Two aspects:

1. Growth and Physical Development of Children.Semiotics (Main Clinical Features) of Deviation of Child’s Physical Development.

2. Two aspects: • Quantity (growth) • Quality (development)

3. Growth • It is a measure of physical development and maturation. • It signifies an increase in size of the body and its various organs. Thus, it can be measured in terms of centimeters and kilograms.

4. Development • It is a measure of functional or physiological maturation. • It signifies accomplishment of mental (acquisition of skills etc.), emotional (development of attidudes etc.) and social (adaptation to family and society etc.) abilities. • Unlike growth, it is rather difficult to assess development.

5. Maturation • It literally means to ripen • It is described as aging or as an increase in competence and adaptability. It is usually used to describe a qualitative change, that is, a change in the complexity of a structure that makes it possible for that structure to begin functioning or to function at a higher level.

6. Physical development • is a dynamical process of growth and biological maturation of a child usually referred to as a unit, express the sum of the numerous changes that take place during the different periods of childhood.

7. Factors Influencing Growth and Development • Genetic • Nutritional • Socioeconomic • Environmental and seasonal • Chronic diseases • Growth potentials • Prenatal and intrauterine • Emotional

8. The main criteria for assessmentof physical development (growth) • weight; • height (stature, head-to-heel length); • head circumference (HC); • chest circumference; • proportionality of these measurements.

9. Weight. Body weightof fetus of 25 to 42 weeks of gestation can be calculated according to the empirical formula: • in average the body weight of 30-weeks fetus is 1300 g, for each previous week minus 100 g, for each next add 200 g. For example: • Body weight of 26-weeks fetus equals 1300 – 1004 = 900 g; • Body weight of 35-weeks fetus equals1300 + 2005 = 2300 g.

10. Measurements of a newborn child • At birth weight is more variable than height and to a greater extent is a reflection of the intrauterine environment. • The average newborn weighs 3200 to 3400 g (7 to 7.5 pounds). • Admissible limits of the norm range from 2700 to 4000 g. • Babies, whose birth weight equals more than 4000 g, are called huge.

11. Technique of procedure. • Weigh infants nude on platform-type scale; protect infant by placing hand above body to prevent falling off scale. Weigh young children (by 2 years) nude on platform-type scale in sitting position. Weigh older children in underwear (no shoes) on standing-type upright scale. Check that scale is balanced before weighting. Cover scale with clean napkin or sheet of paper for each child. Measure to the nearest 10 g or 0.5 ounce for infants and 100 g or 0.25 pound for children. To have exact results weigh children in the morning before first meal, after urination and defecation.

12. Weighing on a platform-type scale

13. General Trends in Weight Gain During Infancy

15. Height Body lengthof fetus of 25 to 42 weeks of gestation can be calculated according to formula: L = gestation age (in weeks) + 10 cm; Or body length of fetus of first 5 months of gestation equals: L = (gestation age (in months))2. For fetus of 6 to 9 months of gestation: L= gestation age (in months)  5. For example: • Body length of 32-weeks fetus equals 32+10=42 cm; • Body length of 3 months fetus equals 32=9 cm; • Body length of 7 months fetus equals 7x5=35 cm.

16. Body length of a newborn child • Birth length is influenced considerably by the prenatal environment and gestation age. It is of great value as a sign of maturity of newborn organism. • Its normal rate in neonate is 50 to 52 cm. • Admissible limits of the norm range from 46 to 56 cm.

17. General Trends in Height Gain During Infancy

19. Technique of procedure. • Measure recumbent length in children below 12 months. Place supine with head in midline, pinna of the ear must be on an imaginary vertical line with lower eyelid of the eye. Grasp knees and push gently toward table to fully extend legs. Measure from vertex (top) of head to heels of feet (toes pointing upward). • Measure standing height (stature) in children over 12 months. Remove socks and shoes. Have child stand as tall as possible, back straight, head in midline, lower eyelid and pinna of the same side ear on one imaginary horizontal line. Check for flexion of knees, slumping shoulders, rising of heels. Measure from top of head to standing surface. Measure to the nearest cm or 1/8 inch.

21. General Trends in Weight and Height Gain During Childhood

23. Head circumference.Head circumference at birth is equal 34 to 36 cm.

24. Chest circumference.Chestcircumference at birth is equal 32 to 34 cm.

25. It is necessary to compare head circumference and chest circumference. • At birth HC exceeds chest circumference by 2 to 3 cm. • At age 4 months HC equals chest circumference. • Later, the rate of chest circumference increases rapidly, at the same time HC continues to grow at a slower rate. So, during childhood chest circumference exceeds HC by about 1 to 7 cm.

26. Methods of assessment of physical development of the child • Anthropometrical indexes • Percentile tables • Standard growth charts • Standard deviation

27. Growth chart It is of value to have serial record of child’s weight periodically on a “growth chart”(“Road to Healh” chart) which is based on percentile curves.

28. Growth charts. Boysand girls: birth to age 36 months – physical growth (head circumference, length, weight).