman et al. 1988] Data quality considered high
  66. 66. ADVANTAGES OF CDC 2000 GROWTH CHART  Most importantly the 2000 charts were representative, of all (non-VLBW) infants in the U.S., not a select group of middle-class.white infants in a, small US community  Extent of breastfeeding in the NHANES III. sample was certainly greater than was the case for the Fels study sample Disadvantage of CDC 2000 Growth Charts pooling of multiple datasets to construct the curves. Though great care to ensure the comparability of the datasets being pooled, we cannot rule out,the possibility that the shape of the curves was affected by using different datasets at different ages.
  67. 67. WHO GROWTH CHART:  In 1993 the World Health Organization (WHO) undertook a comprehensive review of the uses and interpretation of anthropometric references  Did not adequately represent early childhood growth and that new growth curves were necessary.  The World Health Assembly endorsed this recommendation in 1994.  In response WHO undertook the Multicentre Growth Reference Study (MGRS) between 1997 and 2003 to generate new curves for assessing the growth and development of children the world over.
  68. 68. WHO GROWTH CHART:
  69. 69. MGRS STUDY DESIGN YEAR  Longitudinal (0-24 months)  Cross-sectional (18-71 mo)  WHO Multicentre Growth Reference Study (2006)After the age of 5 years, the WHO extended the MGRS chart till 18 yrs by appending NCHS data and extrapolating the MGRS percentile lines.  Many countries choose to use WHO charts only for toddlers {upto 2 yrs in USA} [upto 4 yrs in UK] and their own national charts for older children.
  70. 70. WHO GROWTH CHART:  For the assessment WHO has provided charts for both boys and girls.  Growth indicators are used to assess growth considering a child’s age and measurements together.  length/height-for-age  weight-for-age  weight-for-length/height  BMI (body mass index)-for-age
  71. 71. INTERPRET TRENDS ON GROWTH CHARTS: When interpreting growth charts, be alert for the following situations, which may indicate a problem or suggest risk:  A child’s growth line crosses a z-score line.  There is a sharp incline or decline in the child’s growth line.  The child’s growth line remains flat (stagnant); i.e. there is no gain in weight or length/height.
  72. 72. WHO GROWTH CHART BENEFITS:  Seen as ‘gold standard’ of growth charts in terms of promoting good health outcomes, including across cultures.  Establishes breastfeeding as the biological norm.  More suitable to the aboriginal population as the infants, especially in remote communities, are predominantly breastfed  Have greater capacity to assist the early identification of development of overweight
  73. 73. GROWTH CHART IN INDIA:  The ICMR undertook a nationwide cross sectional study during 1956-1965 to establish indian referance charts. Irrelevant now as they were done on lower socio-economic class.  Indian context Multicenter study : Agarwalet al. (1992,1994); Khadilkaret al. (2009);Marwahaet al. (2011)  The growth charts compiled by Agarwal et al were based on affluent urban children from all major zones of India measured 1989-1991. The data is now 20 years old.
  74. 74. GROWTH CHART IN INDIA:  WHO recommends that each country should update its growth references every decade and hence new growth references were produced in 2009.  Khadilkar et al have published the growth charts on affluent children 5-18 years and have also compared the growth of 2-5 years old Indian children with the new WHO growth charts. These are the most modern national growth references available now at present.
  75. 75. GROWTH CHART IN INDIA:
  76. 76. GROWTH CHART IN INDIA:  India has adopted the new WHO Child Growth Standards (2006) in February 2009  These standards are available for both boys and girls below 5 years of age.

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