Assessment of Growth and Development Note: All measurements should be made in a room with adequate lighting, comfortable temperature, and a firm, level floor. Children should wear only minimal light-weight clothing or none at all. Shoes should not be worn. Length: During the first two years of life, the child's length must be measured while the child is in the recumbent position. Arecumbent-length measuring table is required to obtain a obtain a measurement Length: Two persons are needed, one to hold the infant's head in contact with the headboard, and one to bring the movable footboard firmly against the child's heels. To position the feet so that the soles are directed vertically against the footboard, gentle traction may be applied to the legs. Recumbent measurement should be recorded to the nearest 0.1 cm. Length: The child should face forward, with heels together, back as straight as possible, and with heels, buttocks, and the upper part of the back touching the wall. The measurement should be recorded to the nearest 0.1 cm Weight: The child should be weighed while wearing a minimal amount of clothing, if any. Infants should be weighed on an infant scale having a capacity of approximately 15kg. the accuracy of the scales should be checked and adjusted approximately three times a month, and each time the scales are moved. The infant should be placed centrally on the scale and the older child should stand centrally on the platform. The measurement should be recorded to the nearest 0.1kg. Head circumference: Head circumference is measured until the child is 2 years old. It should be measured with a flexible narrow-width tape. The tape should be placed on the infant's head so as to obtain the maximal frontal-occipital circumference. The head circumference should be recorded to the nearest 0.1cm. The pattern of the growth of the cranium is very different from the of the body; its growth is nearly completed by 6 years of age, so growth evaluation is most relevant in infancy and early childhood. Head circumference: The method for interpretation of head circumference on the growth grid is identical to that for interpretation of height and weight. A measurement outside the normal range does not absolutely indicate cranial abnormality; rather, it is the rate of growth that must be evaluated. Bone Age: Another clinical tool that assists the clinician in evaluating the child's progress toward maturity is bone age assessment. Age can be helpful in interpreting the atypical child's growth. The progress of bone growth can be recorded by x-ray. The appearance of the centers of ossification can be noted because their calcium content makes them radiopaque. The sequence of bong growth is similar in every person. Bone Age: That individual variations caused by genetic differences may account for atypical maturation, that cannot be reconciled with a norm. The clinical purpose of bone age assessment is to identify the level of skeletal maturation. This information assists the examiner in making a decision concerning the child with abnormal growth by allowing a comparison with norms for the same chronological age. Growth Grids The national center for health statistics (NCHS) has developed a growth grid that is commonly used in clinical practice. It is based on a distance curve. The distance curve shows the height, weight, and head circumference of a child at various age. Growth Grids The standards for each age are derived from measurements of a large number of children of the specific age. An average (mean) and a rang (fifth through ninety- fifth percentiles) for each height, weight, and head circumference have been determined for each age. Ideally, every child's growth should be evaluated in relation to norms established for children of the same sex, ethnic group, and socioeconomic status. Growth Grids The rationale for the use of growth grids is that children follow predictable patterns of growth and development. The individual child's measurements are interpreted in relation to the expected norms for other children of the same age, sex, and ethnic group. Achild whose measurements falls outside the normal range is suspected of having disease, although disease should not be regarded as the definite cause of atypical measurements. Asingle measurement determines the size of a child, whereas several measurements must be made in order to evaluate the child's growth. Growth Grids Two important points should be kept in mind in comparing a child's growth to a standardized grid. First, the curve derived from a large group of children naturally obscures the individual patterns of each child in the original sample population and with be a smooth curve with no dramatic peaks; many children with show peaks in the course of normal growth. Second, height is a more stable indicator then weight. Weight is more influenced by environmental factors and may fluctuate more than height. Weight is still a reliable measurement but may be more difficult to interpret, especially in infancy. Developmental Screening: As was said earlier, humans, unlike other animals, do not inherit a repertoire of instinctive behaviors but must learn behavior; the prolonged period of immaturity enables humans to benefit from their experiences for optimal learning. Behavior is divided into five areas: gross motor, fine motor, language, personal social, and adaptive behavior. Developmental Screening: Gross motor behavior includes the control of the head, trunk, and extremities. Fine motor behavior is the control of the movements of the vingers. The acquisition of motor control reflects the integrity of the child's neurological system. Language behavior includes the production of single or combined words, and the ability to comprehend speech. Wide variations exist in personal-social behavior, since it is dependent on the child's interaction with his or her environment and culture. Developmental Screening: Adaptive behavior is significant because it stems from intellectual potential. Adaptive behavior indicates the child's ability to solve problems. It includes the use of motor abilities, to execute practical solutions and the use of past experience in the solution of new problems. Developmental screening, like screening of physical growth, is an integral part of pediatric health care. A development assessment is a clinical estimate of the developmental progress made in each area of behavior. It must be kept in mind that developmental screening tests are not intelligence tests. Developmental Screening: Developmental screening is also used to identify mentally retarded children. Another area of significant clinical use of developmental screening is its use to educate parents about their child's development. Anticipated developmental changes that the child will undergo can be delineated for parents. This information can assist parents in adjusting to their continually changing child. It can also assist parents to adjust the child's environment for optimal support and stimulation of his or her development. Denver Developmental Screening Test: The Denver developmental screening test (DDST) is widely used in clinical practice and is a typical screening instrument. The axiom underlying the DDST is the development follows predicated patterns common to all, and that the child who does not follow the expected pattern is more likely that the typical child to have disease. The rest consists of 105 tasks selected from existing infant and preschool scales. The test Denver Developmental Screening Test: Was first administered to a large group of infants and children in Denver, Colorado; the sample population of he children was chosen to match the sociocultural and economic status of Denver's overall population, and is therefore not necessarily representative of population of other parts of the United states. The ages at which 25, 50, 75, and 90 percent of the subjects passed the items were calculated for the entire sample. Children between 2 weeks and 6 years old are tested on only 20 or so simple tasks by means of a few basic testing materials. Denver Developmental Screening Test: The items are arranged in order of difficulty and are divided into four major behavioral areas: personalsocial, fine motor adaptive, language, and gross motor. The DDST is a useful clinic tool because of its use an age range in establishing the norms, which allows for a wider variation individual patterns. Also, the heterogeneity of the original test population, from which the criteria were derived, allows for variations in children of different cultural and socioeconomic backgrounds. SUMMARY Humans are born immature. On the path to independent function, they progress through the predictable stages of infancy, childhood, and adolescence. The physiological processes of growth and development are responsible for the changes in body size and composition and in abilities that the individual undergoes before attaining adulthood. Growth and development begin at the cellular level and advance under the influence of both the individual's genetic potential and environmental influences. SUMMARY Hormones influence growth and development by stimulating protein synthesis. The degree of influence of the individual hormones varies during the different stage of growth and development. The assessment of growth and development is an integral part of pediatric health care. However, the examiner must keep in mind that individual variations caused by genetic and environmental differences may cause the child to deviate from the norm.