如何上好一堂儿科理论课-14271课件.ppt

1、CHILD GROWTH AND DEVELOPMENTDepartment of PediatricsSoochow University Affiliated Childrens Hospital pPediatrics focuses on the pattern of child growth and development, child health promotion, disease prevention and treatment, and direct care of illness children. pThe children are often among the mo

2、st vulnerable or disadvantaged in society, and thus their needs require special attention. Pediatric worker aims at protecting children from illness and injury, assisting them to attain optimal levels of health.Characteristics of PediatricspThere are significant differences between children and adul

3、ts. pThe younger the children, the greater the difference. pHealth promotion, disease prevention, treatment, and health care of children are unique from that of adults.Childhood is a critical period for physical, psychological and behavioral development. Compared with adult, child is relatively less

4、 independent. Family, kindergarten, school, and community are important settings for their development. Health care should be planned specifically based on their characteristics and needs of children in different age group.It is also significant for health worker to know that there are characteristi

5、c health problems peculiar to each major phase of development.Age stagesearly middlelater7 D28 D14 DNeonatalPerinatal period (from 28 weeks gestination to 7 days after birth) conceptionFetal Periodbirth1st2ndAge stagesPerinatal period28 W3rdbirthBirth 1y 3y 6-7yInfancyBiologic and personality matura

6、tion are accompanied by physical and emotional turmoil, and there is redefining of the self-concept. Age stagesToddlers AgePreschool Age G B11y 13ySchool Age G B18y 20yAdolescence pChild growth and development is a complex process, which includes not only physical growth, but also the maturity of sy

7、stems, development of functioning, The process of growth and development is influenced by a variety of internal and external factors. pTherefore it is one of the most important goals of pediatric to monitor and improve child growth and development,personality, and behaviors.Child growth and developm

8、entGrowthan increase in the number and, size of cells as they divide and synthesize new proteins; results in increased size and weight of the whole or any of its parts.can be viewed as a quantitative change. Development a gradual change and expansion; advancement from a lower to a more advanced stag

9、e of complexity the emerging and expanding of the individuals, capacities through growth, maturation, and learning can be viewed as a qualitative change.Child growth and developmentpGrowthquantitative changepDevelopmentqualitative changepMatura-tionan increase in competence and adaptability; a chang

10、e in the complexity of a structure that makes it possible for that structure to begin functioning to function at a higher level. All of these processes are interrelated, simultaneous, and ongoing processes; none occurs apart from the others. The processes depend on a sequence of endocrine, genetic,

11、constitutional, environmental, and nutritional influences. The childs body becomes larger and more complex. Patterns of Growth and DevelopmentThere are definite and predictable patterns in growth and development that are continuous, orderly, and progressive. These patterns, sometimes referred to as

12、trends or principles, are universal and basic to all human beings. Patterns of Growth and DevelopmentCephalocaudal or head-to-tail The fist pattern is growth and development in the cephalocaudal, or head-to-tail, direction, and reflect the physical development and maturation of neuromuscular functio

13、n. 1.Continuous and Sequential Trends2. Directional TrendsPatterns of Growth and Developmentp Cephalocaudal or head-to-tailp Proximodistal or near-to farpThe second pattern is growth and Development in the proximodistal, or Near-to far, direction (midline to periphery). In the infant, shoulder Contr

14、ol precedes mastery of the hands, the entire hand is used as a unit before the fingers can be manipulated.2. Directional Trends1. Continuous and Sequential TrendsPatterns of Growth and Developmentpcephalocaudal or head-to-tail pproximodistal or near-to farpThe third trend in directional growth, diff

15、erentiation, describes development from simple operations to more complex activities and functions. Specific and refined patterns of behavior emerge from very broad and global patterns. All areas of development (physical, mental, social, emotional) proceed in this direction. 2. Directional Trends1.

16、Continuous and Sequential TrendsdifferentiationPatterns of Growth and DevelopmentIn both total body growth and growth of subsystems there are periods of accelerated and of decelerated growth. The very rapid growth rate during infant gradually levels off throughout early childhood. This rate is relat

17、ively slow during middle childhood, increases markedly at the beginning of adolescence, and levels off in early adulthood. 1. Continuous and Sequential Trends2. Directional Trends3. Developmental PacePatterns of Growth and DevelopmentEach child grows in his or her own unique and personal way. Great

18、individual variation exists in the age at which developmental milestones are reached. Rates of growth vary from one individual to another. Children may grow quickly or slowly during the spurt and may finish sooner or later than other children. 1. Continuous and Sequential Trends2. Directional Trends

19、3. Developmental Pace4. Individual Differences Gender, nutrition, environment are an influential factors. SELECTED FACTORS THAT INFLUENCE GROWTH AND DEVELOPMENTGenderHeredityPrenatal InfluencesNutritionDiseasesInterpersonal RelationshipsEnvironmental HazardsSeasons and Climatesinternal factorsextern

20、al factorsnaturenaturenurturenurturePhysical Growth and Development Weight Weight is the total of all organs, tissues and fluid. It is an easily obtainable measurement and a sensitive index reflecting the childs overall growth and nutrition. In addition, weight is a basis calculating dosage of medic

21、ation in clinic.Physical Growth and DevelopmentmeasurementWeightTake the weight at the same time each day (preferably before breakfast) on the same scale for greatest accuracy. Physical Growth and DevelopmentWeightnewborn3.0Kgpphysiologic weight loss during the first week after birthpinfant may loss

22、 3%-9% of their weight due to the insufficient milk supply, water loss and meconium excretion. 10 %pwhich reaches the peak at 3 to 4 days after birth and return to the level of birth weight at 7 to 10 days after birth. 10 daysPhysical Growth and DevelopmentWeightnewborn3.0KgGrowth is very rapid duri

23、ng the first year of age, especially during the initial 6 months.The younger the infant, the more the weight gain.Infants gain 600-800g per month until age 6 months, when the birth weight has at least doubled. 6 Mo7.2Kg The weight of child (1-6 months) can be estimated by the formula: Weight(kg)=Bir

24、th weight(kg)months0.7(kg)Physical Growth and DevelopmentWeightnewborn 3.0Kg 6 Mo 7.5Kg12 Mo 9.0KgThe younger the infant, the more the weight gain.By 1 year of age the infants birth weight has tripled, with an average weight of 9 kg.Weight gain decreases by half that amount during the second 6 month

25、s. The weight of child (7-12 months) can be estimated With Weight(kg) = 6(kg) month0.25(kg)Physical Growth and DevelopmentWeightNewborn 3. 0Kg 6 Mo 7.5Kg 12 Mo 9.0Kg 2 ys 12.0Kg 5 ys 18.0Kg10 ys 28.0Kg After this point the normal rate of weight gain, assumes a steady annual increase of approximately

26、 2 to 2.75 kg per year until the adolescent growth spurt. The weight of child (2 yrs-12 yrs) can be estimated With Weight(kg) = age28(kg) Physical Growth and Development Individual Differences is within 10 %；If 15 % wasundernutritionIf 20 % wasoverweightWeightNewborn 3. 0Kg 6 Mo 7.5Kg 12 Mo 9.0Kg 2

27、ys 12.0Kg 5 ys 18.0Kg10 ys 28.0KgPhysical Growth and DevelopmentHeight Height is the vertical distance of two points between the top of the head and heel of the feet. Height (a) Children younger than age 3 years are measures lying down in no shoes, socks and cap;measurement (b) Children older than a

28、ge 3 years are measured by standing straight.The measuring varies with age:Physical Growth and Development At approximately 2 years of age the child begins a relalively stable and steady growth rate of 5 to 6 cm per year; this rage continues for the next 10 years.The Height of child (2 yrs-12 yrs) c

29、an be estimated With Height(cm) = age770(cm)Physical Growth and DevelopmentNewborn 50cm6 Mo 66cm12 Mo 75cm2 ys 85cm5 ys 105cm10 ys 140cmHeight Individual Differences is within 30 %；Physical Growth and DevelopmentNewborn 50cm6 Mo 66cm12 Mo 75cm2 ys 85cm5 ys 105cm10 ys 140cmHeightPhysical Growth and D

30、evelopmentHead Circumferencep head circumference is an important determinant of brain growth and potential neurologic function. p It is usually measured in children up to 2 years of age.Head Circumference The measurement is made by placing a tape measure around the head just above the eyebrows and a

31、round the most prominent portion of the back of the skill.measurementPhysical Growth and DevelopmentHead CircumferenceHead growth is also rapid.pThe average head circumference is 33-34cm at birth. pDuring the first 6 months head circumference increases approximately 1.5 cm per month but decreases to

32、 only 0.5 cm per month during the second 6 months. After 2 years of age After 2 years of age the growth is slowly.the growth is slowly.Physical Growth and DevelopmentNewborn 34cm6 Mo 42cm12 Mo 46cm 2ys 48cm 5ys 50cmpOver-bulge of anterior fontanel indicates increased intracranial pressure. Sunken fo

33、ntanel indicates dehydration. pDelayed close of anterior fontanel is evidenced as children with rickets.pThe posterior fontanel measures between 0.5 to 1 cm at its widest part and close at 6 - 8 weeks after birth. Expanding head size reflects the growth and differentiation of the nervous system.Ches

34、t Circumference The measurement of chest circumference is made at the nippier line.Physical Growth and DevelopmentThe chest circumference at birth is about 32 cm, less than the head circumference.The chest circumference approximately equals head circumference by the end of the first year.They can be

35、 estimated after 1 years With (chest one - head one ) = age (years) Head ChestNewborn 34cm 32cm6 Mo 42cm 41cm12 Mo 46cm 46cm 2ys 48cm 50cm 5ys 50cm 55cmPhysical Growth and DevelopmentExternal ProportionsPhysical Growth and Development Variations in the growth rate of different tissues and organ syst

36、ems produce significant changes in body proportions during childhood. After the first year and extending to puberty, the legs grow more rapidly than any other part. However, with the onset of puberty there is a marked alteration in body proportion.Skeletal Growth and Maturation Skeletal, or bone age

37、 appears to correlated more closely with other measures of physiologic maturity than with chronological age or height. Bone age is determined by comparing the mineralization of ossification centers and advancing bony form to age-related standards.Physical Growth and Developmentradiographs of the han

38、d and wrist provide the most useful areas for screening to determine skeletal age, especially before age 6 years. TeethingpThere are totally 20 deciduous (primary) teeth. The first deciduous tooth usually erupts at around 4 to 10 months (average 6 months), followed by a new one monthly.pAll 20 decid

39、uous teeth are generally present by 2 to 2.5 years of age. Physical Growth and DevelopmentThe first permanent (secondary) teeth erupt at about 6 years of age, beginning with the 6-year molar. The others appear in approximately the same order as eruption of the primary teeth and follow shedding of th

40、e deciduous teeth.GrowthGrowthWtHtHeadChestfontanelteethBone agenewborn6 Mo1 y2 ys5 ysGrowth and DevelopmentruleruleKey Points of the ClasspThere are significant differences between children and adults. They younger the children are, the greater the difference is.pThe stage of growth and development

41、 include fetal period, neonatal period,infancy, toddlers age, preschool age, school age, and adolesence.pGrowth and development of children are strongly influenced by genetic and environmental factors. Key Points of the ClassGrowth and development follow predictable patterns in direction, sequence,

42、and pace. Biologic growth is determined by height, weight, bone age, and dentition.Growth and development are affected by a variety of conditions and circumstances, including heredity, physiologic function, gender, disease, physical environment, nutrition, and interpersonal relationships. Neurologic

43、 Maturotion Two periods of rapid brain cell growth occur during fetal life: between 15 and 20 weeks of gestation, and 30 weeks of gestation to 1 year of age. pThe nervous system development allows for increasingly complex movement and behavior. pOne half of postnatal brain growth is achieve by 1 yea

44、r of age, 75% by age 3, and 90% by age 6. At birth the cortex is only about one half its adult thickness, resulting in very little cortical control over body movements. Myelinization （髓鞘化） of the various nerve tracts in the central nervous system accelerates rapidly after birth and follows the cepha

45、locaudal and proximodistal sequence which allows progressively complex neuromotor function. The pathways concerned with sensation are myelinated before the motor pathways. The acquisition of motor skills depends on this myelinization and maturation. Because the vertebral column（脊柱） and the cord（脊髓）

46、have different growth rates, the cord in the newborn ends at the level of the third and fourth lumbar vertebrae. As growth continues, the cord becomes higher in relation to the vertebrae until it ends at the level of the first lumbar vertebrae in the adult. Sensor Changes 感觉发育感觉发育 Development of vis

47、ion 视觉pInfants have a visual preference for looking at the human face; p1mon Can follow in range of 90 degreep4-5 mon Looks at hand while sitting or lying on backp6-7 mon Develop hand-eye coordinationp11-12mon Can follow rapidly moving objects Development of Hearing 听觉p1mon Turns head to side when s

48、ound is make at level of earp4- 5 mon Locates sound by turning to side and then looking up or downp 6- 7 mon Responds to own namep11-12 mon Knows several words and their meaning Sensor Changes 感觉发育感觉发育 Development of smell 味觉 The senses of smell and taste are well developed at birth. Newborn babies

49、can response different to different taste such as sweet, sore, and bitter. Sensor Changes 感觉发育感觉发育 Development of Tactility 触觉 Newborn babies have well-developed sense of tactility, particularly around the areas of eye, mouth, hand, and foot. Sensor Changes 感觉发育感觉发育 Development of Paining 痛觉 Younger

50、 infant are blunt to pain stimuli until 2 months. Sensor Changes 感觉发育感觉发育 Development of Temperature 温度觉 Neonatal are sensitive to the change of temperature, and they have obvious response to cold stimuli. Sensor Changes 感觉发育感觉发育 Motor Development 运动发育运动发育 A childs ability to perform motor functions