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Definition of growth
change in physical characteristics such as size or number as opposed to a change of function
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Normal patterns
- rapid growth=fetal
- deceleration period=newborn to 4mos
- slow & steady=until puberty
- Acceleration=puberty
- deceleration=until maturity
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Variation in Organ's systems
- brain=majority of growth is in the prenatal stage but continues during the 1st 1-2yrs of life. Implicaitons re:diet
- lymphoid tissue=inc 1st yr
- reproductive system=hormonal abn if puberty occurs early
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factors influencing growth
- heredity=chromosomal or family
- prenatal=placental abn, maternal nutrition, drugs, infections
- hormonal=growth, thyroid, sex, insulin, adrenal steroids
- disease=chronic
- nutritional
- environmental=living conditions or nurture
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objective measurements
- ht
- wt=back to birth by 2wks, double by 6mos, triple=1yr
- head circumference=up to 36mos for proper growth
- growth charts=limitations=more concern if child is on natural curve then crosses 2% lines.
- bone age=radiograph hand/wrist
- denition=eruptions of teeth
- body proportions=upper to lower segment ratio, arm span to total ht
- sexual maturation=tanner staging
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Tanner staging for pubic hair
- 1=no hair
- 2=sparse, downy hair at base symphysis pubis
- 3=sparse, coarse hair across symphysis pubis
- 4=adult hair quality, fills in pubic triangle, no spread to thighs
- 5=adult quality & distribution including spread to medial thigh
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tanner staging for breast development
- 1=preadolescent
- 2=breast budding=areola & papilla
- 3=continued enlargement but no separation
- 4=areola & papilla form 2nd mound w/separation
- 5=mature breasts
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Genital development (male)
- 1=prepubertal
- 2=scrotum enlarges w/testes & color changes to redness with generally no enlargment yet
- 3=enlargement penis & tests/scrotum
- 4=inc size penis & breadth & development glans
- 5=mature
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Various in growth patterns
- Short stature
- failure to thrive
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Short stature
ht is less than 3rd % & div into 3 classes
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3 classes of short stature
- family, racial, genetic
- constitutional short & delay of puberty
- attenuated growth
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smaller, subnormal velocity, abnormal bone age
attentuated growth
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Small w/normal curve, velocity, abnormal bone age, delay in puberty, normal adult ht. Ht & wt deviates btwn 6-36 mos family hx & males more likely to be effected
constitutional short stature & delay of puberty
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small but follows normal curve growth velocity is normal, bone age is normal, short adults
familial, race, genetic
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normal adult ht if problem, corrected
problems w/endocrine sys (hypothyr, cushing's, high deletion) inborn errors of metabolism chronic (infections, IBD, cardiac, bone) psychosoical issue
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Failure to thrive definition
wt less than the 3% or wt that rapidly crosses several %. In severe cases, ht & head circumference can be affected
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DDx for fail to thrive
grand & should include=pshychosocial issues
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Evaluation for fail to thrive
- developmental screen
- basic work up: CBC, lead level, BMP, urinalysis & culture, 3 day observed feeding w/calorie count
- other: Torch titers, thyroid, alt
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Torch titers include
- toxoplasmosis
- syphillis, HBV
- Rubella
- cytomegalovirus
- HSV
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fail to thrive prognosis
variable, learning & behavior problems are common
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fail to thrive tx options
- Under lying problems
- multifocused
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Development Definition
refers to the evolution of physical characteristics,language, motor skills & social skills
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Theories of development: freud, Erikson & piaget
Erikson's psycho/social development
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trust vs mistrust
0 to 18mos
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autonomy vs shame/doubt=me do toilet trng
18-36mos
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initiative vs guilt=what sex they are
3-6yrs
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industry vs inferiority=peer pressure begins
6-11yrs
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identity vs role confustion
12-17yrs
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physical characteristics
sex maturation via tanner stages
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language
receptive & expressive using denver II or ELMS
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motor skills
fine/adaptive & gross skills=denver
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begins to understands strangers
3yrs
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motor skills milestones
progression from head then proximal to distal, head lag begins to disappear at 4mos
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Social skills
personal & social interactions using denver
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separation anxiety
- 8-15mos
- peaks=15-18mos then leaves 2yo
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development stages
- theories of development
- physical characteristics
- language
- language milestones
- motor skills
- motor skills milestones
- social skills
- social skills milestones
- other
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