Child Growth and Development Characteristics

10. Growth and development of children. Characteristics of growth and development in different periods of childhood and adolescence

Background:

• - Child development refers to the biological and psychological changes that occur in human beings between birth and the end of adolescence, as the individual progresses from dependency to increasing autonomy

• - Basic Body Characteristics: Body height and weight, circumference characteristics, indexes → inserted in percentile graphs

• - Assessment of Growth:

o Height:

•  Children to 18-24 months are measured in lying position; vertex is touching vertical plain by the zero point of the meter. Legs are straight; heels are touching the next horizontal end of the meter

•  Older children are measured in standing position by the wall, without shoes, in maximal erection. Heels and toes are close together, head has not to be bent backward or forward (accuracy of 0.1 cm)

o Weight:

• Upto18months–weighedonascaleforinfantswearingonlyadiaper(itsweightisdeducted)

• Olderchildren–weightedonanormalscale,wearingonlyunderwear

o Circumference: till the age of 3 (indicator of the brain growth)
 We measure so-called front-occipital circumference

o Indexes:

•  For the evaluation of the state of nutrition

•  2 types:

  •  Weight height proportion – evaluation of body composition according to weight related to body height

  •  BMI – weight (kg)/height (m2)
    Reference Indicators, Percentile Graphs:

• - Evaluation of values of body characteristics of the individuals and groups is conducted with respect to reference (standard) indications

• - These indications are used for construction of mathematically adjusted percentile graphs (growth charts) of body height, weight and their proportionality

• - They are constructed on the basis of monitoring the representative sample of children population on the national level

• - Reference indications WHO (The WHO Child Growth Standards) are also available, they are instrumental to evaluation of growth and development of children primarily in developing countries.

• - Child Growth Standards:

o Data is collected in one of three ways:

•  Transversal – data of large representative samples entered at one time

•  Longitudinal – selected sample observed for longer periods of time

•  Semi-longitudinal – a combination of both: larger samples monitored for shorter time period

• - The value of a certain percentile shows the given percentage of the reference population who will achieve this value or lower

• - We are able to monitor the speed and fluency of growth, development of weight-height indexes in connection with age, and also monitor the relation of achieved values with regard to the genetic potential of a child
  Periods of Childhood/Growth

• - Newborn Period: from birth up to 28 days (1 month of age)

• - Infancy: from 1 month of age up to 1 year of age

• - Toddler: 12months – 24 months (1-2 y.a)

• - Childhood Period: 2-12 years of age

• - Adolescence: 13-19 years of age

• - Young adulthood: 20-40 years of age

• - Middle Adulthood: 40-65 years of age

• - Maturity: > 65 years of age

  Determinants of Growth:

- Growth and development of a child is highly individual. The influences of endogenous and exogenous factors are combined there.
o Endogenous factors : ethnic difference, middle height of parents and the influence of gender
o Exogenous factors : eating habits and health condition of the individual (maltreatment; eating disorders: anorexia nervosa and bulimia, prolonged infectious disease x childhood obesity)

- In connection to higher basal metabolism and high demands on growth and development is higher energetic need on 1 kg of the child’s weight, contrary to an adult individual (kJ/kg/day):
o Infant: 500 kJ

o Pre-school children: 480 kJ

o Adult: 125 kJ
- Hormonal influences

o Infancy – IGF-1, IGF-11, placenta growth hormone
o Childhood – GH
o Puberty – GnRH

Growth Disorders:

• - In ideal case (if the child grows in such conditions that his/her genetic potential can be fully used) the growth curve of the observed child is parallel with percentile curves in range from 25th to 75th percentile

• - By the healthy child from the age of 2 to the beginning of puberty there is no change in percentile zone

• - Growth is sensitive indicator of health

• - If the growth speed of the child is first retarded for example by chronic disease and if the cause of growth retardation is deleted, the child organism has tendency to return to original growth trajectory

• - Temporarily increased growth speed after retardation period is called catch-up growth. This feature also appears, if the smaller children are born to high parents

o The opposite is called catch-down growth. It can appear by children who have smaller parents and were quite big when they were born

- We recognize growth disorders by comparing:

o Actual height of the child with the population norm
o Height at a certain age with the genetic potential
o Growth speed

Growth Retardation:

• - Growth retardation is determined as height of a child under the third percentile or as retardation of growth speed and a decrease of over one percentile zone

• - Normal short children – short due to parental short stature; develop normally

• - Chronic diseases – Crohn’s, chronic renal failure, CF, CHD, DM, anorexia, bulimia, JRA, etc

• - Endocrine conditions – GH deficiency, hypothyroidism, Cushing’s

• - Chromosomal aberrations

  Abnormally Fast Growth:

• - Constitutional

• - Hormonal – gigantism, acromegaly

• - Chromosomal – Klinefelter syndrome

• - CT diseases – Marfan syndrome

• - Pubertas praecox

  Developmental Characteristics: include functional, psycho-motor and psycho-social development

- Motor:

o Reaches sitting position without assistance
o Crawls forward on belly
o Assumes hands-and-knees position
o Creeps on hands and knees

o Gets from sitting to crawling or prone (lying on stomach) position
o Pulls self up to stand
o Walks holding on to furniture
o Stands momentarily without support

o May walk two or three steps without support
- Emotional:

o Stranger anxiety
o Cries when mother or father leaves
o Enjoys imitating people during play
o Show specific preferences for certain toys
o Prefers mother and/or regular caregiver to others
o Repeats sounds and gestures for attention

- Language:
o Pays increasing attention to speech
o Responds to simple verbal requests
o Responds to ‘no’
o Uses simple gestures, such as shaking the head for ‘no’
o Says ‘dada’ and ‘mama’
o Tries to imitate words

- Cognitive:
o Explores objects in many different ways
o Finds hidden objects easily
o Looks at correct picture when the image is named
o Imitates gestures
o Begins to use objects correctly