Growth and Development - Infancy to Adolescence

1. ASSESSMENT
OF
GROWTH & DEVELOPMENT
Infants & Children
1
Lt Col Nirmala Roberts
India

2. Objectives..
Verify the growth and development of a child
Compare against laid down standards
Recognize potential problems and strengths
Plan for comprehensive care of the child
Assist parents to achieve optimum G & D
Work with children effectively in health &
disease
2

3. Daytime
During play
Child –
With parents
Relaxed, comfortable, awake and alert
Not hungry or in pain
When to assess….?

4. Where to assess?
Venue –
Child’s unit/ bed
Play room
Examination room
Room –
Good lighting
Have colorful pictures around
No threatening equipments in the room
No sights/ sounds of painful procedures
Have parents with the child

5. ARTICLES FOR ASSESSMENT

11. PROCEDURE

12. Basic Principles
Principles of microbiology
Wash your hands with soap and water/ sanitize as often as
required
Don gloves
Do not touch the child/ child’s bed unnecessarily
Ensure that toys are washed/ clean before offering to the
child
Disinfect every equipment before and after use
Principles of Psychology
Establish rapport – With parent first and then with child
DO NOT grab the child immediately
Address the child by pet name

13. Procedure
Greet the parent and child – with a
smile
Offer play item - Toy/ book/ crayons
Arrange the articles at the bedside

14. Procedure
Take history –
Complaints on admission
Past, present, family history
Nutritional - Breast feeding, weaning, food habits (24
hr recall), food likes/ dislikes/ fads
Immunization (get full history; look for BCG scar)
Toilet training
Schooling
Rest and sleep
Study habits
Relationships – With parents, siblings, peers

15. Immunization history of 5 yr old child
The following vaccines taken –
BCG, OPV, Hep B – At birth (BCG scar +)
DPT, OPV, Hep B – At 6,10 & 14 wks
Measles vaccine along with Vit A – At 9 months
DPT, OPV, MMR – At 1½ yrs of age
Next due at 5 yrs of age – DT, OPV

16. Toilet training
Age at which begun
Method used – potty chair/ any other
Word used by child to indicate bladder
evacuation and bowel emptying
Age at which bladder control achieved
Age at which bowel control achieved

17. Make your observations through play
Ensure clean and sanitized equipment for each
assessment (incl play items)
Record observations
Compare against normal values and give your
remarks

18. Name of child : Ms Nita Age : 12 months
Diagnosis : Gastroenteritis
Anthropometry Values in
child
Normal range Inference
Wt 6.5 kg 7 – 12 kg Less than normal
Length/ wt 76 cms 73 – 77 cms WNL
OFC 45 cms 43 – 47 cms WNL
Chest
circumference
45 cms Equal to OFC WNL
MUAC 12 cms 15 – 17 cms Less than normal

19. Assessment…
Assessment of growth
Physical anthropometry
Assessment of tissue
growth
Bone age
Dental age
Assessment of
Development
Biological –
Systems
Motor skills
Psychosocial
Psychosexual
Cognitive
Moral
Spiritual

20. PEDIATRIC ANTHROPOMETRY

21. Parameters of Anthropometry
Age dependent factors –
Weight
Height
OFC
Chest circumference
Age independent factors
–
MUAC (1- 5 yrs)
Weight for height
BMI
Skinfold thickness
MUAC : Height ratio
Upper segment/ lower
segment ratio
Arm span

22. Weight
Infant weighing scale (manual/ digital) -
Sanitize the weighing scale
Correct the Zero error
Weigh naked infant (napkin may be permitted)
Ensure safety from falls
Digital – Used for LBW infants
Bathroom scale – Older children
Salter weighing scale – In the community set-up
Wt for age – percentile charts

23. Salter weighing scale

24. Growth velocity (Weight)
At Birth - 2.5 – 3.5 kg
By I wk of life -10% wt loss
By 10th day - Regains lost wt
First 6 months - 20-30 gms/ day
7months – 1 yr - 10 –15 gms/ day
1 - 3 Yrs - 2.25 kg/ Yr
4 - 9 Yrs - 2.75 kg/Yr
10 – 18 Yrs - 5- 6 kg/Yr

25. WEECH’S FORMULA (Weight in Kg)
3 – 12 Months - X + 9
2
1 – 6 Years - 2Y + 8
7 – 12 Years - 7Y - 5
2
Weight at –
5- 6 months – 2 x Birth wt
1 yr – 3 x Birth wt
2 yrs – 4 x Birth wt
3 yrs - 5 x Birth wt
5 yrs - 6 x Birth wt
7 yrs – 7 x Birth wt
10 yrs – 10 x Birth wt

26. Length/ Height
Infantometer – For infants
Stadiometer – for older children
Tape measure
Height charts
Length/ht for age – Percentile charts

27. Growth velocity (Height)
At birth - 50 + 2 cms
Till 6/12 yr - 2.5 cms/ month
Later 6 months - 1.25 cms/ month
1 – 2 yrs - + 12.5 cms
2 – 5 yrs - 6 – 8 cms/yr
5 – 12 yrs - 5 cms/yr

28. WEECH’S FORMULA
(Height in cms)
2 – 12 Years – 6Y + 77
Future (Adult) height – Girls – Ht at 2 yrs x 2
Boys – Ht at 2½ yrs x 2
Height at –
1 yr – Birth length + ½ (50 + 25 = 75 cms)
2 yrs – 75 + ¼ (12.5) = 87.5 cms)
3 yrs - 87.5 + 1/8 (6.25) = 93.75 cms
4 yrs - 93.75 + 1/8 (6.25) = 100 cms) – Birth length doubled!
13 yrs – Birth length trebled

29. OFC
Relevant in first 3 - 5 years of age
Tape measure
Take widest possible circumference
Landmarks - Occipital protuberance, supraorbital ridge
& glabella in front.
4th- 5th day of life - Better accuracy after scalp edema/
molding subsides.
Fontanelle closure - Posterior (6 -8 wks); Anterior (12–
18 months)

30. Growth velocity (OFC)
At birth - 33- 35 cms
First 3 months - 2 cm/month
3/12 - 1 yr - 2 cm/3 month
1 – 3 yr - 1cm/ 6 month
3 – 5 year -1cm/ year
By 1 yr - +12 cm
1- 5 yrs - + 5 cm
5 - 6 yrs - Adult head size
During infancy -
Dine’s formula – Length (cm) + 9.5 cms
2

31. Expected OFC in children
Age OFC (Cms)
At Birth 35
2 months 38
3 months 40
4 months 41
6 months 42 -43
1 Year 45 - 46
2 years 47 - 48
5 years 50 -51

32. Chest circumference
Nipple line in front and parallel at the back
Take reading in mid inspiration
0 – 5 years - lying down position
> 5 years - standing position
Relationship with OFC –
At birth - OFC > chest circumference by upto 3 cms.
At 9/12 - 1 yr – OFC = chest circumference,
> 1 yr - Chest circumference > OFC

33. Abdominal circumference
Take above umbilicus, with tape running
parallel at the back

34. MUAC
Infants – 9 – 16 cms
1 - 5 yrs (Age independent) -16.5 - 17.5 cms
Use fiber glass/ steel tape
Method –
Bend left arm at 90° to the body.
Locate mid-point between acromion and olecranon & mark with a pen
Instruct child to relax the arm and hang down by the side
Wrap the tape firmly around the arm (not tight or loose) at the marking
Take the reading to the nearest millimetre

36. MUAC in Community setting
(Shakir Tape & Bangle test)

38. Females – Length for Age (months)

39. 39
Body Mass index (BMI)
= Weight in Kg
(Height in meter) 2
• Underweight: < 18.5.
(if < 15  Nutritional intervention)
• Normal range : 18.5 to 24.9
• Overweight: 25 to 29.9
• Obese: 30 or > higher

40. Assessment of tissue growth -
Skinfold thickness
Harpendens/ Lange’s calipers
Gives estimation of fat

41. Bone age (by ossification centers)
1- 8 yrs –
No of ossification centers in wrist – Age in yrs + 1
Ossification continues till 25 yrs of age

42. Dental age
Count the teeth
Age in months – 6 = No of teeth
Not a dependable parameter

43. Dental age
Deciduous teeth Permanent teeth
Age
(months)
Eruption of teeth Age (yrs) Eruption
At Birth Nil 6 1st molar
6 – 8 Central incisors 7 – 8 Central lateral incisors
10 Lateral incisors 9 1st premolar
12 – 15 1st molar 10 – 11 2nd premolar
15 – 21 Canine 11 – 12 Canines
21 – 24 2nd molar 12 – 13 2nd molars
17 - 22 3rd molars

44. Biological development
Motor skills – Gross motor and fine motor
Give appropriate tasks
Ask parents about child’s activities

45. What is the age?

47. Use of reference values
Growth charts –
Mean/median values
Percentiles
Indices as wt for ht & wt/ht for age

48. Assessment of Development
Motor skills – Gross & fine
Special senses
Personal & social devt –
Psychosocial
Psychosexual
Cognitive & language
Moral
Spiritual

49. Development screening
Gross motor, fine motor, cognitive –
Baroda screening test – 0 – 30 months
Trivandrum development screening test - 0 – 2 yrs
Denver development screening test (DDST) – 2 - 6 yrs
Denver articulation screening examination (DASE)
Others –
Woodside DST
Cognitive adaptive test
Early language milestone scale

52. Recording & reporting of G & D
Record observations
State the normal range of growth & development
Make inference
State nursing diagnosis

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