Transcript 2 Developmental terminology

INTRODUCTION TO
CHILD HEALTH
DEVELOPMENTAL
TERMINOLOGY
Robyn Smith
Department of Physiotherapy
UFS
2012
After this lecture the learner
should be able to:
• Define important developmental terms
• Explain weight/height/ head circumference for age ratios
• Interpret child mortality statistics
• Familiarise learner with Road to Health Chart
Is the terminology relevant to
physiotherapists?
• Working with babies and children in early intervention services we
have to understand the relevant developmental terminology
 Enables us to accurately interpret important information in
child’s history & medical records
 Helps us communicate effectively with interdisciplinary team &
parents
 Helps us identify children potentially at risk of developing
developmental difficulties
Pregnancy
• Period calculated from the first day of the
woman’s last menstrual period
• Period expressed in weeks
• Normal duration is 38-42 weeks
• 1st trimester: first 13 weeks
• 2nd trimester: 14 to 26 weeks
• 3rd trimester: 27 weeks to the birth of the foetus
Paediatrics
• Healthcare services
provided to the child
from birth through
adolescence
– Prevention
– Diagnosis
– treatment
• South Africa:
Birth to the age of 13
years
• Europe & USA :
Birth through
adolescence
Phases of Growth
•
•
•
•
•
•
Embryo
Foetus
Neonate
Baby/infancy
Toddler
Preschooler
• Scholar
• Adolescent
conception end 8th wk
9th week gestation until birth
1st 28 days of life
1st year of life
2nd year of life
up until school going age
(2-5 years)
from school going age
(>6 years till school leaving
age)
after onset puberty (10-19 yrs)
Neonatal terminology
Gestation
• Term
baby born between 38-42
weeks of pregnancy
• Premature
baby born <37 completed
weeks of pregnancy
• Post mature
Baby born > 42 completed weeks
of pregnancy
Neonatal terminology
Birth Weight
• NBW
2 500 – 4 000g
• LBW
<2 500g
• VLBW
<1 500g
• ULBW
<1 000g
Neonatal terminology
Weight for gestation
• SGA
small for gestational age
growth parameter below 10th
percentile
• AGA
appropriate for gestational age
Growth parameters between
10th and 90th percentile
• LGA
Large for gestational age
Growth parameters above 90th
percentile
Neonatal terminology
Chronological age
age in weeks or months from date of delivery
Corrected age
premature infants where the number of weeks born
prematurely have been deducted from the chronological
age
So when do we stop correcting age?
Controversy still exists where between ages of 12/12
and 18/12 one should stop correcting for age
Decide on an age for your clinic and
be consequent in
applying it in your assessments
Apgar Score
• Scoring system developed by Dr. Virginia Apgar in
1960’s
• This score /10 is used to evaluate the infant’s physical
condition after birth –pulse, crying, respiration, HR,
activity
• Score is taken a 1 minute, 5 minutes and 10 minutes
after birth.
Apgar Score
Scores
Heart rate
Respiratory
rate
Muscle tone
Reflexes
Colour
0
Absent
Absent
Flaccid
No
response
Pale/
blue
1
≺ 100/min
Weak
Some
flexion
Grimace
Blue
2
≻100/min
Strong
cry
Good
flexion
Cough/
sneeze
Pink
Hypoxic Ischaemic Encephalopathy
(HIE) or neonatal asphyxia
• Insult to the foetus or newborn due to a lack of oxygen (hypoxia)
and/or perfusion (ischaemia) to various organs
• Staged according to the Sarnat & Sarnat classification system:
 grade I (mild)
 Grade II (moderate)
 Grade III (severe)
Stage II and III are usually accompanied by convulsions and
neurological dysfunctions
Stage I associated with a normal outcome
Head circumference
• Microcephalic
Abnormally small head size in relation to the body
e.g. brain atrophy
• Macrocephalic
Abnormally large head size in relation to body
e.g. hydrocephalus
Head circumference is measured with a tape measure around the
broadest part of forehead
Measured at developmental follow up and charted on a chart in
relation to age. Good indicator of if the brain in growing appropriately
for age
Head size in an infant...interesting
fact
Higher ratio to the head size versus
rest of body weight
Infant brain =30% total bodyweight
Adult brain = 3 % total bodyweight
Head circumference
WEIGHT AND HEIGHT
TERMINOLOGY
Weight and height terminology
Weight
• Child’s weight in g or kg
• used to evaluate physical
growth
• Reflects on immediate
nutritional status of child
• Underweight for age may
indicate acute or more
chronic nutritional problems
Weight and height terminology
Length/Height
• Child length in cm or m is
measured
• Length for age <3rd percentile
child is considered to be
stunted or of short stature
• Stunted growth usually
indicates a longer term and
more chronic nutritional
problem
EVALUATION OF GROWTH
Growth Charts
• Normal distribution curve over a spectrum of ages
for weight and height
• Different charts for boys and girls
• Charts differ for gender and age
• WHO/ CDC 2000 charts available at most clinics or
on the Road to Health charts carried mothers
Interpretation of growth charts
•
•
•
•
•
Health professionals must be able to interpret charts
Monitor growth and development over time
Trend over time more important single reading
Road to health card/ clinic card
Every month during first year and every six months
during second year life
• 50th percentile = 90 -100% of expected growth
• Low values weight may indicate an acute or chronic
problem
• Low values for height for age indicates a chronic
problem
CHILDHOOD STATISTICS
Mortality rates
• 33% of the South African population under age of 15 years
• Investment in the health and wellbeing of the children of South
Africa is an investment in the future development of our country
• The mortality rates are a fundamental indicator of
– child health in the country ,and
– understanding the causes of death of children and identifying
how the numbers can possibly be reduced
Mortality rates
• Child health has been identified as a priority by the WHO and the
national DOH.
• Many childhood deaths are preventable .Therefore the reduction in
childhood mortality, especially in children under age of 5 years has
gained much priority in South Africa:
– Improved maternal health and antenatal care provided to
mothers
– Better perinatal and neonatal care provided baby
– Reduction in the transmission rate of HIV from mother to child
– Reduction in the number of road traffic accidents and violent
crime
Interpreting perinatal statistics
• Liveborn infant : foetus over 500g, irrespective of gestational age
born, who shows signs of life
• Stillborn infant: foetus over 500g, irrespective of gestational age
born, who shows no evidence of life
Interpreting perinatal statistics
• Perinatal mortality rate: probability of a child (stillborn and live
born) dying within the first seven days of life, per 1000 births. The
perinatal period commences at 22 completed weeks of gestation
and ends seven completed days after birth.(47/1000)
• Neonatal mortality rate : probability of infants dying before age of
1 month, per 1000 live births (SA ranked 19); (21/1000)
• Infant mortality rate: probability of children dying between birth
and one year of age 1000 live births. (SA ranked 43)
• Under-five mortality rate - Probability of dying between birth and
exactly five years of age, per 1000 live births. (ranked 62); (57/1000)
(UNICEF Statistics, 2011)
Top causes of death in children under
age of 1 year in South Africa
1
• HIV related diseases
2
• Low birth weight
3
• Diarrheal diseases
4
• Perinatal respiratory disease
5
• Lower respiratory tract infections
6
• Neonatal infections
7
• Birth asphyxia & birth trauma
8
• Protein energy malnutrition
9
• Congenital heart disease
10
• Neural tube defects
Top causes of death in children under
age of 5 years in South Africa
Rate dropped from 60 to approximately 40 per 1000 children,
the 10 top causes in order of priority are:
1
• HIV related diseases
2
• Low birth weight
3
• Diarrheal diseases
4
• Lower Respiratory tract disease
5
• Protein energy malnutrition
6
• Neonatal infections
7
• Birth asphyxia & birth trauma
8
• Congenital heart disease
9
• Motor and pedestrian vehicle accidents
10
• Bacterial meningitis
Top causes of death in children under
age of 5 -14 years in South Africa
1
• HIV related diseases
2
• Road traffic accidents
3
• Homicide/ violence
4
• Diarrhoeal disease
5
• Fire
6
• Lower respiratory tract infections
7
• Meningitis
8
• Tuberculosis
9
• Nervous system disease
10
• Protein energy malnutrition
Road to Health Chart
• Road to Health chart / Baby card is a card issued by ward or clinic
service providers on first contact
• Instrument that can be used by health professionals to monitor
development
• Card is kept by mother and she should carry it whenever attending
any healthcare services
Road to Health Chart
• This card provides information regarding:
– Perinatal history (gestation, birth weight, length, Apgar Scores,
method of delivery, mothers serology)
– Growth & development aspects (growth charts)
– Immunisations
– Vitamin supplementation
– Brief summary on illness & disease
Mothers are to keep the child for as long as possible throughout
childhood and into adulthood as contains valuable information
References
• Images courtesy of GOOGLE (2011)
• Growth and Development. In Coovadia, H.M. & Wittenberg, D.F.
(eds) in Paediatrics and Child Health. A manual for health
professionals in developing countries. 4th ed. Oxford city Press:
Cape Town pp 21-40
• Van der Vyver, A.E. Normal Growth in Paeditric doctors lectures for
Physiotherapy students. (Unpublished)
• Goldson, E. & Reynolds, A. Child development and Behaviour Hay,
W.W.; Myron, J. L.; Sondheimer, J.M. & Deterding, R.R. (eds). In
current diagnosis and treatment in Paediatrics. 18th ed. McGraw-Hill
companies: NewYork pp65-101
References
•
Aubert, E.J. Motor development in the normal child in Pediatric Physical
Therapy. Tecklin, J.S. (Eds) in Pediatric Physical Therapy. Lippincott,
Williams & Wilkins. Baltimore pp17 -65
•
Smith, R. 2009. Paediatric dictate, UFS (Unpublished)
•
Smith, R. 2009. Normal development (Class notes, Unpublished)
•
UNICEF/ Medical Reasearch Council of South Africa. Bradshaw, D; Bourne,
D & Nannan, N. What are the leading causes of death in children in south
Africa
available online at;
http://www.unicef.org/southafrica/SAF_publications_mrc.pdf
•
National Department of Health . 2011. Road to Health Chart
•
Tshabalala, MD. 2009. Introduction to child health. History and physical
examination. University of Pretoria, Department of Physiotherapy