5th year Pediatric

Physical growth
Session with Dr. Abdulfatah

Definitions
Growth : increase in the size of the organism by simple increase in the size &number
of its cells (physiological hypertrophy & hyperplasia)

Development : is the change in the cells to do new function ( acquiring new skills )

FACTORS AFFECTING GROWTH&DEVELOPMENT

Congenital
Environmental
Hereditary Non Hereditary
Problem in the sperm or Problem in the mother Problem after birth
ova
Genetic , Racial , Age , Sex intrauterine Nutritional , physical ,
seasonal , endocrinal

STAGES OF GROWTH

Intra-uterine Extra-uterine
infancy(1 m.-2 years)
Embryonic (1st trimester)
childhood (2y.-12y.)
Early fetal (2nd trimester)
adolescence (12y.-15y.)
Late fetal (3rd trimester )
adulthood (15y.-18y.)

Adolescence characterized by rapid , physiological and physical growth

The puberty is a period happen in adolescence characterized by spermatogenesis or

ovary genesis

2010 Done by : Faris Baowidan

1
 5th year Pediatric

ASSESSMENT OF GROWTH

Growth

osseous
Fantanells Teething Anthropometrics
growth

1- FONTANELLS

There is 6 fontanels (anterior , posterior , 2 antrolateral , 2 postilateral )

anterior posterior
Normally open at birth Normally close at birth or slightly open
Size : 3 fingers at birth , decreasing 1
Size: Close or 0.5 cm at birth
finger each 6 month
Abnormally open in hydrocephalus and
hypothyroid
Abnormalities : wide – narrow – bulge – depressed – increase or decrease in size

2- ANTHROPOMETRIC MEASURES

( Weight - height - head circumference - midarm circumference)

Wight:
before 1 year :
6 – 7 kg
4 month

750gm/mont 500gm/mont
h h

3 – 3.5 kg 8 – 9.5 kg
At bith 250gm/mont 1 year

After 1 year : Wt. in kg.= age in year x2+8

2010 Done by : Faris Baowidan

2
 5th year Pediatric

HEIGHT &LENGTH:

Height Length
Measuring the child at sleep position Measuring the child at stand position
The height longer than the length because the gravity

50 cm

At birth
1.25cm / m
2.5 cm / m
2nd 6 month
1nd 6 month 75 cm

At 1 year

age Upper seg. Lower seg.

At birth 1.7 1
At 3 years 1.3 1
At 7 years 1 1

Head circumference

— At birth 35 cm. — At 2 years 47cm.

— At6 month 43 cm. — At 5 years 50 cm.

— At 1 year 45 cm. At 12 years 55 cm

Large head Small head

Bones Microcephaly

Meninges craniostenosis

Brain

ventricles

2010 Done by : Faris Baowidan

3
 5th year Pediatric

Mid arm circumference

— Valid in the 1st 4 years only

— Measured midway between shoulder & elbow

Normal Impending malnut. Established Malnut. Severe malnut.

12-14 cm 10– 12 cm 9– 10 cm < 9 cm

—

3- OSSEOUS MATURATION

Normal values

At birth 6 ossify centers (Lower femur, Upper tibia, Talus, Calcareous, Cuboids,
Humorous head)

Bone age: x ray of the wrist to measure the no. of carpal tunnel bone
= chronological age + 1

Ex : 6m –> 1 CT 1y  2CT 2y  3CT …

It clinically imp to differentiate between familial (normal bone age) and

constitutional (delayed bone age) short stature.

Retarded B.A. Advanced B.A.

Prematurity Post maturity
PEM Adrenogenital synd.
Hypothyroidism Hyperthyroidism
hypopituitarism hyperpituitarism

2010 Done by : Faris Baowidan

4
 5th year Pediatric

4- Teething
Permanent teeth
Milk teeth

White Yellowish

Weak Strong

20 in number 32 in number

Early(months) Late(years)

Temporary Permanent

1st one appear is central lower incisor ( 6m) 1st one appear is 1st molar

Causes of delayed teething

General (rick , critin , mongol , achond , Local (rigid gum , cyst,

osteog. Imperfect ) Supernumerary t.)
Usually teething accompanied with fever due to destruction of the tissue and
irritation of the gums >>> inflammation >>> fever and pain.

GROWTH PATTERN & CURVE

 Genital pattern of growth –neurological pattern –physical pattern –lymphoid
pattern of growth

Mental

Physical

Lymphoid

Genital

 Percentile curves : each parameter matched with age

 3rd percentile usually the lowest
 97th percentile usually the highest
N.B. Weight also matched for height & malnut. Classified accordingly wasted,
stunted or dwarf.
 Simple Morley charts : comprehensive ,used for both sex & include feeding
& vaccination data

2010 Done by : Faris Baowidan

5
 5th year Pediatric

FAILURE TO THRIVE
• Is it primary or secondary?
• What is the degree of growth failure?
• What is the pattern of growth failure?
• What is the cause?

History Examination Investigation

Dietetic abn. features Karyotyp.
Chronic symptom. Abn. urine odor urea-creat.gas
Family hx Chest &cardiac ex. according
hepatosplenomegally st.fat & s.car

• Growth velocity (multi blotting in different time) is better than growth

pattern (one blotting in one visit)
• Failures to thrive have 2 forms:
• Running parallel to the lower or higher percentile.
• Going pass through 2 percentile in the middle of normal percentile.

Form 1 Form 2

2010 Done by : Faris Baowidan

6
 5th year Pediatric

Development
Definition:
Acquisition of skills &maturation of already formed organs.

It usually started at early fetal period &continued at late fetal period

Normal Development
• The basic science of Pediatric is Growth & Development

• It is a continuous process from conception to maturity.

• It depend on maturation & myelenation of nervous system.

• The sequence of development is the same but the rate varies.

• Direction of development Cephalocodal.

ASSESSMENT OF DEVELOP

develop

hearing motor Vision mental

2010 Done by : Faris Baowidan

7
 5th year Pediatric

1- LOCOMOTOR DEVELOPMENT

Delay Normal

Go down stairs
Go up stairs
Head support

Sitting Crawl Stand Walk Run

• Note : head support is at shoulder level or more its abnormality called head
lag. ( its pic. imp in OSCE )
• CAUSES OF DELAYED MOTOR DEV.
Normal motor develop : CNS , MS , Environment
Abnormal develop in : MR CP , rick malnut , chronic system disorder

2- MENTAL DEVEOP.

Gross motor
social speach
Social smile 40 day 2 similar word ( ma ma ) 1 year
lough 2m 2 word ( give me ) 1.5 y
Knowing mam 4m 3 word ( give me this ) 2y
Recognition smile 9m

Fine motor
motor drawing
Trnsfer object from 6m Drawing line 2y
hand to hand
Grisp / 2 ear cup / 10-12m Drawing cycle 3y
peek-apo‫يغطي عينو بيده‬
Scrible / tower of 3 box 18m Drawing squair 4y
Tower of 6 box 2y Drawing triangle 5y

• The 3rd year is a line of advance movement like standing, jump and cycling.

2010 Done by : Faris Baowidan

8
 5th year Pediatric

Reflex
Reflex appearance Disappearance
Moro Birth 4 months
ATNR 2 weeks 6 months
Toe grasp ( Plantar ) Birth 8-15 months
Hand grasp ( Palmar ) Birth 3 months
X adductor Birth 7 months
Head writing 4-6 months Persist voluntary
Protective eq. 4-6 months Persist voluntary
Parachute 8-9 months Persist voluntary
• asymmetrical tonic neck reflex (ATNR) "fencing reflex" a normal
response in newborns When the face is turned to one side, the arm and
leg on the side to which the face is turned extend and the arm and leg on
the opposite side bend.

— Delay mental develop

abnormal N .reflexes newborns
No social smile 6 months
nfancy
No laughing 9 months
No speech 18 months preschools
Delayed school perform — school
—
IMP and significant delay
Not intresting to Drop object 6m Cann't diff. bet. Short & long 3y
Cann't doing peek-apo 9m Not knowing his name 4y
Not intresting to hide object 12m Cann't count No. 4.5y
Cann't diff. bet. 2 object 2y Not knowing color & letter 5y
knowing birth date,address 5y

3- Vision.
At birth Light vision , blinking to sudden light
2 month Foucs on fixed object
4m Follow sloe movemnt object
6m Follow raped movemnt object

4- Hering
2 week Start
2 - 4 month Response to strong call
4 – 6 month Turn head to call

2010 Done by : Faris Baowidan

9
 5th year Pediatric

Mental retardation

• What cause MR?

Subcultural 90% , organic 10% ( genitic & non genitic ) .
• DIAGNOSIS
• History
• C/P (odd features )
eye ex. (cataract)
heart ex.(cong. Cyan. D.)
head ex.(micr. & macro-cephally)
hepato-splenomeg.
• Lab screening tests (t3&4)-urin (red.sub.)
urin (cyanide- fe cl)
• Radiology
• CONDITIONS CONFUSED WITH MR
• Abn. Vision in infancy
• Abn. Hearing in preschools
• ADHD in school age

IQ degree
Mild ( IQ 70 – 51 ) Educable
Moderate ( IQ 50 – 36 ) Trainable
Sever ( IQ 35 – 20 ) Minimal self care
Profound ( IQ < 20 ) Total supervision

2010 Done by : Faris Baowidan

10
 5th year Pediatric

Extra info. :
6 week old
• Gross motor:Head control(0-3 mo) , Moro response , Ventral suspension ,
Prone position
• Fine motor and vision : Stares , Follow horizontally .
• Hearing&speech: Rattle or bell , Startle response
• Social behavior : Smile socially , Turn to regard
• Warning signs at 6 week:
No visual fixation, Failure to respond to sound,Asymietrical N.R,Ex Head
lag,No sm.
6-8 mon.
• Gross motor : Wt on leg , Parashut response , Sits , pull to sit , crawl
• Fine motor & vision: Grasp , Transfer , Follows fallen toys.
• Hearing&speech : Vocalize , Babbling , laughs , Respond to own name
• Social behavior : Mouthing , Hand foot regard , Plays peek-apo-.
• Warning Signs:
Hand preference ,fisting , Squint,Persistence of N.R.
12 month
• G.M: Stand , Walk.
• Fine motor & vision : Point with index finger , Through , Pincer grasp ,Hold 2
object.
• Hearing & speech: Turn to sound , Mum&dad.
• Social behaviors & play: Drink , Wave good-by.
18 Month.
• Gross Motor: Climb stair.
• Fine motor & vision: Scribbles , Turn pages.
• Hearing & Speech: Utter 3 or more words sentence , Point to body parts.
• Social: Hold spoon; Explore environment , Takes off choos , toilet need.
2 years
• G.M:Climb &descends stairs , Jump , Kicks a Ball.
• Fine motor&vision: Picks up hundreds , Vertical line.
• Hearing& Speech : Uses pleural;Give name.
• Social: Play alone , Eats with spoon & fork , Puts on clothes , Dry through day.

2010 Done by : Faris Baowidan

11