SCENARIO 1

GROUP 3

“IMPAIRMENT IN CHILDREN GROWTH &

DEVELOPMENT”

A boy was taken to Puskesmas in Desember 5th 2009 due to overnight fever. He born in February the 25th, 2009; supported by a midwife, hardly breathing when he was first delivered, with weak muscle tonus, birth weight (BW) 3000 grams, birth length (BL) 49 cm, head circumference (HC) 35 cm. The last 2 months consequtive weighing records: 6100 grams and 6300 grams and 6500 grams, with HC 44 cm. For daily meal the baby was fed with rice and vegetables, tofu, tempe, and sometimes egg. Starting from the age of 3 months, he consumed formula milk, bananas and baby porridge because he cried most of the time.

He got BCG immunization when he was 2 months old; 4 times polio vaccine; B Hepatitis vaccine twice, in the age of 40 days and 3 months; DPT when he was 2 and 6 months old.

The baby was able to crawl, but not yet sit and stand by him self. Sometimes mumbled, not able to hold jingling toys with his hands. He responded to sound, and able to show the direction of the sound source, can not feed him self with biscuits, and do not know how to play peek-a-boo. His mother was elementary school graduate only. Toys available at home: jingling toys, dolls, a three wheel bicycle. The mother never talked much.

Scenario

History of birthHardly

breathingWeak

muscle tonusBW is

3000 gBL is 49

cmHC is 35

cm

Age of 3

monthsStart

consume formula

milk, bananas,

baby porridge

Age of 7

monthsBW is 6100gHC is 44cm

Age of 8

monthsBW is 6300gHC is 44cm

Age of 9

monthsBW is 6500gBL is 70cmHC is 44cm

Keywords

1. Comprehending the growth and development bases2. Factors influencing the growth and development3. Explaining the existence of disturbance/delay of growth-

development4. Able to application and interpret the body weight, body length,

circumference head at curve5. Determining status of nutrition6. Knowing the types of immunize and the schedule of immunize7. Explaining the existence of disturbance/delay of development

Our objectives

GROWTH An increase in mass and height- body weight, body length, bone age, circumference head, circumference of the arm

DEVELOPMENT A gradual change in abilities, emotions and skills as people get older

The periods of postnatal (after birth) 1. The periods of neonatal (0-28 days) adaption to

environment, the change of blood circulation, start to the function of body organ

2. The periods of baby - The periods of early baby (1-12 months) rapid

growth, maturation process take place continue, the increasing of nerve system function

- The periods of final baby (1-2 years) speed of growth start decrease, progress of growth of motor & function of escretion

Comprehending the growth and development bases

Determinant factors of growthInternal :

genetic : father, mother, grandpa, grandma intrauterine process : nutrition, disease, drug, polution, toxin ,

External : nutrition, disease, pollution, exercise, emotional support

Determinant factors of child developmentInternal : genetic + intrauterine processesExternal : nutrition, diseases, quality of family, baby sitter (care-givers), playmates, school

Factors influencing the growth and development

Gender Pollution Ethnicity Diet Genetic Inheritance Housing conditions Life Experiences (birth, marriage, death and divorce) Employment / unemployment Family relationships Educational experiences Access to health and welfare services Experience of illness or disease

Explaining the existence of disturbance/delay of growth-

development

CASE ANALYSIS

AspectNormal delivery

caseInterpretatio

n

Body weight 2,5 kg – 4,0 kg 2,6 kg normal

variation

Body lengthBCB : 50 cmBKB : 45 cm

50 cmNormal

variation

Head circumference

33 cm – 38 cm 30 cmAbnormalvariation

Delivery History

AspectNormal growing

(9-10 month)case Interpretation

Body weight

10 kg 6 ,5 kg< Percentile-5

(less BW)

Body length

74 cm 70 cm Percentile-25

Head circumfere

nce45 cm 44 cm Mean

Growth HistoryInstrument of measurement : Growth Chart

Aspect Normal condition Case Interpretation

Gross motorRoll over,

Sit without support (6-9 month)

Can’t disturbance

Fine motor

Palmar grasp, transfer hand-to-hand

6 monthReaches out for toys (4

month)Mature pincer grasp (9

month)

Can’t disturbance

Language Responded to sound Can normal

Social & personal

Plays peek-a-boo (6 month)

Eat biscuit (9 month)Can’t disturbance

Developmental HistoryInstrument of measurement : Denver II

Immun PPIImmun until 11

monthCase Interpretation

BCG1 x

(< 3 bulan)since 2 month Normal

Polio4 x

(birth, 2, 4 & 6 month)

4 x Normal

Hep B3 x

(12hours, 1 & 3-6 month)

2x(40 days & 3

month)less

DPT3 x

(2 , 4 & 6 month)2 x

(4 & 6 month) less

Measles1 x

(9 month)never less

Immunization History reference: Rekomendasi oleh Ikatan Dokter Anak

Indonesia (IDAI 2010)

DISCUSSIONreference: Rekomendasi oleh Ikatan Dokter Anak Indonesia

(IDAI 2010)

Nutrition in our case: 1) For daily meal the baby was fed with rice and vegetables,

tofu, tempe, and sometimes egg. 2) Starting from the age of 3 months, he consumed formula

milk, bananas and baby porridge because he cried most of the time.

Ideal nutrition: o ASI exclusive for 6 month!o By 9 months, babies are usually eating two solid meals

in a day

Nutrition History

Nutrition StatusInstrument: Rumus waterlow & Growth

Our case:BW/A= 6.5/9.2= 70.65% (moderate malnutrition)BL/A= 70/72= 97.2% (normal)BW/BL= 6.5/8.8= 73.86% (moderate malnutrition)

Status Percentage

Obesity >120%

Overweight 110% - 120%

Mild malnutrition

90% - 110%

Moderate malnutrition

70% - 90%

Severe malnutrition

>70%

Age (months) Calorie (kcal)1-3 1104-6 1007-9 100

10-12 100

Nutrition Status

Calorie requirement Calorie requirement is depends on the body weight that suitable with current body length of the baby.According to the scenario:

Calorie = 100kcal X 8.8 = 880kcal per day

Improving nutrition status by giving the appropriates nutrition.

Give the enough immunization and on time. Optimalize of parent’s responsibility in stimulation

of infant in order to development of infant achieving the appropriates ASUH, ASIH and ASAH.

Controls the fever and give appropriate treatment based on diagnosis if need

Monitoring is very important and helpful!

ConclusionEarly management

No question right????