Lecture 11: Infant and Child Growth Flashcards
What direction does muscle control and coordination develop from?
- Top down
- Centrally to peripherally
What direction is top down?
Head control to lower leg coordination and walking
What direction is centrally to peripherally?
Shoulders and arms before hands and fingers
At what age should head control be achieved? (Plunket)
6 months
At what age should infants be able to sit and pivot? (Plunket)
10 months
At what age should infants be able to pull self to standing? (Plunket)
12 months
At what age should infants be walking independently? (Plunket)
18 months
What is the WHO window of achievement for walking alone?
8-18 months
What is the WHO window of achievement for standing alone?
7-17 months
What is the WHO window of achievement for walking with assistance?
6-14 months
What is the WHO window of achievement for hands and knees crawling?
5-14 months
What is the WHO window of achievement for standing with assistance?
5-12 months
What is the WHO window of achievement for sitting without support?
4-9 months
It is important to determine whether a child is…
Growing normally or has a trend towards a growth concern that should be addressed
What are the two stages of a child growth assessment?
- Measure: weight, length/height, head circumference and BMI
- Plot measurements of a child’s body size on growth charts
What is weight a good indicator of?
Acute changes in dietary intake
What does height reflect?
Long-term nutrition
What does head circumference reflect?
Brain growth
What is BMI used to screen for?
Over nutrition or growth faltering
How often are clinical electronic scales calibrated?
Every 6 months
When weighing children up to 2 years, remove..
Clothing and nappy
When weighing children over 2 years…
Minimal clothing, remove shows, empty bladder and before a meal
Measured weight is recorded to the nearest…
10g
What do you do when baby doesn’t want to sit or lie to be weighed?
Get mother to hold them, weigh both, subtract mothers weight
At what age should children be able to sit or stand independently to be weighed?
Beyond 2 years
At what age is length used rather than height?
For under 2’s
What is length measured using?
A calibrated length board with fixed headpiece and movable footpiece
How should the infant be placed on a length board?
On back in centre, lying flat, eyes looking up, both legs fully extended, toes pointing upwards, feet flat against food piece
Length is measured to the nearest….
0.1cm - good practice to take 3 measurements
When should weight and length be measured?
- Often by LMC/GP/Well Child Provider
- In the first week of life
- At routine checks
- When there is concern about weight, growth or health
How often should weight and length be measured?
- Measuring too often can be misleading
- Should be measured >2 weeks apart after 6 months of age
What should be used to measure head circumference?
Flexible, non-stretchable tape
How is head circumference measured?
Position the tape just above eyebrows, above the ears - around the biggest part on the back of the head
How accurately should head circumference be measured?
To the nearest 0.1cm - three measurements and take average
What age is head circumference measured?
Up to 1 year of age
What is a growth reference?
Describes how certain children grew in a particular place and time
What is a growth standard?
Describes how healthy children should grow under optimal environmental and health conditions
- used during the early periods of life
A reference is NOT a…
Standard
What does the WHO Child Growth Standards (0-5 years) provide?
A single international standard that represents the best description of physiological growth for children from birth to 5 years
What do WHO Child growth standards (0-5 years) establish as the normative model for growth and development?
Breastfed infants
WHO Child Growth Standards represent the best….
Description of physiological growth and should be applied to all children everywhere regardless of ethnicity, socio-economic status and type of feeding
What are the main attained growth measures?
- Weight for age
- Length/height for age
- Weight for length/height
- BMI for age
Why is it a lot more challenging to develop the same standards for infants compared to children…..
Because we can’t control as much of diet and exercise
What WHO growth reference data is used for children aged 5-19 years? (3)
- Weight for age (5-10 years)
- Height for age (5-19 years)
- BMI for age (5-19 years)
Z-scores are more used in ?? rather than ?? setting
More used in research rather than clinical setting
What are z-scores a measure of?
The deviation of the anthropometric measurement from the reference mean or median in terms of SD
How do you calculate z-scores?
- Find Mean
- Calculate SD
- Get Z-score
What is the equation for z-scores?
z-score = (measured value - average value in the reference population) / standard deviation of the reference population
Severe poor growth would be referred to a…
Pediatrician
Why plot on a growth chart?
To compare children’s measurements against healthy children of the same age
- To track how a child grows over time
Normal growth is an important indicator of….
Heath
- So growth should be assessed regularly
For children aged 0-5 years what should be used to monitor growth?
The NZ WHO growth charts (0-5 years)
For children and young people aged 5-18 years what should be used to monitor growth?
Use either:
- WHO reference 2007 growth charts
- Centers for disease control (CDC) growth charts
If a child is growing normally, growth will usually ‘track’ parallel to…
one of the centile lines on the chart
If a childs growth starts to track up or down significantly (two or more inter-centile spaces)…..
Further investigation is necessary to identify the cause
To plot growth you need data on…
- Sex
- Age
- Weight/length/head circumference
Each percentile line marks….
The weight or height below which the percent of children of that age and gender fall
Which centile represents the median?
50th Centile
What does each centile show?
Describes the number of children expected to be below that line (e.g. 50% below the 50th centile)
Half of children will fall between…
the 25th and 75th centiles
If a point is within 1/4 space of a line we say it is…
On the centile (e.g. on the 91st centile)
Why is the 50th centile de-emphasized?
50th percentile now looks the same as all of the others, as it brings fear and worry if they are not at this
Why is head circumference taken in the first 24 hours unreliable?
The head may be subject to molding
Why do growth charts have a gap in the first 2 weeks of life?
Because babies lose weight in the first 3-5 days and 80% have regained it by 2 weeks
- Weight loss is normal after birth
When is weight loss not normal after birth?
> 10% weight loss
- may indicate a feeding problem or illness
When do we switch from measuring length to measuring height?
At 2 years of age
What happens to the centiles when we switch from measuring length to height?
Centiles shift down slightly
- This is because when a child is standing up their spine is compressed slightly compared to when lying down
Head circumference usually tracks within a range of…
One centile space
Rapid head growth can be a sign of…
Hydrocephalus (fluid in the brain)
Slowing head growth may be a sign of…
Underlying problems of brain or skull growth and development
Why do we stop measuring head growth after 2 years?
Growth in HC is slow and measurement is no longer useful
BMI is for screening and is not a ?? tool
Diagnostic
How often should infants and toddlers be measured?
- In first week of life
- At 1, 2, 4, 6, 9, 12, 18 and 24 mo
- Between 4 to 6 years
How often should older children and adolescents be measured?
Once a year
