GROWTH AND DEVELOPMENT

Mentor:dr. Pulung M. Silalahi, Sp.A Written by :Trianggi Putri Husni

Lubis

Introduction

Growth and development is a continuous process that occurred since conception and continues into adulthood. In this process of becoming an adult, a child must go through various stages of growth and development.

Growth and Development

1 Growth is a quantitative change, the increasing number, size, and dimensions at the level of cells, organs, and individuals

2 The development is the qualitative change. development is the increasing skill in the structure and function of the body, which is more complex in a regular pattern and can be predicted as a result of the maturation process

1. Genetic Factors 2. Environmental Factors

a. prenatal factors b. postnatal factors

biological environment physical factors psychosocial factors Family factors and customs

Factors that affect Growing and development

• ASUH (biomedical Needs) Regarding child nutrition during pregnancy and thereafter, the need for shelter, proper clothing and safety, health care such as immunizations and early detection and early intervention would be the onset of symptoms.

• ASIH (emotional needs) It is important creates a feeling of safety (emotional security) with physical and psychic contact with the mother as early as possible. Children's needs affection, attention and appreciated, a new experience, praise, responsibility for independence is essential for granted. Not prioritize sentence with anger, but more give examples of affectionate.

Child’s Basic Needs

• ASAH (The need for early mental stimulation) early learning, education, and training provided as early as possible and as appropriate. Especially in the first 4-5 years of age (golden year) so it will be realized ethics, personality steady, wise, with intelligence, independence, skills and good productivity.

Stages of Growth1. The period of prenatal (prenatal period)

a. Zygote period: conception - 2 weeksb. Embryonic period: 2 weeks - 8/12 Weekc. Fetal / fetus: 9/12 weeks – born

Early fetal period: 9 weeks-2nd trimester Further fetal period: the last trimester of pregnancy

2. Infancy (infancy): 0-1 yearsa. Neonatal period: age 0-28 days

Early neonatal period: 0-7 days Further neonatal period: 8-28 days

b. Post-neonatal period: 29 days - 12/15 months

3. Early Childhood / (toddlerhood): age 1-3 years

4. The period of pre-school (preschool / early childhood): age 3-6 years

5. The school year: 6 - 18/20 yearsa. Pre-teens (middle adolescence): age 6-11 yearsb. Adolescence (adolescence):

Early Adolescence (early adolescence): 11-13 Adolescence middle (middle adolescence): 14-17 years Further Adolescence (late adolescence): 17-20 years

1. Changes in sizes 2. Changes in the proportions 3. The loss of the old traits 4. The emergence of new traits

Characteristics of Growth

Growth and Calorie Needs

Antrophometry

• There are several ways to assess the nutritional status of the community. One of them is the measurement of the human body, known as anthropometry.

• In use for the assessment of nutritional status, anthropometric index are presented in the form associated with other variables.

Anthropometry variable

• Age• Weight• Height• Head circumference

Example:• A boy– Age : 12 months– Weight : 11 kg– Height : 80 cm

Interpretation of nutritional status based on Waterlow’s theory

• Based on weight for height’s formula

– Normal 90-110%– Mild Malnutrition 80-90%– Moderate Malnutrition 70-80%– Severe Malnutrition <70%

Interpretation of nutritional status based on Jelliffe’s theory

• Based on Weight for age’s formula

– Over Nourished : >110%– Normal : 90-110%– Mild Malnutrition : 80-90%– Moderate Malnutrition : 60-80%– Severe Malnutrition : <60%

Interpretation of nutritional status based on CDC/WHO

• Based on Height for age’s formula

– Normal : ≥90%– Stunted : <90%

• Conclusion:– WFA = 107%• Normal

– HFA = 106%• Normal

– WFH = 96%• Normal

• Good Nourished

Head circumference

• Head circumference counting is commonly used method to determined the growth and brain development of children.

• Usually the size of the skull growth following the development of the brain, so that when there are obstacles to the growth of the skull the brain development of children is also inhibited.

• Measurements were taken at occipitofrontal diameter by taking the average of 3 times measurements as standard. Rapid growth rate in the first 6 month of the baby, 35 cm to 43 cm at birth at the age of 6 month.

• Growth rate then decreases, only 46,5 cm at age 1 and 49 cm at the age of 2 years. Furthermore drastically reduced to only grow 1cm to 3 years of age and increased again about 5 cm to adolescence/adulthood.

• Therefore the benefits of the measurements head circle limited to age 3 years, except when required as in the case of hydrochepalus.

Child development

• In toddler years, the development of language skills, creativity, social awareness, emotional intelligence, runs very fast and is the foundation for the next development.

• Moral development as well as the basics of personality is also formed in this period.

• So that any abnormalities / slightest deviation is detected especially if not handled properly, will lessen the quality of human resources in the future days.

Developmental phase

• Assessment of child development in the early phase is generally divided into four functional capabilities:– gross motor and fine motor,– Vision and Hearing, – Language and speech, – Emotional behavior and social behavior.

0 – 6 MONTHS

6 – 12 MONTHS

12 – 18 MONTHS

18 – 24 MONTHS

2 – 3 YEARS

4 – 5 YEARS

Developmental screening

• A brief assessment procedure designed to identify children who should receive more intensive diagnosis or assessment

• Goal:• To determine abnormalities child development

and other issues that are the risk of developmental abnormalities

• Knowing various developmental problems that require treatment or genetic counseling

• Knowing when a child should be referred to a higher service center

Screening instrument• STANFORD-BINET test

– For age 2 – adult– Mostly verbal– To score IQ and mental age

• Wechsler intelligence scale for children test– For pre school age 4-6½ years– Verbal and performance test– To score IQ– Take a long time to finish, but it could score children who has learning problem or

mental retardation• Gesell infant scale

– For 4 weeks – 6 years age– To score motor, adaptive, language, and social behavior

• BAYLEY infant scale of development– For 2 – 30 months– To score mental, and motor development, and behavior record

• Denver II screening test– For birth to 6 years old– To score developmental level, screen children without symptom

DENVER II SCREENING TEST• Frakenburg, et al (1981) through the DDST (Denver Developmental

Screening Test) suggested four parameters used in assessing the developmental progress for toddler are:

– Personal social (personality / social behavior)• Aspects related to the ability of independent, socialize and interact

with its environment– Fine Motor adaptive (fine motor movement)

• Aspects related to the child's ability to observe something, do movements that certain body parts only and do small muscles, but requires careful coordination For example, the ability to draw, holding some object, etc.

– Language• Ability to respond to sound, follow orders and speak spontaneously

– Gross Motor (gross motor development)• Aspects related to movement and posture

Denver screening

• Only use the corrected age

• Scoring:– P (Pass)– F (Failure)– NO (No Opportunity)– R (Refusal)

• Advanced : Pass <25%• Normal : Pass 25%-90%, Failure, Refuse <75%• Caution : Failure, Refuse 75%-90%• Delayed : Failure, Refuse >90%

Advanced : Pass <25%

Normal: Pass 25 % - 90%Failure, Refuse <75%

Caution : Failure, Refuse 75%-90%

Delayed : Failure, Refuse >90%

Interpretation• Normal

– Without (F) or at least 1 (C)– Retest on the next control

• Suspect– 2 or more (C) / 1 or more (F)– Retest in 1-2 weeks to eliminate the momentary factor (fear, illness/pain,

drowsy, or tiredness)• Abnormal

– 2 or more (F)– Refer for evaluation diagnostic

• Cannot be tested– If the patient refuse on 1 or more items on the left of the age line / refuse on

more than 1 item on 75%-90% area– Retest in 1-2 weeks

Normal

NormalWithout (F) or at least 1 (C)Retest on the next control

Abnormal

Abnormal2 or more (F)Refer for evaluation diagnostic

Abnormal

Suspect

Suspect2 or more (C) / 1 or more (F)Retest in 1-2 weeks to eliminate the momentary factor (fear, illness/pain, drowsy, or tiredness)

Growth and developmental problem

• Physical Growth Disorders• Impaired motor development• Impaired language development • Emotional and Behavioral Disorders

WARNING SIGN IN DEVELOPMENT

• Children 0-6 months– physical development

• a. At 2 months of age the child is not able to hold his head when you picked it up.

• b. At the age of 3 or 4 months the child can not hold his head very well.

• c. At 6 months of age a child can not sit even if you have been helped.

– language development• a. At the age of 4 months, the child can not imitate your voice.• b. At 6 months of age the child does not want to laugh or cry

• 2. Children 6-12 months– physical development

• a. At the age of 7 months, the child can not control his head well when the child is placed in a sitting position, do not want to reach something around it, and can not put something in his mouth.

• b. At the age of 8 month child can not sit alone.• c. At the age of 12 months, your child is not able to crawl and could not

stand although in cling to.

– language development• a. at the age of 9 months, the child can not give voice to seek attention.• b. At the age of 10 months, the child did not respond when on call• c. At the age of 12 months, the child is not trying to communicate to you

even if he needed help, the child also can not be waved wishful nod or shake his head.

Problems of growth and development of children

• Disorders of speech and language. • Cerebral Palsy • Down Syndrome• Short stature• Disorders autism• Mental Retardation• Attention deficit disorder

• THANK YOU