Child’s Physical Development
Oxana TURCU
PhD, Associate Professor
Department of Pediatrics
Growth definition
• Is a dynamic process defined as an increase in the physical size of the body as a whole or any
of its parts associated with increase in cell number and/or cell size
• Reflects changes in absolute size, mass, body composition
• Growth in children is usually steady and predictable, and good references are available for
assessment and comparison
• Growth is a key component of nutritional status and indicator of health
• Growth can be measured objectively by using various anthropometric measurements and is
universally part of any pediatric care
• Quantitative growth
- changes in the mass of body tissues (muscle, fat, and bone)
• Qualitative growth
- specify maturation of the function
- it is related to the maturation and myelination of the nervous system – acquisition of a
variety of skills
- differences in maturation and body composition between boys and girls
Growth patterns • Cephalocaudal pattern (head down to toes)
• Proximodistal pattern (center of the body to peripheral)
• General to Specific (children at first are able hold the big things by using both arms, in the
next part able to hold things in a single hand, then only able to pick small objects)
• Although infancy and adolescence are characterized by rapid growth, growth occurs in
spurts, with rapid growth followed by slower growth
Factors influencing child’s growth
• Genetic factors (Growth potential)
- gender
- race and nationality • Prenatal factors
- maternal malnutrition
- maternal infection
- maternal substance abuse
- maternal illness
- maternal hormones
- miscellaneous
• Postnatal factor
- hormonal influence
After birth the somatotropin has the main role in growth
Growth hormone from hypophysis influence anabolic processes and growth regulation
Thyroid hormones have an influence in the first year of life with (T3, T4,)
Parathyroid hormones – on skeletal mineralization
- birth order of the child
- child’s nutrition
- childhood illness
- physical environment
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- psychological environment
- cultural influence
- socio-economic status
- climate and season
- play and exercise
Methods of growth assessment
• Somatometry – measurement of weight, height, head and chest circumference
• Somatoscopy – visual observation of physical features of different parts of the body (shape
of the chest, spinal column, muscle development, fat development, skin elasticity
• Dynamometry – spirometry, muscle’s stretch
• All the parameters are compared with standard/references values according to age and gender
of the child
Somatometry (anthropometric measurements)
• are inexpensive, noninvasive, and fast
• reflect both short- and long-term nutrition status
• the accuracy of measurements is an essential component of the assessment
• are objective, but growth must be interpreted in the context of clinical assessment
Main parameters of growth
• Linear growth (Length/Height)
• Weight and body mass index
• Weight/Height
• Head and chest circumference; HC/CC ratio
• Mid arm circumference
• Body proportions (arm span and upper-to-lower segment ratio)
• Growth velocity
• Growth patterns
• Dentition
• Bone Age
Physical characteristics of newborn
• In medical contexts, newborn or neonate refers to an infant in the first 28 days after birth; the
term applies to premature infants, postmature infants, and full term infants
• Full term newborn characteristics
- A normal duration of pregnancy between 37-42 weeks of gestation
- The average birth weight is 3.5 kg, the normal range is 2.5-4.5 kg
- Newborns often lose around 230 g (6-8%) in the first 4-5 days after birth but regain it by
about 10 to 12 days of age
- In the first month, the typical newborn gains about 20 g a day, or about 110-230g a week.
- The average length of full-term babies at birth is 51 cm, the normal range is 46-56 cm
- In the first month, babies typically grow 4 cm to 5 cm Infant & child’s growth – weight
• 1-3 month – weight gain is 25-30 g/day
• 3-12 month – 400-1000 g/mo (average 800 g/mo)
Milestones
• 6 month – infant double birth weight
• 12 month – triple birth weight
• 2 years – four times
• 3 years – five times
• 5 years – six times
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• 7 years – seven times
• 10 years – ten times
Rules for body weight measurement
• Child up to 6 months is placed on the special children’s scale in the supine position.
• Baby older than 6-7 months may be measured on the same scale in a sitting position
Child after a year in the measurement of body weight to be in a standing position
Formulas for calculating the ideal weight and height for healthy infants and children •
Ideal weight of infant 0-6 months
Wi = BW + 800 n, (n – mo)
• Ideal weight of infant 6-12 months
Wi = BW + 800x6+400 (n-6), (n – mo)
• Ideal weight of infant 6-12 months
Wi = 10.5 kg + 2 (n-1), (n – yrs)
Height measurement in children
• In children under 2 years, length is measured lying horizontally, using the mother to assist.
- the legs need to be held straight and infants often dislike being held still
• In children over 2 years of age, the standing height is measured Child’s length in the first
year of life
• 0-3 mo – 3 cm per month
• 3-6 mo – 2,5 cm per month
• 6-9 mo – 2 cm per month
• 9-12 mo – 1,5 cm per month
Child’s height in older children
• Ideal height after 1 year = 75 cm + 5 cm x n (n – number of years) Infant & child’s length
milestones
• 3 month – 60 cm
• 9 month – 70 cm
• 12 month – 75 cm
• Second year – 12 cm increase
• Third year – 9 cm increase
• Fourth year – 7 cm increase (double the birth length)
• Fifth year – 6 cm increase
• Afterwards – till onset of puberty – 5 cm/year
Head circumference
• Head circumference is measured over the most prominent part on the back of the head
(occiput) and just above the eyebrows (supraorbital ridges)
• Head circumference is generally measured in infants and children until age three years
Infant & child’s HC milestones
• It is related to brain growth and development of intracranial volume
• Newborn HC – 34-36 cm (average 35 cm)
HC milestones
• 3 month – 40 cm
• 6 month – 43 cm
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• 12 month – 45 cm
• 2 years – 48 cm
• 7 years – 50 cm
• 12 years – 52 cm (similar to adults)
• If HC increase >1 cm in 2 weeks during first 3 month – hydrocephalus should be suspected
Chest circumference
• The tape should be located in the back at an angle of the shoulder blades, and in front – at the
lower edge of the areola
• Circumference of the chest in infants measures in lying position, in older children – standing
Infant & child’s CC milestones
Newborn CC – 32-34 cm (2-3 cm less than HC)
• 6-12 month – HC and CC become equal
• After first year of age CC is greater than HC by 2.5 cm
• 5 years – CC is 5 cm larger than HC
Calculation of chest circumference
• 0-6 months: CC = 45 - 2 (6 - n)
• 6-12 months: CC = 45 + 0,5 (n - 6); n - the child’s age in months
• 1-10 years: CC = 63 - 1.5 (10 - n)
• 10 years and older: CC = 63 + 3 (n - 10); n - the child’s age in years
Growth Charts for Infants and Children •
Child growth is monitored to:
- Assess adequacy of nutrition
- Identify weight status and potential for obesity
- Screen for disease related to abnormal growth
• Growth charts are the standard tool for interpreting growth
• Growth Parameters
- Weight-for-age
- Length-for-age
- Weight-for-length
- Head circumference-for-age
• No BMI percentile are used for children younger than 2 years
• Centile levels
- 0-3 – Very low development
- 3-10 – Low development
- 10-25 – Decreased development
- 25-75 – Average development
- 75-90 – Increased development
- 90-97 – High development
- 97-100 – Very high development
Somatoscopy
Muscle system development
• First degree – low development
- decreased elasticity
- plate thorax, scapula is moved on thoracic surface
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- abdomen has low muscular tone
• Second degree – well development
- medium elasticity
- cylindrical thorax
- abdomen muscle with good tonus • Third degree – excellent development
Examination of subcutaneous tissue
• Skin fold in following regions
• Thorax – vertical at the level of medioclavicular line, at the level of third rib
• Abdomen – vertical 5 cm to the left from umbilicus
• On shoulder – on the triceps muscle and the line between acromion and olecranon
• Under the scapula – at inferior angle of scapula
4 degrees of development
• Ist degree – skin fold has 5 mm
• IInd degree – 5-9 mm
IIIrd degree – 10-15mm
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• IVth degree – 15 mm
Skin assessment
• Color
• Elasticity and turgor
• Humidity
• Temperature
• Hypo- or hyper-trichosis
• Mucousa layer of oral cavity and conjunctiva
• Characterized after inspection and all pathological changes noted
Biological growth (age)
• Bone maturation (ossification points on x-ray examination of left hand )
• Teeth eruption (temporary and permanent dentition)
• Appreciation of development of sexual stage and degree of sexual maturity (development of
secondary sexual signs)
