Growth & Development Flashcards
(36 cards)
Differentiate between growth and development
Growth denotes a net increase in the size or mass of tissue.
It is largely attributed to multiplication of cells and increase in the intracellular substance.
Hypertrophy or expansion of cell size contributes to a lesser extent to the process of growth.
Development specifies maturation of functions.
It is related to the maturation and myelination of the nervous system and indicates acquisition of a variety of skills for optimal functioning of the individual.
Growth and development usually proceed concurrently. They are closely related and so factors affecting one also tend to have an impact on the other.
Outline the order of growth
Order of growth is cephalocaudal and distal to proximal.
During fetal life, growth of head occurs before that of neck, and arms grow before legs. Distal parts of the body such as hands increase in size before upper arms.
In the postnatal life, growth of head slows down but limbs continue to grow rapidly
LIst the parameters you look at when assessing physical growth
Includes assessment of (Anthropometric measurements):
Weight
Height
Head circumference/ Occipital frontal circumference (OFC)
Chest circumference
Mid upper arm circumference (MUAC)
Outline the prerequisites when assessing weight as a physical factor of growth in a child
The weight of a child in the nude or minimal light clothing is recorded accurately on a lever or electronic type of weighing scale.
Spring balances are less accurate.
The weighing scale should have a minimum unit of 100g.
It is important that the child is placed in the middle of the weighing pan.
The weighing scale should be corrected for any zero error before measurement.
Serial measurements should be done on the same weighing scale
Outline the prerequisites when assessing lying down height/length as a physical factor of growth in a child
Length/height is recorded for children under 2 years of age.
Hairpins are removed and braids undone.
Bulky diapers should be removed.
The child is placed supine on a rigid measuring table or an infantometer.
The head is held firmly in position against a fixed upright head board by one person.
Legs are straightened, keeping feet at right angles to legs, with toes pointing upward.
The free foot board is brought into firm contact with the child’s heels.
Length of the baby is measured from a scale which is set in the measuring table.
Measurement of length of a child lying on a mattress and/or using cloth tapes is
inaccurate and not recommended
Outline the prerequisites when assessing head circumference as a physical factor of growth in a child
Hair ornaments are removed and braids undone.
Using a non-stretchable tape, the maximum circumference of the head from the occipital protuberance to the supraorbital ridges on the forehead is recorded.
The crossed tape method, using firm pressure to compress the hair is the preferred way to measure head circumference
Outline the prerequisites when assessing chest circumference as a physical factor of growth in a child
The chest circumference is measured at the level of the nipples, midway between inspiration and expiration.
The crossed tape method is recommended
How do you measure mid arm circumference as an assessment of physical growth in a child?
To measure this first mark a point midway between the tip of acromial process of scapula and the olecranon of ulna while the child holds the left arm by his side.
Thereafter, the crossed tape method is used for measuring the circumference.
It should be ensured that the tape is just tight enough to avoid any gap as well as avoid compression of soft tissue.
What is the formula for BMI?
The formula to calculate BMI is weight (kg)/ height (meter)2
What is the purpose of body mass index?
BMI is primarily used to assess obesity.
BMI at or above the 95th centile for age or more than 30kg/m2 is obesity.
How is the adequacy of growth and development assessed at the under 5 clinic?
Weight, height, head circumference (until the age of 5) and sexual maturity are routinely monitored during under-5 clinic to assess for adequacy of growth and development.
Standardized growth curves represent normal values for age for 95% of children
and are used to plot weight, height, body mass index and head circumference.
Special growth curves exist for children with particular genetic conditions (e.g.
Down syndrome, achondroplasia)
list the domains of development
The domains of development include:
Motor development
o Gross motor development
o Fine motor skill development
Cognitive
Social and emotional development
Hearing, speech and language
Attainment of a particular skill depends on the achievement of earlier skill
outline the progression of the development of gross motor functions in a child
Motor development progresses in a cephalocaudal direction with suppression of primitive reflexes and development of postural tone and secondary protective reflexes.
what are postural motor reactions?
Postural reactions such as parachute reaction are not present at birth (i.e. they are required). These reactions which help facilitate the orientation of the body in space, require complex interplay of cerebral and cerebellar cortical adjustments to proprioceptive, visual and vestibular input.
Infants with CNS damage have delayed development of postural reactions
outline the development of gross motor functions
By 2-3 months the infant:
Lifts their head when lying prone
Has head lag when pulled from supine position
By 4 months the infant is able to roll over and there is no head lag when pulled from supine position. The infant also pushes chest up with arms.
By 6 months the infant is able to sit alone and leads with head when pulled from supine position.
By 9 months the infant pulls to stand and cruises.
An infant stands holding on furniture.
By 12 months the infant is able to walk.
At 18 months of age, a child can climb onto a chair and walk up and down stairs two feet per step by 24 months of age.
By two and half years of age a child should be able to stand on tip-toes, jump on both feet and kick a ball.
A 3-year-old child can walk backwards and can ride a tricycle.
There is further development of gross motor skill and balance with age and most children can participate in a variety of activities like swimming, skating, gymnastics and ball games by 6-7 years of age
what are fine motor skills?
Involve the use of the small muscles of the hands.
An infant’s fine motor skills progress from control over proximal muscles to control over distal muscles.
During the first year of life, as balance in sitting and ambulatory positions improves the hands become more available for thee manipulation of objects.
As control over distal muscles improves reaching and manipulative skills are enhanced
outline the development of fine motor skills
During the second year of life the infant learns to use objects as tools (e.g. building blocks).
At birth the infant keeps the hands tightly fisted.
By 3-4 months the infant can bring the hands together to the midline and then to the mouth.
By 4-5 months they can reach for objects.
By 6-7 months they can rake objects with the whole hand as well as transfer object from hand to hand.
By 9 months they can use the immature pincer (ability to hold small objects between the thumb and index finger)
By 12 months they can use the mature pincer
what are primitive reflexes?
The primitive reflexes include the Moro, grasp, stepping and asymmetric tonic neck reflexes must have disappeared by 3-6 months of age before head control (4 months) and independent sitting at 6-8 months can occur.
Each primitive reflex requires a specific sensory stimulus to generate the stereotypical motor response
Infants with CNS injuries show stronger and more-sustained primitive reflexes
what are the red flags in motor development?
A delay in walking beyond 18 months of age is a warning sign in children who have been crawling as the early locomotor pattern
Persistent fisting beyond 3 months of age is often the earliest sign of neuromotor problems.
Early rolling over, early pulling to stand instead of sitting and persistent toe walking may all indicate spasticity.
Spontaneous postures such as scissoring in a child with spasticity or a frog-leg position in a hypotonic infant are important visual clues to motor abnormalities.
Early hand dominance (before 18 months of age) may be a sign of weakness of the opposite upper extremity associated with a hemiparesis.
what is the differential diagnosis for motor delay?
Differential diagnosis of motor delay:
CNS injury
Spinal cord dysfunction
Peripheral nerve pathology
Motor endplate dysfunction
Muscular disorder
Metabolic disorders
Neurodegenerative conditions
Describe language skills as a development parameter
Delays in language development are more common than delays in other domains.
Receptive language is always more advanced than expressive language (i.e. a child can usually understand 10 times as many words as he or she can speak).
Language and speech are not synonymous. Language refers to the ability to communicate with symbols i.e. sign language, gestures, writing and body language. Speech is the vocal expression of language.
A window of opportunity for optimal language acquisition occurs during the first 2 years of life
outline the development of language skills
At birth the infant attunes to human voice and is able to differentially recognize parents’ voices.
By 2-3 months: cooing (runs of vowels), musical sounds (e.g. ooh-ooh, aah-aah)
By 6 months: babbling (mixing vowels and consonant together) (e.g. ba-ba-ba, da-da-da)
By 9-12 months: Jargoning (e.g. babbling with mixed consonants, inflection and cadence). They also begin using mama and dada (non-specific).
By 12 months: 1-3 words, mama and dada (specific).
By 18 months: 20-50 words, beginning to use 2 word phrases.
By 2 years: 2-word telegraphic sentences e.g. mommy come, 25-50% of child’s speech should be intelligible.
By 3 years: 3 word sentences, more than 75% of the child’s speech should be intelligible.
what is the differential diagnosis of speech or language delay?
Differential diagnosis of speech or language delay:
Global developmental delay or mental retardation
Hearing impairment
Environmental deprivation
Pervasive developmental disorders including autism spectrum disorders
what is cognitive development?
Involves skills in thinking, memory, learning and problem solving.
Intellectual development depends on attention, information processing and memory.
Infant intelligence can be estimated by evaluating problem solving and language milestones.
Language is the single best indicator of intellectual potential.
Gross motor skills correlate poorly with cognitive potential
