120. Methods for control and evaluation of child and adolescents’ growth and development anthropometry and somatoskopiya.

What is child development?

Biological and psychological changes occurring from birth to the end of adolescence.

What are the periods of development?

• Prenatal: Germination (12–60 days), embryonic (8 weeks), fetal (9–40 weeks)

• Postnatal:

  • Neonatal: birth–1 month (early: 1st week, late: 2nd–4th week)

  • Infancy: 1 month- 1 year

  • Toddlerhood: 1–3 years

  • Preschool: 3–6 years

  • School age: 6–12 years

  • Adolescence: 13–18 years

Main processes of growth and development?

• Growth: Quantitative, physical changes

• Development: Qualitative, improvement of tissues, organs, and emotional changes

Types of age in child development?

• Chronological/Calendar age: Since date of birth

• Biological age: Determined by teething, body proportions, etc.

• Discrepancy between the 2 may indicate disorders or genetic factors

Characteristics of growth and development?

• Different speeds for growth and development up to 18 years

• Varying intensity in different organs and systems

• Unevenness at different times

• Gender differences (puberty)

What does medical examination include?

• Anthropometric measurements: height, weight, head/chest circumference

• Morphological type: direct measurements

• Functional type: organ/system function

• Mental development assessment

• Physical skills/capacity tests

• Blood, urine, intestinal parasite analyses

• Doctor’s and dental examination

Frequency of medical examinations by age

Younger children → more frequent exams:

• 0–1 year: monthly

• 1–2 years: every 3 months

• 2–7 years: every 6 months

• 7–18 years: yearly

Why evaluate physical development and skills?

• Establish objective health criteria

• Set age/gender standards

• Assess effects of strain, nutrition, activity, environment

• Guide preventive programs & dietary recommendations

What is anthropometry?

Measurement of human body dimensions to evaluate growth and functional indicators.

• Morphological: height, weight, head/chest circumference, lengths/widths

• Functional: chest mobility, muscle strength, endurance

Evaluation of anthropometric data groups?

• Group I (norm): x ± 1 SD

• Group II (extended norm): x ± 1–2 SD

• Group III (outside norm): >2 SD above or below

Anthropometry measures?

• Morphological: height, weight, head/chest circumference, widths/lengths

• Functional: chest muscle mobility, physical capacity

• Measured in the morning, 2–3 hours after breakfast, children in shorts

Best conditions for anthropometric measurements

Morning, 2–3 hours after breakfast; children wear only shorts.

How to measure height?

• ≤2 years: Lying down on anthropometer, head against headboard, knees flat, feet toes up, ±1 mm accuracy

• >2 years: Standing against wall, shoes off, head/shoulders/back/buttocks touching wall, eyes perpendicular to wall, ±0.5 cm accuracy

how is longitudinal growth assessed?

Tracks overall health over time; reflects dynamic changes.

How to measure weight?

Anthropometer or medical balance

• 1-year-olds: ±10 g

• Older children: ±50 g

Head and chest circumference measurements?

• Head: Non-elastic tape, widest circumference, measure 3 times

• Chest:

  • ≤3 years: bottom scapula to front mamillus

  • Older children: max inhalation, pause, max exhalation → assess chest mobility

Skinfold thickness

• Calliper measurement; indicates subcutaneous fat

Physical capacity (functional anthropometry)

• Muscle strength: dynamometer (flexors >3 yrs)

• Speed: smooth running

• Leg strength: standing long jump

• Arm/back strength: throw 80 g ball

• Endurance: max squats 20 s (>3 yrs); 600 m run (boys >10 yrs), 300 m (girls >10 yrs)

• Values <1 SD = alarming

Somatoskopiya includes?

• Anamnesis: personal history, birth, family, nutrition, immunization, social status

• Physical examination: skin, mucus, lymph nodes, respiratory, CV, thyroid, senses, locomotor system

Thyroid gland grading?

• Grade 0: not palpable/visible

• Grade 1: palpable, not visible

• Grade 2: clearly visible enlargement

Body poses for locomotor assessment?

• A (very good): Face ahead, flat abdomen, axes aligned, normal spinal curves

• B (good): Head slightly forward, arms lowered, slight inclination

• C (medium): Axes considerably inclined

• D (bad): Head forward, belly out, dorsal curves increased

Scoliosis and degrees?

Permanent lateral spine deviation, vertebrae rotation

can be congenital/acquired

• I: ≤10º, slight asymmetry

• II: 10–25º, primary stiffness

• III: 25–50º, permanent chest deformation

• IV: ≥50º, highly deformed, operative treatment required

Adam’s test purpose?

Forward bend to detect scoliosis by assessing symmetry of

• head,

• shoulders,

• scapulae,

• waist triangles,

• ribs

Pubertal growth

• Puberty: 10–13 girls, 10.5–14 boys

• Sexual Maturation Rating (Tanner stages 1–5)

  • Females: pubic hair, breasts, axillary hair, menarche

  • Males: testicular/penile growth, pubic/axillary/facial hair, nocturnal emission

Neuropsychological assessment

Examines neurological status, speech, social skills, senses

SMR (Tanner staging)

• Tracks secondary sexual characteristics to evaluate puberty

• Females: pubic/axillary hair, breast development, menarche

• Males: testicular/penile growth, pubic/axillary/facial hair, nocturnal emission

• Stage 1: prepubertal

• Stages 2–5: progression

• Stage 5: sexual maturation complete

Sexual maturation correlates with?

Linear growth, weight changes, body composition, hormonal changes

Determining biological development?

Skeletal or pubertal maturation, bone age (average of small wrist/hand bones)

Hallmarks of puberty

• Adolescent growth spurt (preadolescent dip → midpuberty acceleration)

• Body composition changes (water, muscle, fat, bone)

• Boys: increased bone & muscle growth due to testosterone and GH interaction

Evaluation of physical development?

Compare measured values with norms → calculate SD → classify:

• Group 1: norm ±1 SD

• Group 2: extended norm ±1–2 SD

• Group 3: outside norm >2 SD