growth

 ? is an essential component of pediatric health surviliance, there is overlaping between growth and development.

 Definations ? Embryo = fertilized ovum to 12 weeks ? Fetus =12 weeks to delivery ? Newborn =newly delivered ? Neonate =1st 28 days ? Infant =from 28 days to end of 1st year ? Toddler =1-3 years ? Preschool =3-5 years ? School age =5-10 years ? Early childhood= 1st 6 years ? Later childhood=6-12 years ? Early adolescent=9-13 ? Middle adolescent= 13-16 years ? Late adolescent=16-18 years

 Growth chart ?

 The most powerful tool In assessing of growth, each chart contain 7 or 8 percentile(3rd , 5th, 10th, 25th, 50th, 75th, 90th, 95th), there is separated chart for male and female ?

 Types of growth chart

 ? WT for age, HT(length, stature) for age, OFC for age, WT for HT, BMI ? There are special chart for premature baby(catch up growth), Down syndrome, Klinfelter syndrome

 Analysis of growth

 ? 1 –for infant, size in 1st 2years= reflect intrauterine life, size more than 2years= midparental ?

 2- In infant, the linear groth was taken by measuring board(supine), older(2 years and above)by steadiometer ?

 3- WT for HT, <3rd centile remain the single best indicator for acute undernutrition,in which it is normal in chronic malnutrition ? 4- Chronic and severe malnutrition in 1st year of life may limit the head growth(ominus sign of late congnative disability 

? 5- in both male and female, the rate of growth velocity is decrease in 1st 2years of life and then persist up to 11 years old in female and 13 years old in male. ?

 6- e.g 9 MO age on 25th centile (BODY WT)8.5kg(75% of peers more than this, similarly if BWT more than 11.2kg is heavier than 95th of his peers)

 The height (HT)

 ? SUPINE=length(less than 2year) ? Standing=stature(more than 2year) ? At birth =50 cm ? At the end of 1st year=75cm ? 2-12 year=age (in years)x7+66cm ? At age of 2year, in BOY, final adult HT=HT at this age x2 ? At age of 18month, in GIRLS, final adult HT= HT at this age x2 ?

 The birth HT doubled at the age of 4years and tripled at the age of 13 years ? The best pridictor of child eventual adult HT is MID parntal HT ? For BOYS=mother HT+13cm +father HT/2 ? FOR girls=father HT -13cm +mother HT /2 ? This iss give approximately +/-5cm of final adult HT ? HT less than 3rd centile=SHORT stature ? HT more than 95th centile =TALL stature

 The weight(WT) ? Birth wt 2.500-3.750 gram, decreacing in about 10% in 1st 10-14 day of life then et gained in about 20-30 g/day in the remaing if 1st month, then 750 gram/month in the next 2month ? 3-12month= age in month+9/2 ? 1-6years= age in years x2+8 ? 6-12 years=age in years x7-5/2 ? The above equations give idea aboyt the rough ideal body wt ? The birth wt was doubled at the age of 6month ,and triplled at the age of 12month ?

 Body wt less than 3rd cntile =underweight ? Body wt more than 95th centile =obese

 Occipitofrontal circumfernce (OFC) ? At birth =35 cm +/- 2cm ? In 1st 3months= increase 2cm/month ? In the next 3 months= increase 1cm/month ? In the next 6months= increase 0.5cm/month ? At the end of 1st year =47cm ? At the end of 2nd year=49cm ? At 12 years 53cm ? OFC less than 3rd centile=microcephaly ? OFC more than 95th centile =macrocephaly Occipitofrontal circumfernce (OFC)

 Body Mass Index(BMI) ? Wt(KG)/ht(M2) ? BMI for age < 5th centile=underweight ? BMI for age between 5th-85th percentile=healthy ? BMI for age between 85th-95th percentile= risk of overweight ? BMI for age >95th percentile=overweight(obese) ? ?

 BMI Categories: ? Underweight = <18.5 ? Normal weight = 18.5–24.9 ? Overweight = 25–29.9 ? Obesity = BMI of 30 or greater ? CLASS I OBESITY=30-34 ? 35-39 CLASS II OBESIYU= ? CLASS III OBESITY=>40 ? ? NOTE ? 1 . accurate assessment of WT, HT, and OFC is important ? 2 . reguler calbiration of scale is vital ? 3 .tight measure tape should be avoided ? 4 . OFC measured from supraorbital ridge in front to farest point of occipit in back(3measures and take the largest one)

 OTHERS indicators of growth ?

 1 . Body proportion ? Upper body segment/Lower body sgement(U/L) ? At birth=1.7, 3years=1.3, more than 7years=1 or 0.9 ? Increase U/L= short limb, rickets, achondroplasia, hypothyrodism ? Dcrease U/L =Marfan syndrome, scoliosis, spinal deformity

 2 . Bone age ? Measure the somatic growth(slkeletal maturation), radiograpg of the hand and wrist ? A . delayed bone age but with normal HT age=constitutional growth delay ? B . marked delayed bone age (to chronical and HT age)=endocrinopathy

 3. Dental development ? Mineralization started in the 2nd trimaster and go ? Eruption sarted in 5-6 months postnatally , central then lateral, mandibuler then maxillary, delayed if no any tooth more than 13 months of age ? Exfoliation (4-6 years) ? Teething by itself if used alone , is poor indicator

 Constituational growth delay ? 1 . No sign or symptomes of systemic disease ? 2 . bone age delayed up to 2-4 years but costant with HT age ? 3 . period of poorest growth 18-24months with steady linear growth after(normal rate of growth) ? 4 . Hisory of parent or sibling of delayed growth