Child’s Growth

and Development

EVIELYNE J. LABBAY-KALI, MD
Ambulatory Pediatrics
PHYSICAL GROWTH
 It is the process of physical maturation resulting
in an increase in size of the body and various
organs.
 It occurs by multiplication of cells and an
increase in intracellular substance.
 It is quantitative changes in the body.
DEVELOPMENT
 It is the process of functional and
physiological maturation of the individual.
 It is progressive increase in skill and
capacity to function. It is related to
maturation and myelination of the nervous
system.
 It includes psychological, emotional and
social changes.
 It is qualitative aspect.
 GROWTH

FETAL POSTNATAL

Prenatal
Ovum 0-14 days of gestation
Embryo 14 days – 9 wks gestation
Fetus 9 wks of gestation to birth

Postnatal
Neonate 0-28 days
Infant 1st year of life
Toddler 1-3 years
Pre-school 3-6 years
School age 6-12 years
Adolescence 10-19 years
LAWS OF GROWTH
 Continuous and in specific order
- Cephalo-caudal and Disto-proximal
- Change in body proportions Average BL
is 50cm

1st 6 2 nd 6
months months
2.5cm/ 1.25cm/
mo. mo.
Age US:LS Ratio
Birth 1.7:1 At 1yo
3 years old 1.3:1 75cm
7 to 9 years old 1:1
LAWS OF GROWTH
 Growth rate or velocity is different in different phases of
life
LAWS OF GROWTH
 Differential tissue growth
FACTORS AFFECTING GROWTH

POSTNATAL
FETAL GROWTH GROWTH

Genetics Genetics
Nutrition
Fetal hormones and
Growth factors Socioeconomic
Maternal factors Adverse events
Placental factors Hormones
ICP MODEL

N
U
T GROWTH
R GROWTH HORMONE
I HORMONE AND
T SEX
I STEROID
O
N

0 2 4 6 8 10 12 14 16 18 20
ASSESSMENT OF GROWTH
 Anthropometric:
LENGTH and HEIGHT
Length/Height
Birth 50cm
1 year old 75cm
2-12 years old Age in yrs x 6 + 77
ASSESSMENT OF GROWTH
 Anthropometric: 2X 6-7Kg
BW
WEIGHT

In 4 months In 4 months
750g/month 500g/month

At birth
3-3.5kg
In 4 months

3X At 1yo 8-9.5Kg
250g/month
BW 9-10.5Kg

>1yo to 6yo: Wt in Kg = Age in yrs x 2 + 8

>6yo-12yo: Wt in Kg = Age in yrs x 7 – 5 ÷ 2
ASSESSMENT OF GROWTH
 Anthropometric:
HEAD CIRCUMFERENCE

Birth 35cm
6 months 43cm
1 year old 47cm
2 years old 49cm
5 years old 50cm
12 years old 55cm

1st 4mons 2 nd 4mons 3rd 4mons

1.5cm 1cm 0.5cm
ASSESSMENT OF GROWTH
MUAC (Mid-Upper Arm
Circumference)
 Valid in the 1st 5 years of life
 Measured midway between

shoulder and elbow.

Severe Acute Moderate At Risk for Well-

Malnutrition Acute Acute Nourished
Malnutrition Malnutrition
<110mm 110-125mm 125-135mm >135mm
(<11cm) (11-12.5cm) (12.5-13.5cm) (>13.5cm)
ASSESSMENT OF GROWTH
 Body Mass Index (BMI)

BMI = Weight (Kg)

Height (m2)

BMI categories
Underweight <18.5
Normal weight 18.5-24.9
Overweight 25-29.9
Obesity 30 or greater (>95
percentile)
GROWTH CHARTS
 In 2006, the WHO published new growth chart standards
 We use growth charts to:
- Assess growth
- Identify potential nutrition or health concerns
- Share information with caregivers
- Open conversations about growth, nutrition and
healthy habits.
A Brief History of Growth Charts

1977 NCHS 2000

CDCCenter for 2006 WHO
National Center
Disease Control
for Health Published 2006
Statistics From Used since
1977-2000 2000 Growth
Growth Growth standard
reference reference
Growth Reference vs Growth Standard
 Growth Reference – describes how certain children grew in
particular place and time. It gives a point of comparison.
- compares to other children

 Growth Standard – describes how healthy children

should grow in a healthy environment regardless
of time,
 place, or ethnicity. It defines what is normal or optimal.

- defines what is normal or desirable.

Comparing 2000 CDC and 2006 WHO
Charts
Characteristics 2000 CDC 2006 WHO
Reference or Reference: Standard:
Standard Describes growth of Describes how children should grow under optimal
children in US conditions regardless of time, place, or ethnicity
during 1970’s and
1980’s
Data Limited number of Large number of measurements taken frequently from
measurements taken birth to 24mos
less often

Based on data from Based on data taken sin 6 countries (Brazil, Ghana,
national health India, Norway, Oman, USA)
surveys, and birth
certificates in the US
Requirements No special req to be Had to meet these req to be included in the data:
included in the data - Adequate socioeconomic status
- Access to healthcare and breastfeeding support
- Fullterm birth
- No smoking during pregancy and breastfeeding
-Exclusive breastfeeding >/= 4mos; solid food started
at 6mos, BF cont upto > 12mos
Z score = (X-Mean)/SD
INTERPRETATION OF PLOTTED
GRAPH
EXAMPLE 1
A6 month old male baby weighs 8kg.
 What is his weight-for-age Z-score?
EXAMPLE 2
A5 month old male baby weighs 5kg. He was
born at 32 weeks of gestation/NSVD/Birth
weight.
 What is his weight-for-age Z-score?
EXAMPLE 2
A5 month old male baby weighs 5kg. He was
born at 32 weeks of gestation/NSVD/Birth
weight

Weeks of Prematurity = 40wks – Gestational age

Corrected Age = Chronological age – Weeks of Prematurity

WP = 40wks – 32wks = 8wks

CA = 20wks – 8 wks = 12wks or 3months
EXAMPLE 3
8 year old girl
Ht = 140cm, Wt = 25kg

What is her Height-for-age Z-score?

EXAMPLE 4
6 year old girl
Ht = 110cm, Wt = 15kg
Father’s Ht = 150cm
Mother’s Ht = 145cm

What is the Mid-parental height?

What is the target height?
Mid-Parental Height & Target Height
 For MALES:
(Mother’s height + 13) + (Father’s height)
2
 For FEMALES:
(Father’s height - 13) + (Mother’s height)
2

TARGET HEIGHT Range: MPH ± 2SD (6cm)

MPH is plotted on 18yr line of gender appropriate chart
Child’s current growth is extrapolated to arrive at the predicted height
Estimate of genetic potential
EXAMPLE 2
6 year old girl
Ht = 110cm, Wt = 15kg
Father’s Ht = 150cm
Mother’s Ht = 145cm

What is the Mid-parental height?

Ans: 141cm
What is the target height?
Range 135 to 147cm
What is the ideal body weight and
height for a 7-year-old boy?
What is the ideal body weight and
height for a 7-year-old boy?

IBW = 22Kg

IH = 119cm
If you decide to prepare for intubation

What ET size would you use?

What is the depth of the ET?

If you decide to prepare for intubation

What ET size would you use?

size 5

What is the depth of the ET?

Level 15
The patient’s actual weight is 18Kg, and
the height is 110cm

What is his BMI?

What is the Z-score?

THANK YOU
Teething
Milk Teeth Permanent Teeth
White Yellowish
Weak Strong
20 in number 32 in number
Early (months) Late (year
Temporary Permanent:
First eruption: Appears at 6 yo
Central lower incisor at
6 months
Causes of delayed teething:
(1yo with no teeth)

Local (rigid gum, cyst,

supernumerary t.)

General (ricket, critin, mongol,

achond, osteogenesis
imperfecta)
Osseous Maturation
Ossific Centers at
Birth
Lower femur
Upper Tibia Xray of the Wrist
Bone Age = Chronological Age + 1
Talus
Calcaneous
Cuboid
Humerous Head

Retarded BA Advanced BA
Prematurity Post-maturity
PEM Adrenogenital syndrome
Hypothyroidism Hyperthyroidism
Hypopituitarism Hyperpituitarism
What is the difference between Natal and
Neonatal teeth?
 Natal – seen at birth, right after delivery
 Neonatal teeth – erupt at anytime during the neonatal
period (usually the center/lower incisors)
 Should we remove? Do a panoramic xray if there is root..
If no root, better to remove to avoid aspiration.. Leave it
be if there is root,
Fontanelles
 6 (1 ant, 1 post, 2 anterolaterals, 2 posterolaterals)
 Anterior fontanelle – site of meeting of sagittal suture, 2
coronal sutures, and the frontal suture (diamond in shape)
admits 3 fingers at birth, 6 months 1 finger, usually closed
at 18months old, flat,
 Posterior fontanelle – point of meeting of sagittal suture
and 2 lamboid sutures (triangular shape), normally closed
at birth but the normal range if open is 0.5cm in diameter
and no more than 2 months
 Abnormalities.. Wide, narrow, bulging depressed
Growth Patterns and Curves
 Genital pattern of growth
 Neurological pattern of growth
 Physical pattern
 Lymphoid pattern of growth – may have clinical importance, it increase
til the age of 4 years then decline.. In the first 4 yrs of life, the normal
infant has a high rate of lymphoid pattern of growth, what is the
clinical significance, if the patient in the first 4 yrs of life develop an
infection, it responds to this infection by lymphocytosis and
hepatosplenomegalyand lymphadenopathy, cbc picture, usually there is
lymphocyte predominance after 4yrs old PMN dominates.. Another
point regarding adenoidectomy or tonsillectomy, if it is done in the first
4 yrs of life and incompletely removed the remnant of this may grow or
develop again , that is why adenoidectomy/tonsillectomy is wise to be
posponed to a much later date unless ofcourse highly indicated
Growth Charts
 The percentile or centile curves… 100 apparently healthy
infants/children, and measure the parameters
regularly/serially according to age..
 Bold line in the middle of normal is the median or average
reading
interpretation
Failing to thrive??
Increasing in chart but not enough
Slow steady weight gain but still below the normal
percentile