Assessment of Growth and Development

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4 years: 16 kg. 5 years: 18 kg. 6 years: 20 kg. Weight gain is about. 2 kg/year ... Average length or height for age. At birth: 50 cm. 6 months: 68 cm. 1 year: 75 cm.
Assessment of Growth and Development By

Prof. Mohammad Saleh M. Hassan PhD. (Pharma); MSc. (Ped.); MHPE (Ed.)

Assessment of Growth and Development Physical growth Motor and mental development

Physical growth Main Parameters

Bone Age

1-Weight 2- Length or height

Others

3-Head circumference Body proportions 1-Weight/Length ratio 2-Upper/Lower segment ratio 3-Arm span/Height ratio

Times for Teeth Eruption

• Assessment of physical growth

• Wide range of variations among normal infants and children  Growth curves • Growth Curves for: weight, length or height, and head circumference in

percentile values

• 50th percentile  average • 25th, 10th, and 5th  Low normal values • 75th, 90th, and 95th  high normal values

Growth curves are useful in two ways

• A- With single measurement: Values below 5th percentile  abnormal  underweight, short stature, small head. Values above 95th percentile  abnormal  overweight, tall stature, large head.

• B- With repeated serial measurements: Assessment of growth rate or velocity. Any normal infant or child should follow his own percentile on serial measurements. Any deviation from the own percentile  abnormal

If the weight and length are equally affected  the infant is small or stunted  growth delay or failure to thrive.

If the weight is more affected than length  the infant is wasted or marasmic  severe and rather recent illness If height is more affected than weight  the infant or child is dwarf or having a short stature  other body proportions measurements are important.

Average weight for age At birth: 3 kg. During the 1st 4 months: 1 month: 3.75 2 months: 4.50 3 months: 5.25 4 months: 6.00

kg. kg. kg. kg.

750 gm/month

During the 2nd 4 months: 5 months: 6.5 kg. 6 months: 7.0 kg. 7 months: 7.5 kg. 8 months: 8.0 kg.

Weight gain is 500 gm per month

During the 3rd 4 months: 9 months: 8.25 kg. 10 months: 8.50 kg. 11 months: 8.75 kg. 12 months: 9.00 kg.

Weight gain is 250 gm per moth

During early childhood: 2 years: 12 kg. 3 years: 14 kg. 4 years: 16 kg. 5 years: 18 kg. 6 years: 20 kg.

During late childhood: 7 years: 22.5 kg. 8 years: 25.0 kg. 9 years: 27.5 kg. 10 years: 30.0 kg.

Weight gain is about 2 kg/year

Weight gain is about 2.5 kg/year

Average length or height for age At birth:

50 cm.

6 months: 1 year: 2 years: 3 years: 4 years:

68 cm. 75 cm. 87 cm. 94 cm. 100 cm.

Between 4-8 years: 5 years: 107 cm. 6 years: 114 cm. 7 years: 121 cm. 8 years: 128 cm.

The height increases about 7 cm/year

Between 8-12 years: 9 years: 135 cm. 10 years: 140 cm. 11 years: 145 cm. 12 years: 150 cm.

The height increases about 5 cm/year

Average head circumference for age At birth:

35 cm.

6 months: 1 year: 2 years: 6 years: 12 years:

43 cm. (8 cm more) 47 cm. (4 cm more) 49 cm. (2 cm more) 51 cm. 53 cm.

Approximate time of teeth eruption

Primary (milk) teething (20 teeth): Central incisor: 6 months. Lateral incisor: 9 months. First molar: 12 months. Canine: 18 months. Second molar: 24 months.

Secondary (permanent) teething (32 teeth): First molar: 6 years. Central incisor: 7 years. Lateral incisor: 8 years. Canine: 9 years. First premolar: 10 years. Second premolar: 11 years. Second molar: 12 years. Third molar: 18 years.

Developmental Childhood Milestones

Definition of milestone: • It is a stone at the side of a road that shows you how far it is to the next event. It is a very important measure.

Developmental milestones

Gross Cognitive & Fine Motor Language

Social & Adaptive

Language Definition of speech: • It is defined as the physical production of individual sounds. It involves movement of the lips, tongue, Jaw, and velum in coordination with respiration and phonation to form speech sounds.

Definition of language: • It is defined as the meaning or message conveyed between individuals. It is the cognitive component of speech. In assessing a child’s language development one must look at:

• Receptive language: The child’s ability to understand the language of others.

• Expressive language: The child’s ability to choose appropriate words to convey a message, to use the appropriate word forms and to put the words together in an appropriate order in a sentence.

Normal speech and language development:

At birth:

Waa

Waa

-Starts by birth cry. Waa

2 Months: - Watches the speaker’s face. ghaa ghaa - Coos with verbal sounds. ghaa - Cries are differentiated by needs. o o o

4 to 6 Months: O

- Localizes to sounds. - Coos with intonation. - Vocalizes in response to others.

6 to 9 Months: - Responds to name. -Recognizes names of family members. - Responds to simple commands accompanied by a gesture.

O

Ali No

Bye

Bye

6 to 9 Months (Cont.): - Uses gesture for communication (pointing, reaching, waving for hi/bye). - Imitates actions. - Babies using early developmental consonants (i.e. b, m, w, d, n, g). B

B B

M M

M

eye OO

10 to 12 Months:

- Begins to point to some body parts following a command. - Follows simple, one-part commands (i.e. get your shoe). - Gives objects to others upon verbal request. - Jargons with different sound O O combinations Ded bob bob - May begin to use first words. Money Money Money

Ball

Car

12 to 18 Months: -Can identify many objects and pictures following a verbal command. - Follows commands easily. - Listens more to the meaning of conversations. - Uses several single words. - Communicates with a combination of words and gestures. I need a car I need a pen

OO

18 to 24 Months:

Cars

Car

- Understands concepts (adjectives, pronouns, plurals). - Follows compound and complex commands. - Uses two- to- three- word combinations. - Tries to tell about experiences. - Begins to use more speech sounds. I go to school

2 to 3 years: - Shows interest in explanations for “why” and “how” questions. - Uses phrases and short sentences for communication. - Begins to use more complex morphologic and syntactic forms. - Speech is intelligible most of the time.

I am a doctor in college of medicine

3 to 4 years: - Uses long and structurally complex sentences. - Tells stories and relates experiences from the past. - Errors in syntax include regularization of irregular forms. - Speech is intelligible to all listeners, although minor articulation errors are noted.

Cognitive development: Factors affecting cognitive development: • • • •

Genetic factor. Environmental stimulation. Motor function and development. Sensory function and development.

Assessment of cognitive development by: • Observing child’s interaction with toys. • Obtaining language milestones. • Observing problem-solving skills with standardized blocks, puzzles and pegboards.

Cognitive and intelligence tests include: • •

Gesell developmental Schedule (0 to 4 years). Bayley Scales of infant development (o to 2.5 years).

The conclusion of Gesell developmental 1 Schedule is that: 2

There is defined sequence of 3 development. 4 Development proceeds in a 5 cephalocaudal progression. Development proceeds from gross undifferentiated skills to precise and refined ones.

Gross and fine motor development: Primitive reflexes: • 1-Moro reflex: The baby is cradled in a semi reclined position of about 45 degree; the head is supported with the examiner’s hand. Keeping the hand and forearm under the head and trunk, the examiner drops the infant’s body downwards and back  good Moro response “ positive Moro by extending the arms from the body and quickly opening the hand and fingers”. This reflex should disappear at about 4 months of age.

Moro reflex . .. . .

• 2-Asymmetric tonic neck reflex: The baby is placed in a prone position (on the back). Keeping the neck in line with the body and stabilizing the trunk with one hand, the head is gently turned to one side and held for about 10 seconds, watching the child’s arms  “positive response: e.g. head turned to the left, the baby responds by flexing the right elbow and straightening the left arm”. This reflex should disappear by 1 to 4 months of age.

Asymmetric tonic neck reflex

At 2 months: - with ventral suspension; head in same plane as body; lifts head on flexed forearms; hands open 75% of the time; active grasp of a toy.

3 to 4 months: - With ventral suspension, head held up beyond the body plane; lifts head and chest off flat surface on extended forearms.

O

4 to 5 months: - Slight head lag on pull to sit, rolls over prone to supine, crude reach and grasp, hands with midline play, toy to mouth, shakes rattle. oo

6 to 7 months: - Bears full weight on legs if held standing, sits with support, begins to support self leaning on forearms. ..

oo

..

8 months:

.

- Independent sit; may assume quadruped position, good reach, developing palmar grasp patterns, bangs toy; takes two 1-inch cubes.

9 to 11 months: - Forward parachute, crawls, pincer grasp, pulls to stand, cruises, puts small toy in a container but will not release.

Forward parachute

puts small toy a in container but will not release.

12 to 14 months: - Pivots in sitting, attains independent walking (average 12 months, range 9-15 months), releases toys into container, may show preference for one hand.

15 to 18 months: - Creeps up stairs, stoops and recovers, begins stiff run, walks with pull toy, turns pages of a book, scribbles in imitation and then spontaneously.

Attains independent walking.

Releases toys into container.

24 months: - Walks up and down stairs, rarely falls, kicks larg ball, tower of 6 cubes, turns door knob, overhand throw.

3 years: - Pedals a tricycle, stands on one foot for a second, jumps from bottom of step, unbuttons, zips and unzips, tower of 9 to 10 cubes.

4 years: - Stands on one foot for 5 seconds, hops on one foot, buttons clothes, pours from pitcher.

Walks up and down stairs

Tower of 6 cubes

Stands on one foot for a second

Social and adaptive development: At 6 weeks:

o

Mother

- Infant smiles in response to a friendly human face.

At 3 months: - Begins to react with excitement to familiar and pleasant situations such as feeding and bathing. o o o o o

o o

At 6 months: - Can successfully grasp suitable toys and transfer them to the mouth. Capable of grasping a rattle and shaking it. At 9 months: - Much more wary of strangers and sensitive to separation from mother. Lost toys are looked for. Can play games such as peep-bo. Can feed himself with a biscuit. Attempts to hold his own cup or bottle.

At 1 year: - Able to drink from a cup. Spoon feeding can be managed with help at this age, understands how to cooperate in dressing, recognizing that shoes go on feet and arms go in the sleeves, able to imitate gestures such as clapping hands and waving bye-bye, Often concentrate for long periods of time, putting objects in and out boxes or quietly emptying mother’s cupboard.

At 15 months: - Curiosity and exploratory behaviour becomes more intense. Grasps anything within reach and cannot distinguish safe from dangerous objects. Will be frequently told “no” and reacts adversely if removed from unsuitable situations.

At 18 months: - Able to manage a cup without too much spillage and to be pretty adapted at using a spoon independently. Able to take off shoes and socks. Negativism is marked. Symbolic play can be seen i.e. putting dolly to sleep or giving mother ‘a cup of tea’ in a toy cup. Sand and water are most appreciated and the child will begin to be able to use drawing and painting materials in a chaotic uncoordinated and sometimes undesirable manner.

At 2 years: - Negativism continue to be more apparent, competent in eating and drinking, ready though frequently not willing to be toilet trained. Most children will become dry during the day around this age. Wants to join in and ‘helps’ with adult activities. Stories and picture books remain very popular.

At 3 years: -Fairly independent with toileting and accomplish all the subsidiary functions such as pulling pants up and down and washing hands. Able to play together with other children and understands concepts such as sharing and taking turns. Confident enough to separate from their parents. Recognizable drawings of a human body or a house begin to be made. Able to remember nursery rhymes and also stories. Constantly asking questions about things that he sees.

At 4 years: - Continues to ask questions though they are now of the “why” or “how” variety rather than of “what” or who”. Can dress and undress. Imagination is shown strongly in play. Idea of “friends” becomes a well-established need.