GROWTH AND DEVELOPMENT

DR CHIKONDE
• Definitions: Growth is increase in size of organism due to
increase size and I or increase number of its constituent
cells.
• Development is maturation of functions & acquisition of
skills.
STAGES OF GROWTH & DEVELOPMENT
 Intrauterine stage
• Embryonic period
 1st trimester (1st 12 weeks of gestation)
 Devoted for organogenesis. By end of this phase the embryo
weight is 9 gm and 5 cm
 Teratogenic agents in this period may lead to: abortion or
congenital anomalies.
• Early fetal period
 2nd trimester (12-28 weeks)
 Rapid growth mainly in length, Fetus is pre viable
• Late fetal period
 3rd trimester (28-40 weeks)
 Rapid growth mainly in weight, Fetus is viable
 Teratogenic agents in fetal period may lead to fetal death,
stillbirth, premature delivery or IUGR.
 Extra uterine stage
• Neonatal
1st 4 weeks of life
• Infancy
Early infancy up to one year
Late infancy during the 2nd year.
• Childhood
Early childhood(2-5 years)
Late childhood (6- 12 years
• Adolescence
From (12-15 years)
 FACTORS AFFECTING GROWTH
Factors before conception: a. Racial b. Familial
c. Constitutional
- Maternal factors
- Hormonal role
 PATTERN OF GROWTH
• General
growth of bones, muscles & soft tissues
• Genital
growth of genital organs
• Nervous
growth of CNS
• Lymphatic
growth of lymphatics
 ANTHROPOMETRY
• Anthropometrics are a set of non-invasive, quantitative body
measurements used to assess growth, development, and health
parameters.

• Include length or height, weight, head circumference and mid-upper

arm circumference help providers determine if a child is growing
appropriately and can indicate when the child’s health and well-being
are at risk.

• Calculate: WFH, WFA, HFA, BMI

• Assist providers in establishing a diagnosis, selecting appropriate

treatment options and follow up on progress of a child or adolescent.
• Some conditions that are important in Paediatrics:
severe acute malnutrition, stunting, overweight and
obesity, hydrocephalus, microcephaly, short stature
(Upper segment versus lower segment height)
 Weight: formulae
• 0 to 4 months gain 750g each
Weight at one yr triples
month
Weight at 2 years quadruples
• 4 to 8 months 500g each month
Weight at 7 yrs is 7x
• 8 to 12 months 250g each
month
• 1-6yrs: (AGE IN YRS X 2) + 8 Head circumference:
Measure thrice, count the
highest
Birth: 33cm to 37cm (35)
• Normal birth weight: 2.5 to 4kg 3 months: 40cm
• LBW: 1.5 to 2.5kg 6 months: 43cm
9 months: 45cm
• VLBW: 1 to 1.5kg
1 year: 46 cm
• ELBW: < 1kg 3/4 years: 50cm
9 years: 55cm
Length At birth. At 6 months. At I year. At 2 years.
After the 2"d year
50 cm .68 cm .75 cm .87 cm .Length is calculated as:
Length = age in years x 5 + 80.
Mid upper arm circumference (MUAC)
• In a baby 1-4 years MUAC is>14cm
• In subclinical malnutrition MUAC is 12-14cm
• In clinical malnutrition MUAC is < 12 cm
Head circumference(HC) & chest circumference (C.C)
ratio
Growth charts
• GC – measurements
recorded over time.
• Deviation in growth
profile from normal
• satisfactory tool to
diagnose deviation
•
 Weight for age
• WFA
• The weight varies according to a Childs age.
And sex.
• WFA assesses appropriate wt. for age.
Underweight (<-2SD) and severely
underweight (<-3SD) is proportional to risk for
severe disease
• Under five card Zambia
 Weight for height/length
• Assesses for acute malnutrition/wasting
• <-2SD Moderate malnutrition/wasted
• <-3SD severe malnutrition/severely wasted
 Height for age
• Asssesses stunting
• Stunting, severe stunting
 BMI
• Used to assess over weight and obesity
• Wt (kg)/ht2 (m2)
‘Under 5’ card
Activities of an Under 5 clinic
 Under 5 clinic
• Derived from the well baby clinic in developed
countries
• For comprehensive health care of the child
and mother. Under 5 - child
• Preventive, promotive, curative, referral and
educational health services are provided in a
package to children under 5 under one roof
 Activities of clinic
• Growth monitoring – weighed done. monthly in the first yr
• Adequate nutrition
• Immunization – schedule, vaccines given
• Health education – child care, breastfeeding, nutrition,
growth monitoring, cleanliness, ‘danger signs’ etc
• Deworming
• Vitamin A supplementation
• Referral of sick child
• Other things done in the MCH: Family planning (MCH
model)
D EN TIO N
TEETHING PROBLEMS
Delayed teething no eruption beyond 13 months
age.
Causes:
I. Local: e.g. supernumerary tooth, cysts, over
retained primary teeth
II. Generalized : - Mongolism - Achondroplasia -
Cretinism -Rickets - Osteogenesis imperfecta -
Hypopituitarism , hypoparathyriodism
III. Idiopathic : the commonest cause
1. Diarrhea, drooling or fever have doubtful real
correlation with teething.
2. Teething pains: treated by paracetamol,
teething gel, and rubber toys
3. Congenital missing teeth: frequently maxillary
lateral incisor
4. Congenital extra teeth: frequently extra molar
teeth
5. Premature teething is seen is: Natal teeth
(should be extracted to avoid aspiration).
Ellis Van Creveled syndrome: micromelic short
stature, polydactyly, and atrial septal defect. -
Congenital syphilis
ASSESSMENT OF DEVELOPMENT
• NEWBORN PERIOD Observation of any asymmetric
movement or altered muscle tone and function
may indicate a significant central nervous system
abnormality or a nerve palsy resulting from the
delivery and requires further evaluation
• The Moro reflex is elicited by allowing the infant’s
head to gently move back suddenly (from a few
inches off of the mattress onto the examiner’s
hand), resulting in a startle, then abduction and
upward movement of the arms followed by
adduction and flexion. The legs respond with
flexion.
• The rooting reflex is elicited by touching the corner
of the infant’s mouth, resulting in lowering of the
lower lip on the same side with tongue movement
toward the stimulus. The face also turns toward
the stimulus
• The sucking reflex occurs with almost any object
placed in the newborn’s mouth. The infant
responds with vigorous sucking.
• The asymmetric tonic neck reflex is elicited by
placing the infant supine and turning the head to
the side. This placement results in ipsilateral
extension of the arm and the leg into a “fencing”
position. The contralateral side flexes as well.
1. MOTOR MILESTONES : (LOCOMOTOR
DEVELOPMENT)
A. Gross motor
At -3 months Head support ( no head lag )
-6 months Sit without support
-9 months Crawling
-12 months Walking alone
-16 months Run
-2 years stairs in child
-3 years Ride a tricycle
B. Fine motor
At -3 months Grasp rattle
-6 months Palmer grasp
-9 months Pincer grasp
-1 years feed on their own
2. MENTAL MILESTONES
A. Social adaptation
At -3 months Social smile
-6 months Mother recognition
-9 months Father recognition, respond to his
name, waves bye bye
B. Speech development
At -3 months cooing
-6 months bubbling
-1year one syllable
-5 years Says clear speech
3- SPECIAL SENSE DEVELOPMENT
A. Hearing
At –Birth. Hearing is impaired due to amniotic fluid in
middle ear
-2 weeks. Good hearing and baby can respond to
noise by Moro reflex
-5-6 months. Turns his head to the sound
B. Vision
At -1 month. Macula not yet developed
-2 months. Fix on steady objects
-3 months. Fix on slowly moving object
-7 months. Follow rapidly moving object
PRECOCIOUS
PUBERTY
OBJECTIVES

• Physiology of Puberty
• Tanner staging
• Def. of Precocious Puberty
• Causes
• Treatment
PUBERTY

• Puberty is the developmental stage during which a

child becomes a young adult, characterized by the
maturation of gametogenesis, secretion of
gonadal hormones, and development of secondary
sexual characteristics and reproductive functions.
HYPOTHALAMIC-PITUITARY-GONADAL AXIS
TANNER STAGING
STAGES OF BREAST DEVELOPMENT

• B-1: pre-pubertal
• B-2: breast bud
• B-3: enlargement of breast and areola with no separation of the
contours
• B-4: projection of areola and papilla to form a secondary mound above
the level of the breast
• B-5: recession of the areola to the general contour of the breast with
projection of the papilla only.
STAGES OF PUBIC HAIR DEVELOPMENT IN
FEMALES

• Ph-1: pre-pubertal
• Ph-2: sparse growth of long slightly pigmented hair usually slightly
curly mainly along the labia
• Ph-3: the hair is darker, coarser and curlier and spreads over the
junction of the pubes
• Ph-4: the hair spreads covering the pubes
• Ph-5 the hair extends to the medial surface of the thighs and is
distributed as an inverse triangle
TANNER STAGING
STAGES OF PUBIC HAIR AND GENITAL DEVELOPMENT IN
THE MALE
• G-1: pre-pubertal testicular volume > 4ml or 2.5 cm long
• G-2: the testis and scrotum enlarge, and the skin of the scrotum shows some reddening
and change in the texture. testicular volume 4ml-8ml or 2.5-3.3 cm long. Sparse growth of
pigmented hair usually slightly curly mainly at the base of the penis (Ph-2)
• G-3: Testis and scrotum enlarge further, the penis grows mainly in length but also in
breadth. testicular volume 9ml-12ml or 3.4-4.0 cm long. The hair is darker, coarser and
curlier and spreads over the junction of the pubes (Ph-3)
• G-4: Scrotum, testis and penis grow further with development of the glans and further
darkening of the scrotal skin. testicular volume 15ml-20ml or 4.1-4.5 cm long The hair
spreads covering the pubes
• G-5: adult stage. testicular volume >20ml or >4.5 cm long. spreading of the hair to the
medial surface of the thighs
• Thelarche denotes the onset of breast
development, an estrogen effect.
• Pubarche denotes the onset of sexual hair growth,
an androgen effect.
• Menarche indicates the onset of menses
• spermarche the appearance of spermatozoa in
seminal fluid
PRECOCIOUS PUBERTY

• DEF: Onset of secondary sexual characteristics before the age of 8yrs

in girls and 9 yrs in boys.
• Depending on the primary source of the hormonal production
classified as : -
1. Central
2. Peripheral
CLASSIFICATION

• Central Precocious Puberty aka Gonandotrophin Dependent Precocious

Puberty (GDPP) is caused by early maturation of the hypothalamic-
pituitary-gonadal axis.
• It is characterized in girls by both breast development and pubic hair
sexual maturation and both pubic hair and testicular enlargement in
boys.
• Peripheral Precocious Puberty aka Gonadotrophin
Independent Precocious Puberty (GIPP) is caused
by excess secretions of sex hormones derived
either from the gonads or adrenal glands
CONDITIONS CAUSING PRECOCIOUS PUBERTY

• CENTRAL PRECOCIOUS PUBERTY:

- Idiopathic
- Organic brain lesions
- Brain tumors
- head trauma
- Hypothyroidism
PERIPHERAL PRECOCIOUS PUBERTY CAN
EITHER BE-

• Isosexual precocious puberty, feminizing signs appear in

girls, masculinization in boys.
• Heterosexual precocious puberty causes signs of
masculine characteristics in girls and feminization in boys.
PERIPHERAL PRECOCIOUS PUBERTY

Isosexual ( Feminizing) conditions in females:

- McCune-Albright Syndrome.
- Ovarian Tumors
Heterosexual (Masculinizing) conditions in females:
Congenital Adrenal Hyperplasia
Adrenal tumors
Ovarian tumors
Isosexual (Masculinizing )conditions in boys:
• Congenital Adrenal Hyperplasia
• Leydig cell tumors
• hCG secreting tumors
Heterosexual (Feminizing ) conditions in boys:
• Faminizing adrenocortical tumor.
EVALUATION OF A PATIENT WITH
PRECOCIOUS PUBERTY

• MEDICAL HISTORY:
- Age at onset
- Sex
- Pubertal Progression
- Symptoms suggestive of hypothyroidism
- H/o past CNS infection, headache, visual disturbances & seizures.
EVALUATION

• Physical Examination :
- Measurements of height, weight, height velocity
- Pubertal staging according to Tanner’s staging.
- Evaluate androgen & estrogen effects. - Inspection of skin. ( Café au
lait macules in McCune –Albright Syndrome.
- - Examination for signs of hypothyroidism
INVESTIGATIONS

• Basic Radiology :
• Bone Age
• Pelvic & Abdominal Sonography
• Hormone Evaluation:
- Intravenous administration of gonadotropin releasing hormone (GnRH
stimulation test) or a GnRH agonist (leuprolide stimulation test) is a
helpful diagnostic tool for boys.
- In girls, the central nature of sexual precocity can be proven by
detecting pubertal levels of estradiol (>50 pg/mL), 20-24 hr after
stimulation with leuprolide
TREATMENT

MEDICAL : Indications of treatment:

- Predicted adult height is less.
- Psychologically distressing to child.
- - Rapid progression.

GnRH Agonists :
- Inj .Leuprolide ( 0.5-0.3 mg/kg/dose) monthly.
TREATMENT

• SURGERY :
- Tumors of the ovary,testis & adrenals require surgical removal. -
Hypothalamic
- Germ cell, pineal tumors & hCG producing suprasellar tumors can be
treated by radiotherapy.
•THE END