Evaluation of growth and development may be a crucial element within the physical examination of a patient. A bit of excellent working knowledge and therefore the skill to guage growth and development are necessary for any patient’s diagnostic workup. The first recognition of growth or developmental failure helps for effective intervention in managing a patient’s problem. This activity reviews the varied aspects of human growth and development and highlights the interprofessional team’s role in assessing the youngsters for growth and developmental delay.
In the context of childhood development, growth is defined as an irreversible constant increase in size, and development is defined as growth in psychomotor capacity. Both processes are highly hooked in to genetic, nutritional, and environmental factors. Evaluation of growth and development may be a crucial element within the physical examination of a patient. A bit of excellent working knowledge and therefore the skills to guage growth and development are necessary for any patient’s diagnostic workup. The first recognition of growth or developmental failure helps for effective intervention in managing a patient’s problem.
Stages in Human Growth and Development
Fetal health issues can have detrimental effects on postnatal growth. One-third of neonates with intrauterine growth retardation may need curtailed postnatal growth. Good perinatal care is an important think about promoting fetal health and indirectly postnatal growth.
The method of postnatal growth and development happens together but at different rates. the expansion occurs by discontinuous saltatory spurts with a stagnant background.
There are five significant phases in human growth and development,
- Infancy (neonate and up to at least one year age)
- Toddler ( one to 5 years of age)
- Childhood (three to eleven years old) – infancy is from three to eight years old, and middle childhood is from nine to eleven years old.
- Adolescence or teenage (from 12 to 18 years old)
Factors Affecting Growth and Development
The growth and development are positively influenced by factors, like parental health and genetic composition, even before conception.
- Genetic factors play a primary role in growth and development. The genetic factors influencing height is substantial within the adolescence phase.An outsized longitudinal cohort study of 7755 Dutch twin pairs has suggested that the additive genetic factors predominantly explained the phenotypic correlations across the ages for height and body mass index.
- Fetal health features a highly influential role in achieving growth and development. Any stimulus or insult during fetal development causes developmental adaptations that produce permanent changes within the latter a part of life.
- After birth, the environmental factors may exert either a beneficial or detrimental effect on growth.
- *Socioeconomic Factors: Children of upper socio-economical classes are taller than the youngsters of an equivalent age and sex within the lower socioeconomic groups. Urbanization has positively influenced growth. The secular trend is observed in growth where the youngsters grow taller and mature sooner than the previous generation. This secular trend is observed significantly in developed countries like North America.
*The Family Characteristics: Higher family education levels have a positive impact on growth. The inadequate emotional support and inadequate developmental stimulus, including language training, might cause growth and development deterioration.
*The Human-Made Environment: Influences human growth and development significantly. Certain ongoing studies have proven the connection of pollutants in sexual maturation, obesity, and thyroid function.The surplus lead exposure antenatally significantly associates with low birth weight. sound pollution thanks to transportation sources also has an association with reduced prenatal growth.
1.Malnutrition plays a detrimental role within the process of growth and development.
2.Deficiencies of trace minerals can affect growth and development. Iron deficiency usually affects growth and doesn’t affect growth. deficiency disease might cause growth retardation and developmental delay. Selenium, iodine, manganese, and copper also play a big role.
3.Growth faltering or rapid weight gain in infancy influences health within the later a part of life. The diet in infancy features a strong association with the likelihood of obesity later in life. ‘Early Protein Hypothesis’ shows that lowering the protein supply during infancy helps achieve normal growth and reduce obesity in infancy . this idea of the first protein hypothesis helps in improving the food products for youngsters .
5.Genetic and environmental factors influence the expansion and development during a perplexing interrelated pathway. Genetic and environmental risk factors aren’t mutually exclusive. Plasticity is that the potential of a selected genotype to bring out diversified phenotypes in response to diverse environmental factors. The developmental plasticity can happen from the embryonic stage to adolescence and may be passed onto subsequent generation.
6.Role of experience during infancy : Exposure to adverse experiences in early childhood might hinder development. Profound neglect during infancy can impair development. Children adopted before six months aged have similar development in comparison to their non-adoptive siblings. If children adopted after six months have a high risk of cognition deficits, behavioral issues, autism, and hyperactivity. Early intervention for youngsters with adverse experiences is that the pillar in healthy development.
Measurement of Growth
Anthropometry is that the gold standard by which clinicians can assess nutritional status. the main anthropometric measurements for age up to 2 years are weight, length, weight for length, and head circumference. the main measurements used for youngsters above two years are weight, height, body mass index (BMI), and head circumference for the 2-3 years age bracket .
- Length or height: for youngsters but two years or children with severe spastic paralysis , the length is that the ideal way of measuring stature. Length is measured by placing the kid supine on an infant measuring board. for youngsters aged quite two years, standing height is measured within the stadiometer after removing shoes. The supine length is typically 1 cm above standing height. Length and height are often documented to the closest 0.1 cm. for youngsters with severe spastic paralysis or spinal deformities, upper arm length, tibial length, and knee height are often useful to assess stature.
- Weight: the youngsters below one year are weighed on a scale after removing the garments , shoes, diaper, and documented to the closest 0.01 kg. the youngsters outside the infancy phase should be measured without shoes, with little or no outer clothing, and documented to the closest 0.1 kg.
- Head circumference or occipitofrontal circumference: Head circumference is assessed by measuring the most important area from the prominent site at the rear (occiput) to the frontal prominence above the supraorbital torus . Brain growth is maximum within the first three years of life, so head circumference is employed in children but three years. it’s measured because the maximum diameter through the supraorbital torus to the occiput and documented to the closest 0.01 cm. Microcephaly is quite two standard deviations below the mean. Macrocephaly is quite two standard deviations above the mean.
- Measure of adiposity:
1).Body mass index (BMI) may be a useful predictor of adiposity. BMI is calculated with formula,weight (kg) / height (m) squared. BMI is that the single best indicator for detecting overweight or obesity
< 5th percentile – underweight
>>>5th to 84th percentile – normal
>>>85th to 95th percentile – overweight
>>>95th to 98th percentile – obesity
>>>More than 99th percentile – severe obesity
2).The weight to length ratio is an alternate for body mass index in predicting adiposity in but two years.
3).Self-assessment of the hep waist ratio can help to guide the measure of central adiposity,
4).Triceps and subscapular skinfolds also can be a useful measure of adiposity.
- Body proportions
1).The upper segment to lower segment (U/L) ratio is 1.7 at birth, 1.3 at three years, and reaches 1.0 at greater than seven years. a better U/L ratio may be a feature in short-limb dwarfism.
2).Arm span to height ratio may be a fixed ratio across all ages. The ratio of quite 1.05:1 is implicational Marfan syndrome.
- Sexual Maturity: Tanner’s stage are often wont to assess sexual maturity.
- Skeletal Maturity: Age are often determined by doing Hand & Wrist radiographs from 3 to 18 years aged .
- Dental Assessment: deciduous tooth eruption begins with the central incisors at six months. No single tooth by 13 months aged is of concern. adult tooth eruption starts at six years aged and continues up to 18 years aged .
The growth velocity is different at different stages of life. Also, different tissues grow at different rates at an equivalent stage of life. The lymphoid tissues can exceed adult size at six years aged . Girls are taller than boys at 12 to 14 years, but later they’re going to not grow taller than their boy’s counterpart. Growth velocity is maximum during infancy and adolescence. the top circumference reaches closer to adult size by six years aged . The prepubertal height velocity of but 4 cm per annum is of concern. During puberty, the peak velocity is 10 to 12 cm per annum in boys and eight to 10 cm per annum in girls. The prepubertal weight velocity of but 1 kg per annum is of concern. Weight velocity is highest during puberty, up to eight kg per annum .
Stages of Development
Development may be a continuous process from neonatal to adulthood. Though the expansion ceases after adolescence, adolescence isn’t the top for development. Each developmental stage features a new set of challenges and opportunities.
Development progress in cephalo-caudal direction and also from the midline to the lateral direction. a 3 to four-month variation are often there in achieving the developmental milestone. Social development may be a cortical function that develops before motor skills. Lack of social smile by four weeks is of concern. At birth, the infant is provided with primitive reflexes. Certain primitive reflexes help within the normal physiology of infants. Sucking and reflex helps inefficient feeding. Most of the primitive reflex disappears to facilitate the mature development process. for instance , the grasp reflex disappears by six months, and therefore the child develops mature grasp development from 6-12 months.
2.Early and late childhood:
Between ages 1 and three years, locomotion and language are crucial. the simplest predictor of cognitive function is language. Fine motor skills are associated with self-help skills. the foremost common development in infancy is to determine self-identity. a toddler may have independent existence by three years aged . the youngsters learn independent existence skills like feeding behavior, toilet training, and self dressing during this stage of early and late childhood. Questioning skills develop during infancy development.
Adolescence is hallmarked by puberty changes, which occur two years earlier in females than in males. Puberty changes are assessed using the Tanner staging. Acceptance of a replacement body and separation from home, and establishing oneself as an independent adult in society are the many challenges in puberty.
Erikson has postulated eight stages of psychosocial development.
1).Trust and mistrust in infancy (< 1 year): Infants develop trust with a warm response from the caretaker.
2).Autonomy and doubt within the toddler age bracket ( one to 3 years): Children feel autonomous if caregivers encourage independence. Otherwise, they’re going to doubt their abilities.
3).Initiative and guilt within the preschool age bracket (three to 6 years): By imaginative play, kids experiment with their ambitions. If parents don’t encourage their initiative, the youngsters will feel guilt.
4).Industry and inferiority in early school years: in class , children learn to figure as a gaggle . they’re going to have inferiority feelings if the peer environment is hostile.
5).Identity and role confusion in adolescence: Self-identity may be a significant development during adolescence.
6).Intimacy and isolation in early adulthood: those that cannot establish relationships or intimacy are susceptible to be socially isolated.
7).Generativity and stagnation in middle adulthood: Parenting is that the best example to guide the younger generation.
8).Ego integrity and despair in late adulthood: people that aren’t satisfied with what they did during their lifetime are going to be in despair.