بحث حول التعطيم والتعقيم والتحصين للاطفال والبالغين والنساء الحوامل

1. Growth and
Development

2. Growth :
It is the natural increase in
size by cellular multiplication.
It includes the aspect which can
be measured e.g., weight ,height
, head circumference.
Development :
It is the maturation of
organs and systems to perform
skills and functions e.g., motor
d e v e l o p m e n t , s o c i a l
development, language
development.

3. Stages of growth and
development
Intrauterine stage Extrauterine stage
Embryo
1st trimester
Fetus
2nd &3rd trimester

4. Extrauterine stage
Neonatal
period
Infancy Toddler Childhood Adolescent
1st 4
week
1-2
year
2-3
year
12-18
year
Preschool
child
School
child
4-5yr
6-12y
r

5. Importance of Growth and Development
for Nurses:
• Knowing what to expect of a particular child at any given
age.
• Gaining better understanding of the reasons behind
illnesses.
• Helping in formulating the plan of care.
• Helping in parents’ education in order to achieve optimal
growth & development at each stage.

6. Principles of Growth & Development
• Continuous process
• Predictable Sequence
• Don’t progress at the same rate (↑ periods of GR in early
childhood and adolescents & ↓ periods of GR in middle
childhood)
• Not all body parts grow in the same rate at the same time.
• Each child grows in his/her own unique way.

7. Growth Pattern
The child’s pattern of
growth is in a head-to-toe
direction “cephalocaudal”,
and in an inward to
outward pattern called
proximodistal.

8. Factors Affecting Growth and Development
Factors affecting during
intrauterine growth
Factors affecting during
extrauterine growth
Maternal
factors
Fetal factors
Endocrinal
factors
Non endocrinal
factors

9. Factors affecting during intrauterine growth
Maternal factors :
1-Poor maternal nutritions
2-Poor antenatal care
3-Maternal infection “TORCH”
4- Maternal systemic diseases “ DM , Hypertension ..”
5- Smoking
Fetal factors :
1- Multi pregnancy
2- Chormosomal abnormalities
3-Congenital malformation
4- Inborn error of metabolism

10. Factors affecting during extrauterine growth:
Endocrinal factors
1- Growth hormone
2-Thyroid hormons
3-Sex hormons
4- others : insulin ,parathyroid hormones ..
Non endocrinal factors :
1-Genetics
2-Nutrition
3-Socio-economic
4-Environmental
5-Psychological
6-Chronic illness : chronic renal failure , DM

11. Growth Assessment
• Assessment of growth is
essential for determination of
normal growth and good health
of the child.
• It carried out by :
A. Measurement of growth
parameters “anthropometric
measures”
B. Growth charts

12. Anthropometric Measures
1. Weight
2. Length and height
3. Head circumference
4. Anterior fontanelle
5. Teething +..-
6. others

13. Weight :the most reliable parameter for growth assessment .
• Average Wt at birth =3 kg
• It increased by 750 gm /month for the
1st 4 months “infant double Wt at age
of 4 mo”
• It increased by 500 gm/ month for the
2nd 4 months.
• It increased by 250 gm/month for the
last 4 months.”the infant triple his Wt at
age of 1 year”
• After age of one year , Wt can
measured roughly :
Wt = age/yr X 2 +8

14. Length and height :
Length : measured in supine position “ for infant”
Height :measured in stand position
• Average length at birth = 50cm
• child double length at age of 4 years
• After 4 years height roughly
measured by
Height = age/yr X 5 +80

15. Head circumference: is Indirect parameter of assessment
of brain growth
• Average head circumference at
birth = 35 cm
• Increased by about 2 cm /month
for the 1st 3 months
• Increased by about 0.5 cm/ month
for the next 9 months of life.
• HC increases 10 cm in the 1st
year of life and 10 cm in the
remaining of life
• At age of 15 yr = 55 cm

16. Anterior fontanelle
• At birth = 3 finger
• At 6 month = 2 finger
• At 1 year = 1 finger
• At 1.5 year = closed
• However normal closure may
range from 6- 24 month

17. Teething :
1st teething “milk teeth “ = no 20
2nd teething “ permanent teeth “ = no 32
1st teething :
• At 6 mo = central incisors
• At 9 mo = lateral incisors
• At 12 mo = 1st molar
• At 18 month =canine
• At 24 month = second molar.

18. Others :

19. Growth charts
Values of growth curves :
• Prevention
• Diagnostic
• Prognostic

20. Development
1. Motor development
2. Social development
3. Language development

21. 1st month
• Body lies in flexion position
attitude
• turn head from side to side
• follow a moving object to
midline
• Alert to sound by blinking

22. 2- 3 Month

23. 2-3 Month
• Head support
• Hand come together
• Social smile
• Vocalize “ coo”

24. 4 Month

25. 4 Month
• Setting with support
• Grasp objects by palm of hand
• Lough loudly

26. 6 Month

27. 6 Month
• Setting without support
• Transfer object from side to side
• Recognize the mother.

28. 9 Month
• Crawling
• Grasp object by fingers
• Respond to sound of name
• Says part of words : Da Da, Ba
Ba.

29. 12 Month

30. 12 Month
• Standing and walks with holding hand
• hold a cup to drink
• Throw the object
• Waves bey bey
• Understands many words and says 2 - 3 words

31. 15 Month
• Walks alone
• Feeds with spoon

32. 18 Month
• Runs
• Walks up stair step by step
• Says more words “ 10”

33. 2 Years

34. 2 Years
• Run well
• Walks down stairs step by step
• Draw horizontal line
• Dry by day
• Says 3 word sentence.

35. Red Flags in infant development
• Unable to sit alone by age 9 months
• Unable to transfer objects from hand to hand by age 1
year
• Abnormal pincer grip or grasp by age 15 months
• Unable to walk alone by 18 months
• Failure to speak recognizable words by 2 years.

36. Toddler “2-3 years”
• Pedals tricycle
• Dry by day and night
• Says full name and age

37. Issues in parenting – toddler (emotional
development)
• Stranger anxiety – should dissipate by age 2 ½ to 3 years
• Temper tantrums: occur weekly in 50 to 80% of children –
peak incidence 18 months – most disappear by age 3
• Sibling rivalry: aggressive behavior towards new infant:
peak between 1 to 2 years but may be prolonged indefinitely
• Thumb sucking
• Toilet Training

38. Pre-school “4-5years”

39. Pre-school “4-5years”
• Hops one foot
• Button and unbutton clothes
• goes to toilet
• Feeds himself
• tell story and count to 10
• Clear speech

40. Red flags : preschool
• Inability to perform self-care tasks, hand washing simple
dressing, daytime toileting
• Lack of socialization
• Unable to play with other children
• Unable to follow directions during exam

41. School Age

42. Red flags: school age
• School failure
• Lack of friends
• Social isolation
• Aggressive behavior: fights, fire setting, animal abuse

43. Adolescent age
Adolescence is a transition period from childhood to
adulthood.
It begins with the appearance of secondary sex
characteristics and ends when somatic growth is
completed and the individual is psychological mature.
Physical growth:
Growth spurt begins earlier in girls (10–14 years, while it is
12–16 in boys).

44. Appearance of secondary sex characteristics:
1- Secondary sex characteristics in girls:
• Increase in transverse diameter of the pelvis.
• Development of the breasts.
• Change in the vaginal secretions.
• Growth of pubic and axillary hair.
• Menstruation (first menstruation is called menarche, which occurs
between 12 to 13 years).

45. 2- Secondary sex characteristics in boys:
• Increase in size of genitalia.
• Swelling of the breast.
• Growth of pubic, axillary, facial and chest hair.
• Change in voice.
• Rapid growth of shoulder breadth.
• Production of spermatozoa (which is sign of puberty).