PEDIA

• Pediatrics is a branch of medicine concerned with the development, care and diseases of infants, children and adolescents.
• Very/extremely preterm neonate = <32 weeks gestational age (GA)
• Moderate preterm neonate 32 – 36 weeks GA
• Late preterm neonate 34 – 37 weeks GA
• Full term neonate 38 – 42 weeks GA, to first month of postnatal life
• Infant 1 to 12 months
• Toddler 12 to 36 months (1 – 3 years)
• Preschool-age child 4 to 5 ½ years
• School-age child 5 ½ to 12 years
• Adolescent 12 to 18 years
• Adult 19 years and up
• At 3 months old: • cooing – an infant begins to produce long, musical vowel sounds. Starts to reach familiar people or objects and will anticipate feeding.
• At 6 months old: • an infant will make more advances noises (babbles, razz, ah-goo noises); can recognize strangers. No expression of anticipatory fear.
• At 9 months old: • infant will start to say “mama” or “dada”, gesture, wave bye-bye or understand the word “no”. Begins to explore the environment, puts items to her mouth.
• At 15 months old: • toddler can use 4 – 6 words and follow one-step command. Can imitate actions, come when called, cooperate when dressing; use spoon or cup.
• At 18 months old: • toddler can say 7 – 10 words and knows some body parts. She can imitate some tasks and play with other children. Cooperates during assessments and begins to ask questions. She may be able to verbalize pain.
• At 2 years old: • toddler may have a 50-word vocabulary, uses pronouns though not always appropriate, begins to use two-word sentences.
• Around 3 years old: • a toddler knows at least 250 words, knows all pronouns, and can repeat two digits. Knows full name, age, gender. Can assess how she feels physically but may still need visual cues to help localize sensory input like pain.
• At 4 years old: • identifies colors, can sing a song or a poem from memory, and asks questions. She can tell stories and play cooperatively with other children.
• At 5 years old: the child can print her name, abides by rules, and likes to do some daily tasks. Begins to be physically involved in own self care. Improved understanding of physical senses (pain), and cooperates during procedures/assessments.
• Patterns of Growth and Development: Children grow in size at a very fast rate. At birth infants are only about a quarter of their adult height. This final adult height is usually reached at about twenty years of age.
• There are four characteristic stages of growth from birth to adult:

  • Rapid growth in infancy and early childhood

  • Slow, steady growth in middle childhood

  • Rapid growth during puberty

  • Gradual slowing down of growth in adolescence until adult height is reached
• Patterns of Growth and Development:
• Patterns of Growth and Development: Both sexes are of a comparable shape and size during infancy and childhood.
• Patterns of Growth - Changes in Proportions
• Patterns of Growth - Changes in Proportions

  • The physical proportions of the body at birth are very different from those of the adult.

  • Some body parts grow more than others during development to reach the final adult proportions.
• Body Proportion and Composition Comparison:

  • The head is proportionally large and the legs proportionally short during childhood
• Body Proportion and Composition Comparison:

  At birth the head is one quarter of the length of the body compared with about one sixth in the adult.
• Body Proportion and Composition Comparison:

  • The legs are about one third the length of the body at birth and one half in the adult
  • Because the body proportions change this means that not all of the body segments grow by the same amount.
• Patterns of Growth and Development:

  Head x 2

  Arms x 4

  Trunk x 3

  Legs x 5
• Patterns of Growth and Development:

  • Changes in the size and shape of the body are caused by different segments growing at different times
• Patterns of Growth and Development:

  • These changes in body proportions will have a great influence on how skills will be performed.
  • For example, changes in the relative size of the head in childhood affects the balance of the body during movement and the relative shortness of the legs in the very young limits running ability.
  • At the beginning of puberty children have long arms and legs. They are better suited for running but the rapid growth may make them appear to be clumsy and to have difficulty in coordination.
• Growth Spurts:
• Growth Spurts:

  • Rate of growth increases rapidly.
  • The most important growth spurt is the one which occurs at puberty.
  • This spurt produces a rapid increase in both weight and height.
  • The peak of this growth spurt occurs at about age 12 for girls and age 14 for boys.
  • Before this growth spurt there are no important differences between boys and girls in weight and height.
• Growth Spurts:

  • During growth spurts most of the child's energy is used for growing.
  • Children will be easily get tired and may not be able to keep up their usual volume or intensity of activities.
  • Light activities (training) will stimulate bodily growth if the child has enough energy
• Differences Between Boys and Girls:

  1. The growth spurt and puberty occur at different ages for girls and boys.
  2. Girls usually start and finish the stages of puberty and adolescence earlier than boys.
  3. The characteristic differences between boys and girls occur at puberty in response to changes in hormones produced by the body.
  4. Typically, this results in broader shoulders and little change in hip width in boys and broader hips and little change in shoulder width in girls.
  5. These changes affect the way boys and girls move.
• Differences Between Boys and Girl:

  • Wider hips in the girls result in the thighs being angled more inwards which changes their movement (ex. running). This period of adjustment can take up to two years.
  • The sexual development which happens at puberty can bring physical difficulties for adolescent children, as well as causing them mental and emotional preoccupation.
  • Menstruation (period) is a normal biological process that commences with the sexual development at puberty for girls and generally lasts for about five days.
• Early and Late Developers:

  • Each child develops at their own rate and some children develop earlier and some later than the average.
  • For both boys and girls the age at the peak of the major growth spurt frequently occurs up to two years before or after the average age.
  • There can easily be differences of four years in development between children of the same age.
• Age for peak times for growth in height for boys and girls:

  
• Hormones Related to Growth and Development:

  • Pituitary growth hormone (somatotropin), a protein that is secreted by the pituitary gland throughout life.
  • Its function in adult is not clear, but in the child it is necessary for growth; without it dwarfism results.
  • Secretion by the pituitary gland is controlled by a substance sent to it from adjacent hypothalamus.
  • It is not secreted at a constant rate all day but in small bursts of activity.
  • During fetal life it seems not to be necessary, though normally present.