POST NATAL GROWTH

IntroductionIt would seem obvious to say that development does not stop at birth. In fact many systems (cardiovascular, respiratory, gastrointestinal, homeostasis) undergo significant changes at birth, and many others (neural) have not yet completed their development. Postnatal development can be broadly divided into the age categories of: Neonatal (birth to 1 month), Infancy (1 month to 2 years), Childhood (2 years to puberty), Puberty (12 years to mid-teens) and Young Adult a new category (late teens to early twenties).

ASSESMENT OF GROWTH AND DEVELOPMENT

1 .ANTENATAL ASSESMENT:A. Clinical Examination of mother; To correlate gestational age of uterus, abdominal

girth, and weight.B.Ultrasonography Measurement of foetus.C.Amniocentesis Examination of amniotic fluid will help in

assesing maturity of foetus and diagnosis of neural tube defects and chromosomal anomalies.

Pediatric Fundamentals - Growth and Development

Neuro notes

Nervous system anatomically complete at birth except:Myelination

rapid for 2 yearscomplete by 7 years

Posterior fontanelle closed by 6 weeks.Anterior fontanelle closed by 18 months.Primitive reflexes disappear in few months.

POSTNATAL ASSESMENT:

1.Physical Examination

2.Maturity:

A.Dental- Primary decidous

B.Skeletal by radiological method.

C.Sex maturity rating

3.Mile Stones.

DENTAL:

EVALUTION OF DENTAL MATURATION:

Deciduous or temporary teeth -20 in no.

2 lower central incisors-6-8 months.

4 upper incisors-8-12 months.

2 lower lateral incisors-12-15 months.

4 anterior molars-12-16 months.

4 canines-16-20 months.

4 posterior molars-20-30 months.

ERUPTION OF PERMANENT TEETH The first permanent teeth to erupt are the first

molars usually by 6 years. They are the focal points in the dental arch

and form basis for the ultimate shape of the jaw and hence should not be extracted.

Approximately 4 teeth are replaced per year.4 first molars-6 years.8 incisors-7-9 years.8 bicuspid(premolar)-10-12 years.4 canines-11-12 years.4 second molars-13-14 years.4 third molars-17-22 years.

EVALUATION OF SKELETOL MATURITY BASED ON RADIOLOGICAL METHOD:

1.The number and size of certain epiphyseal centres.

2.Size, shape ,density and sharpness of the outlines of the ends of bones.

3.The distance of separation between the epiphyseal centre and zone of provisional calcification.

ADOLESCENT GROWTH SPURTS;

It is the time interval between childhood and adulthood usually beginning at about 10 years in girls and 2 years later in boys, and ends with complete physical, sexual, mental, social,psychological and behavioral maturation.

It is the period of maturation related to anatomical

and physiological changes with appearance of

secondary sex charecters, maturation of

reproductive system under the influence of

hormones.

During adolescent growth spurts, there is

increase in body fat, body mass, change in

voice, specially in boys due to increase length

of vocal cords.

MILESTONES:

A.Physical parameters:

Weight,height, head,chest, and midarm circumference

Weight-20gm/day---5 month.

15gm/day----6month

doubles------5to6months

triples-------1 year

four times----2years.

five times----3 years.

six times-----5years

C.Height At birth-----50cms At one year----75cmsD.Head circumference: At birth--------33to35cms I year --------+12cms 2year --------+2cms 3to 5years------+1.25cms 5to15 years------1.5cm/years by 12 to 15 years it reaches

adult size.

E.Chest measurement: birth-3cms more than head circumference. one year-both equal after one year-it is more than head

circumference.F. Mid arm circumference: birth--------11.5cms to 12cms. I year------14 to 16 cms I to 5 year—0.25cm. hence it is an age independent criteria for

assessing malnutrition.

Sitting height/sub ischial height; 70% of body length---in neonates 57% of body length---3years 52% 0f body length---puberty.Span: The span is equal to the length of

the child.

ROAD TO HEALTH CHART (GROWTH CHART)

ROAD TO HEALTH CHART

GROWTH CHART:(road-to-health) Growth chart helps in monitoring the

growth and development of child. It gives complete information about

childs immunization and nutritional grade. It also gives complete information about

family size, health of siblings and parents. Child weight is also recorded.

WHY DO DOCTORS AND NURSES NEED THE CARD?Doctors and nurses will check the card to see:

if your child received the necessary immunisations

if your child received the necessary vitamin supplementations

the growth of the childthe child's development according to the

milestones for a growing child.

The card - a record of immunisations and growth rate - is given to mothers when their infant is born and is used to monitor the development of the child until it is five years old.

Upward growth curve shows child is growing normally,during illness and malnutrition growth charts shows downwards or flattens curve.

Feeding advise to the mother is also printed on chart.

Childs minor ailments and the treatment advised is printed and recorded.

Hence growth chart offers a simple way of monitoring weight gain.

The space between the two growth curves has been called the road-to-health.

If the child is growing normally, the growth line will run parallel to the road-to-health curves.

Flattening or falling of the childs weight curve, signals growth failure,which is the earliest sighn of protein-energy malnutrition.

Nutritional factors affecting GrowthThe body needs different kinds of nutrients for growth, energy and

repair.Nutrients: 1.Carbohydrates,Fats, Proteins , Vitamins ,Minerals and Water. Carbohydrates and Fats provide the materials for growth and

development. Proteins for growth and repair. Vitamins keep the body in good conditions. Water is essential for Metabolism and Bowel movements.

Water determines the amount of blood in circulation.

Minarals-builds strong bones and Teeth, for helping the nerves work for regular growths and for clotting blood.

Metabolism refers to all the activities going on in the cells so that they can absorb food and energy.

CURVATURES OF VERTEBRAL COLUMN

Primary curvatures:1.During intrauterine life the whole

vertebral column is CONCAVE ventrally and CONVEX dorsally.

In Adult Primary curvatures are retained only in thoracic and sacral regions.

They are mainly due to the shape of the vertebrae.

SECONDARY CURVATURES

Secondary curvatures are CONVEX forwards.They develop after Birth.They develop due to posture.They are mainly due to the shape of

intervertebral discs.

Secondary curvatures are observd in cervical and lumbar regions.

Cervical curvature appear around 6 to 9 months when the child starts holding his head by himself.

Lumbar curvature appears at about 12 to 18 months when the child starts walking.