小兒生長(zhǎng)發(fā)育GrowthandDevelopment

小兒生長(zhǎng)發(fā)育GrowthandDevelopment第1頁/共79頁

Growth:definedasanincreaseinsizeofbody,biologicalgrowthofanorganismtakesplacethroughcellmultiplication,thismorphologicalgrowthcanbemeasuredclinically.第2頁/共79頁theenlargementoftheorganandthesystemmorphologicalgrowthcanbemeasuredbyexactvalues第3頁/共79頁Development:Agradualchangeandexpansion;advancementfromalowertoamoreadvancedstageofcomplexity;increasedcapacitythroughgrowth,maturation,andlearning第4頁/共79頁AnincreaseincompetenceandadaptabilityAQUALITATIVEchangeFunctioningatahigherlevel第5頁/共79頁

Thus,sincebothprocessesarepartofonewhole,thecombinedtermsgrowthanddevelopmentformanunitaryconceptthatindicatesthequatitativeandqualitativeofmaturationalchangesofanorganism.第6頁/共79頁GrowthisacontinuousandorderlyPROCESS第7頁/共79頁weightheightAge(y)FMMF第8頁/共79頁Notalltissuesystemsofthebodygrowatthesamerate第9頁/共79頁第10頁/共79頁VariabilityNoteveryoneisalikeinthewaythattheygrowPercentilegrowth/standarddeviationtothenormRacialandethnicdifferencesBoysvsGirls第11頁/共79頁FactorsInfluencingGrowthHeredityNutritionGenderDiseaseEnvironmentHazardsSocioeconomicinfluences第12頁/共79頁GrowthCurvesBoys:2to18yearsGirls:2to18yearsBoysreachmostoftheirheightatageof17whereasgirlsreachtheirsataround15第13頁/共79頁IndicesofGrowth

Bodyweight(kg)theweightofaperson’sbody.theweightofalltissues,organsandbodyfluids.oneindicatorofthenutritionalstatusofchild.thebasisofdrugdosageandamountofinfusion.第14頁/共79頁1、Thefirstgrowthspurtoccursinthefirstyearoflife(theincrementisabout6kg).PatternsofWeightIncrement2、Growthisnotatthesamerateindifferentage:Theincrementofweightduringthefirst3monthsisequaltothatofthefollowing9months.

Yearlyincrementsincreaseslowlyuntiltheonsetofpuberty.

第15頁/共79頁Birthweight3kgMaturebaby’sweightgainatfirstmonth1--1.5kg3—12monthsweight=(month十9)/2kg

1—6yearsweight=age×2十8kg7—12yearsweight=age×7-5/2kg第16頁/共79頁Aboutformulae:

Theseformulaeareusedonlyforcalculatingdosageofdrugandfluidinclinic.Becausethegrowthisnotatthesamerateindifferentage,especiallyininfant;andthegrowthisaffectedbymanyfactors,suchasgene,environmentandindividualvariation.Attention第17頁/共79頁Weightloss:Physiologicalweightloss:3-9%recoverat7-10thday

Lossof3%~9%ofbirthweightinthefirstfewdaysoflifeisconsiderednormalandiscommonformostnewborns.第18頁/共79頁Height(cm)ThelengthfromvertextoplantaeTheindexoflongtimenutritionalstatus第19頁/共79頁Theheightforinfantsuptothreeyearsshouldbemeasuredasrecumbentlengthusingaproperlyconstructedmeasuringdevice.Heightmeasurementsforchildrenoverthreeyearsofageshouldbeaccomplishedusingverticalmeasuringboardorfixedwalldevice.第20頁/共79頁Length/Stature---

Stature---

Length<3y≥3yStand

Supine第21頁/共79頁atbirth50cm1yearold75cm2yearsold85cm2--12yearsold=age×6+77第22頁/共79頁Thefirstgrowthspurtoccursinthefirstyearoflife(theincrementisabout25cm).

Growthisnotatthesamerateindifferentage:Theincrementofweightduringthefirst3monthsisequaltothatofthefollowing9months.

Yearlyincrementsincreaseslowlyuntiltheonsetofpuberty.

PatternsofLengthIncrement第23頁/共79頁Shortnessmaybecausedbymalabsorption,chronicillness,psychosocialdeprivation,hormonaldisorders,familialpatterns,orsyndromeswithdwarfism.Gigantismmaybetheresultofpituitaryabnormalities.第24頁/共79頁Male

10yH88cm10yGHD第25頁/共79頁Crown-rump/Sittingheight-Crown-rumplength

Sittingheight<3ySitSupine≥3y

Theygiveameasureofthelengthoftheheadandtrunk.Itisameasurementofthedistancefromthehighestpointontheheadtothebasesittingsurface.

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Duringthefirstyearoflife,spinalincreaseisfasterthanextremities.Lateron,theextremitiesgrowatafasterratethanthetrunk,whichiscontributetothebodylengthandleadingtoagraduallychangeinrelativeproportions.第27頁/共79頁ChangesinOverallBodyProportions第28頁/共79頁HeadCircumference

HCisameasurementofperimeterofhead,fromeyebrowstooccipitalprominence.ThechangeoftheHCisrelatedwiththegrowthofbrainandskull.第29頁/共79頁Atbirth34cm1year46cm2years48cm5years50cm15years54cm(thesameasadult)第30頁/共79頁

Headcircumferenceshouldbemeasuredwithatapemeasureateachvisitduringthefirsttwoyearsoflife.

Alargeheadmaybeanearlysignofhydrocephalusoranintracranialmass.Asmallheadmaybearesultofearlyclosureofsuturesorlackofbraindevelopment.第31頁/共79頁chestcircumference

reprentthegrowthofthoraxandlung

atbirthCC<HC1-2cm1year

CC=HC>1yearCC－HC(cm)=age－1第32頁/共79頁GrowthonPubertyAtpuberty,thereisamarkedgrowthspurt(Thesecondpeakofheightvelocity,PHV),thatis,averyrapidincreaseinsizeandweight.

第33頁/共79頁Girlsusuallyshowingtheirpubertalgrowthspurtaroundage9~11.Forboysthesameprocessbeginsatapx.age11~13.AccordingtoTanner(1990),girlsfinishpubertalgrowthbyaboutage16whereasboyscontinuetogrowuntilapproximately18yearsofage.第34頁/共79頁SexualPrecocity：Secondarysexualcharacteristicsappearbeforepuberty.

Girls<8y，Boys<10yDelayedsexualmaturity：

Secondarysexualcharacteristicsdonotappearafterpuberty

Girls>14y，Boys>16y第35頁/共79頁Cranialdevelopment第36頁/共79頁Closuretimeoffontanel/sutureFontanel/suture

AtbirthTimeofclosureAnteriorfontanel1.5-2cm≦18mPosteriorfontanel0.5-0.71-2mCranialsutureSmallest3-4m第37頁/共79頁

Smallsizeorearlyclosure：Largesizeordelayedclosure：AbnormalityofanteriorfontanelMicrocephalyHydrocephalus,Cretinism第38頁/共79頁Intracranialhypertension(Encephalitis,Meningitis)DehydrationAbnormalityofanteriorfontanelBulgingfontanel：

Sunkenfontanel：第39頁/共79頁

Osteite(centerofossification),whichislocatednearendsoflongbones(epiphyses),withgrowthplates.Itisveryimportantforbone’sgrowthinlength.Bonedevelopment第40頁/共79頁Thesequenceofappearanceofsecondarycenters

第41頁/共79頁Boneage

Boneageisthattheageshouldbe

accordingtotheosteitenumber

fornormalchild.ThemostcommonlyusedstandardsarethoseofGruelichandPyle,whichrequireradiographsof

thelefthandandwrist;kneefilms

aresometimesaddedforyounger

children(usuallylessthan1yearold).

第42頁/共79頁

AbnormalityofBoneAge

Hypothyoidism,Hypopituism

PrecocityofBA：Adrenogenitalsyndrome,Precocity

RetardationofBA：第43頁/共79頁DentitionPrimaryteeth:Primaryteethare20totally.Thefirsteruptionisatabout6months(4~10months).Thetimingoftootheruptionismorevariablethanotherdevelopmentalparameters第44頁/共79頁Delayederuptionisusuallyconsideredwhentherearenoteethbyapproximately12monthsofage.

Thelasteruptionofprimaryteethisat2~2.5yearsofage.Primaryteeth第45頁/共79頁第46頁/共79頁Delayederuption:Hypothyroidism,idiopathicDisorder:Hypothyroidism,BraindysplasiaFailingtoerupt:Ectodermaldysplasia,MechanicalblockageAbnormalityofdentalenamel:EctodermaldysplasiaAbnormalityofDentition第47頁/共79頁EvaluationofgrowthGrowthlevelGrowthvelocityProportion第48頁/共79頁EvaluationofgrowthReliableandaccuratedataSingleValueandseries

investigationreference第49頁/共79頁Choosingreference

Reference,basedonaNorthAmericanpopulationbyNCHS,USA,isrecommendedbytheWHOastheinternationalstandardofgrowth.第50頁/共79頁Choosingreference

Besides,therearemanylocalornationalreferences,forexample,physicalgrowthindicesof9citiesinChina.第51頁/共79頁MethodsofassessmentReferencetableGrowthcurve第52頁/共79頁GrowthCurvesBoys:2to18yearsGirls:2to18yearsBoysreachmostoftheirheightatageof17whereasgirlsreachtheirsataround15第53頁/共79頁AGEP3P5P10P20P30P40P50P60P70P80P90P95P9702.52.62.72.93.13.23.33.43.53.73.94.14.213.03.23.43.73.94.14.34.54.64.95.15.45.623.63.84.14.54.75.05.25.45.65.96.26.56.734.24.44.85.25.55.76.06.26.46.77.17.47.644.85.15.45.86.26.46.76.97.27.57.98.28.455.45.76.06.56.87.07.37.57.88.18.58.99.166.06.26.67.07.37.67.88.18.48.79.19.49.776.56.77.17.57.88.18.38.68.99.29.610.010.287.07.27.58.08.38.58.89.09.39.610.110.510.797.47.67.98.48.78.99.29.49.710.110.510.911.1107.77.98.38.79.09.39.59.810.110.410.911.311.5118.08.28.69.09.39.69.910.110.410.811.311.611.9128.28.58.89.39.69.910.210.410.711.111.612.012.2第54頁/共79頁Growthlevel

Everysinglemeasurementcanbeplottedonagrowthcurvewhichillustratestheamountofgrowthinchildrenwithindifferentagegroup.第55頁/共79頁Evaluationofgrowthmeanstandarddeviation：

cut-offpointx±2SDpercentile：cut-offpointP3--P97

Z

scoreZscore=(x-x)÷SD

Growthcurve：

－－第56頁/共79頁Example：（Weightofgirls）

P3P25

P50P75P971y～7.498.549.189.9111.37(kg)

-2SD-1SD+1SD+2SD1y～7.188.219.2410.2711.30(kg)

Theweightofaoneyearoldgirlis8.2kg.Growthlevel：XX

W/A

P3-P25

W/A

-（1SD～2SD）第57頁/共79頁

Growthvelocitycanshowtheprocessofgrowth.Growthvelocityismeasuredintermsofhowmuchachildgrowswithinaspecifiedperiodoftime.Growthvelocity第58頁/共79頁第59頁/共79頁NeuropsychologicalandBehavioralDevelopment第60頁/共79頁第61頁/共79頁Nervoussystemanatomicallycompleteatbirthexcept:Myelination rapidfor2years completeby7yearsPrimitivereflexesdisappearinfewmonths 第62頁/共79頁TheBaby’sBrain-InfantVisionDevelopmentnewborn1month2months3months6monthsadult第63頁/共79頁Audition

Auditionisimportantbecauseitrelateslanguagedevelopment.Ifachildhashearingloss,thechildwillhaveimpairedspeech,languageandlearningandbehaviouralproblemsstemmingfromdifficultyincommunication.第64頁/共79頁Newbornsprefersweettastesoversour,bitter,andsaltytastes.Theycandistinguishodorsrightfrombirthandsoonlearntoknowthesmelloftheirmother’smilkandbodies.第65頁/共79頁BEHAVIORDEVELOPMENT

FourAttributes

GrossmotorFinemotorLanguagePersonal—socialskill

第66頁/共79頁grossmotorPhysicalskillsinvolvinglargebodymovementssuchasliftinghead,walking,andjumping.第67頁/共79頁FineMotorPhysicalskillsinvolvingsmallbodymovements,especiallywiththehandsandfingers