I N F A N C Y

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Growth and development of an infant in the various domains - physical, psychosocial, cognitive, psychosexual, spiritual and moral. Also discusses the special health concerns during infancy.

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I N F A N C Y

  1. 1. GROWTH & DEVELOPMENT
  2. 2. Growth and Develo pment as a unit expresses th e sum of nu merou s changes that take p lace durin g the life c ycle of an indivi dual. The entire cour se is a dynamic p rocess that encom passes several int er-related d i mensions.
  3. 3. WHY STUDY GROWTH & DEVELOPMENT? <ul><li>Know what to expect of a child at any age </li></ul><ul><li>Know certain behaviours that are likely to emerge in mature forms </li></ul><ul><li>Assess the sequence and norms of G & D of a child </li></ul><ul><li>Know how to influence G & D favourably </li></ul><ul><li>Diagnose undernutrition, infectious and other diseases affecting G & D </li></ul><ul><li>Recognize the potential problems and strengths of individual children & their parents </li></ul><ul><li>Plan for comprehensive care of the child </li></ul><ul><li>Work with children effectively in health & disease </li></ul>
  4. 4. STAGES OF GROWTH & DEVELOPMENT <ul><li>Prenatal period (Conception to Birth) </li></ul><ul><li>Infancy ( Birth to 12 months of age ) </li></ul><ul><li>Early Childhood ( 1 – 6 years) </li></ul><ul><li>Middle Childhood (6 – 12 years) </li></ul><ul><li>Late Childhood (12 – 19 years) </li></ul>
  5. 5. PRENATAL GROWTH <ul><li>Zygote – Increased cell organization and differentiation into three basic layers – Ectoderm, Mesoderm, Endoderm. </li></ul><ul><li>Embryo – Marked organization upto 8 weeks. </li></ul><ul><li>Fetal phase – 8 weeks to 40 weeks (birth). </li></ul><ul><li>- Increases in length and weight </li></ul><ul><li>- Linear growth with maximum velocity </li></ul><ul><li>at 4 months </li></ul>
  6. 6. GROWTH & DEVELOPMENT IN INFANCY
  7. 7. INFANCY <ul><li>Neonate – Birth – 28 days ( Early and late neonatal period) </li></ul><ul><li>Infancy - 28 days – 12 months </li></ul><ul><li>- Rapid motor, cognitive, and social development </li></ul><ul><li>- Trust, physical adjustment to outside </li></ul><ul><li>- Psychological adjustment of parents </li></ul>
  8. 8. GROWTH & PHYSICAL MATURATION
  9. 9. WEIGHT <ul><li>NBB – 2.7 – 3.9 Kg ( Av 2.5 Kg ) </li></ul><ul><li>0 – 7 days – 10% loss of Birth weight </li></ul><ul><li>10 th day - Lost weight wt regained </li></ul><ul><li>0 – 6/12 yr - > by 30 gms / day OR 150 gms / wk </li></ul><ul><li>5 – 6/12 yr – Birth weight doubled </li></ul><ul><li>7 – 12 “ - > by 15 gms / day OR 75 gms / wk </li></ul><ul><li>1 year - Birth weight trebled </li></ul><ul><li>There after - > by 2.2 Kg / year </li></ul><ul><li>2½ Year - Birth weight Quadrupled </li></ul>
  10. 10. HEIGHT (LENGTH) <ul><li>NBB – 50 cms (20”) + 2 cms </li></ul><ul><li>First 6 months - > by 2.5 cms / month </li></ul><ul><li>Later 6 months- > by 1.25 cms / month </li></ul><ul><li>1 – 2 year - + 12.5 cms (5”) </li></ul><ul><li>2 – 12 years - 6.25 – 7.5 cms / yr </li></ul><ul><li>4 years - Birth height doubled </li></ul><ul><li>13 years - Birth height trebled </li></ul>
  11. 11. OCCIPITO-FRONTAL CIRCUMFERENCE (OFC) <ul><ul><li>NBB – 35 cms ( 1.25 – 2.5 cms > Chest Circumference) </li></ul></ul><ul><ul><li>0 – 3 months - > by 2 cms / month </li></ul></ul><ul><ul><li>3 – 12 months - > by 2 cms / 3 months </li></ul></ul><ul><ul><li>1 – 3 years - > by 1 cm / 6 month (Equals chest </li></ul></ul><ul><ul><li>circumference 1 yr) </li></ul></ul><ul><ul><li>3 – 5 years - > by 1 cm / year </li></ul></ul><ul><ul><li>5 – 6 year - Adult head size </li></ul></ul><ul><li>Thus, OFC at - </li></ul><ul><li>1 year - 47 cms </li></ul><ul><li>2 years - 49 cms </li></ul><ul><li>3 years - 50 cms </li></ul><ul><li>4 years - 50.4 cms </li></ul><ul><li>5 years - 50.8 cms </li></ul><ul><li>10 years - 53 cms </li></ul><ul><li>15 years - 55 cms </li></ul><ul><li>Fontanelle closure – </li></ul><ul><li>Post - 6 – 8 wks </li></ul><ul><li>Ant – 12 – 18 months </li></ul><ul><li>Increase of brain weight – </li></ul><ul><li>By 2½ times in the first year </li></ul>
  12. 12. CALCULATION OF ANTHROPOMETRICAL PARAMETERS <ul><li>WEIGHT – </li></ul><ul><li>3 – 12 MONTHS – Age ( months ) + 9 K g </li></ul><ul><li>2 </li></ul><ul><li>1 – 6 YEARS - Age ( Years) x 2 + 8 Kg </li></ul><ul><li>7 – 12 YEARS - Age (Years) x 7 + 5 Kg </li></ul><ul><li>2 </li></ul><ul><li>HEIGHT – </li></ul><ul><li>2 – 12 YEARS – Age (Years) x 6 + 77 (cms) </li></ul><ul><li>Future (Adult) height – Girls – Ht at 2 yrs x 2 </li></ul><ul><li>Boys – Ht at 2½ yrs x 2 </li></ul><ul><li>OFC </li></ul><ul><li>Infant - Length (cm) + 9.5 cms </li></ul><ul><li>2 </li></ul>
  13. 13. Mnemonic for Growth and Development 52 50 48 45 40 35 OFC 100 90 75 50 Ht (Cm) X 10 X 6 X 5 X 4 X 3 X 2 3 Wt (Kg) 10 7 5 4 3 2 1 5/12 3/12 0 Age (yrs)
  14. 14. CHEST CIRCUMFERENCE & MUAC <ul><li>Chest Circumference </li></ul><ul><li>- 33 cms at birth, barrel shaped </li></ul><ul><li>- At 1 year Transverse diameter > AP diameter by 25 % </li></ul><ul><li>- At 6 years transverse diameter > AP diameter by 33 % </li></ul><ul><li>6 months – 39 cms </li></ul><ul><li>1 year - 45 cms (Equals OFC) </li></ul><ul><li>2 years - 49 cms </li></ul><ul><li>5 years - 55 cms </li></ul><ul><li>10 years - 64 cms </li></ul><ul><li>15 years - 77 cms </li></ul><ul><li>MUAC (Mid upper arm circumference) – NBB – 14.5 cms </li></ul><ul><li>1 year – 16 cms. </li></ul><ul><li>Then > by 0.25 cm / yr </li></ul>
  15. 15. BODY PROPORTIONS <ul><li>Big heads, large trunk, short </li></ul><ul><li>extremities upto 2 years </li></ul><ul><li>Mid point of body </li></ul><ul><li>- In infants - 1.8 cms above </li></ul><ul><li>umbilicus </li></ul><ul><li>- At 2 years - Just below umbilicus </li></ul><ul><li>- In adults - At symphysis pubis </li></ul><ul><li>Sitting Height </li></ul><ul><li>- At Birth – 70% of total length </li></ul><ul><li>- At 3 years – 57% </li></ul><ul><li>- At Puberty - 53% </li></ul>
  16. 16. CARDIO-CASCULAR SYSTEM <ul><li>Heart – Transversely placed, Apex beat at IV ICS </li></ul><ul><li>H R – NBB – 140/mt, 5 yrs – 100/mt, 10 yrs – 90/mt, </li></ul><ul><li>12 yrs – 85/mt, 15 yrs – 80/mt </li></ul><ul><li>Sleeping Pulse Rate – 10 – 20 beats lower </li></ul><ul><li>BP – 80/50 …. 90/60 mm Hg </li></ul><ul><li>Systole rises in the 2 nd month </li></ul><ul><li>Diastole falls in the first 3 months, then gradually </li></ul><ul><li>rises </li></ul>
  17. 17. <ul><li>Hematological system </li></ul><ul><li>Hb F – The primary Hb for the first 2 -3 months </li></ul><ul><li>( >>> Physiological Anemia ) </li></ul><ul><li>then Hb A increases upto 6 months </li></ul><ul><li>Respiratory System </li></ul><ul><li>Resp rate – 50 – 35/ mt </li></ul><ul><li>Abdominal & diaphragmatic </li></ul><ul><li>Trachea close to bronchi, narrow lumen </li></ul><ul><li>Short straight eustachean tube </li></ul><ul><li>< IgA in mucosal lining </li></ul>
  18. 18. <ul><li>Lymphatic System – Hyperplastic in children. Resolves after puberty </li></ul><ul><li>Nervous System – </li></ul><ul><ul><li>NBB – Brain wt – 10% of body weight </li></ul></ul><ul><ul><li>Infancy – Rapid brain growth. 80% achieved by 4 </li></ul></ul><ul><ul><li>yrs </li></ul></ul><ul><ul><li>Myelination begins after 3 months, completed by 2 </li></ul></ul><ul><ul><li>years </li></ul></ul><ul><ul><li>Primitive reflexes replaced by righting reflexes & </li></ul></ul><ul><ul><li>voluntary, purposeful movements </li></ul></ul>
  19. 19. GASTRO-INTESTINAL SYSTEM <ul><li>Salivation begins at 3 months </li></ul><ul><li>Stomach capacity – 90 ml at birth, 360 ml at 1 yr </li></ul><ul><li>Enzyme amylase inadequate – Poor digestion of complex CHO </li></ul><ul><li>Liver immature throughout infancy </li></ul><ul><li>By 1 yr – 3 meals + 1 bed time feed </li></ul><ul><li>- 1 or 2 bowel movements </li></ul>
  20. 20. <ul><li>Immunologic System </li></ul><ul><li>- Maternal IgG upto 3 months </li></ul><ul><li>- Synthesizes IgG (40% of adult levels) by 1 year </li></ul><ul><li>- IgM produced at birth. Adult levels by 9 months </li></ul><ul><li>- IgA production gradual. Adult levels by puberty </li></ul><ul><li>Skin – Absent shivering and sweating at birth </li></ul><ul><li>- Accumulation of adipose tissue in 6 months </li></ul><ul><li>( helps insulation) </li></ul>
  21. 21. <ul><li>Fluid & Electrolytes </li></ul><ul><li>NBB – 75% of total body wt is water </li></ul><ul><li>- ECF vol is 40% which <es to 20% in adulthood </li></ul><ul><li>Renal System – Immature at birth </li></ul><ul><li>Complete maturity in 18 to 24 months </li></ul><ul><li>Urine Sp.Gr – 1000 – 1010 </li></ul><ul><li>Dentition – Begins at 6 – 12 months </li></ul><ul><li>By 3 yrs – all 20 teeth </li></ul><ul><li>Rule – Age (months) -6 = No of teeth </li></ul><ul><li>Permanent teeth by 6 – 12 years </li></ul>
  22. 22. SPECIAL SENSES <ul><li>Hearing – Acuity at adult levels at infancy </li></ul><ul><li>6 months – can differentiate familiar voices </li></ul><ul><li>7 months – vestibular function begins </li></ul><ul><li>Short ext auditory meatus & Eustachian canal </li></ul><ul><li>Visual – Low acuity. Hypermetropic </li></ul><ul><li>6 wks – 4 months – Binocularity well estd. </li></ul><ul><li>7 -12 months – Stereopsis ( depth perception) begins to develop </li></ul>
  23. 23. MOTOR DEVELOPMENT
  24. 24. GROSS MOTOR (Devt.al maturation in posture) General movements Head balance (3/12) Rolling over (5/12) Sitting with support (4/12) Crawling & Creeping (8/12) Standing (10/12) Walking (1 yr)
  25. 25. Sitting without support…
  26. 26. Standing with support Coo, that’s How it looks to Ma and Pa!
  27. 27. FINE MOTOR <ul><li>Use of hands and fingers in prehension </li></ul><ul><li>Grasp reflex at 0 – 3months </li></ul><ul><li>Palmar grasp </li></ul><ul><li>Crude pincer grasp – 8-9 months </li></ul><ul><li>Neat pincer grasp – 11 months </li></ul><ul><li>Builds a tower of 2 blocks by 1 year </li></ul>
  28. 28. PSYCHOLOGICAL DEVELOPMENT
  29. 29. Psychosocial Development <ul><li>Reflex behaviour – parent, peer response </li></ul><ul><li>1 month – Social smile, 4 months – laughs aloud </li></ul><ul><li>Play helps socialize </li></ul><ul><li>Attachment- Indiscriminate response. cry, smile </li></ul><ul><li>Vocalize more to mother, distinct preferences </li></ul><ul><li>6 months – ‘peekaboo’, asks to be carried </li></ul><ul><li>- Stranger anxiety & separation anxiety </li></ul><ul><li>Eric Erickson- Trust Vs Mistrust </li></ul><ul><li>- 3-4 months – Oral phase (pri narcissism) </li></ul><ul><li>- 5-12 months – Social phase </li></ul>
  30. 30. <ul><li>Language </li></ul><ul><li>Cry – for displeasure and pleasure </li></ul><ul><li>2 months – ah, eh, uh…. </li></ul><ul><li>3 months – coos, gurg;es, laughs (n,k p, g) </li></ul><ul><li>8 months – Imitates sounds t,d,w </li></ul><ul><li>9-10 months – Understands ‘NO’, obeys simple commands </li></ul><ul><li>1 yr – 3-5 words with meaning </li></ul><ul><li>Play – Sensorimotor, narcissistic, dependant, solitary </li></ul><ul><li>- Laughs, peekaboo, pat-a-cake, repetition, imitation </li></ul><ul><li>- Selective after 6-8 months ( No strangers!) </li></ul><ul><li>Sleep – 0-6 months – 18-20 hrs /day </li></ul><ul><li>- 6-12 months – 16-18 hrs/day </li></ul><ul><li>- 2-4 yrs - 12-16 hrs/ day </li></ul><ul><li>- 5-10 yrs - 10-12 hrs/ day </li></ul>IMPORTANT – Not only ‘to play’, but to be ‘played with’.
  31. 31. <ul><li>Psycho- sexual development </li></ul><ul><li>Sigmund Freud – Oral phase </li></ul><ul><li>Cognitive ( Intellectual) development </li></ul><ul><li>Jean Piaget – Sensorimotor Phase ( 0-2 yrs) </li></ul><ul><li>- Use of reflexes, deliberate acts, repetitive acts(4-8 months), object permanence(10 months), develops self image by 1 yr </li></ul>
  32. 32. SUMMARY OF MILESTONES OF DEVELOPMENT <ul><li>1 Month - Social Smile </li></ul><ul><li>2 Months - ah, eh, uh sounds </li></ul><ul><li>3 months - Head holding </li></ul><ul><li>4 Months - Grasps objects, sits with support </li></ul><ul><li>5 Months - Rolls over </li></ul><ul><li>6 months - Sits without support </li></ul><ul><li>7 Months - Crawls & creeps </li></ul><ul><li>8 Months - Thumb- finger prehension </li></ul><ul><li>9 months - Pulls up to sit, stands with support </li></ul><ul><li>10 Months - Walks with support </li></ul><ul><li>11 Months - Stands with support </li></ul><ul><li>12 months - Takes a few steps by self </li></ul>
  33. 33. NEEDS & SPECIAL CONCERNS IN INFANCY <ul><li>Love & security ( warmth, support to head & neck) </li></ul><ul><li>Nutritional needs – 120 Cal/Kg (0-6 month), 100 Cal/Kg (6-12 months), Protein 5-3 gm/Kg. Weaning, prevent obesity </li></ul><ul><li>Protection from infection (skin, eye, ear, oral, GIT, Resp, umbilical). </li></ul><ul><li>Personal hygiene </li></ul><ul><li>Protection from accidents </li></ul><ul><li>Promotion of growth & development </li></ul><ul><li>Promotion of play </li></ul><ul><li>Care in teething, thumb sucking </li></ul><ul><li>Sleep & activity, infant shoes </li></ul><ul><li>Dental health </li></ul><ul><li>Regular medical check up </li></ul><ul><li>Psychological needs - Care to prevent separation anxiety </li></ul><ul><li>- Encourage inquisitive behaviour </li></ul><ul><li>- Develop sensory perception </li></ul><ul><li>- Avoid unpleasant tastes </li></ul><ul><li>- Avoid painful experiences </li></ul>
  34. 34. Thank you !

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