Determinants of Human Growth & Development

GROWTH
Normal, progressive anatomic, physiologic, psychological, intellectual, social & cultural development from infancy to adulthood as a result of gradual & normal processes of accretion & assimilation An increase in physical measurement Structural aspect of development Quantitative 2 rapid phases of growth: Infancy: 3 time BW, 2 times of Ht. Puberty: adult ht, secondary sexual characteristics

DEVELOPMENT
Development includes maturation of organs and systems, acquisition of physical, intellectual, and interpersonal skills, ability to adapt more readily to stress and assumption of personal responsibility, and capacities for creative expression Acquisition & refinement of skills Development Motor Gross Fine Reflex Speech & Language Cognitive Psychosocial Psychosexual Moral

Principles of Development CEPAHALOCAUDAL PRINCIPLE

PROXIMODISTAL PRINCIPLE Growth Principles Cephalocaudal Trend Organized pattern of physical growth && motor control that proceeds from HEAD TO TAIL Growth of head & chest before trunk & legs Proximodistal Trend Pattern of physical growth & motor control that proceeds from the CENTER OF BODY OUTWARD growth of arms & legs before hands & feet

Physical & Brain Growth Body & Brain Growth

Cell Division Mostly prenatal After birth Enlargement of existing cells New cells are also formed Infancy is a period of RAPID, DECELERATING physical growth which includes: Head circumference Body length Weight Babies have big heads Newborn head is 25% of own body length Head length is 40% of mature length at birth Adult head is only ~ 15% of body length Head growth allows brain growth At birth 1 lb. 15% of total birth weight 25% of final (adult's) brain weight At 6 mo. 50% of final (adult's) brain weight

Head Circumference
Size and shape A tower-head, or oxycephalic skull Suggests premature closure of sutures and is associated with craniosynostosis A broad forehead may indicate hydrocephalus Small head microcephaly Square or a box-shaped skull Suggest chronic subdural hematomas because the long-standing presence of fluid in the subdural space causes enlargement of the middle fossa Inspection: Scalp venous pattern Cutaneous abnormalities Face (eyes, ears, nose, lips, dentition, palate) Fontanels Two fontanels at birth: Anterior fontanel Posterior Fontanel

Diamond-shaped open anterior fontanel Situated in the midline at the junction of the coronal and sagittal sutures Measurement approximates 2 by 2 cm Average time of closure is 18 mos, but may normally close as early as 9 mo. A very small or absent anterior fontanel indicate premature fusion of the sutures or microcephaly

Very large fontanel could signify a variety problems Posterior fontanel Between the intersection of the occipital and parietal bones Usually closed and nonpalpable after the 1st 68 wk of life; Its persistence suggests underlying hydrocephalus or the possibility of congenital hypothyroidism

The fontanel is normally slightly depressed and pulsatile Best evaluated when an infant is held upright while asleep or feeding A bulging fontanel is a reliable indicator of increased ICP, but vigorous crying can cause a protuberant fontanel in a normal infant

Head Circumference Measurement

Plastic measuring tape should be used Tape is placed over the midforehead SUPRAORBITAL RIDGE and extended circumferentially to the prominent portion of the occiput / OCCIPITAL PROTUBERANCE Average rate of head growth: Healthy premature infant 0.5 cm in the 1st 2 wk 0.75 cm during the 3rd wk cm in the 4th wk until the 40th wk Ave. HC of term infant: at birth 3435 cm 44 cm by 6 mo 47 cm by 1 yr of age

Genes & Environment Body size influenced by multiple genes Each has small effect Some do not function until birth When individual differences emerge Body size influence by: Environment Nutrition Length / Height / Stature Birth 12 months 4 years Early school age Prepubescence/ad olsecence 50 cm 75 cm 100 cm 5 cm (annually) 5-8 cm (annually)

Computation: HEIGHT HEIGHT At birth At 1 yr 212 yr CENTIMETERS 50 75 age (yr) 6 + 77 INCHES 20 30 age (yr) 2 + 30

WEIGHT
Average infant weighs approximately 7 pounds 5 ounces (3.33 kg at birth) Within the first few days of life the newborn loses up to 10% of the birth weight Birth weight doubles between 4 and 5 months of age Triples by the end of the first year Quadruples by the end of the childs second year Between ages 2 & 9 years the annual increment in weight averages about 5 pounds (2.25 kg) per year

Weight
Birth (full term) 5 months 12 months Until adolescent growth spurt 3400 g Double Triple 2 kg (annually)

Computation: Weight
WEIGHT At birth 312 mo 16 yr 712 yr KILOGRAMS 3.25 age (mo) + 9 / 2 age (yr) 2 + 8 age (yr) 7 5 / 2 POUNDS 7 age (mo) + 11 age (yr) 5 + 17 age (yr) 7 + 5