2014年下學(xué)期兒童生長(zhǎng)發(fā)育大課

1/64兒童生長(zhǎng)發(fā)育中南大學(xué)湘雅二醫(yī)院兒童醫(yī)學(xué)中心羅雪梅新生兒期(0~28d)嬰兒期(0~1y)幼兒期(1y~3y)學(xué)齡前期(3y~6y)學(xué)齡期(6y~12y)青春期(12~18y)AgePeriodofChildDefinitionRulesofthegrowth&developmentPhysicalgrowthNeuro-psychologicaldevelopmentGROWTH&DEVELOPMENTDefinitionRulesofthegrowth&developmentPhysicalgrowthNeuro-psychologicaldevelopmentGROWTH&DEVELOPMENTGrowth生長(zhǎng)各器官、系統(tǒng)、身體的長(zhǎng)大，量的變化，可以用度量衡測(cè)定，有相應(yīng)的測(cè)量值DEFINITIONBodyweightBodylengthSittingheightHeadcircumferenceChestcircumferenceUpperarmcircumferenceDevelopment發(fā)育指細(xì)胞、組織、器官功能上的分化與成熟，機(jī)體質(zhì)的變化，包括情感—心理的發(fā)育成熟過(guò)程，不能用數(shù)量指標(biāo)來(lái)衡量DEFINITIONSensoryandperceptionDevelopment感知覺(jué)MotorDevelopment大運(yùn)動(dòng)SpeechandLanguageDevelopment語(yǔ)言言語(yǔ)Cognitive,Social-emotionalDevelopment情感

…GROWTH&DEVELOPMENTDefinitionRulesofthegrowth&developmentPhysicalgrowthNeuro-psychologicaldevelopmentAcontinuousprocess連續(xù)性Imbalancebetweendifferentsystems不均衡Generalrulesofdevelopment普遍規(guī)律Interpersonaldifference個(gè)體差異性RULESOFGROWTH&DEVELOPMENTGirlsBoysContinuousofprocessImbalancebetweendifferentsystemsGeneralrulesofdevelopment

一般規(guī)律Upper上

Lower下Proximal近

Distal遠(yuǎn)Clumsy粗

Fine細(xì)Lowergrade低級(jí)

Highergrade高級(jí)Simple簡(jiǎn)單

Complex復(fù)雜GeneralrulesofdevelopmentUpper LowerHeadup1moChestup2moUponhands4moSit7-8moStandandwalk11-12moGeneralrulesofdevelopmentProximal DistalClumsy FineGeneralrulesofdevelopmentLowergrade HighergradeSimple ComplexDrawastraightlinetodrawgraphicsSeeThinkListenAnalysisFeelJudgeGROWTH&DEVELOPMENTDefinitionRulesofthegrowth&developmentPhysicalgrowthNeuro-psychologicaldevelopmentCommonparameters&methodsBodyweight體重Bodylength/Stature身高∕身長(zhǎng)Headcircumference頭圍Bodymassindex體重指數(shù)RelatedSystemsGrowthOsseousdevelopment骨骼發(fā)育Dentaldevelopment牙齒發(fā)育PHYSICALGROWTHBodyweight體重器官、系統(tǒng)、體液的綜合重量，反映兒童生長(zhǎng)與營(yíng)養(yǎng)狀況的靈敏指標(biāo)

Criterionofgrowth&nutritioncondition

differinspeedofBWincreasetheyounger,thefasterfirstpeak:newborn-1yearsecondpeak:adolescenceBodyweight體重Bodyweight體重

Birthweight 3.2~3.3kgPhysiologicallossofbodyweight:Bodyweightdeceased(<10%ofbirthweight)overthefirst3to7daysafterbirth,andrecoveredtobirthweightby7th-10thday.Doublebirthweight:3~4moTriplebirthweight:~12mo

1~12y Age×2+8(kg)Aboutformulae

AttentionDonotbeusedingrowthassessment

Why?DifferentgrowthrateIndividualdifference

公式僅用于藥量和補(bǔ)液計(jì)算Bodylength/stature身高∕身長(zhǎng)指頭、脊柱、下肢長(zhǎng)度的總和，即頭頂?shù)阶愕椎拇怪遍L(zhǎng)度

CriterionofbonegrowthThesameregularrulesasBW

<2-3y

shouldbemeasuredbyrecumbentlength Atbirth averages50cminfullterm 1y 75cm(increase25cm)2y 87cmDoublebirthlength:~4yTriplebirthlength:~13y 2~12y Age×7+75(cm)(5-7cm/y)

LinearGrowth---

Height---

Length<3y≥3yStand

Supine上部量

upperpart

從頭頂至恥骨聯(lián)合上緣下部量

lowerpart

從恥骨聯(lián)合上緣至足底

＜3yrs(crown-rumplength)

Criterionofskull&spinegrowthSH/BHatbirth0.6714years0.53

下肢增長(zhǎng)速度隨年齡增長(zhǎng)而加快坐高

SittingHeight(SH)頂臀長(zhǎng)∕坐高Crown-rumpLength/Sittingheight-Crown-rumplength

Sittingheight<3ySitSupine≥3yDifferentialdiagnosisofshortstatureProportionate勻稱(chēng)型Disproportionate非勻稱(chēng)型20頭圍

Headcircumference

relatedtodevelopmentofbrainandskullmeasurementismostvaluableinthefirst2yHeadsizeisobtainedbymeasuringthegreatestoccipito-frontal(geison)circumferenceusingaflexiblebutnon-stretchabletapemeasureHeadcircumference

Atbirth 32-34cm 3months 40cm(increase6cm) 1Yr 46cm(increase6cm) 2Yr 48cm 5Yr 50cm 15Yr 54~58cmSmall—Cerebraldysplasia腦發(fā)育不良,Microcephaly小頭畸形,etcHydrocephalus腦積水,etcAbnormalityofH.CIncreasetoofast—胸圍

ChestCircumferenceCriterionofthorax胸&lungs肺growth

AtbirthCC32cm1year=HC

＞1yearCC＞HC上臂圍

UpperArmCircumference

Criterionofmuscle,bone,fat,&skingrowthinupperarmCriterionofnutritioncondition

＜1yrgainrapidly

1-5yrsgainslowly

＜5yrs

＞13.5cmbestnutrition12.5-13.5cmbetternutrition

＜12.5cmmalnutrition體重指數(shù)

BodyMassIndexBMIis

ameasureforhumanbodyshapebasedonanindividual'smassandheightBMIisuseddifferentlyforchildrenItiscalculatedthesamewayasforadults,butthencomparedtotypicalvaluesforotherchildrenofthesameageBMI=W(kg)/H2(m)18-25(adult)

體格生長(zhǎng)的評(píng)價(jià)Evaluation

發(fā)育水平

developmentallevel

生長(zhǎng)速度

growthspeed

勻稱(chēng)程度

equabledegreeGrowthCurves

birthto36monthsBoys,weight-for-agebirthto36monthsBoys,length-for-agebirthto36monthsBoys,headcircumferencefor-age

birthto36monthsgirls,weight-for-agebirthto36monthsgirls,length-for-agebirthto36monthsgirls,headcircumferencefor-age

2to20yearsBoys,weight-for-age2to20yearsBoys,stature-for-age2to20yearsBoys,bodymassindex-for-age

2to20yearsgirls,weight-for-age2to20yearsgirls,stature-for-age2to20yearsgirls,bodymassindex-for-age

……Boysreachmostoftheirheightatageof17whereasgirlsreachtheirsataround15GrowthChartspublishedonline()Thechild‘sgrowthisdeterminedbycomparisonwithothersofthesamesexandsimilarage.NormalResultrepresentationDescendingAcceleratedNogainsSlowed

頭顱骨發(fā)育GrowthofSkull顱骨縫cranialsutureclosedin3-4monsafterbirth前囟anteriorfontanelle

closedin1-2yrs后囟posteriorfontanelleclosedin6-8weeksafterbirth

前囟

AnteriorFontanelSize:

1~2cmatbirthClosureTime:

18~24m

Smallsizeorearlyclosure：AbnormalityofanteriorfontanelMicrocephaly頭小畸形,etcHydrocephalus腦積水,Cretinism呆小病,etcLargesizeordelayedclosure：Intracranialhypertension顱高壓(Encephalitis腦炎,Meningitis腦膜炎,etc)Dehydration脫水AbnormalityofanteriorfontanelBulgingfontanel：Sunkenfontanel：抬頭坐頸曲胸曲腰曲骶曲脊柱的發(fā)育GrowthofSpine

年齡動(dòng)作肌肉群脊柱彎曲3月抬頭頸后肌頸前曲

6月坐腰肌胸后曲

12月走下肢肌腰前曲脊柱的發(fā)育GrowthofSpine

Endochondral軟骨內(nèi):LengthIntramembranous膜內(nèi):Width長(zhǎng)骨的發(fā)育GrowthofLongLone1-9yrsossificcenter＝age(yrs)+1骨齡：骨化中心與標(biāo)準(zhǔn)圖譜比較，相當(dāng)于某一年齡標(biāo)準(zhǔn)圖譜時(shí)，該年齡即為骨齡長(zhǎng)骨的發(fā)育GrowthofLongLoneBoneAge:ThenumbersandprogressivechangesofossificationcentersaremeasuredbyX-ray,andstandardizedbycorrespondingchronologicalageandsex.Ossificationcenters牙齒的發(fā)育GrowthofTeeth

6yrseruption20-30yrscompletion7-8yrsexchange乳牙

primaryteeth20

4-10monseruptioncompletionby2.5yrs<2yrsnumber＝age(mons)－(4~6)恒牙

permanentteeth32Delayederuption–>13mIdiopathic原發(fā)性,Hypothyroidism甲低,etcCrowdingorDisorder–

Hypothyroidism甲低,Braindysplasia腦發(fā)育不良,etcFailingtoerupt–Ectodermaldysplasia外胚層發(fā)育不良,Mechanicalblockage機(jī)械性阻塞,etc

牙齒的發(fā)育GrowthofTeethGROWTH&DEVELOPMENTDefinitionRulesofthegrowth&developmentPhysicalgrowthNeuro-psychologicaldevelopmentIncludingMotor,Sensory,Language,EmotionPersonalityandBehaviorpatternsIsthesameimportantasphysicalgrowthDeterminedbyaninterplaybetweennature(genetictalent)andnurture(providedbyparents)NEURO-PSYCHOLOGICDEV.PsychologicalDevelopmentAttentionMemoryThinkingImaginationEmotionPersonali