human growth

1. Human Growth
Surg Cdr RW Thergaonkar

2. Introduction
• Growth differentiates children
from adults
• A process from conception to
maturity
• Hyperplasia and hypertrophy

3. Growth vs Development
• Growth: a net increase in size or
mass of tissues
• Development: maturation of
function; related to myelination of
nervous system and indicates
acquisition of skills

4. Factors Affecting Growth
FETAL GROWTH
• Genetic potential
• Sex
• Fetal Hormones

5. Factors Affecting Growth
FETAL GROWTH
• Fetal Growth Factors
• Placental Factors
• Maternal Factors

6. Factors Affecting Growth
POSTNATAL PERIOD
• Sex
• IUGR
• Genetic Factors
• Hormonal Influence

7. Factors Affecting Growth
POSTNATAL PERIOD
• Nutrition
• Infections
• Chemical Agents
• Trauma

8. Factors Affecting Growth
SOCIAL FACTORS
• Socioeconomic level
• Poverty
• Climate

9. Factors Affecting Growth
SOCIAL FACTORS
• Emotional Factors
• Cultural Factors
• Parental Education

10. Factors Affecting Growth
CONSEQUENCES OF IMPAIRED GROWTH &
UNDERNUTRITION
• 35 million deaths
• 35% of disease burden in children < 5 yrs
• India: 61 million stunted children (34% of global)
• Fetal Origins of Adult Disease
– Developmental adaptations
– Predisposition to DM, Htn, CAD & dyslipidemia as adults

11. Laws of Growth
• A continuous and orderly process: specific
periods of acceleration, steadiness &
decceleration
• Growth sequence is cephalocaudal and distal to
proximal
• Different organs grow at different rates

12. Periods of Growth
Prenatal
Ovum 0 to 14 days
Embryo 14 days to 9 wks
Fetus 9 wks to birth

13. Periods of Growth
Postnatal
Newborn first 28 days
Infancy first year
Toddlerhood 1-3 yrs
Preschool 3-6 yrs
School Age 6-12 yrs

14. Periods of Growth
Adolescence
Early 10-13 yrs
Middle 14-16 yrs
Late 17-20 yrs

15. Laws of Growth
• A continuous and orderly process: specific
periods of acceleration, steadiness &
decceleration
• Growth sequence is cephalocaudal and distal to
proximal
• Different organs grow at different rates

16. Brain Growth Somatic Growth
100%
100%

17. Lymphoid Growth Gonadal Growth
100%
100%

18. Skeletal Growth
• Continuous process with spurt at puberty
• Epiphyseal fusion: 18 yrs (girls) and 20-22 yrs (boys)
• Bone Age
– Number , shape and size of epiphyseal centres
– Size, shape and density of the ends of bones
Gruelich-Pyle & Tanner
Whitehouse

19. Assesment of Growth
• Weight
• Length
• Standing Height
• Head Circumference
• Chest Circumference
• Midarm Circumference

20. Normal Growth

21. Normal Growth
Age Weight (kg) Length/Height
(cm)
Head
Circumference
(cm)
Birth 3 50 34
6 mths 6 65 42
1yr 9 75 45
2 yrs 12 85 47
3 yrs 14 95 49
4 yrs 16 100 50

22. Normal Growth
• Target Height = Father’s Ht + Mother’s Ht/2
+ 6.5 (boys)
- 6.5 (girls)
• Chest Circumference
– 3 cm less than head at birth
– Equals at 1 yr
• BM I = Wt (kg)/[Ht (m)] ²
– > 95th centile is obesity

23. Growth Standards
• NCHS
• ICMR
• WHO (MGRS)
• IAP

24. When to Measure?
Age Ht/Len
gth
Weigth HC Other
Birth Y Y Y
11/2, 31/12, 6,
9,15 mths
Y Y Y
18-36 mths Y Y Y
31/1 to 5 yrs Y Y
6-8 yrs Y Y BMI & SMR
9-18 yrs Y Y BMI & SMR

25. What to Remember?
• Growth v/s Development
• Factors Influencing
• Laws of Growth
• How to measure
• When to measure
• Norms

26. Thank You