Lecture 11 - Infant and Child Growth Flashcards
how does muscle control and coordination develop in children
top down and centrally to peripherally
Critical or sensitive time periods or windows of development occur where
certain skills must be learned in order for subsequent learning to occur
all infants progress on …
their own timeline of development
the world health organisation recommends that infants should sit alone by what age
7 months
the world health organisation recommends that infants should stand holding furniture by what age
9 months
the world health organisation recommends that infants should stand alone by what age
14 months
the world health organisation recommends that infants should walk alone by what age
15 months
child growth assessment is important to determine whether a child is
growing “normally” or has a trend towards a growth concern that should be addressed
in child growth assessment weight is a good indicator of what
of acute changes in dietary intake
in child growth assessment height reflects
long term nutrition (better nutrition they will grow better standing height)
in child growth assessment head circumference reflects
brain growth
in child growth assessment BMI screens for
overnutrition or growth faltering
what are the two components of child growth assessment
- measure = weight, length / height, head circumference and BMI
- plot measurements of a childs body size on growth charts
clinical electronic scales are calibrated how often
every 6 months
what must be done when measuring children’s weight up to 2 years
remove clothing and nappy
what are the guidelines of measuring weight for children 2 years and above
minimal clothing, remove shoes, empty bladder and before a meal
weight in children is recorded to the nearest what
nearest 10g
what is an alternate method of measuring a childs weight when they are younger than 2 years
weigh mother and infant together and subtract the weight of the mother
what is used to measure length in children
a calibrated length board with fixed headpiece and moveable footpiece which is perpendicular to the surface of the table
how many people are needed to get an accurate length measurement of a child
two people
when measuring an infants length what must they be wearing
without shoes, and wearing light underclothing or diaper
how should an infant be positioned to have their length measured
- should be placed on their back in the centre of the board, lying flat against the surface.
- eyes should be looking up
- both legs should be fully extended and toes should be pointing upwards with feet flat against the foot piece
length in infants should be measured to the nearest (it is good practice to take how many measurements)
nearest 0.1cm
good practice to take 3 measurements
what is the change in terms of measuring a childs height at 2 years
at 2 years we measure their height standing up rather than their length
when should weight and length be measured in children
- in the first weeks of lide
- at routine cheeks
- when there is a concern about weight gain, growth or general health
how often should we measure weight and height in infants and why should we not doo this too often
- measuring too often can be misleading
- should be measured > 2 weeks apart after 6 months of age
how to measure head circumference
position the tape just above the eyebrow, above the ears and around the biggest part on the back of the head
what should be used to measure head circumference
use a flexible, non stretchable tape
head circumference should be measured to the nearest
0.1cm
head circumference is measured up until what age
1 year of age
what is a growth reference
describes how certain children grew in a particular time and place
what is a growth standard
describes how healthy children should grow under optimal environmental and health conditions
why are we unable to use growth standards after the age of 5 years
after 5 years we are unable to control for the same factors that could when younger so we use references not standards
what was the criteria used for the WHO multi centre growth reference study
- mothers willing to exclusively breastfeed for at least 4 months
- introduction of complementary feeding by the age of 6 months and continued partial breastfeeding up to at least 2 months
- no maternal smoking before and after delivery
how many home visits were included in the WHO multi centre growth reference study (and how often were these)
20 home visits
- once fortnightly until 2 months old
- once monthly until 13 months old
- thereafter every 2 months until second birthday
what was recorded in the WHO multi centre growth reference study
anthropometrics (from birth) and developmental milestone age (from 4 months of age)
what was found about the variance in the WHO multi centre growth reference study
variance in growth was due to differences among individuals and only minimally to difference among site (country)
what is the growth reference data for children aged 5-19 WHO
- weight for age (5-10 years)
- height for age (5-19 years)
- BMI for age (5-19 years)
what is the growth reference data for children aged 2-20 years CDC
- stature for age (2-20 years)
- weight for age (2-20 years)
- BMI for age (2-20 years)
how to calculate z-scores
- mean (find the avereages)
- standard deviation (calculate how spread out the values are from the mean)
- z score
what does a z score tell you
tells you how many standard deviations away a specific value is from the mean
if the z score is 0 it means
the value is exactly the average
if the z score is positive it indicates
the value is above the average
if the z score is negative it indicates
the value is below the average
the higher the z score ( in the positive or negative direction), the …
the more unusual or less typical the value is compared to the average
what is the z score equal to
measured value - average in the reference population / standard deviation of the reference population
why plot on a growth chart ?
- to compare a childs weight, height or head circumference against other healthy children of their age
- to track how a child grows over time
- normal growth is an important indicator of health
what are the New Zealand Growth Charts for children aged 0-5 years
New Zealand - World Health Organisation Growth Charts (0-5 years)
what are the New Zealand Growth Charts for children aged 5-18 years
either WHO reference 2007 or the Centres for Disease Control (CDC) Growth Charts
on a growth chart, if a child is growing normally growth will
‘track’ parallel to one of the centile lines on the growth chart
if a childs growth on a growth chart starts to track up or down significantly, further investigation is necessary (how many centiles for weight and height would this be a concern)
there is a consistent change in centile position by two or more intercentile spaces for weight
or by one or more inter-centile spaces for height
if there is a difference of …….. or more inter-centile spaces between the weight and heigh values of a child this also requires investigation
a difference of two or more inter-centile spaces
what does each percentile (centile line) mark
the weight or height below which the percent of children of that age and gender fall
how many centiles are there on growth charts and where do they extend from
9 centiles that extend from 0.4th to the 99.6th
what does the 50th centile represent
the mean
a child is described as being …. or …. on a growth chart
on a centile or between two centiles
a centile describes
the number of children expected to below that line ( e.g 50% below the 50th centile)
head circumferences taken within the first 24hrs of life are
unreliable because the head may be subjected to molding
babies often lose weight in the first 3-5 days, what % regain by 2 weeks
80%
is weight loss in babies after birth normal
yes
baby weight loss is expressed as a
percentage of birthweight
a baby weight loss greater than …. may indicate a feeding problem or illness
> 10%
why do the centiles shift slightly when length is changed to height measure at 2 years of age
because when a child is standing up their spine is compressed / squashed slightly compared to lying down
head circumference usually tracks within
a range of one centile space
rapid head growth can be a sign of
hydrocephalus
slowing head growth may be a sign of
underlying problems of brain or skull growth and development
why is head growth no longer useful after 2 years of age
because it is slow
BMI reflects
how heavy a child is relative to their height
BMI is for …. not
BMI for screening tool not a diagnostic tool
how often should infants and toddlers be measured
- in the first week of life
- at 1, 2, 4, 6, 9, 12, 18 and 24 months
- between 4 - 6 years
- older children and adolescents should be measured once each year
what are the NZ recommendations of measuring weight and height and head circumference up until what age
weight and height = up to 5 years
head circumference = up to 1 year
