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ETIOLOGY OF IMPAIRMENT IN CHILDREN GROWTH AND DEVELOPMENT When a child's growth seems to be lagging behind, the cause may

be a natural growth delay or a growth disorder. For infants, children, or teens, any type of problem that prevents them from meeting realistic patterns of growth may be a growth disorder. Disorders may include failure to thrive, failure to gain height and weight in young children, and short stature or delayed sexual development in teens 1. 2. 3. 4. 5. Infection Chronic disease Endocrine disorder Poor nutrition Environmental

1. FEVER

2. CHRONIC DISEASE Chronic illnesses are another common cause of delayed or slower growth patterns. Growth can be impaired by illnesses like asthma, congenital heart disorders, chronic kidney failure, and poorly controlled diabetes. Persons with neuromuscular diseases, cleft palate, or some psychosocial problems may not get enough to eat. Some diseases such as diabetes, cystic fibrosis, heart failure, and HIV interfere with the body's use of nutrients. 3. HYPOTONIA(LOW MUSCLE TONE) An infant or child will get a diagnosis of low muscle tone when: The muscles appear to be less firm than usual The child appears to be floppy and to have loose joints The child appears to be less alert and have poor posture and attention Hypotonia can be caused by the following:a) Congenital: i. genetic (Down syndrome) ii. Developmental disability ( hypothyroidism) b) Acquired (onset after birth): i. Genetic (muscular dystrophy) ii. Infection (encephalitis, sepsis, meningitis) iii. Toxin (infantile acrodynia (mercury poisoning) iv. Autoimmune disorder (abnormal vaccine reaction) v. Metabolic disorder (hypervitaminosis, rickets) vi. Neurologic (brain trauma, lower and upper motor neuron lesion) Babies with low muscle tone have delayed motor skills, muscle weakness, drooling and speech difficulties, coordination problems and poor attention that can follow them into adulthood. They are likely to sit up, crawl, walk and speak later than babies without hypotonia; they often need physical or occupational therapy to reach these developmental milestones. PHYSICAL CHARACTERISTICS AND MOTOR SKILLS A 9 month old has usually reached the following milestones:

Gains weight at a slower rate -- about 15 grams per day, 1 pound per month Increases in length by 1.5 centimeters per month Bowel and bladder become more regular Puts hands forward when the head is pointed to the ground (parachute reflex) to protect self from falling Is able to crawl Sits for long periods Pulls self to standing position Has a pincer grasp between thumb and index finger

Feeds self with fingers Throws or shakes objects

SENSORY AND COGNITIVE SKILLS The 9 month old typically:


a) b) c) d) e) f) g) h) i)

Is developing depth perception Understands that objects continue to exist, even when they are not seen (object constancy) Responds to simple commands Responds to name Understands the meaning of "no" Imitates speech sounds May be afraid of being left alone Plays interactive games, such as peek-a-boo and pat-a-cake Waves bye

PLAY To help the development of the 9 month old: Provide picture books Provide different stimuli:
o o

Go to the mall (people) Go to the zoo (animals)

Play ball Build vocabulary by reading and naming people and objects in the environment Teach hot and cold through play Provide large toys that can be pushed to encourage walking Sing songs together Avoid television time until age 2

4. ENDOCRINE DISORDER A deficiency or excess of hormones caused by endocrine diseases can cause growth failure during childhood and teen years. A failure of the thyroid gland to make enough thyroid hormone, which is essential for normal bone growth, is called hypothyroidism. If the pituitary gland is damaged or malfunctioning, it may not be able to produce enough hormones for normal growth. A deficiency or excess of hormones caused by endocrine diseases can cause growth failure during childhood and

teen years. A failure of the thyroid gland to make enough thyroid hormone, which is essential for normal bone growth, is called hypothyroidism. If the pituitary gland is damaged or malfunctioning, it may not be able to produce enough hormones for normal growth. 5. POOR NUTRITION Malnutrition is the most common cause of growth failure around the world. Malnutrition on a continual basis prevents a child from reaching his full growth potential. The body becomes frail and weak with signs of muscle, bone, and tissue wasting. Symptoms associated with this type of growth disorder result from a lack of protein and other basic nutrients needed in the diet such as protein energy malnutrition, iodine deficiency, vitamin A deficiency, and iron deficiency anaemia. Protein is required by the body for the growth, maintenance and repair of all cells. Protein is a major component of all muscles, tissues and organs and is vital for practically every process that occurs within the body such as metabolism, digestion and the transportation of nutrients and oxygen in the blood. It is also necessary for the production of antibodies, which fight against infection and illness, and is the main nutrient that keeps our hair shiny and healthy, our nails strong, our skin fresh and glowing and our bones strong and healthy. Nutrient Neurological disorder when deficient Macronutrients Total energy 2200 (kcal) in childhood: long-term mental deficit Vitamins Vitamin B1 Thiamine 1.1 mg Beri-beri, polyneuropathy, Wernickes encephalopathy Vitamin B3 Niacin 15 mg NE Pellagra including dementia and depression Vitamin B6 Pyridoxine 1.6 mg Polyneuropathy Vitamin B12 Cobalamine 2.0 g Progressive myelopathy with sensory disturbances in the legs Folate 180 g Neural tube defects (myelomeningocele) of the fetus, cognitive dysfunction in children and elderly Minerals Iodine 150 g Iodine defi ciency disorders Iron 15 mg Delayed mental development in children Zinc 12 mg Delayed motor development in children, depression Selenium 55 mg Adverse mood states