Good

1. Chapter four
Growth And Development

2. At the end of this unit, the students will be able to
• Understand components of weight during pregnancy
• Risk factors, which have an influence on a child’s
nutritional state
• Describe low birth weight and its causes
• Explain the nutrition of the mothers
• Assess the nutritional status
• Tell uses of nutritional assessment.

3. Components of weight gain during pregnancy.
􀂃 Fetus, placenta, amniotic fluid 4750gms
􀂃 Uterus and breasts 1300gms
􀂃 Blood 1250gms
􀂃 Water 1200gms
􀂃 Fat 4000gms
Total 12500gms

4. Causes for low weight gain during pregnancy
Low food intake,
􀂃 Many women continue to do hard physical
activities like carrying wood and water, and do
other strenuous jobs until childbirth.

5. Cont…
Many factors cause variation in weight at birth, but
in developing countries the mothers' health and
nutritional status and her diet during pregnancy
are probably most important.
Low birth weight (LBW) is defined as being below
2.5kg. There are two main reasons for L.B.W:
􀂃 Premature or early delivery
􀂃 Retarded fetal growth

6. Causes of premature delivery
Poor maternal nutrition,
􀂃 High maternal blood pressure
􀂃 Acute infections
􀂃 Hard physical work
􀂃 Multiple pregnancies
􀂃 In many cases the cause is unknown

7. Factors affecting growth and development:
• Hereditary
• Environmental factors
Pre-natal environment
1-Factors related to mothers during
pregnancy:
- Nutritional deficiencies
- Diabetic mother
- Infection with German measles
- Smoking
- Use of drugs

8. Cont…
2-Factors related to fetus
• Mal-position in uterus
• Faulty placental implantation
Post-Natal Environment
I - External environment:
- socio-economic status of the family
- child’s nutrition
- climate and season
- child’s ordinal position in the family
- Number of siblings in the family
- Family structure (single parent or extended family … )

9. Internal environment
• Hormonal influences
• Emotions

10. Types of growth and development
Types of growth:
- Physical growth (Ht, Wt, head & chest
circumference)
- Physiological growth (vital signs …)
Types of development:
- Motor development: the growth ability of
children to use their bodies and physical skills.
- Cognitive development
- Emotional development
- Social development

11. Stages of Growth and Development
• Prenatal
- Embryonic (conception- 8 w)
- Fetal stage (8-40 or 42 w)
• Infancy
- Neonate
- Birth to end of 1 month
- Infancy
- 1 month to end of 1 year
• Early Childhood
- Toddler
- 1-3 years
- Preschool
- 3-6 years
• Middle Childhood
- School age
- 6 to 12 years
• Late Childhood
- Adolescent
- 13 years to approximately 18
years

13. 1- Newborn stage
• Newborn stage is the first 4 weeks or first
month of life. It is a transitional period from
intrauterine life to extra uterine environment.

14. Normal Newborn Infant
Physical growth
- Weight = 2.700 – 4 kg
- Wt loss 5% -10% by 3-4 days after birth
- Wt gain by 10th days of life
- Gain ¾ kg by the end of the 1st month

15. Weight:
They loose 5 % to 10 % of weight by 3-4 days
after birth as result of :
Withdrawal of hormones from mother.
Loss of excessive extra cellular fluid.
Passage of meconium (feces) and urine.
Limited food intake.

16. Height
• Boys average Ht = 50 cm
• Girls average Ht = 49 cm
• Normal range for both (47.5- 53.75 cm)
Head circumference
33-35 cm
Head is ¼ total body length
Skull has 2 fontanels (anterior & posterior)

17. • Chest circumference
It is 30.5 to 33cm (usually 2–3cm less than head
circumference).

18. Physiological growth
• Vital signs
- Temperature (36.3 to37.2C ).
- Pulse ( 120 to 160 b/min ).
- Respiration ( 35 to 50C/min) .

21. Simulation for vital signs

22. APGAR scoring chart

24. • Senses
- Touch
- Vision
- Hearing
- Taste
- Smell

25. Proper care of children
􀂃 Appropriate hygiene and sanitation
􀂃 Safe food preparation and storage
􀂃 Successful breast feeding and adequate weaning
practice
􀂃 Psychosocial care such as attention, affection and
encouragement
􀂃 Equitable health services and a healthy environment,
􀂃 Spacing of child birth.

26. Children at risk
High risk factors which often have influences on
a child's nutritional states are the followings:
􀂃 Low birth weight
􀂃 Twins or multiple births
􀂃 Many children in the family
􀂃 Short intervals between births

27. Poor growth in early life
􀂃 Early stopping of breast milk < 6 moths
􀂃 Introduction of complementary feeding either
too early or too late
􀂃 Many episodes of infections
􀂃 Illiterate mothers,
􀂃 Resources scarcity,
􀂃 Recent migration of mother to the area,
􀂃 Children with single parent.

28. Assessment of nutritional status
o Nutritional assessment is the process of estimating
the nutritional position of an individual or groups, at
a given point in time, by using proxy measurement of
nutritional adequacy.
o It provides an indication of the adequacy of the
balance between dietary intake and metabolic
requirement.

29. Nutritional Assessment Why? 2
To develop health care programs that meet
the community needs which are defined by
the assessment
To measure the effectiveness of the
nutritional programs & intervention once
initiated

30. Methods of Nutritional Assessment
Nutrition is assessed by two types of methods;
direct and indirect.
The direct methods deal with the individual
and measure objective criteria, while indirect
methods use community health indices that
reflects nutritional influences.

31. Direct Methods of Nutritional Assessment
These are summarized as ABCD
• Anthropometric methods
• Biochemical, laboratory methods
• Clinical methods
• Dietary evaluation methods

32. Uses of Nutritional Assessment
• It should aim at discovering facts to guide
actions intended to improve nutrition and
health.

33. Diagnostic tool; (individual and group)
- Does a problem exist – identify
- Type of problems
- Magnitude of the problem
- Who are affected by the problem?

34. Monitoring tool (individuals and group)
– Requires repeated assessment over time
– Has the situation changed?
– Direction and magnitude of change

35. Evaluation tool (individual or group).
• To what extent has the intervention, treatment, or
programme had the intended effect (impact).

36. Anthropometrics assessment
• It is the measurement of the variation of
physical dimensions and the gross
composition of the human body at different
age levels and degrees of nutrition.

37. Anthropometrics assessment of growth
Common measurements include;
– Stature (height)
– Body weight
– Skin fold
– Mid Upper Arm Circumference (MUAC)

38. indices derived from growth measurements;
– Weight-for-height,
– Height-for-age,
– Body Mass Index (BMI) = Weight in Kg divided
by Height in meter square that is Wt/(Ht)2

39. End