Clinical assesment in pediatrics,

growth and developement,

psychomotor development
S. Drobakov
 Childhood
Prenatal period

Newborn period - first 28 days /perinatal - first 7

days/
Infancy - to the end of the 1st yr
Toddler age - to the end of 3rd yr
Preschool age - to the end of 6th yr
School age - to the end of 15th yr
Adolescence - to 18th yr + 364 days
 Newborn period
transition to the
neonatal physiology occurs at the birth
separation by the clamping the umbilical cord

Apgar score
1th, 5th, and
10th minute
resuscitation
 Infancy

dramatic growth and

psychomotor development
transfer from breast/bottle feeding to normal
diet
mother as the center of world shared with
people/objects
fear of separation and outsiders
 Toddler age
first fight for independence (period of
defiance)
development of speech
games are played amongst children not with
children
know right from wrong
 Preschool age

second fight for independence

games are played with other children
complex movement patterns
period of the slowest growth
 School age

YOUNGER up to 12 OLDER from 12 to 15

maturation of early puberty in full speed
developmental skills hormonal
cognitive development dysregulation
/imagination + creativity/ SOCIALIZATION
puberty starts FIGHT for independence
 Adolescence

sexual and psychological maturity

decrease of growth velocity, increase of
muscle strength
soared mental performance , professional
orientation
peers groups of same interests
 All organ systems

starting from the minute the child is seen for

first time
seize the opportunity
OBSERVE ! OBSERVE! OBSERVE! OBSERVE!
traumatic procedures should be left to the end
 Maturity of organs function

Child is not small adult!

the younger the child the more differences
differences in maturity of organ systems in the
patient
differences in children according to sex and
personal development /e.g. puberty/
 Weight
Weight is one of the best criteria for
assesement of growth and a good indicator of
health and nutritional status of child
There is about 10% loss of weight first week of
life, which regains by 10 days of age.
Among the Slovakia children, weight of the full
terms neonate at birth is approximatly 3200g,
children under 2500g premature, newborns
above 4000 g hypertrophic
 Weight

Then weight gain is about 25-30gm per day for

1st 3 month and 400gm/month till one year of
age
The infants double weight gain their birth
weight 5 month of age, trebled by one year,
fourth time by two years, five times by three
year, six times by five year, seven times by
seven year and ten times by ten year
 Length and height
Increase in height indicates skeletal growth.
Yearly increments in height gradually
diminished from birth to maturity.
At birth average length of healthy newborn
baby is approx. 50 cm.
It increases to 60 cm at 3 months, 70 cm of 9
month and 75 cm at one year of age
 Length and height
In the second year, there is 12 cm increase,
third year it is 9 cm, fourth year it is 7 cm,
and in fifth year it is 6 cm.
So the child double the birth by 4 to 4,5
years, of age afterwards there is about 5 cm
increase in every year till onset of puberty.
 Body Mass index (BMI)
Is is important criteria which helps to asses the
normal growth or its deviation i.e. malnutrition or
obesity.
Weight in Kg
BMI = ........................................
(Height in meter)

BMI more than 30 kg/m = obesity

BMI less than 15 kg/m = malnutrition

/
http://www.who.int/features/factfiles/obesity/facts/en
 BMI Categories:

Children
BMI under 5th: Malnutrition
BMI between 5th - 84th percentile: Normal weight
BMI between 85th - 95th percentile: overweight
BMI >95th percentile: Obesity
 Head circumference
Average head circuference measured about
35 cm at birth

At 3 months it is about 40 cm, at 6 month 43

cm, at one year 45 cm, at 2 years 48 cm, at 7
year 50 cm and 12 years of age it is about 52
cm, almost same as adult
 Fontanelle Closure
At birth, anterior and posterior fontanelle are
usually present. Posterior fontanelle closes
early few weeks (6-8week) of age.
The anterior fontnelle normally closes by 12-
18 months of age. Early closure of fontanelle
indicates craniostenosis due to premature
closure of skull sutures.
 Chest circumference
Chest circumference or thoracic diameter is an
importance parameter of assesment of
growth and nutrition status.

At birth it is 2-3cm less than head

cimcuference. At 6 to 12 months of age both
become equal.
 Chest circumference is measured by placing
the tape measure around the chest at level
by placing the tape measure around the
chest at the level of the nipple, in between
inspiration and expiration.
Mid Upper Arm circumference (MUAC)

This measurement helps to asses the

nutritional status of younger children.

There is growth due to inadequate nutritional,

which can be this simple particle and useful
measurement.
 The average MUAC at birth is 11 to 12 cm, at
one year of age it is 12 to 16 cm, at 1 to 5
years it is 16 to 17 cm, at 12 years it is 17 to
18 cm and at 15 years it is 20 to 21 cm.
 Eruption of teeth

First teeth commonly the lower central

incision may appear in 6 to 7 months of age
It can be delayd even up to 15 months, which
also can be considered within the nomrla
range of time for teething
 puberty includes: - acceleration of linear growth -
development of sexual characteristics

Puberty scoring system by Tanner:

Breast development in girls /B1-B5/
Genital changes in boys /G1-G5/
Pubic Hair in both sexes /PH1-PH5/
Assesment of Development
Normal development is a complex process and
has a multitude of facets. However, it is
convenient to understand and assess
development under the following domains.
 Gross motor development

Motor development progress in an olderly

sequence to ultimate attainment of
locomotion and more complex motor tasks
thereafter.
Key gross motor development milestones
Age Milestones
NB Lying in prone position is able to put his head from one cheak to another gradually lifting
his head for a moment from the pad.
1m Keeps his head up for a moment in prone position. Head sags forward in sitting position
and head lag is evident when pulling the infant to sitting position.
2m In prone position repeatly lifts his head and keeps it lifted for a while. In sitting position
does not sag the head forward.
3m Keeps head steadily in an angle of 45 grades in prone position, supporting himself on
elbows ( shepherds position). Tries to keep his head straight when is pulled to sitting
position.
4m Head holds steady in sitting position. Head lifted in 90 grades when prone on forearms.
6m Sits with own support. Turn from supine to prone position.
7m Begins crawl.
8m Sitting without support.
9m Standing holding on (with support).
12m Creep well, stand without support.
15m Walks alone, creeps upstairs.
18m Runs.
2yr Walks up and down stairs.
3yr Rides tricycle.
4yr Hops on one foot, alternate feet going downstairs.
 Fine motor skill development

Fine motor development promotes adaptive

actives with fine sensorimotor adjusment and
include eye coordination, hand eye
coordination, hand to mounth coordination,
hand skill as finger thumb apposition,
grasping, dressing etc.
Key fine motor development milestones
Age Milestones
4m Reaching out for the objects with both hands
6m Reaching out for the objects with one hands
9m Immature pincer grasp
12m Pincer grasp mature
15m Immitates scribbling, tower of 2 blocks
18m Scribbles, tower of 3 blocks
2 yr Tower of 6 blocks, vertical and circular stroke
3 yr Tower of 9 blocks, copies circle
4 yr Copies cross, bridge with blocks
5 yr Copies triangle, gate with blocks
Personal and social development

Personal and social development includes

personal reaction ot his own social and
cultural situations with neuromotor
marutity and enviroment stimulation
 Negative milestones
Age Milestones
After 2nd No smile
month
3rd month Does not lift head being in prone position on elbow
5th month No palmar grasp of toy
8th month Does not sit without support
9th month Does not crawl
10th month Does not hold pellet among thumb and index finger
12th month Not a single word
13th month Does not stand
15th month Does not walk
2nd year Does not speak in short sentence
 References
1. Nelson, Textbook of Pediatrics, 2016.
2. ainka. Pediatria, 2007.
3. Kostalova, Kovacs et al. Uvod do pediatrie,
2005.
4. Kovacs, Introduction to pediatrics,2000.