PAE502 — Nutrition, Growth and Development: Lecture Note

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la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Course code: PAE 502 Course title: Nutrition, Growth and Development Course credit load: 3 Units Series 1: Normal Growth and Development, Milestones, and Primitive Reflexes • Part 1.1: Normal Growth in Children o Sub Part 1.1.1: Definition and principles of normal growth o Sub Part 1.1.2: Patterns of growth in weight, length, and head circumference o Sub Part 1.1.3: Factors regulating normal growth • Part 1.2: Normal Development in Children o Sub Part 1.2.1: Definition and general principles of development o Sub Part 1.2.2: Domains of development o Sub Part 1.2.3: Factors influencing development • Part 1.3: Developmental Milestones: Gross Motor and Fine Motor o Sub Part 1.3.1: Gross motor milestones in infancy o Sub Part 1.3.2: Gross motor milestones beyond infancy o Sub Part 1.3.3: Fine motor milestones • Part 1.4: Developmental Milestones: Language and Social/Personal Development o Sub Part 1.4.1: Receptive and expressive language milestones o Sub Part 1.4.2: Social and personal development milestones o Sub Part 1.4.3: Self-care and personal skill milestones • Part 1.5: Primitive Reflexes o Sub Part 1.5.1: Definition and significance of primitive reflexes o Sub Part 1.5.2: Common primitive reflexes and their timing o Sub Part 1.5.3: Clinical significance of abnormal primitive reflexes Introduction

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Picture a mother bringing her nine month old to a routine clinic visit, proudly reporting that her baby can now sit without support and has started babbling, while another parent expresses concern that her child of the same age is not yet doing either. Distinguishing normal variation from a genuine cause for concern depends entirely on a solid understanding of normal growth and development, the foundation on which this entire PAE 502 course, and indeed a great deal of everyday paediatric practice, is built. The aim of this Series is to equip you with a thorough understanding of normal growth, the major domains and milestones of normal development, and the primitive reflexes present in infancy. This Series begins with normal growth, before turning to normal development and its major domains. Next, we examine developmental milestones, covering gross motor and fine motor development, then language and social and personal development, before concluding with primitive reflexes. Series Learning Outcomes At the end of this Series, you should be able to: • SLO 1.1: define normal growth in children, • SLO 1.2: describe the general principles and patterns of normal growth, • SLO 1.3: define normal development and describe its general principles, • SLO 1.4: describe the major domains of child development, • SLO 1.5: list the milestones of normal gross motor development by age, • SLO 1.6: list the milestones of normal fine motor development by age, • SLO 1.7: list the milestones of normal language development by age, • SLO 1.8: list the milestones of normal social and personal development by age, • SLO 1.9: define primitive reflexes and list the common primitive reflexes present in infancy, and • SLO 1.10: describe the clinical significance and normal timing of appearance and disappearance of primitive reflexes.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.1 Normal Growth in Children 1.1.1 definition and principles of normal growth Growth is a continuous, but not constant, process Growth is defined as a quantitative increase in body size and mass, reflected in measurable parameters such as weight, length or height, and head circumference, and represents one of the most fundamental indicators of a child's overall health and nutritional status, since growth is a sensitive process that responds relatively quickly to illness, inadequate nutrition, or psychosocial adversity. Growth is not a linear process but instead proceeds at variable rates across different periods of childhood, with particularly rapid growth during infancy and again during the pubertal growth spurt, and comparatively slower, steadier growth during mid-childhood, a pattern reflecting the changing hormonal and physiological drivers of growth at each life stage. Fill in the blank: Growth is not a linear process but proceeds at variable ________ across different periods of childhood. 1.1.2 patterns of growth in weight, length, and head circumference A healthy term newborn typically weighs between 2.5 and 4.0 kilograms, and, after an expected initial physiological weight loss of up to 10 percent in the first few days of life, generally regains birth weight by around 10 to 14 days, before gaining weight at a predictable, though gradually slowing, rate throughout infancy, with birth weight typically doubling by around 5 months and tripling by around 12 months of age. Length increases most rapidly during infancy, with growth rate then slowing progressively through childhood before the pubertal growth spurt, while head circumference, reflecting underlying brain growth, increases most rapidly in the first year of life, a period during which the majority of postnatal brain growth occurs, making head circumference measurement a particularly important component of infant growth monitoring. Fill in the blank: A newborn’s birth weight typically doubles by around ________ months of age. 1.1.3 factors regulating normal growth Normal growth depends on an interplay of factors, including adequate nutrition, normal hormonal function, particularly growth hormone, thyroid hormone, and, later, sex steroids

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS during puberty, and normal genetic potential, generally estimated using parental heights, together with the absence of chronic illness or significant psychosocial deprivation, both of which can meaningfully impair growth even when nutrition and hormonal function are otherwise adequate. Recognising the relative contribution of each of these factors is important clinically, since a child growing poorly requires a systematic evaluation considering nutritional, hormonal, genetic, and psychosocial contributors together, rather than assuming a single cause in isolation, an approach that will be developed further in later Series of this course when specific growth disorders are addressed in detail. Fill in the blank: Genetic growth potential is generally estimated using ________ heights. Table 1.1: Typical growth velocity across childhood. Age period Typical growth pattern Infancy (0 to 12 months) Most rapid postnatal growth; weight roughly triples by 12 months Early to mid-childhood Slower, steady growth rate Puberty Second major growth spurt, variable timing by sex Pilot questions 1.1 1. Define growth and list the three main anthropometric parameters used to assess it. (Linked to SLO 1.1) 2. Describe the typical pattern of weight gain in the first year of life. (Linked to SLO 1.2) 3. Explain why head circumference measurement is particularly important in infancy. (Linked to SLO 1.2) 4. List three factors that regulate normal growth. (Linked to SLO 1.3) 5. Explain why parental heights are used to estimate a child’s genetic growth potential. (Linked to SLO 1.3) 1.2 Normal Development in Children 1.2.1 definition and general principles of development Development follows a predictable, if individually variable, sequence Development refers to the progressive acquisition of skills and functional abilities, encompassing physical, cognitive, emotional, and social capacities, and, unlike growth, is a

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS qualitative process reflecting increasing complexity of function rather than simply increasing size, though the two processes are closely interrelated and both depend on adequate nutrition and a supportive environment. Development generally follows a predictable sequence, proceeding in a cephalocaudal direction, from head to tail, meaning control of the head and neck is achieved before control of the trunk and limbs, and a proximodistal direction, from the centre of the body outward, meaning control of the shoulders is achieved before fine control of the fingers, though the rate at which individual children pass through this sequence varies within a normal range. Fill in the blank: Development proceeds in a cephalocaudal direction, meaning head and neck control is achieved before ________ and limb control. 1.2.2 domains of development Child development is conventionally divided into four major domains: gross motor development, involving control of large muscle groups for activities such as sitting, crawling, and walking, fine motor development, involving control of small muscle groups, particularly of the hands, for activities such as grasping and drawing, language development, encompassing both receptive understanding and expressive communication, and social and personal development, encompassing interaction with others and self-care skills. While these domains are described separately for clarity and assessment purposes, they are, in reality, closely interconnected, since progress in one domain often supports or depends on progress in another, meaning a comprehensive developmental assessment should always consider all four domains together rather than focusing on a single domain in isolation. Fill in the blank: The four major domains of development are gross motor, fine motor, language, and social and ________. 1.2.3 factors influencing development Normal development depends on adequate central nervous system integrity, meaning the absence of significant structural brain abnormality or injury, together with adequate sensory input, particularly vision and hearing, since impairment in either can significantly affect the acquisition of related skills, and a stimulating, responsive environment, including consistent caregiver interaction, which provides the opportunities and

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