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Growth and Development (Pediatrics) - Coggle Diagram
Growth and Development (Pediatrics)
Types of growth and development :
Quantitative change
Physical growth
Ht, Wt, head & chest circumference
Physiological growth
vital signs
Qualitative change
Cognitive development
Emotional development
Motor development
Social development
Stages of Growth and Development
Early Childhood
Toddler
1-3 years
Preschool
3-6 years
Middle Childhood
School age
6 to 12 years
Infancy
Neonate
Birth to end of 1 month
Infancy
1 month to end of 1 year
Late Childhood
Adolescent
13 years to approximately
18 years
Prenatal
Embryonic (conception- 8 w)
Fetal stage (9-40 or 42 w)
Development
Fetal Development
The Zygote
3 stages
Embryonic period
The 3rd to the 8th week after conception
20% aborted spontaneously :warning:
Fetal period-
The 9th week after conception to birth
Germinal period
The first 2 weeks after conception
Prenatal Development
:star:1 wk ;begining of the embrionic preriod
:star:8 wk;Ovaries,Testes
:star:7 wk;Eyelids
:star:9 wk;Fetal period - lenght 5 cm,weight 8 g
:star:6 wk;Nose,Palate
:star:12 wk; External genitals
:star:5 wk;Lens,Mouth,Digital rays on hand
:star:20 wk;weight 460 g , lenght 19 cm.
:star:3 wk;Missed mentrual peroiad,Trilamina
:star:25 wk;Weight 900 g,lenght 24 cm
:star:4 wk;Neural fold fuse
:star:28 wk;Eye open,Weght 1000 - 1300 g
:star:2 wk ;Bilaminar embryo
:star:38 Wk;Term
Maternal & Perinatal
Perinatology
Maternal Fetal Medicine
Caring ;
20-28 wks up to 4 wks postpartum
Neonatology
Perinatal-Neonatal Medicine
birth up to the 1st month (1st 4 weeks)
Optimizing Maternal & Perinatal Outcome
Peripartum Care
labor, delivery & postpartum period
. delivery by skilled birth
Pregnancy care
1st prenatal visit during 1st trimester, with at least 4 visits through
out course of pregnancy
Iron & folate supplementation for at least 3 months
Iodine ,TT immunization 2 doses,
Pre-pregnancy care
Iron & Folate supplementation
family planning & lifestyle,nutrition
Clinical conditions
Risk factors
Fetal
congenital defects (terathanasia)
multiple
gestations
fetal size-date discrepancy
abnormal fetal position
oligo/polyhydramnios
fetal hydrops
Environmental
maternal
medications
toxins
maternal illness
teratogens
radiation
physical &
emotional trauma
Maternal
biologic-genetic risk
reproductive
risks
medical risks
socio-economic risks
Major causes of perinatal & neonatal
mortality
Severe congenital anomalies
Abruptio placenta & placenta previa
Infections (intra-uterine & neonatal)
Umbilical cord accidents
Asphyxia – antepartum & intrapartum
Fetal hydrops
Prematurity
Neonatal
Critical events during transition
Cord clamping>>>inc systemic BP>>>further inc pulmonary blood flow
Higher volume of oxygenated blood returns to the left side of the heart>>>inc left atrial pressure>>>closure of foramen ovale
Oxygenated blood coming from left side of the heart>>>closure
of ductus venosus & arteriosus via oxygen sensitive receptors
First breath stimulates alveolar expansion >>>stimulates pulmonary vasodilation>>>dec pulmonary vascular resistance>>>blood flows to pulmonary bed>>>gas exchange begins
The APGAR Score
Scoring is done at 1 and 5 minutes
Score of 8-10 is considered normal
2 neurologic parameters
Muscle tone, reflex response
APGAR score of 3 or less at 20 minutes >>>mortality and long
term neurologic morbidity (Ex. Cerebral Palsy)
3 physiologic parameters
Color, Respiration, HR
Not reliable in premature infants due to immature nervous system (tone & reflex)
Physical examination
Vital signs
RR: 40 -60 breaths/min
HR: 120 – 160 beats/min
Temp: 36.5 – 37.5 C
BP
Anthropometric measurements; Wt, length, HC, CC and plot in
Lubchenco Chart to determine whether AGA, SGA or LGA
Gestational Age
Term: 37 – 41 6/7 weeks
Postterm > 42 weeks or more
Preterm: <37 weeks
The New Ballard Score
Reliable if done within 72 hours; preterm within the first 12 hours of life
Physical features
done once stable
Neurological features
quiet and awake state
General appearance
Inspectation
umbilical stump
vein (1) and arteries (2)
placenta
thorax
size, shape & movement of
the chest
Mammary glands
engorged,witch’s milk
Skin & Color
acrocyanosis, pallor, plethora (hct > 65%),mottling, harlequin color change, hyper/hypopigmented skin lesions, portwine stains, hemangiomas & telangiectasias
Vernix caseosa, Lanugo,Mongolian spots,Meconium staining
Head
shape & size, sutures, fontanel
Eyes
subconjunctival hemorrhages, red orange reflex, cataract (Rubella & Galactosemia)
Face
facies of certain syndromes, facial paralysis or paresis
Cry
hoarseness (laryngeal edema ex. after airway manipulation),highpitched cry, stridor
CVS
General appearance, color, perfusion & resp. status,Central cyanosis, PMI, Murmur,
Normal HR 120-160 beasts/min; slowing may be due to congenital heart block, hypoxia or intracranial hemorrhage
Abdomen
Abd. Distention, Diastasis recti ,Umbilical hernia,omphalocoele
Palpate
Kidneys normally palpable by bimanual palpation(hydronephrosis, cystic
kidney disease)
Liver;2-3 cm below right subcostal arch
Back
abnormal curvature, evidence of occult dysraphic state (tuft of hair,sinus, dimples, skin tag,hemangiomata, subcut lipoma
Extremities
malformations (ex. clubfoot deformity), joint contractures, asymmetry, discolorations ( ex. Erb’s palsy),hip
dysplasia
Genitalia
ambiguity (importance in sex assignment), testes (descended or not), hydrocele, hernia
Anus
presence, patency & location
Neurologic examination
Basic
Motor examination
Developmental reflexes
Palmar & Plantar grasp
Rooting & sucking
Tonic neck
Moro
Cranial nerve examination
Sensory testing
rarely done in NB
Complete exam is necessary in the following case ;
Diminished alertness
Seizures
Hypotonia
CNS infection
Prematurity
Palsies
Low APGAR score
Trauma
Dysmorphism & congenital anomalies
Discharge
Danger signs
difficult
feeding, hypothermia/fever, seizures, difficulty/fast/slow breathing,redness/discharges from umbilical stump & surrounding area,jaundice, moves only when stimulated