Factors affecting growth and development in children and laws of growth and rules of development

1. Dr G.Rajkumar
Associate professor

2. At end of this lecture you will be able to
• Define growth and development
• Enumerate determinants of growth
• Know Variation in growth of various tissues
• State Laws of growth
• Enumerate Factors influencing development
• State rules of development
DR GRK DSMCH 2

3. Definition
• Growth denotes an increase in size of an individual due
to increase in the number and size of the cells(Quantity)
• Hypertrophy < multiplication
• Development denotes functional maturity CNS
(Quality)
• Growth and development are not synonymous but they
are assessed simultaneously.
• Growth and development begin at conception and end
at maturity.
• They are unique characteristics of children and any
obstacle in this process at any stage can possibly result
in aberration of growth and/or development.DR GRK DSMCH 3

4. Factors Influencing Growth
• Growth is influenced by interaction of both
• Genetic and
• Environmental factors.
• Children generally grow to their genetic height
potential with little outside assistance.
• Growth-Fetal & Postnatal growth
DR GRK DSMCH 4

5. Fetal growth
• Influenced by fetal, placental and maternal factors
• 40% of birth weight variation due to genetic cause
rest due to environment cause
• Maternal-placental-fetal unit works in harmony
DR GRK DSMCH 5

6. Fetal growth -Genetic potential
• Parental traits transmitted to offspring
• Tall parents tall children
• Head size>size and shape of hand-closely
related to parents
• Structure of chest and fatty tissue better genetic
association
DR GRK DSMCH 6

7. Fetal growth -Gender
• Boys are taller and heavier than girls at birth
DR GRK DSMCH 7

8. Fetal hormones
• Thyroxine and insulin-regulation of tissue
accretion and differentiation
• Required for normal growth and development
especially late gestation
• Glucocorticoids- late gestation, for maturation
of liver, lungs and GIT
• GH-though fetal levels are high NO ROLE
DR GRK DSMCH 8

9. Fetal growth factors
• Locally synthesised- autocrine and paracrine
function
• Main effect on cell division
• Growth promoting or inhibitory
• Promoting-IGF-I,IGF-II, EGF, TGF-alfa,PDGF,FGF,
NGF
• Inhibitory-TGF –beta, Mullerian inhibitory
substance, Inhibin /activin family
DR GRK DSMCH 9

10. Placental factors
• Fetal weight correlates with placental weight
• Fetal growth depends on structural and
functional integrity of placenta
• Total villous surface area increases, diffusion
distance increases, fetal capillaries dilate and
resistance in fetoplacental vasculature falls
DR GRK DSMCH 10

11. Maternal factors
• Maternal growth, nutrient intake and body
composition affects fetal growth
• Teenage, advanced age, high parity, anemia-
negative influence
• Maternal smoking and alcohol intake
• Obstetric illness-PIH, preeclampsia, multiple
gestation
• Pre-existing illness-CRF, CCF
• Acquired infection-TORCH
DR GRK DSMCH 11

12. Postnatal period
• Genetic Disorders- chromosomal mutation and
disorders
Certain genetic disorders can adversely influence
growth.
• These include chromosomal disorders (e.g. Down
syndrome and Turner syndrome) and
• Genetic mutations (e.g. mucopolysaccharidosis).
• Single gene mutations- Prader-Willi syndrome,
Noonan syndrome
• Klinefelter and Sotos syndrome-tall stature
DR GRK DSMCH 12

13. IUGR
• IUGR resulting in LBW –important risk factor for
postnatal malnutrition and poor growth
• During early infancy breast feeding provides
adequate nutrition, prevents infections and
protects from further malnutrition.
• Complementary feeding plays major role in
nutrition
DR GRK DSMCH 13

14. Hormonal influences:
After first 6–8 months of life, the GH and thyroxine
deficiency
During puberty, the sex hormones have important
role in induction of the pubertal growth spurt and
final adult height.
Sex: pubertal growth spurt is earlier in girls than
boys but final height and weight is less compared
to boys
DR GRK DSMCH 14

15. Nutrition:
• Children suffering from PEM, anemia and vitamin
deficiencies show retarded growth
• Calcium, Iron, Zinc, Iodine, Vitamin A and D
have major role in growth and development
• Over eating may lead to obesity
Infections:
• Persistent or chronic diarrhea, recurrent
respiratory tract infections, parasitic infections
DR GRK DSMCH 15

16. Chemical agents:
• Administration of androgenic hormones initially
increases growth later causes fusion of epiphysis
and reduces final height
Trauma:
• Fracture or injury to epiphysis has impact on
final height
DR GRK DSMCH 16

17. Social factors
• Socioeconomic level: higher the SES lower
infection better nutrition
• Natural resources
Climate:
• Velocity of growth is higher in spring and low in
summer
• Infections & infestations are common in hot &
humid climate
• Emotional factors: Emotional deprivation, broken
family anxiety and insecurity influence the
neurochemical regulation of GH and may affect a
child’s growth.
DR GRK DSMCH 17

18. Social factors……
Cultural factors:
• Childrearing and infant feeding practices vary in
various cultures
• Religious food taboos
• Parental education:
• Parental education especially maternal education
plays a major role on child’s nutrition
DR GRK DSMCH 18

19. Growth periods
• Embryo: implantation to 8 weeks of gestation
• Fetus: 9th week of gestation to birth
• Infant: birth to 1 year of age
• Toddler: 1–3 years of age
• Preschool: 3–5 years of age
• School age: 5–12 years
• Adolescence: 10–19 years
DR GRK DSMCH 19

20. Laws of growth
• Growth and development is a continuous and
orderly process
• Different tissues grow at different rates
• Growth pattern of every individual is unique
DR GRK DSMCH 20

21. Growth Pattern of Different Body Systems
• General Body (Somatic growth)
• The general body growth is rapid during fetal life
and first 1–2 years of age.
• The growth velocity slows later during mid-
childhood and accelerates once again during
puberty
• The limbs and arms grow faster than the trunk
so that body proportions undergo marked
variation as an infant grows into an adolescent.
DR GRK DSMCH 21

22. Brain (Head Circumference-Brain Size)
Brain growth -very rapid-during fetal life and infancy.
Although brain cell formation is almost complete
before birth, brain maturation(synapse formation)
continues after birth.
At birth, the brain of the infant is 25% of the adult
size.
 75% by one year
 80% by age three
 90% by age seven
DR GRK DSMCH 22

23. The influence of the early environment on brain
development is crucial. Infants exposed to good
nutrition, toys and playmates have better brain
function at age 12 than those raised in a less
stimulating environment.
The rapid brain growth is reflected by an increase
in head circumference.
DR GRK DSMCH 23

24. Lymphoid Tissue Growth
• The growth of lymphoid tissue is the highest
during mid childhood when children are often
observed to have enlarged tonsils and lymph
nodes, maximum being at 8–9 years of age and
later decreases in size.
DR GRK DSMCH 24

25. Body fat and muscle mass
• Growth of lean body mass is primarily due to
increase in muscle mass and correlates well with
stature
• After puberty boys have greater lean body mass
• Girls tend to have more subcutaneous adipose
tissue
DR GRK DSMCH 25

26. Reproductive (Sexual) Development
• It grows at different rates around 9–11 years in
girls and 11–13 years in boys.
• The sexual development is complete by 19–20
years of age.
DR GRK DSMCH 26

27. DR GRK DSMCH 27

28. ICP model of growth
• The three components of postnatal growth, that are
infancy, childhood and puberty, represent
different modes of growth regulation.
• The growth rate during infancy is rapid but sharply
decelerating and is principally dependent on nutrition.
• The GH and thyroxine have an increasingly important
role from 1 year of age.
• During the first 2 years, the infants establish their own
growth trajectory (path); later from about 2 years of
age to the onset of puberty, growth occurs in
relatively constant annual increments.
DR GRK DSMCH 28

29. Development
• Development is defined as maturation of
functions and acquisition of various skills for
optimal functioning of an individual
• Especially maturation and myelination of central
nervous system
29DR GRK DSMCH

30. RULES OF DEVELOPMENT
• Continuous process- in utero to maturity child-
child passes through developmental stages
• Depends on maturity of CNS
• Sequence of attainment is same in all children
• Variation occurs only in time and manner of
attainment
• Cephalocaudal ,
• Proximodistal
• Primitive reflexes should disappear for relevant
milestones to appear
• Disorganised mass activity to specific wilful
actions DR GRK DSMCH 30

31. Factors affecting development
• Heredity
• Biological integrity
• Physical & psychological milieu
• Emotional stimulation
31DR GRK DSMCH

32. Prenatal factors
• Parental IQ
• Speech
• Parental attitudes, involvement , education,
desire for child affect child's development
Genetic factors
• Genetic disorders like Downs syndrome, Fragile X
syndrome
• Mutation leading to brain malformations, Inborn
Errors of Metabolism(IEM) (PKU)
32DR GRK DSMCH

33. Maternal factors
• Factors affecting brain growth
 Drug use- alcohol, anti epileptics
 Pregnancy induced hypertension(PIH)
 Hypothyroidism
 Malnutrition- Micro & Macro
 Fetoplacental insufficiency
 Intra uterine infection-TORCH
 Stress & anxiety
33DR GRK DSMCH

34. Neonatal risk factors
• Low birth weight
• Prematurity
• IUGR
• Perinatal Asphyxia
• Premature- intracranial bleed, white matter
injury, hypoxia, hyperbilirubinemia,
hypoglycemia
• IUGR> premature
• Neonatal seizures-IEM, hypoxia, intracranial
bleed intracranial infections
34DR GRK DSMCH

35. Post neonatal factors
• Nutritional factors
Calorie, protein, vitamins, iron, iodine
• Acquired insult to brain
Trauma, infection, hemorrhage, Irradiation, hypoxia
• Endocrine factors
Hypothyroidism
• Sensory impairment
Vision , hearing
• Environmental toxins
Lead, mercury, pesticides
• Infections
35DR GRK DSMCH

36. Psycho-Social factors
• Parenting
Cognitive stimulation, caregivers sensitivity, affection,
responsiveness to child, poverty, cultural practices
affect child development
• Poverty –
Most common cause worldwide, progresses to next
generation too
• Lack of stimulation
Social & emotional deprivation, lack of interaction &
stimulation
• Violence & abuse
Psychological & cognitive impact
36DR GRK DSMCH

37. Psycho-social factors
• Maternal depression: negative impact on
child’s development
• Institutionalization: institutional
care(orphanages) during early life increases the
risk of poor growth, ill health, attention
disorders, poor cognitive function, anxiety and
autistic- like behaviour
DR GRK DSMCH 37

38. Protective factors
• Breast feeding – promotive and protective
effect
• Maternal education- reduces child mortality
and promotes better child health-better
educated mothers have children with better
cognition
DR GRK DSMCH 38

39. DR GRK DSMCH 39

40. 3/13/2015 DR.GRK DSMCH 40