- Clinical science
Charting an infant or child's growth and development plays an important role in the monitoring of pediatric health and is therefore an important tool of pediatric screening. Several parameters factor in to the assessment, including weight-for-age, height-for-age, and developmental milestones. Developmental milestones are physical and behavioral skills that children with normal development are expected to reach at certain ages. The main domains of developmental milestones include gross motor, fine motor, language, cognitive, social, and self-care skills. Developmental regression and the persistence of primitive reflexes are indicators of global developmental delay. Failure to thrive (FTT) is defined as inadequate physical growth of a child for its age. The most common cause is wrong infant nutrition and feeding practices. Assessment of health and development is typically performed during well-child examinations, which ensure timely detection of underlying diseases and enable early intervention to help minimize mortality and disability.
Definition: : Reflexes that are normally present in infancy and early childhood that resolve as the child develops inhibitory pathways to the subcortical motor areas. Persistence of primitive reflexes indicates impaired brain development.
|Reflex||Description||Age at resolution||Functional significance|
|Stepping reflex|| || |
|Asymmetrical tonic neck reflex (ATNR)|| |
|Plantar grasp|| |
|Palmar grasp|| || |
|Moro reflex (startle reflex)|| |
|Reflexes which assist in feeding|| || || |
|Galant reflex|| |
|Glabellar tap sign|| || || |
|Babinski sign|| |
|Gross motor milestones||Fine motor milestones||Cognitive milestones||Social milestones||Language milestones||Self-care milestones|
|2nd month|| || || || || || |
|4th month|| || || || || || |
|5th month|| || || || || || |
|6th month|| || || || || || |
|8th month|| || || || || || |
|9th month|| || || || || || |
|10th month|| || || || || || |
|12th month|| || || || || || |
|15 months|| || || || || || |
|18 months|| || || || || || |
|2 years|| || || || || || |
|3 years|| || || || || || |
|4 years|| || || || || || |
|5 years|| || || || || || |
Growth charts are used to calculate a child's growth percentile by plotting the child's weight and height on standardized graphs.
- Normal weight-for-age velocity
Normal height-for-age velocity
- An infant's height increases by approx. 30% within the first 6 months and by approx. 50% within the first year.
Midparental height (target height):
- ♀ height = [mother's height in cm + (father's height in cm - 13)]/2
- ♂ height = [father's height in cm + (mother's height in cm + 13)]/2
Head circumference-for-age: used for microcephaly and macrocephaly screening, especially during the first 3 years of life
- In a healthy infant, head circumference increases by
- 5 cm during first 3 months.
- 4 cm between 3–6 months.
- 2 cm between 6–9 months.
- 1 cm between 9–12 months.
- A head circumference that is ≥ 2 standard deviations above the mean size for a given age and sex (usually ≥ 97th percentile)
- Seen in hydrocephalus, neurofibromatosis, tuberous sclerosis, skeletal dysplasia, acromegaly, intracranial hemorrhage, cerebral metabolic diseases (e.g., Tay-Sachs disease, maple syrup urine disease)
- In a healthy infant, head circumference increases by
According to the Rule of Fives, normal growth rates in children can be approximated by multiples of five: birth–1 year (50–75 cm, 25 cm/year), 1–4 years (75–100 cm, 10 cm/year), 4–8 years (100–125 cm, 5 cm/year), 8–12 years (125–150 cm, 5 cm/year).
- Exclusive breast feeding is recommended until the infant is 6 months of age
- On-demand feeds are recommended
Advantages of breastfeeding
- Better gastrointestinal function and motility
- Passive immunity against infections → lower rates of gastrointestinal, respiratory, urinary tract, and middle-ear infections/sepsis
- Long-term benefits: lower risk of obesity, cardiovascular diseases, diabetes mellitus, cancer (leukemia, lymphoma); possibly also asthma and allergies (controversial)
- Supplementation with formula only recommended if
- Any lactose protein-based formula fortified with iron is recommended
- Vitamin D supplementation
- Iron supplementation
- Vitamin B12 supplementation: if the mother is vegan
- Solid foods should be slowly initiated in infants between 4–6 months of age, with continued breast/formula feeding
- The recommended initial weaning food is rice cereal fortified with iron
- Honey should not be given to infants because of the risk of botulism.
- Inadequate growth of a child for his/her age
- Seen in up to 10% of children in the United States (most < 18 months of age)
- Nonorganic FTT: no underlying disorder (∼ 90% of cases)
- Organic FTT: due to an underlying disorder (∼ 10% of cases)
- Inadequate intake of calories
- Inadequate absorption of calories
- Excessive loss of calories
- Red flag features of organic FTT
- Anthropometric criteria of FTT
- History of feeding habits (e.g., quantity of feeds, frequency of feeds, food refusal)
- Laboratory studies
- Treatment of underlying cause
- Counseling parents on appropriate child nutrition
- Formula supplementation for infants and calorie-dense food supplementation for toddlers
- Close follow-up and monitoring of the child's growth
- Definition: a preventive health care schedule for children to promote health or detect and treat a disease early
- 3–5 days after birth; examinations performed in hospital before discharge
- At 1, 2, 4, 6, 9, and 12 months
- After the first year, well-child examination schedule is carried out at 15, 18, 24, and 30 months; then annually until the child is 10 years old.
- Physical examination; , charting of growth and developmental milestones; , and, in infants, the evaluation of resolution of primitive reflexes at each visit
Screening for visual development and acuity
- Routine ocular fundus examination in newborns: absence of physiologic red reflex/detection of leukocoria should prompt further workup (see also )
- Routine screening at each well-child examination is recommended for newborns and children between 1 month to 4 years of age to detect and treat eye/vision problems (e.g., amblyopia, strabismus, refractive errors, cataracts) early
- Screening tests include hand-held autorefraction (photoscreening) to assess for amblyopia; vision fixation and tracking test in infants and toddlers ; testing for visual acuity and ophthalmoscopy in older children
- Screening for hearing loss in children
- Health promotion: education of care-givers on nutrition and vaccination
- Definition: significant delay in ≥ 2 of the major developmental domains; (gross motor, fine motor, language, cognition, and social milestones) in children < 5 years of age
- Prevalence: up to 5% of children in developed countries
- Clinical features