2. The physical development is one of
the criteria for complex health assessment
Absent or present of chronic diseases
Functional conditions of organs and systems
Resistance and reactivity of organism
3. The term «physical development» in
Pediatrics means
the dynamic process
of growth – the
increase of body
length and mass
the development of
some parts of body
biological maturity
of the child
4. The rate of growth, maturity of different
organs and systems are determined by:
🟃 Endogenic factors
🟃 Condition of the
health and age of
the parents
🟃 Genetic factors
🟃 Hormone
regulation
Exogenic factors
🟃 Intrauterus factors -
harmful effect,
pregnancy course
🟃 Postnatal factors –
nutrition, diseases,
physical activity, social
conditions
5. Genetic factors of growth
Hereditary factors determine future probable
height of the child and peculiarities of stature
in favorable of environment
The lack of normal conditions of environment
may lead to disorders of genetic development
program
6. Hormone factors
There are four phases hormones influence
during of human growth
Fetal – lactogen
The infantile phase – till 5 yrs. - thyroids hormones
Early school period -5 to 12 yrs. - growth [somatotropic] hormone
Pubertal growth spurt - after 12 yrs. - androgenic hormones
8. Environment factors
Nutrition factors (protein and energy insufficiency, deficit
of vitamins, aminoacids, iodine, zinc) can violate the process
of growth
Adequate emotional loads, sufficient sleep, correct care
stimulate normal development
Acute and chronic diseases can influence negatively on
the growth and development processes
Influence of different climatic and geographical
conditions. Hot climate and high-mountain climate slow
down growth process, but they also can accelerate
children’s maturity, even sexual development
9. Methods of physical development
assessment
Somatoscopy - assesses the subcutaneous, muscles and
bones development, form of a chest and extremities,
type of the constitution and body proportion
Somatometry - measure of the body weight, body
length, head circumference, chest circumference
Physiometry - check of vital capacity of the lungs,
dynamometria
10. Child’s physical development must correspond to
chronological and biological ages
The chronological age is counted from the day
of birth
Biological age is individual level of
morphological and functional maturity of some
tissues, organs and the organism as a whole
Biological age can differ from
chronological one
11. Criteria (measures) of biological age
Morphological Functional Other
Skeletal maturity (bone
age)
“Teeth” maturity
(eruption and changing of
teeth)
Level of physical
development
Maturity of body form
(proportion, stature)
Development of the
secondary sexual sings
Maturity of:
CNS and
vegetative NS,
cardiorespirat
ory system,
Locomotor
system
Hormones
level in blood
serum and
urine
Results of
biochemical
and
immunological
analyses
12. Criteria of physical development
Length - most stabile parameter
Weight- more changeable parameter
Head circumference
Chest circumference
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13. Physical development
of term newborn infant
Weight - between 2,7 and 4,2 kg (more often –
3200 – 3400 g)
Length - 45-55 cm (more often – 50-52 cm)
Head circumferences of 32,6-37,2 cm (more
often - 32-34-36 cm)
Chest circumferences – 30-32 cm
14. Classification System
Low Birth Weight (LBW)
<2500 grams or 5.5 pounds
Very Low Birth Weight (VLBW)
<1500 grams of 3.3 pounds
Extremely Low Birth Weight (ELVW)
<1000 grams or 2.2 pounds
15. Classification System
Small for gestational age (SGA)
Birthweight less than the 10th %tile
Appropriate for gestational age (AGA)
Birthweight between 10th and 90th %tile
Large for gestational age (LGA)
Birthweight greater than the 90th %tile
16. Newborn infants loose the weight (6-8% of
birth weight) at first 3-5 days
By the 5th-6th day of life the child begins
to gain weight, and gets it restored by 10-
14 days
A losing more than 8% of birthweight and
low gaining of weight indicates perinatal
pathology, hypogalactia of the mother and
child’s starvation or his illness
Physiological
loosing of weight
17. Body mass
The weight of term infant doubles by 4 months
triples by 1 yr.
Weight of infant before 6 mo =
birth weight + 600-800 x n (n – mo number)
Weight of infant after 6 mo =
BW + 800 x 6 + 400 x (n-6) (n – age in month)
Weight after 1 yr
10 kg + 2 kg n (n – years)
After 10 years the body weight increases by 4 kg
annually
18. Weight:
4 months:
12 months:
Double birth weight
Triple birth weight
then 2.3 kg/year until 9 or 10
then adolescent growth spurt
19. Body length/height
Increase on the 25 cm during 1 yr.
1– 3 mo + 3 cm every mo
4-6 mo + 2,5 cm every mo
7-9 mo +2 cm every mo
10-12 mo +1 cm every mo
1 year = 75 cm
1-4 yrs + 4 cm every year
4 year = 100 cm
after 4 year + 6 cm every year
8 year = 130 cm
20. The main rules of the growth
🟃 Craniocaudal gradient of the growth means:
🟃 Intrauterus period – high growth rate of head and upper
part of body
🟃 After birth – distal segments of body increase faster
than proximal: foot increase faster shin/tibia, shin
increase faster thigh
Change of the
body proportion
21. At birth – 34 – 36 cm
1-6 mo +1,5 cm every mo
in 6 mo = 43 cm
7-12 mo +0,5 cm every mo
Before 5 year + 1 cm every year
in 5 year = 50 cm
5 - 15 year + 0,6 cm every year
🟃Head circumference is market of pathology of
Central Nervous System (micro- and hydrocephaly)
Head
circumference
24. Chest circumference
• At birth 32-34 cm
• 1-6 mo +2 cm every mo
4 month head circumference = chest
circumference
in 6 mo = 45cm
7-12 mo +0,5 cm every mo
In 1 year – 48 cm
Before 10 year + 1,5 cm every year
in 10 years = 63 cm
10 - 15 year + 3 cm every year
25. Methods of assessment of parameters
of physical development
special table with
percentiles/sigma's
charts
graphs of data of children
physical development
28. 3rd 10th 25th 50th 75th 90th 97th
The marks between the 25th and 75th centiles correspond to
the average physical development
29. WHO Child Growth Standards
16
17
16
1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
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Assess
Body Mass Index
30. Index body mass = М(kg)/ L(м)2, boys
0 – 2 years (z-scores) 2 – 5 years (z-scores)
31. Interpretation of BMI
Body mass index Conclusion
16 and less Marked deficiency of body mass
16.5—18.49 Deficiency of body mass
18.5—24.99 Norma
25—29.99 Overweight
30—34.99 Obesity I degree
35—39.99 Obesity II degree
40 and more Obesity III degree
32. Acceleration
(Faster growth and development)
🟃 Facts
🟃 for 40-50 years past – length of newborn increase on 1-
2 сm, children of 2 –year-old – on 4-5 сm
🟃 average height of 15 –years-old children is increased on
20 сm for 100 years past
🟃 Reasons:
🟃 Good nutrition
🟃 Increases of protein food
🟃 Decreases of infection diseases
🟃 Genetic factors (migration of people)
🟃 Sport, modern communication
🟃 Acceleration may be harmony or disharmony
🟃 Retardation – slowdown growth and development
35. Dystrophy is a pathological condition causes by
the chronic disorder of feeding, which
characterizes deviation in the growth and
development and decrease of the immunity
Hypotrophy is classified into
congenital hypotrophy,
acquired hypotrophy and
hypotrophy of mixed genesis.
Terminology
36. The main causes of hypotrophy:
Unbalanced diet and mother’s diseases during pregnancy.
Disturbances in the child's feeding and his care.
Chronic diseases of a gastrointestinal tract, pulmonary
system, metabolism in children, etc.
There are three levels of hypotrophy:
1st level - deficiency in body weight=11-20%
2nd level - deficiency in body weight=21-30%
3rd level - deficiency in body weight=31% or more
37. During general examination of the child certain
signs of hypotrophy can be noted. The main among
them is decreased thickness of subcutaneous fat layer.
The subcutaneous tissue disappears:
- at first only on the abdomen (1st level),
- then on the limbs (2nd level) and
- later on the face (3rd level)
39. Paratrophy - is a result of chronic deviation in feeding of
1 year old children which is characterized by the increase in
body weight in comparison with the normal data by 10% and
more.
After 1 year - obesity
Terminology
40. Levels of obesity are established
depending on the amount of excess
body weight:
1st level -10-29%
2nd d level - 30-49%
3rd d level -50-99%
4th level - 100% and more
41. Short stature or hypostature is a dystrophy
with the almost even (equal) delay in child’s
length and weight growth in conjunction with
the child’s satisfactory fatness
Terminology
42. Nanism (dwarfism)
🟃 < 130 сm (m) и < 120сm (f)
🟃 Chinese – He Pinpin, his age is 21-year-old, his
height is 73 сm.
44. TALL
STATURE
Causes of excessive growth
or tall stature.
Familial Most common cause
Secondary
Excess sex steroids - precocious puberty from whatever cause
Excess adrenal androgen steroids (congenital
adrenal hyperplasia)
True gigantism (excess GH secretion)
45. The tallest persons (gigantism) in the
world (from Ginner's book)
Sultan Cosen (Turkey)
Height - 2 m 47 сm
Cause – tumor of hypophysis gland
