Growth and Development DR. REKHA DUTT GROWTH- It is increase in physical size. Development – It is increase in skills and functions. Normal growth and development occur if there is optimum nutrition, freedom of recurrent infections and freedom from adverse genetic and environmental influences. Determinants of growth and development Genetic inheritance Nutrition Age – more in fetal life, infancy and puberty Sex Physical surroundings Psychological factors Infection and parasitosis Economic factors Birth order, education of parents Normal growth A normal child is that whose characteristics fall with in the range of measurements accepted as normal for majority of children in same age group. Normal variations are assumed to include 2 Standard Deviation above and below the mean i.e.3rd and 97th centiles. Surveillance of growth and development It is done to identify those children who are not growing normally. Weight for age – A single weight record only indicates size at the moment but does not give any information whether a child’s weight is increasing or decreasing. Repeated measurements at intervals ideally monthly from birth to 1 year,2 monthly during 2nd year and 3 monthly should be taken upto 5 years of age. A baby should gain 500gm/month for first 3 months, doubles the birth weight by 5 months ,trebles by 1 year and quadruples by 2 years. Height for age – Birth length is approx. 50 cm.It increases by 25 cm at first year and another 12 cm during second year. Low height for age – also called as stunting. It reflects past and chronic malnutrition. Weight for height – Low weight for height is nutritional wasting or emaciation( acute malnutrition). Head and chest circumference – At birth head circumference is approx. 34 cm.It is about 2 cm more than chest circumference. By 6-9 months the two measurements become equal after which chest circumference takes over head circumference. Behavioral development Motor development Head holding – 3 months Sits without support – 6-8 months Crawling- 9 months Stands with support – 10-11 months Walks – 12-14 months Language development Experimenting with noises – 6-8 months First words – 10-11 months Short sentences – 24 months Sociopersonal development Looks at mother and smile – 6-8 weeks Recognizes mother – 4-5 months Suspicious of strangers – 9-10 months Growth Chart Definition: It is a visible display of a child’s physical growth and development. First designed by David Morley . Growth chart offers a simple and inexpensive way of monitoring weight gain. Any deviation from “normal” detected by comparison with reference curves. The WHO growth chart It has two reference curves. Upper reference curve -the median (50th percentile) for boys. Lower reference curve – 3rd percentile for girls Space between two growth curves called weight channel or road to health – zone of normality for most population. Interpretation Normal - growth line above 3rd percentile and will run parallel to reference curves Abnormal- flattening or falling of child’s weight curves signals growth failure Earliest sign of PEM Precede clinical signs by weeks or even months Such child needs special care Objective- keep child above 3rd percentile Growth Chart Used In India It has four reference curves. Top most curve – 80 %of the median (50th percentile) of the WHO reference standard. Lower lines represent 70% ,60% and 50% of the standard. 80% median weight is approximately equal to 2 SD below the median which is the conventional lower limit of “normal range”. Purpose of reference curve – It indicates degree of malnutrition. INTERPRETATION 1st degree (grade 1)malnutrition- child’s weight between 80% and 70% lines. 2nd degree (grade 2 or moderate) malnutrition –child’s weight between 70% and 60% lines. 3rd degree (grade 3 severe) malnutrition - weight below 60% line. Grade 4-weight below 50% line. Weight b/w top 2 lines – is considered satisfactory. Management Weight b/w curves 1 & 3- undernourished,require supplementary feeding at home Weight below curve 3-consult the doctor and follow his advice. Weight below curve 4-hospitalized for treatment Uses of growth chart Growth monitoring Diagnostic tool Planning and policy making Educational tool Tool for action Evaluation Tool for teaching Reference:www.commedutm.org/pics/ug- presentations/growth%chart.