Growth and Development

last authored: April 2012, David LaPierre
last reviewed:

 

 

Introduction

Growth has been called the best measure of health of children.

 

Early childhood is the most important developmental phase in life; our 'sensitivity periods' for development of the central nervous system, as well as emotional response and control, are within the first few years. These years affect the rest of our lives in profound ways; socioeconomic conditions are therefore critical to consider and improve as best as possible. "The conditions in which children are dying are the same conditions in which children are surviving." (Arjumand Siddiqi, CPHA national conference, 2008).

 

1. Describe variants of normal growth in health children (e.g. familial short stature and constitutional delay). (CP)

2. Identify and describe abnormal growth patterns based on the family growth history and the child’s previous growth e.g. microcephaly, macrocephaly, short stature, obesity, growth abnormalities related to specific physical findings. (CP)

3. Identify failure to thrive and overweight/obesity in a child or adolescent using BMI and other growth measures and outline the differential diagnosis and initial evaluation. (CP)

 

 

Neonatal Growth

During the fetal period, growth is essentially independent of growth hormone and thyroid hormone. Newborn size at birth is influenced by fetal, placental, and maternal factors such as smoking, nutrition, and other indicators. There are, in part, mediated by factors such as insulin, IGF-I and IGF-II.

 

A weight loss of up to 10% is normal during the first week, with weight regained by 10 days. Newborns should grow 20-30g/day - 1oz/day except on Sunday (eg 6oz/week).

 

Growth after 30 Days

During infancy, the growth pattern becomes more influenced by genetics, though environment continues to play a significant role. Growth is the most rapid during the first two years.

Many infants switch percentiles within the first 18 months, and this is normal.

Growth is normally 18 cm/year to age 6 mo, then decreases till puberty to ~ 5-6cm/year. Growth of below 4cm/year is cause for concern. From age 3 until puberty, growth is normally constant along a given percentile channel.

 

Growth during puberty

Early/late puberty can lead to crossed percentiles. Peak height velocity occurs at Tanner stage 2-3 for girls and stage 3-4 for boys. Girls grow, on average, less than two inches after menarche. Men are taller than women due to taller height at puberty take-off.

 

 

 

 

 

 

Growth Charts

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Growth Concerns

If parents bring concerns about growth to you, ask:

• who is worried? why?
• are the clothes sizes changing normally?
• does this child's pattern of growth differ from the rest of the family?
• are there signs of puberty? Early signs of puberty (testicular growth) are less obvious in boys, and can be cause of concern for parents.

 

Other potentially important indicators include attachment and trauma.

Early Development Instrument is a population-based measure developed by McMaster. Five scales: physical health and well-being, communication skills, language and cognitive, emotional maturity, and social competence. It takes 15-20 minutes per child.

 

Development

Competencies: Knowledge: 1. Describe the four developmental domains of childhood (e..g gross motor, fine motor, language, and social development. (CP) 2. Describe the initial evaluation and need to refer a patient with evidence of developmental delay or abnormality. (M)

 

Milestones

Age	Gross Motor	Fine Motor	Language	Social
6 weeks	lifts chin when prone			smiling at others
2 months	extends arms when prone	pulls at things	coos	recognizes parents
4 months	raises head and chest when prone, rolls over	grabs objects, brings them to mouth	laughs
6 months	can support self with hands, tripod sitting	hand-to-hand transfer	babbles	stranger anxiety
9 months	sits without support, pulls to stand, crawls	pincer grasp	mama	plays games, peek-a-boo
12 mo	walks with support	overhand pincer, throws	two words, follows one word commands
15 mo	walks without support	draws a line		points to wants/needs
18 mo	stairs with help	tower of three cubes; scribbles	10 words	uses spoon; points to body parts
24 mo	up and down steps, kicks a ball	tower of 6 cubes; undresses	2-3 word phrases, simple pronouns	helps get dressed; plays alongside others
3 years	tricycle, stands on one foot, jumps	copies circle; puts on shoes	prepositions, plurals, counts to 10	dresses, undresses, knows age and gender
4 years	hops on one foot	copies square, uses scissors	tells story, uses past tense	plays with others, toilet trained, knows body parts
5 years	skips, rides bicycle	copies triangle, prints name	future tense; speech fluent

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Red Flags

not walking at 18 months

handedness at <10 months

<3 words at 18 months

not smiling at 3 years

no peek-a-boo at 9 months

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Hormones Involved with Growth

Growth hormone is released from the anterior pituitary. It has a number of roles related to growth, including:

• acts on the liver to induce IGF-1 expression
• increases muscle mass
• decreases glucose utilization, opposing insulin
• increases lipolysis and fat mobilization

Both growth hormone and IGF-1 provide negative feedback.

 

Growth hormone releasing hormone (GHRH) and somatostatin stimulate and inhibit, respectively, growth hormone releasing cells in the anterior pituitary.

 

Ghrelin, secreted by gastric neuroendocrine cells, are elevated during fasting and stimulate GH secretion by acting on the hypothalamus and pituitary.

 

Too much GH results in acromegaly, is what is responsible for the giants we've known - people 7 ft tall and higher, while growth hormone deficiency can cause pituitary dwarfism.

 

 

Resources and References

http://www.dbpeds.org/articles/detail.cfm?TextID=701

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