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.