≈- Using height for age measurement to monitor growth as well as weight for age
- Use CDC chart for this purpose
- Refer to specialist clinic as early as possible when a child’s growth curve is abnormal
- Encourage parents to come for growth monitoring as they are dealing with the vaccination program
v## Growth and Development
- Growth is an increase in the size of the body & its organs.
- Growth & development monitoring are essential components of WBC.
- Growth can be monitored by growth charts.
- Development can be monitored by developmental milestones checklist &
- By risk assessment & eliciting parents concerns for growth & development.
Early Detection of Growth Disorders
Normal Infant Growth
- Head circumference (HC).
- Approximately 35 cm at birth
- Approximately 47 cm at 1 year of age
- Use charts to detect any abnormalities:
- Large or small head
- Length/ height (H).
- Length at birth approximately 50 cm
- Length at 1 year = 75 cm
- Double birth length by 4 years (100 cm)
- Use charts to detect any abnormalities:
- Under/ over growth
- Weight (wt.)
- Weight at birth = 2.5 - 4 kg
- 4-6 months: birth weight doubles
- 1st year: birth weight triples
- 2nd year: birth weight quadruples
- Gain rate:
- 1st month: 20-30 g / day
- 1st year: 10 g / day
Weight for Age
Boys Birth to 2 Years
(Egyptian Z score)
- Weight (kg)
- Age (Months)
Girls Birth to 2 Years
(Egyptian Z score)
- Weight (kg)
- Age (Months)
Z Score (Percentile)
-
3 (99)
- Length/height for age: May be abnormal
- Weight for age: May be abnormal (Use BMI)
- BMI for age: Obese
-
2 (97)
- Length/height for age: Normal
- Weight for age: Use BMI
- BMI for age: Overweight
-
1 (85)
- Length/height for age: Normal
- Weight for age: Use BMI
- BMI for age: Risk of overweight
-
0 (50)
- Length/height for age: Normal
- Weight for age: Use BMI
- BMI for age: Normal
-
<0 (15)
- Length/height for age: Normal
- Weight for age: Use BMI
- BMI for age: Normal
-
<1 (3)
- Length/height for age: Stunted
- Weight for age: Underweight
- BMI for age: Wasted
-
<3 (1)
- Length/height for age: Severely Stunted
- Weight for age: Severely Underweight
- BMI for age: Severe wasted
Note: BMI: Body mass index
Definition of Z-Score Curves
- Above 2,3: Significantly > average
- Above 1: Moderately > than average
- Above 0: Average
- Below -1: Moderately < than the average
- Below -2, -3: Significantly < than average
Case Study
A woman known of gestational DM brought her child for routine immunization: your nurse brought the girl immunization card, with this information:
- Name: Sara Khalid
- Age: 12 Months
- File number: 2500-7-01
- Date: 25/09/2019
- Department: Almaarifa paediatric clinic
- Code: 6822
- Consultant name: Write your name
- Consultant Number: 3178
- Beep: 3070
Clinical Findings:
- Head circumference: 46 cm
- Body weight: 10 Kg
- Length: 74 cm
Fill the Form Provided
- What you are going to tell her mum about your finding?
- What is your explanation to the abnormal finding?
-
The head circumference is: -------------------------------------------------
-
Her length is: -------------------------------------------------------------
-
Her body weight is: -------------------------------------------------------
-
Your explanation:
-------------------------------------------------------------------------------.
Developmental Milestones
3 Months
- Turns head toward direction of sound
- Recognizes familiar faces and smiles back
- Follows moving objects
- Watches faces with interest
- Raises head and chest while lying on stomach
- Brings hand to mouth
- Takes swipes at dangling object with hands
- Begins to babble and imitate some sounds
6 Months
- Responds to other people’s emotions
- Enjoys social plays/games (especially peek-a-boo)
- Struggles for out of reach objects
- Uses voice to express pleasure and displeasure
- Interested in mirror images
- Responds to their own name
- Babbles chain of sounds
- Rolls both ways (front to back, back to front)
- Sits with, and then without support on hands
1 Year
- Pulls up to stand, Walks holding onto furniture
- Tries to imitate during play (like winking when you wink or clapping when you clap)
- Explores objects; finds hidden objects and begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver)
- Uses simple gestures like shaking head to say ‘NO’ or waving to say ‘BYE BYE’
- May speak single words like “Mama” and “Dada”
- Cries when Mother or Father leaves
- Babbles with inflection (changes in tone)
- Uses exclamations, such as “oh - oh!”
- Pokes index finger
2 Years
- Excited about the company of other children
- Begins to sort by shapes and colors; starts simple make-believe play
- Follows simple instructions; recognizes names of familiar people
- Walks without help; plays pretend (like talking on a toy phone)
- Points out at the objects, when you name it (like toy or photo)
- Imitates behavior of others, especially adults and older children
- Uses 2-4 word sentences
- Repeats word overheard in conversation
- Pulls toys behind him/her while walking
3 Years
- Imitates adults and playmates
- Shows affection for playmates/friends
- Sorts objects by shape and colors; and matches objects to pictures
- Plays make-believe with dolls, animals and people (like feeding a doll)
- Uses pronouns (I, you, me) and sometimes plurals too (cars, dogs)
- Uses simple phrases or micro sentences to communicate with others
- Understands concept of ‘mine’ and ‘his/her’s’
- Expresses wide range of emotions
- Walks up and down stairs, alternating feet (one foot per stair step)
- Runs easily and pedals tricycle
- Starts to make friends
4 Years
- Follows three-step commands (like wash your hands, comb your hair)
- Draws circles and squares
- Speaks in sentences of 5-6 words; Speaks clear enough for outsiders to understand
- Names some colors; understands counting
- Shares and takes turns with other children
- Knows the difference between boys and girls
- Enjoys humor (like laugh at silly faces or voices)
- Brushes his/her teeth by self
- Dresses and undresses without help except for shoelaces
- Pretends by role playing
- Knows opposite (hot/cold, big/small)
Gross Motor Skills
- The acquisition of gross motor skills precedes the development of fine motor skills
- Both processes occur in a cephalocaudal fashion
- Head control preceding arm & hand control, Followed by leg and foot control
Head Control
-
Newborn
-
Age 6 months
Sitting Up
-
Age 2 months
-
Age 8 months
Ambulation
-
Nine to 12-months
-
13 month old
Fine Motor Development
- Newborn has very little control
- Objects will be involuntarily grasped & dropped without notice
- 6 month old: palmar grasp
- uses entire hand to pick up an object
- 9 month old: pincer grasp
- can grasp small objects using thumb & forefinger
Fine Motor Development
-
6-month-old
-
12-month-old
Speech Milestones
- 1-2 months: coos
- 2-6 months: laughs
- 8-9 months: babble: mama/dada as sounds
- 10-12 months: “mama/dada specific”
- 18-20 months: 20 - 30 words (50% understood by strangers)
- 22-24 months: two word sentences, >50 words, 75% understood by strangers
- 30-36 months: almost all speech understood by strangers
Hearing
- BAER hearing test done at birth
- Ability to hear correlates with ability enunciate words properly
- Always ask about history of otitis media – ear infection, placement of PET – tubes in ear
- Early referral to ENT to assess for possible fluid in ears (effusion) to avoid speech delay
- Repeat hearing screening test
- Speech therapist as needed
**
Red Flags in Infant Development
- Loss of developmental skills at any age
- Parental or professional concerns about vision
- Hearing loss at any age
- Asymmetry of movements or other suggestive features of cerebral palsy
- Not rolling, Not reaching for & holding toys, Not starting to babble by 6 months
- Not sitting unsupported, Can’t move toy from one hand to another, by 9 months
- Not walking without support, No clear words, not saying dada, mama or other names, not following one-step direction by 18 months
- Not pointing to pictures or body parts when named, Unable to run, Not use two-word phrases by 2 years
- Not running well or walking up or down stairs, Not following two-step direction by 3 years