Semiotics changes in the length of the body in children. Physical development of children. Factors affecting physical development. Laws of physical development. Semiotics of disorders. Dates of sexual ripening of children

Physical development of the child. Evaluation of physical development. Semiotics of disorders.

Features of writing the history of the disease in pediatrics.

Methodical development for students

Specialty: Medical Case

Training Discipline: Pediatrics

Head Department: Professor Griganov V.I.

Astrakhan - 2009.

The topic of the seminar: "The physical development of the child. Evaluation of physical development. Semiotics of violations. Features of writing the history of the disease in pediatrics"

Objectives:

Educational

Emphasize the importance of a physical development pediatrician;

Solve complex deontological tasks arising in relationship with sick child, parents, middle and younger medical staff, colleagues.

Training

Teach the technique of anthropometric measurements in children of different ages.

Teach evaluating the growth and weight of the body, the head circumference, the trigger of the chest of children of different ages.

Teach to assess the physical development of children of different ages by formulas and tables.

Evaluate data of laboratory research, functional and instrumental methods for studying children with this pathology.

Know the classifications of the most common diseases of this pathology

Make plans for treating and preventing diseases of this pathology in children of different ages

Independent work of students

Extracurricular

The student should know the foundations of physical development, with whom the student meets on its own textbook.

Audited - Collaboration of the topic on issues

Teaching materials for students:

1. Folder "Educational and methodological manuals for students"

2. Educational tasks for independent work on pediatrics. Under the editorproof. V.I.Griganova Suprun S.V., Murzov O.A., Suprun O.I., Schwechikhina E.R. Astrakhan: Agma.-2009

3. Anthropometric assessment of the physical development of children. Supil O.I., Chelnokov M.M., Murzova O.A., Suprun S.V. Astrakhan: Agma.-2009

4. Chronic nutrition disorders in children. Schwechikhina E.R., Suprun S.V. Astrakhan: Agma.-2009

5. Methodological manual for writing the history of the disease for students of the medical faculty Miroshnikova E.M. Astrakhan: 2009.

6. Some aspects of the physical development of children normally and in pathology. Stroikova TR, Griganov V.I. .. Astrakhan: Agma.-2009

1. Handbook of Vidal. Medicinal preparations in Russia. http://www.vidal.ru/

2. Electronic pharmacological directory for doctors http://medi.ru/

3. "Pediatrics" Journal named after G. Spöransky http://www.pediatriajournal.ru/about.html

4. All-Russian Medical Portal http://bibliomed.ru/

5. Website of the Astrakhan State Medical Academy

http://agma.astranet.ru/

6. Internet portal "ConsultantPlus" - Legislation of the Russian Federation: Fundamentals of the legislation of the Russian Federation on the protection of citizens' health. http://base.consultant.ru/cons/cgi/online.cgi?req\u003ddoc;base\u003dlaw ;n\u003d58254

7. Site of the Russian Pediatrician Union: Methodical recommendations http://www.pediatr-russia.ru/news/recomend/

8. Russian medical server http://www.rusmedserv.com/

Questions to control the level of learning material

1. Classification of childhood periods.

2. Functional characteristics of each age period of childhood and features of pathology.

3. The concept of physical development.

4. The main indicators of the physical development of children, their stability and lability.

5. Factors affecting the growth of the child.

6. The physiological laws of growth rates in different age periods.

7. Causes that determine possible changes in body weight.

8. Physiological laws of body weight increase.

9. Formulas for calculating the length and mass of the body, the circle of the head and chest of a child of different ages.

10. Methods for assessing the physical development of a child in central tables.

11. Calculation of the surface of the child's body.

12. Changing body proportions with age.

13. Methods for assessing the proportionality of the development of the child.

14. Determination of the degree of prematurity of the child.

15. Determination of the concept of intrauterine hypotrophy and causes of the development of this pathology.

16. Determination of the degree of intrauterine hypotrophy by mass and the length of the body of the newborn.

17. Anatomical and functional signs of domesticity and prematurity.

18. The concept of hypotrophy, patrofy, hypostatic, their clinical characteristics.

19. The degrees of hypotrophy, patrofy, obesity.

Plan - chronokart

№	Epaat classes	FUNDS	Activity teacher	Student's activities	TIME
1.	Organizational stage	Magazine	Notes the presence of students, draws attention to the appearance of the student, reports the topic and purpose of classes	Listen	Min.
2.	Control of the initial level of knowledge	Tests	Interviewes students on the topic orally or distributes tests, checks tests on references	Answer orally or writing	Min.
3.	The main stage		Stresses the relevance of the topic studied. Based on the definition of the original knowledge, the knowledge of the patient necessary for independent work is carried out by the patient's bed, shows the methodology for studying the organs of the system being studied	Listen, look	Min.
4.	Sick children	The teacher distributes 1 patient on 2 students	Students independently find out complaints, clarify history, examine children, write down the results of inspection in the learning history of the disease	Min.
5.	Folder "Methodical development on the topic" (for students)	Controls students	A brief conclusion according to the inspection and analyzes of the patient.	Min.
6.	The final stage	Sick children	The teacher, together with students, selectively examines 1-2 patients, corrects the results of the inspection and descriptions, paying attention to the clinical significance of various symptoms and syndromes, as well as laboratory research, functional and instrumental research methods.	Report demonstrate the examined patient. Discuss the results of inspection, semiotics of identified symptoms and syndromes of damage to this system of organs	Min.
7.	Tests, tasks	Responsible to the students arising from students, discuss answers with them	Solve several situational problems	Min.
8.	Magazine	The teacher provides an assessment of students' activity at the lesson. Stresses the main issues to be studied on the following topic.	Listen	Min.

ANNOTATION

HEIGHT

The most stable indicator of physical development is the growth of the child. It determines the absolute length of the body and, accordingly, an increase in body size, development, ripening of its organs and systems, forming functions to one or another period of time.

Throughout the life of the child, the growth process proceeds unevenly, then intensifying, then slowing down. An assessment of anthropometric indicators is produced mainly in 2 minutes: parametric or sigmal and non-parametric - centent. The parametric scale includes the average arithmetic ("norm") and deviations from it, measured by the sigma value (average quadratic deviation). Central tables show the quantitative boundaries of the feature in a certain share or percentage (valuable) of children of this age and gender. For normal values, values \u200b\u200bwere taken - in the intervals of the 25-50-75th centuries (it is desirable to evaluate 50 centress) (see the Table of changes in the growth and weight of the child from 0 to year :: Table 1 and Table 2).

The greatest growth energy falls on the first quarter of the year (Table A). Funny newborn growth ranges from 46 to 60 cm. On average - 48-52 cm, but adaptive growth indicators are considered to be 50-52 cm. This means that adaptation in the intrauterine period has occurred not only at the organizational level, but also at the organization level and enzymatic.

Table A. Growth and body weight gain in children of the first year of life

Age, months	Growth increase in the month, see	Rising growth over the past period, see	Monthly weight gain of body, gr.	Grease body weight over the past period, gr.
	2,5	11,5
	2,5
	2,5	16,5
		19,5
		21,5
		23,5
	1-1,5	24,5-25
	1-1,5	25,5-26
	1-1,5	26,5-27

In the first year, the child adds in an average of 25 cm., So by the year its growth is an average of 75-76 cm. With the right development of the child, the monthly increase in growth can fluctuate within ± 1 cm, but by 6 months and by year these fluctuations Growth should not exceed 1 cm.

The growth reflects the features of plastic processes occurring in the human body. Hence the importance of high-quality food, especially the content of a sufficient number of balanced full-fledged protein component and vitamins of the group B, as well as A, D, E. Of course, the "gold standard" of optimal nutrition for children before the 1st year is the female milk. The deficit of some food components selectively violates growth processes in children. These include vitamin A, zinc, iodine. Rag in growth can cause various chronic diseases.

Measuring the growth of the child in the first year of life is produced on a horizontal growth rate. Measurements produce 2 people. Measuring is on the right side of the child. The assistant keeps the head of the child in a horizontal position to the top edge of the ear goat and the lower edge of the orclass were in the same plane perpendicular to the board of the header. The top of the head should touch the vertical fixed bar. Hands of a child stretched along the body. The gentle hand measuring with a light hand with a light hand holds his legs in a straightened position, and the right hand moves the movable plank of the growth tightly to the plantar side of the stop, bent at right angles.

BODY MASS

In contrast to growth, the body weight is a rather labile indicator, which reacts relatively quickly and changes under the influence of a wide variety of reasons. Especially intensively gaining body weight occurs in the first quarter of the year. The mass of the body of the docking newborns ranges from 2600g to 4000 and on average is 3-3.5 kg. However, the adaptive body weight is 3250-3650 grams. Normally, most children have a "physiological" loss of up to 5% noted by 3-5 days of life. This is explained by greater loss of water with an insufficient amount of milk. The restoration of the physiological loss of body weight occurs to the maximum of 2 weeks.

The dynamics of body weight is characterized by a greater increase in the first 6 months of life and lesser by the end of the first year. The mass of the child's body is doubled by the year, by the year it triples, despite the fact that this indicator may vary and depends on the nutrition, transferred diseases, etc. The energy of body weight increases with each month of life gradually weakens.

To determine body weight under the age of a year it is better to use Table. 3.

Based on this table, the weight gain of the child's body for each subsequent month of life can be calculated, deducted from the addition of the previous month (but only after the 3rd month) 50 grams, or by the formula: x \u003d 800-50 x n, where 50 is a child adds to the mass of the body by 50 g. less for each subsequent month of life, after the 3rd month; P - number of months of life of a child minus three.

For example, for the tenth month of life, the child adds in mass 800- (50x7) \u003d 450g.

There is another opinion that the average monthly increase in body weight in the first half of life is 800g., In the second half of the year - 400g. However, it should be emphasized that the calculation according to the data given in Table. 3 is considered preferable (physically). Data on the assessment of body weight relative to growth (body length) for boys and girls in central intervals are given in Table. 4 and 5.

On average, for one year, the mass of the baby's body is equal to 10-10.5 kg. The increase in body weight in infants is not always distinguished by such a pattern. It depends on the individual characteristics of the child and a number of external factors. Children with an initial low body weight give relatively large monthly weight gains and it doubles and triples earlier than children are larger. Children on artificial feeding immediately after birth, double their body weight approximately a month later children on natural feeding. The mass of the body is a labile indicator, especially at the child of an early age, and can change under the influence of various conditions sometimes during the day. Therefore, the body weight is an indicator of the current state of the body, in contrast to growth, which does not immediately change under the influence of various conditions and is a more constant and stable indicator. Deviation of body weight from the norm to 10% is not considered pathology, however, the children's doctor must analyze this loss.

Proportionality of development

In assessing the physical development of the child, it is necessary to know the right relationship between body weight and growth. Under the mass indicator (MRP) means the ratio of mass to growth, i.e. What a mass is 1 cm. Body lengths. Normally, the newborn (MRP) is 60-75.

In addition to the growth and body weight, the correct proportions of the body are important to assess physical development. It is known that the chest circumference of the docking is less than the circumference of the head at birth. The head of the head in the docking children fluctuates in fairly wide range - from 33.5 to 37.5 cm., On average, 35 cm is equal. When analyzing these digital indicators, the growth and weight of the child's body should be taken into account, as well as the ratio of the circle of the head with a thoracic circle. . When compared, it should be borne in mind that at birth, the head should not exceed the circle of the chest more than 2 cm. In the future, it is necessary to navigate the growth rate of the head of the head. In the first 3-5 months, the monthly gain is 1.0-1.5 cm, and then 0.5 -0.7 cm. By the year, the head circumference increases by 10-12 cm and reaches 46-47-48 cm (on average 47 cm.).

In a child born with adaptive indicators of growth and body weight, the head circumference is about 36 cm. In the first 3 months of life, the head circumference should "grow" by 4 cm (i.e. at 3 months - 40 cm.). Over the next 3 months, the head circumference increases by another 3 cm and it becomes 6 months equal to 43 cm, and by year 46-48 cm. The size of a large springs at birth should not exceed 2.5x3cm, 3x3cm.

The head circumference is measured when a centimeter tape is behind at the level of the occipital bell, and in front of the eyebrows.

To characterize the physical development of the child, the correct assessment of the peculiarities of its chest is of great importance, since the vital activity of internal organs largely depends on the form and size of the latter. The increase in the circumference of the chest is most intensively in the first year of life, especially in the first 6 months.

The newborn chest circle is 33-35 cm. The monthly increase in the first year of life is an average of 1.5-2 cm. Per month. By the year, the trigger of the chest increases by 15-20 cm, after which the increment energy drops and the chest circumference increases on average to the preschool age by 3 cm, and in preschool - by 1-2 cm per year.

For the individual assessment of the physical development of the child, it is important to know the periods of crossing the circumference of the head and chest. In healthy children, this crossing occurs approximately 3-4 months, and children in which in 5-7 months. The cross did not come, you need to check and analyze the dynamics of the development of the chest and the head. An earlier crossroads may indicate the developing microcephaly, so it is necessary to follow the timing of the closure of a large spring. Large springs should overcome by the end of the first year in 80% of children, the rest of the children - by 1.5 years. The front-rearness of the chest in most of the trimmed newborn fewer transverse diameters or is equal to it. Already during the first year of life, the transverse diameter begins to prevail over the anticipation and the shape of the chest is compact.

Static functions

Static functions are assessed taking into account the pace of motor development of the child. These are various baby's motor skills. It is necessary to take into account the ability of a child at a certain age to hold the head, make movements with hands (feeling the object, grabbing, holding toys in one hand, performing various actions), the appearance of dynamic functions (turning from the back on the stomach and from the belly on the back, pull up, crawl, sit down , get up to your feet, walk, run).

In 2 months, the child keeps his head well,

in 3 months - turns well from the back on the stomach,

5.5 -6 months - turns well from the belly on the back,

in 6 months - sits if he was planted,

at 7.5 months, (when the child learn how to crawl well) - SYTS himself,

at 9 months - it's good

at 10 months - the mannet, holding his hand,

by 12 months - on its own.

The development of static functions contributes to various sets of exercises for children: from the 1st to 3 months; from 3 to 6 months; from 6 to 9 months; from 9 to 12 months.

Etiology of hypotrophy

Exogenous (external) Factors:

· Alimentary factors

v. quantitative subframe : More often with natural feeding (hypogalactium, low content of proteins and fats in breast milk, "sluggish" sausages)

v. high-quality subframe: more often with artificial feeding, especially non-adapted mixtures (milk, kefir), with untimely administration of supplies

· Infectious factors (frequent ARZ, intestinal infections, pyelonephritis, sepsis, etc.)

· Toxic (maybe with acute and persistent infections, poisoning, chronic alcoholism and other toxicomicia from the mother)

· Deprivational (defects of care, upbringing, especially at the so-called "refusal" children)

· Mixed

Endogenous (internal) Factors: connected with

· Development deposits (CNS, respiratory organs, gastrointestinal tract)

· Chromosomal and genital defects, including congenital immunodeficiency

· Endocrine disorders (hypothyroidism, pituitary nanice, adrenogenital syndrome)

· Anomalies of constitutions

· Fermentopathy (disaccharidase insufficiency, celiac disease, exudative enteropathy, fibrosis, etc.)

· Primary metabolic disorders (phenylketonuria, homocystinuria, etc., xantomatosis)

· Acquired diseases of internal organs.

Pathogenesis of hypotrophy

As a result, the secretory and motor functions of the gastrointestinal tract are reduced by subframe, in particular:

· The acidity of the gastric juice is reduced;

· The content of enzymes in the pancreas juice is reduced;

· The enzymatic activity of the intestine is reduced;

· Breakdown and membrane digestion;

· Dysbacteriosis develops.

In hypotrophy, there are always metabolic disorders. In addition, liver functions are disturbed, for example, antitoxic, protruding education. Criminal biochemical shifts occur:

· Hypoproteinemia;

· Hypolypidemia;

· Hypoglycemia;

· Hypercholesterolemia with an increase in the content of free fatty acids.

Water and mineral exchanges are disrupted, which in the aggregate leads to metabolic acidosis and endogenous toxicosis. Violation of primarily protein metabolism contributes to the development of immune failure, primarily humoral, and then cellular immunity.

Power disorders also leads to disorders of the CNS function, impaired formal reflexes; In severe cases - to the delay in the mental development of the child.

Thus, during hypotrophy, the disposal of food substances (primarily protein) in the intestines is broken, all types of metabolism are broken, immunity is depressed.

Clinic of hypotrophy

The gravity of the disease distinguish 3 degrees of hypotrophy.

I degree: The subcutaneous fat layer is thinned on the body and the stomach. Reduced muscle tone and leather turgor. Body mass deficiency 11-20%. The index of chulitsk is reduced to 20-11. Psychomotor development is somewhat delayed, but does not continue in the future.

II degree: The subcutaneous fat layer is significantly thinned or absent on the body and the stomach, reduced on the limbs. Body mass deficiency 21-30%. The Chulitsky index is reduced to 10-0. Moderately violated tolerance to food - lowered appetite, the weight curve is flattened. Psychomotor development lags behind the age standards, the intellectual potential of the child is reduced in the future.

III degree: There is no subcutaneous fat layer, the last turn disappears on the face, in the area of \u200b\u200bKischkov, Bisha. Index Chulitskaya 0 or negative. Body mass deficit more than 30%. Reduced tours of fabrics and muscle tone, muscle atrophy. Significantly lagging behind physical and psychomotor development. Disruled tolerance for food - appetite is absent or perverted, bother meteorism, constipation or unstable stools, the weight curve is reduced. Violated metabolism. Anemia is possible, hypoproteinemia with edema. The frequency and severity of infections that are prone to generalization increases.

The formation of nervous and endocrine systems is disturbed, which in the future reduces the intellectual potential of the child.

Treatment of hypotrophy

1. Basis therapy

· Mode: sleep lengthening, maximum restriction of painful manipulations, fresh air, sunbathing, medium temperature at least 23-24 degrees

· Etheological treatment: Sanitation of infections, correction of deprivation, compensation of impaired functions at vices and diseases of internal organs

· Diet (principles: Stage, rejuvenation, individuality):

Stage:

stages of feeding

1. Clarification of tolerance for food,

2. Transition

3. Stage of enhanced nutrition

power rejuvenation principle: - The products and mixtures for feeding smaller children are used, the number of feedings increases, the volume of each feed decreases.

it is selected individually: -the content of stages depends on the degree of hypotrophy, that is, from the state of the child,

2. Medicia treatment

A. Replacement therapy:

· Enzyme preparations (Mezim-Forte, Creon, etc.)

· Vitamins (C, B1, B6, a)

· Macro - and micrementar correction (preparations Fe, Zn, etc.)

· Immunopreparations (immunoglobulins, plasma, piles, interferons)

· Probiotics (lactobacterin in the first months of life, nutroline with vitamins gr. B, in the second half of Bifidum Bacterin, Bifidum-Bacterin Forte, Bifiform - Kid, Bifiliz, Hilak Forte, Lines)

· Glucocorticosteroids, thyroxine, doxin, etc. (with severe forms of hypotrophy-analimentary marasme)

B. Metabolic tools:

· Hormonal Anabolics - 0.5-1.0 mg / kg per day once a week (Nerochol, retabolil - with sufficient protein admission to the child's body)

· Non-uniform anabolics (orotat k, and other courses for 2-3 weeks)

B. Stimulating means:

· Communicative (apilax, ginseng, massage, UFO, etc.)

· Immunostimulating (tactivin, thymogen, immunal, methyluracil, dibazole, sodium nucleicate, pentoxyl)

Symptomatic means

A. Organone Supplement

· Citomak 0.5-1.0 ml / kg intravenously (improves tissue respiratory intensity, microcirculation)

· Coenzyme Q 2 mg / kg drip to 1.0 ml per day (improves oxidation and rehabilitation processes and energy potential of cells)

· Actovegin to 1.0 ml intramuscularly or intravenously (activates cellular metabolism, replenishes energy resources in tissues)

· Potassium orotat for ¼ Tab-1 Table for night at least 3-4 weeks (anabolic action)

· Akti-5 to ½-1 teaspoon of syrup 2-3 times a day (anabolic action)

· Limontar up to 1 ½ tablets per day dissolved in water or juice (increases appetite, anabolic effect)

· Biotrine 2 mg / kg per day to 1 ½ tablets per day (normalizes metabolic processes)

· Kogitum up to 2 ampoules per day (in ampoule 10 ml) enteral (generalizing action)

· Apilak on ½ -1 Candle 2-3 times a day 2-3 weeks

B. Ornasicifications:

· Essentialy up to 6 capsules per day (antioxidant, antihypoxant, improves hepatic tissue metabolism)

· Carsyl and Liv-52

· Nootropyl 50-100 mg / day

· Glycine up to 100 mg / day

· Sexax 1-3 drops intranasally daily or every other day

· Riboxin 1-2 tablets per day

Hypostatic

The variant of dystrophy with a more or less uniform lag behind the child in the growth and mass of the body during satisfactory fattening.

Hypostatic usually happens

· Stage removal from severe hypotrophyflowing with growth deficit, because the child is usually gaining weight faster.

· Hypostatic is possible when unbalanced nutrition, predominance of carbohydrates with a shortage of other ingredients.

· It happens constitutional hypostatic (parents of small growth), with nervous arthritic diathesis.

· Sometimes a consequence endocrine pathology (pituitary nanism).

· It is necessary to exclude endogenous character of hypostatic (onthe background of congenital and acquired pathology).

Clinic hypostatic

The child is proportionally lagging behind in growth, mass, intelligence, teething timing timetable, i.e. the biological age of the child lags behind the calendar.There are trophic disorders and signs of polyhypovitaminosis, disproteinemia, a decrease in fat absorption in the intestine, aminoaciduria.

DIAGNOSIS

installed on the basis of clinical and anthropometric data.

TREATMENT

it is carried out at home according to the same principles as in hypotrophy of the II degree. It is very important to eliminate the causal factor.

Pararoid

Chronic nutrition disorder with a predominance of body weight with relatively normal growth of the child.

The causes of patrofy are more often:

· Child repos

· Food with excess carbohydrates or protein

· Ethrenal food of pregnant with excess carbohydrates, fats, with a lack of vitamins, minerals

· Hereditary constitutional factor.

Clinic Parroid

Eliminate 3 degrees of patrofy.

· 1 degree: increase in body weight compared with the average standard by 10-20%;

· 2 degree:- by 20-30%;

· 3 degree: - by 30-40%.

The excess body of the body is manifested more often for 3-5 months of life. Children have manifestations of rickets, exudative diathesis, often find an increase in the fork gland. In history, such patients often observe the presence of asphyxia, intracranial injury in the perinatal period. During the examination, various violations of carbohydrate, protein or fat exchanges are found.

Carbohydrate patrofy nutrition disorder.

The carbohydrate congestion is even possible in a child who is naturally feeding, with random nutrition, introducing a large number of sweet tea, apple or juice with a large number of sugar.

Improper nutrition contributes to the deposition of an excessive fat in subcutaneous fat tissue and leads to water delay in the body. The child looks fat, pastoral, with a flabby tv fabrics. Anthropometric indicators can correspond above the average or high physical development.

Excess carbohydrates may result in the exhaustion of the enzymatic ability of the gastrointestinal tract and to strengthen the fermentation processes. The chair becomes liquid, foam, dark color, acidic reaction. A lack of vitamin B1, acidosis develop. The child, as it were, from the "remedy" turns into a hypotro firm, pale, sluggish, with a sharply lowered tunic tissue. As a result of sharply reduced immunity, he begins to slander ARVI, pneumonia and other diseases.

Protein food disorder type of patrofy.

Protected protein is possible:

· in the first half of the year With early administration (2-3 months), one-piece cow or goat milk.

· In the second half of the year The cause of protein crumple can be overhaul of cottage cheese, protein entita, using adapted dry mixtures in greater concentration or diluted milk instead of water.

With overpressure of the protein, it first is well digested, and the child adds well in weight. However, in the exhaustion of the enzymatic ability of the GTS, its splitting of the intestinal rotary microflora is enhanced. Cal becomes dense consistency, dry, whitish color, alkaline reaction, with a grinding smell containing a large amount of calcium and magnesium soap. In the body accumulate intermediate products of protein metabolism (azotemia). As a result of intoxication and azotemia, the appetite is reduced, the child is losing weight. Anemia develops. Children with protein nutritional disorder are becoming less likely than with a carbohydrate food disorder, but the kidney pathology is somewhat more often.

Treatment is aimed primarily on power correction.

Endogenous factors

Endogenous causes are dependent on the effect that has an increase in the growth and mass of the body endocrine glands.

In the earliest period, this influence comes from the fork gland, from the end of the first year of life - from the thyroid gland and from 3-4 years old - from the pituitary gland. The level of hormones involved in the process of growth and tissue sensitivity to their action is determined by the genotype. Hormones, contributing to growth, are: a somatotropic pituitary hormone (STG), thyroid hormones and insulin. Stgh stimulates hondrogenesis, and thyroid hormones are more affected by osteogenesis.

Exogenous factors

Exogenous factors are those conditions in which the child falls after birth.

This is primarily nutrition (plastic and energy material). Quantitatively and qualitatively insufficient nutrition in the first place inhibits the increase in body weight, and then growth.

Climatho-geographical conditions

The growth of the child affect the movements that increase the growth of bones, increase the metabolism

To assess the physical development of children up to 1 year, it is better to use the following indicators:

2. body weight;

3. Proportionality of development (head circumference; chest circumference, some anthropometric indices);

4. Static functions (Motor skills of a child);

5. Timely teething of dairy teeth (in children up to 2 years).

The main criteria for the physical development of children of different ages:

Body mass

Body Length

Head circumference

Body Proportions: Build, Posture

HEIGHT

The most stable indicator of physical development is the growth of the child.

The greatest rate of growth is celebrated in the first three months of the child's life.

Funny-born growth ranges from 46 to 60 cm. Average -48-52 cm, but adaptive growth indicators are considered to be 50-52 cm.

For the first year, the child adds in growth on average 25 cm. So by year its growth is an average of 75-76 cm.

For the second year of life, the child will grow by 12-13 cm, for the third - 7-8 cm.

BODY MASS

In contrast to growth, the body weight is a rather labile indicator, which reacts relatively quickly and changes under the influence of a wide variety of reasons.

Especially intensively gaining body weight occurs in the first quarter of the year. The mass of the body of day-free newborns ranges from 2600 to 4000 g and on average is 3-3.5 kg. However, the adaptive body weight is 3250-3650 grams.

Normally, most children have a "physiological" loss of up to 5-8% noted by 3-5 days of life. This is explained by greater loss of water with an insufficient amount of milk. The restoration of the physiological loss of body weight occurs on 3-5 days a maximum of 2 weeks.

BODY MASS

The dynamics of body weight is characterized by a greater increase in the first 6 months of life and lesser by the end of the first year.

The mass of the child's body is doubled by the year, by the year it triples, despite the fact that this indicator may vary and depends on the nutrition, transferred diseases, etc. The energy of body weight increases with each month of life gradually weakens.

Monthly body weight gain in children up to year

Chest Circle

The newborn chest circle is 33-35 cm. The monthly increase in the first year of life is an average of 1.5-2 cm. Per month.

By the year, the trigger of the chest increases by 15-20 cm, after which the increment energy drops and the chest circumference increases on average to the preschool age by 3 cm, and in preschool - by 1-2 cm per year.

Central tables

Two-dimensional central scales - "body length - body weight", "body length - chest circumference", in which the values \u200b\u200bof body weight and circle of the breast are calculated to the proper body length, make it possible to judge the harmonicity of development.

Usually, the 3rd, 10th, 25th, 50th, 75th, 90th, 97th valued are used to characterize the sample.

The 3rd centle is such a value of the indicator, less than which it is observed in 3% of the members of the sample; The magnitude of the indicator is less than the 10th century - 10% of the sample members, etc., the gaps between the values \u200b\u200bare called centent corridors. Select 7 centle corridors

Indicators that have fallen:

in the 4-5th corridors (25-75-I applied), it should be considered average

in the 3rd (10-25th centuries) - below average,

in the 2nd (3-10th centuries) - low,

in the 1st (up to 3rd) - very low,

in the 6th (75-90th) - above average,

in the 7th (90-97th, I was fitted) - high

in the 8th (higher than the 97th fitted) - very high.

Harmonious is physical development, in which the body weight and the chest circumference correspond to the length of the body, that is, it falls in the 4-5th centuries (25-75th hundred).

Physical development is considered disharmonary, in which the body's mass and the chest circumference lags behind the proper (3rd corridor, the 10-25th centuries) or more due (the 6th corridor, 75-90th) due to increased grease.

Fundamental criteria for a comprehensive assessment of the health of the child. The presence or absence of chronic (including congenital) diseases The functional state of organs and systems resistance and reactivity of the body level and harmony of physical and neuropsychic development.

Under the term "physical development of the child" means a dynamic process of growth (an increase in the length and mass of the body, individual parts of the body) and the biological ripening of the child in one or another period of childhood under the term "physical development of the child" means a dynamic growth process (increasing body length and body weight, individual parts of the body) and the biological ripening of the child in one or another period of childhood

The most stable indicator of physical development is the length of the body (growth). The most stable indicator of physical development is the length of the body (growth). The body weight is unlike the length of a more changeable feature, due to this body weight, compared with the body length. Circle of chest and head - the third mandatory sign of the assessment of physical development.

Other indicators of the in-depth assessment of the morphofunctional state of the organism organism - the length of the body, height is sitting, length of hand, legs, shoulder width, pelvis; The circle of the shoulder, hips, legs, abdomen, etc. Somatoscopic - the shape of the chest, stop, posture, the condition of grease, musculature, the floor ripening functional - the life capacity of the lungs, the power of the brush compression, the rain force, the shock volume of the left ventricle, etc.

In the assessment of physical development, it is generally possible to verify the biological age or biological maturity, assessing which in children take into account somatoscopic and somatometric data, the deadlines for the appearance of points of the osenation, the timing of teething of dairy and constant teeth and their number, the presence and severity of the signs of puberty. In the assessment of physical development, it is generally possible to verify the biological age or biological maturity, assessing which in children take into account somatoscopic and somatometric data, the deadlines for the appearance of points of the osenation, the timing of teething of dairy and constant teeth and their number, the presence and severity of the signs of puberty.

The leading indicators of the biological development of children of primary school age are the number of permanent teeth, skeletal maturity, body length. When assessing the level of biological development of children of secondary and older age, the degree of severity of secondary sexual characteristics, the ossification of bones, the nature of growth processes, less and the length of the body and the development of the dental system are greater importance. The leading indicators of the biological development of children of primary school age are the number of permanent teeth, skeletal maturity, body length. When assessing the level of biological development of children of secondary and older age, the degree of severity of secondary sexual characteristics, the ossification of bones, the nature of growth processes, less and the length of the body and the development of the dental system are greater importance.

Anthropometric indicators of a newborn baby are sufficiently stable, genetic factors at this age are negative. Therefore, even relatively small deviations from the average indicators, as a rule, indicates disadvantaged in a state of a newborn. In the most difficult cases, especially when not only the mass, but also the length of the fetus suffers, have to talk about the delay in the development of the fetus, which is often combined with various defects of development. Anthropometric indicators of a newborn baby are sufficiently stable, genetic factors at this age are negative. Therefore, even relatively small deviations from the average indicators, as a rule, indicates disadvantaged in a state of a newborn. In the most difficult cases, especially when not only the mass, but also the length of the fetus suffers, have to talk about the delay in the development of the fetus, which is often combined with various defects of development.

This delay can be as symmetrical, i.e. With a uniform decrease in the mass and body length, which indicates more severe lesion and asymmetric. With asymmetric delay, if the body length prevails, you can talk about intrauterine hypotrophy. Excess mass is more often characteristic of edema syndrome or for obesity, for example, in children born from materic diabetes. This delay can be as symmetrical, i.e. With a uniform decrease in the mass and body length, which indicates more severe lesion and asymmetric. With asymmetric delay, if the body length prevails, you can talk about intrauterine hypotrophy. Excess mass is more often characteristic of edema syndrome or for obesity, for example, in children born from materic diabetes.

The length of the body is an indicator characterizing the state of plastic processes in the body. In the first year of life, a monthly increase in body length: in the first quarter - 3 cm in the second - 2.5 cm in the third - 1.5-2 cm in the fourth - 1 cm total gain for 1 year is 25 cm. You can also use the following Formula: child 6 months It has a body length of 66 cm, for each missing month from this value, 2.5 cm is subtracted from this value, for each month after 6 is added 1.5 cm.

Body mass - reflects the degree of development of internal organs, muscular and bone systems, fatty fiber. In contrast to the body length, the mass of the body is a rather long indicator, which relatively responds relatively and changes under the influence of various reasons - both endo- and an exogenous nature. Immediately after birth, the mass of the child's body begins to slightly decrease, i.e. The so-called physiological loss of body weight occurs, which by 3-5 days of life should be approximately 5-6%, the restoration of body weight should happen to 7-10 days of life.

These changes in body weight are due to the mechanisms of adaptation of the newborn. After restoration, the mass of the body steadily begins to increase, with the rate of its rise in the first year, the higher, the less age, these changes in body weight are due to the mechanisms of adaptation of the newborn. After restoration, the mass of the body steadily begins to increase, with the rate of its rise in the first year, the higher the less age

A number of formulas for the estimated calculation of the body mass in the first year of life the mass of the body (M.T.) can be defined as the sum: M.T. At birth, plus 800 g x n, where N is the number of months. During the first half of the year, and 800 g - the average monthly increase of M.T. During the first half of the year. For the second half of the life of M.T. Equal: M.T. At birth, pole abscess M.T. In the first half of the year (800 x 6), plus 400 g x (n-6) - for the second half of the year, where N is age in months, and 400 g is the average monthly increase of M.T. For the second half of the year. M.T. The child is 6,000 g, the child is 8,200 g, for each missing month, it is subtracted at 800 g, each subsequent is added to 400 g. But this formula does not take into account individual fluctuations in body weight at birth, therefore less reliable.

Observation of the change in the head of the head is an integral component of medical control over physical development. This is due to the fact that the head of the head reflects the general laws of the biological development of the child, namely the first (cerebral) type of growth; Disturbances of the growth of the skull bones can be reflected or even the cause of the development of pathological conditions (micro and hydrocyphalia). After birth, the head grows quite quickly in the first months and years of life and slows down his height after 5 years. Observation of the change in the head of the head is an integral component of medical control over physical development. This is due to the fact that the head of the head reflects the general laws of the biological development of the child, namely the first (cerebral) type of growth; Disturbances of the growth of the skull bones can be reflected or even the cause of the development of pathological conditions (micro and hydrocyphalia). After birth, the head grows quite quickly in the first months and years of life and slows down his height after 5 years.

Approximately the head circumference can be estimated according to the following formulas: for children up to 1 year: the circle of the head at birth plus 1.5 cm x N for the first half of the year and the head of the head plus 0.5 x N for the second half of the year. The circle of the head of a 6 month old child is 43 cm, on each missing month, we take 1.5 cm by one, for each subsequent - add 0.5 cm or an average of 1 cm per month.

Breast circle - is one of the main anthropometric parameters for analyzing changes in the transverse sizes. The chest circumference reflects both the degree of breast development, closely correlating with the functional performance of the respiratory system, and the development of the muscular apparatus of the chest and the subcutaneous fat layer on the chest. At birth, the chest circumference, about 2 cm less than the circumference of the head, and then the rate of increasing the chest is ahead of the head growth, approximately 4 months, these circles are compared, after this, the chest circumference is steadily increasing compared to the head circumference.

Formulas for indicative estimation of the rate of development of the chest: For children up to 1 year, a monthly gain in the first half of the year is 2 cm, in the second half of the year - 0.5 cm. The circle of the chest 6 month old baby is 45 cm, for each month to 6 should be subtracted 2 cm, and for each subsequent month after 6 add 0.5 cm.

For children from 2 to 15 years, the length of the body can be calculated by the formula: the body length is 8 years old - 130 cm, for each missing year to subtract 7 cm, for each exceeding-take 5 cm. For children from 2 to 15 years old, the length of the body can be calculated According to the formula: the body length is 8 years old - 130 cm, for each missing year to subtract 7 cm, for each exceeding-take 5 cm. Body mass for children from 2 to 12 years old: in 5 years old body weight 19 kg, for every ladder 2 kg is subtracted, and 3 kg is added to each subsequent.

Head circumference. At 5 years - 50 cm, 1 cm is subtracted for each missing year, and 0.6 cm is added to each subsequent. At 5 years - 50 cm, 1 cm is subtracted for each missing year, and each subsequent 0.6 cm is added. Breast circle aged 2 to 15 years: up to 10 years 63 cm minus 1.5 cm (10-N) Where n is the number of years of a child younger than 10 years old, over 10 years old - 63 + 3 cm (N-10).

Genetic and exogenous factors affect the physical development of children. The effect of heredity affects mainly after two years of life, and two periods are distinguished when the correlation between the growth of parents and children is most significant, it is age from 2 to 9 years and from 14 to 18 years. At this age, the distribution of body weight relative to the length of the body can be significantly different in connection with the pronounced constitutional characteristics of the physique.

Exogenous factors, in turn, can be divided into intrauterine and postnatal. Intrauterine factors - parents' health, their age, the environmental situation in which parents live, professional harm, the course of pregnancy, etc. Postnatal factors - factors that influence the physical development of the child in the process of its life: these are nutrition conditions, education, diseases who transfers the child, social conditions. So, a moderate nutritional deficit delays the rise of body weight, but the body length, as a rule, does not affect. Long-term high-quality and quantitative starvation, unbalanced nutrition with a deficiency of micronutrients lead less frequently to the shortage of body weight, but also to shortness with a change in body proportions.

For young children, high motor activity is characterized, which is an osteogenesis stimulant and cartilage growth. However, physical mobility must be an adequate age of the child. For example, excess vertical load when lifting weights leads to the opposite effect - growth inhibition. For young children, high motor activity is characterized, which is an osteogenesis stimulant and cartilage growth. However, physical mobility must be an adequate age of the child. For example, excess vertical load when lifting weights leads to the opposite effect - growth inhibition. The physical development of children is influenced not only by the correct wakefulness, but also sleep, since it is in a dream all the basic metabolic changes are carried out that determine the growth of the children's skeleton (and the growth hormone stands out precisely during sleep).

In early age children, especially in the first year of life, there is a close interdependence of physical and neuropsychic development. The absence or lack of positive, as well as an excess of negative emotions affects the physical condition, and can become one of the causes of growth violations. In early age children, especially in the first year of life, there is a close interdependence of physical and neuropsychic development. The absence or lack of positive, as well as an excess of negative emotions affects the physical condition, and can become one of the causes of growth violations. Climato-geographical conditions relate to environmental factors affecting growth and development. For example, an acceleration of growth in spring, braking in the autumn-winter period is noted. Hot climate and highlands inhibit growth, but can accelerate the ripening of children.

In the postnatal period, the endocrine growth regulation is of great importance. Hormones, contributing to growth, are a somatotropic pituitary hormone, hormones of thyroid gland and insulin. Growth hormone stimulates hondrogenesis, while thyroid hormones affect osteogenesis. The influence of STGs relatively little affects the growth of the child for up to 2-3 years old and especially large in the period from 7 to 10 years. In the postnatal period, the endocrine growth regulation is of great importance. Hormones, contributing to growth, are a somatotropic pituitary hormone, hormones of thyroid gland and insulin. Growth hormone stimulates hondrogenesis, while thyroid hormones affect osteogenesis. The influence of STGs relatively little affects the growth of the child for up to 2-3 years old and especially large in the period from 7 to 10 years. The greatest growth of thyroxine is determined in the first 5 years of life, and then in prepubertal and pubertal periods. Tyroxin stimulates osteogenic activity and enhancing the ripening of bones. Androgens acting in prepubertate and pubertate periods enhance the development of muscle tissue, endo-ended ossification and chondroplastic bone growth. The effect of androgens as growth stimulants is short-term.

Throughout the childhood, the growth intensity of children is unequal. The phase of intensive growth and primary increase in body weight lasts up to 4 years of age. The most expressed increase in body weight. Normally feeding children acquire rounded shapes. Throughout the childhood, the growth intensity of children is unequal. The phase of intensive growth and primary increase in body weight lasts up to 4 years of age. The most expressed increase in body weight. Normally feeding children acquire rounded shapes. The first phase of rapid growth (pulling) - age from 5 to 8 years. The body weight increases in proportion, but lags behind the length of the body length. The second phase is the gain of body mass - age from 9 to 13 years. Body mass increases faster than body length. The second phase of rapid growth - between 13 and 16 years. Growth ceases to girls about 17 years old, young men - in 19 years.

Changes in body length with age is characterized by varying degrees of elongation of different body segments. So the height of the head increases only 2 times, the length of the body is 3 times, and the length of the lower limbs is 5 times. The most dynamic changes in the two segments - the upper part of the face and the length of the legs. Changes in body length with age is characterized by varying degrees of elongation of different body segments. So the height of the head increases only 2 times, the length of the body is 3 times, and the length of the lower limbs is 5 times. The most dynamic changes in the two segments - the upper part of the face and the length of the legs. The growth rate has a pronounced craniocaudal gradient, at which the lower body segments grow faster than the upper. For example, the stop grows faster than the shin, and the shin is faster than hips, it affects the proportions of the body. In practice, various development proportion indices are often used.

The largest propagation was determined by the determination of relations between the upper and lower segments of the body (index Chulitskaya II). In addition to changing the relationship between long-term body, the age-related change of proportions is significantly affected by relations between the body length and various transverse dimensions (for example, the circumference of the breast and the length of the body - the erysman index) - the definition of the relationship between the upper and lower segments of the body was the greatest distribution (Chulitskaya II index ). In addition to changing the relationship between lengths of the body, the age change of proportions significantly affects the ratios between the body length and various transverse dimensions (for example, the circumference of the breast and the body length - the Erisman index) is the index of Chulitiquoli I (shoulder circumference, hips and body length). The decline in the index confirms the failure of the child's nutrition. When using various indices, the idea of \u200b\u200bthe degree of harmony of the child's physique is significantly refined.

In practical work, the physical development of the child is usually assessed by comparing its individual indicators with age standards. In practical work, the physical development of the child is usually assessed by comparing its individual indicators with age standards. Currently, this goal is used for a central method, which is easy to work, as the calculations are excluded using cignifice tables or graphs. Two-dimensional centers "body length - body weight", "body length - breast circle", in which the body weight is calculated and the busty circumference is calculated to judge the harmonicity of development. Harmonious is considered physical development, in which the body weight and the chest circumference correspond to the length of the body, i.e. Find in the 25-75th cent. With disharmonious physical development, these indicators are lagging behind due (10-25 - 10-3-3) or exceed them (75-90-90-97) due to increased fat.

Currently, a comprehensive scheme for assessing the physical development of children is becoming increasingly used. It involves both the biological level, so the morphofunctional state of the body. Currently, a comprehensive scheme for assessing the physical development of children is becoming increasingly used. It involves both the biological level, so the morphofunctional state of the body. The physical development of children is estimated in such a sequence: first determines the correspondence of the calendar age of biological development, which meets the calendar age, if the majority of biological development indicators are in the average age limits (M1). If biological development indicators are lagging behind the calendar age or ahead of it, this indicates a delay (returation) or acceleration (acceleration) of the pace of biological development.

Then estimate anthropometric and functional indicators. To evaluate the first, the central method and functional indicators are used, as already noted, compared with age standards. Functional indicators in children with harmonious development are within the limits of M1 to M2 or more. In children with disharmonious and sharply disharmonious physical development, these indicators are usually below the age norm. Then estimate anthropometric and functional indicators. To evaluate the first, the central method and functional indicators are used, as already noted, compared with age standards. Functional indicators in children with harmonious development are within the limits of M1 to M2 or more. In children with disharmonious and sharply disharmonious physical development, these indicators are usually below the age norm. Also, the anthropometric indicators use somatograms.

Modern anthropometric indicators in young people during the completion of growth is much higher than they were 100 years ago. This process, called the acceleration and observed over the past 100 years, affected mainly young populations in developed and prosperous countries. Acceleration is most pronounced among urban children and among the more secured segments of the population. The well-known causes of accelerations are in good and more complete nutrition, in a varied set of stimuli (sports, travel, means of communication), as well as in reducing the frequency of infectious diseases that delay the development of the child. Modern anthropometric indicators in young people during the completion of growth is much higher than they were 100 years ago. This process, called the acceleration and observed over the past 100 years, affected mainly young populations in developed and prosperous countries. Acceleration is most pronounced among urban children and among the more secured segments of the population. The well-known causes of accelerations are in good and more complete nutrition, in a varied set of stimuli (sports, travel, means of communication), as well as in reducing the frequency of infectious diseases that delay the development of the child.

Acceleration is considered as a result of the complex interaction of ex- and endogenous factors: a change in the genotype due to a large migration of the population and the emergence of mixed marriages, changing the nature of nutrition, clinical conditions, scientific and technological progress and its influence on the environment. Acceleration is marked in all age groups, starting with intrauterine. Over the past 40-50 years - the length of the bodies of newborns increased by 1-2 cm, children 2 years old - 5-5 cm. The average height of 15 years of summer children became more than 20 cm. There is also a faster development of muscle strength. Accelerated the term of biological ripening.

Distinguish the harmonious and disharmonious type of acceleration. Distinguish the harmonious and disharmonious type of acceleration. The first is children who have anthropometric indicators and biological maturity above indicators for this age group. The second belongs to children who have enhanced body growth in length without accelerating sexual development or early puberty without increasing growth in length.

But if earlier the acceleration process was considered only as a positive phenomenon, in recent years there have been information about the more frequent imbalance of development in such children of individual systems of the body, especially neuroendocrine, cardiovascular. According to the evidence of numerous publications, the process of acceleration in economically developed countries is slowed down. There is no reason to believe that in the future there is a significant decrease in the age of puberty, as well as an increase in body length above the average growth rate established for millennia. But if earlier the acceleration process was considered only as a positive phenomenon, in recent years there have been information about the more frequent imbalance of development in such children of individual systems of the body, especially neuroendocrine, cardiovascular. According to the evidence of numerous publications, the process of acceleration in economically developed countries is slowed down. There is no reason to believe that in the future there is a significant decrease in the age of puberty, as well as an increase in body length above the average growth rate established for millennia.

If we talk about the assessment of the indicators of body length, then low growth is an increase below the average, for the age of more than 2, or below the third percentile, which corresponds to the deviation from them by 10%. If we talk about the assessment of the indicators of body length, then low growth is an increase below the average, for the age of more than 2, or below the third percentile, which corresponds to the deviation from them by 10%. Dwarf growth: growth rates below average by 3 and, accordingly, below 0.5 percentile. GREAT GROWTH, MACROMIA: Growth indicators exceed the average by 1-3, or turn out to be 87th percentile. Giant growth, giantism: growth rates exceed average more than 3.

About 3% of children and boys belong to the category of lowered. Most of them are somatically well healthy. They can detect a mental vanity when it comes to their low growth. Low growth may be due to family, constitutional factors, when both parents or at least one of them have low growth. Constitutional dwarf growth is always associated with the special pathology of genes or chromosomes, regardless of whether it is possible to confirm with scientific methods or not. About 3% of children and boys belong to the category of lowered. Most of them are somatically well healthy. They can detect a mental vanity when it comes to their low growth. Low growth may be due to family, constitutional factors, when both parents or at least one of them have low growth. Constitutional dwarf growth is always associated with the special pathology of genes or chromosomes, regardless of whether it is possible to confirm with scientific methods or not.

Causes of pathological lowness: primary low growth with a small body weight at birth Secondary low growth due to disorders of metabolism (including the pathology of the internal secretion glands), which manifest themselves only after the birth of growth disorders associated mainly with the development of long tubular bones

Two main groups of shortness: proportional low growth with general slow development. The age physiological proportions are preserved (ratio of the sizes of the head to the body, limbs). The newborn, the ratio of the length of the head and the body corresponds to 1: 4, at the age of 6 - 1: 5, by 12 years - 1: 7, in adults - 1: 8. Disproportional low growth usually happens in isolated disorders in the most active growth zones. Normal relations between the sizes of the head, the body and limbs are violated.

The most frequent causes of proportional low growth is constitutional (family) low growth. This group includes healthy children of healthy parents, the growth of which is lower than average values. Such children remain lower than their peers. The mass and length of the body at birth can be normal, the skeletal osenation (the appearance of the osenation nuclei) occurs during normal time. The level of growth hormone in the blood is normal.

The most frequent causes of proportional low growth initial lowness. The frequency of the phenomenon is determined by the prevalence of low-speed in previous generations and preferential marriages between the persons of low growth. Its signs already at birth serve as low weight indicators and body length. A child is born with all signs of maturity, pregnancy usually has a normal duration. The proportions of the body in children are observed, the ossification of the skeleton and mental development, as well as the pubertal period flow normally, which makes it possible to exclude the pathology of metabolic processes.

The most frequent causes of proportional low growth is alimentary lowness. The causes of alimentary shortness are either in defective nutrition, or in violation of the digestibility of nutrients. The most adversely affects the shortage of proteins. Such children are especially susceptible to infectious diseases.

The consequences of quantitative and high-quality malnutrition anorexia in severe mental or physical disorders. Sugar diabetes, difficult to compensate and regulation. Moriak syndrome (diabetes mellitus, lowness, hepatomegaly, stagnation in the system of portal veins, obesity, chronic acetoneuria, hypercholesterolemia). Nonachar diabetes. Low growth is a consequence of metabolic disorders due to a disadvantage of antidiuretic hormone (adiuretin). At the same time, almost always the defeat of the front lobe of the pituitary gland (growth hormone) or hypothalamus (vegetative centers).

The consequences of quantitative and high-quality malfunction Insufficient nutrition in the nestlessness, the nestness of children, as a manifestation of severe hospitalism (not only in orphanages, but also in some families), with a quashoror, associated with chronic lack of proteins in food. Frequent vomiting on the basis of psychogenic disorders or as a result of anatomical anomalies (stenosis of the esophagus or 12-rosewood, hernia of the diaphragm, Gyrshprung disease, Yab stomach and 12-rosewoman). Digestive disorders (Maldigesty), including in cycling and other diseases. Violation of suction (Malabsorption), partial or complete after an extensive resection of the small intestine, with Crohn's disease, celiac disease, etc.

The most frequent causes of proportional low growth of lowerness at the last three reasons are combined into the concept of lowness of intestinal origin. Low growth due to hypoxy. It is found in chronic diseases of the lungs and respiratory tract, heart disease, chronic heavy anemia (children attract attention with pallor and constant cyanosis or cyanosis when moving). They suffer shortness of breath, have chronic cough, fingers in the form of drum sticks.

The most frequent reasons for proportional low growth is low growth in violation of puberty: hypogonadotropic hypogonadism, later puberty adiposogenital diestrophy FREELIKH ovarian disgenesis (Sherosezhevsky-Turner syndrome)

Low growth on the soil of cerebral and hormonal pathology. Low growth on the soil of cerebral and hormonal pathology. Cerebral Causes: Slowly growing brain tumors Residual phenomena of stem encephalitis, tuberculosis meningoencephalitis and neurosofilis Microcephalus, hydrocephalus Alcohol embryochia

Hormonal pathology Hypophizar lowness caused by hypofunction of the front lobe of the pituitary gland primarily by deficiency of the STG, and very significant (growth begins to slow down from 2 years of age, a dwarf growth is formed by the end of school age) - a decrease in all the functions of the hypothyroidism of hypothyroidism. IMPORTANT SIGNS - STUDS, MIXEDEMA, SPECIALLY SCHOOL OUCENCY, ALLOVAME ADRENAL LOCK SILM (dysfunction of adrenal cortex, C-M Cushusha, adrenogenital S-M, long-lasting corticosteroid therapy)

Low disproportional growth of xondrodstrophy (ahondroplasia, xondromblasis). The predominantly hereditary pathology of cartilage cells is manifested by a violation of the growth of long tubular bones and the base of the skull. Imperfect osteogenesis. At the heart of the disease lies the hereditary inferiority of Osteoblasts, leading to increased bone fragments with minimal reasons and shortening limbs due to multiple fractures.

Low imbieldal growth of mucopolysaccharideosis. Spinal defects. It is characterized by a decrease in the size of the body at the normal length of the limbs. Vitamin D - rickets resistant forms (ricket-like diseases). Hereditary hypophosphate (Ratbana syndrome). Cystinia (Abdergalden-Fanconi disease). Rachitic bone change and low growth.

High growth high initial growth. As a rule, the family predisposition to high growth. In many previous generations, there is a significant number of tall people, as in cases of prioritial low-speed. Arahanodactilia (Martha Syndrome) is hereditary (autosomal dominant) Common Mesodermal dysplasia: high growth, thin long bones, expressed pattern of leptosomal asthenia, long brushes and feet, often deformation of the chest, general muscular hypotension. Often ectopia lens and aortic expansion.

High growth pituitary giantism (eosinophilic adenoma of the front lobe of the pituitary gland in children). In adults acromegaly. In children, high growth and slender build. High height in the early sexual maturation (early sexual maturation is a strong incentive to growth, but it is temporary, and then growth is stopped). Chromosomal aberrations. Chaninfelter syndrome (chromosomoopathy) with primary testicular underdevelopment. Heller-Nelson syndrome. Huu Syndrome, Khhhhhu.

Deviation in increasing M.T. Hypotrophy - reduced body weight. Eythiffia is a condition in which the increase in body weight and an increase in body length does not go beyond the physiological ratios (that is, it is a state of normal nutrition). Dystrophy - a condition in children, whose body weight is 15-20% lower than normal. They attract the attention of thinness, subtle limbs, weak development of muscles and subcutaneous fatty fiber. Atrophy - the child's condition, the mass mass of which is 30% lower than the average or below 3 percentile.

Constitutional factors prematurity, newborns with intrauterine dystrophy (matter and other moments - embrypathics, chromosomal anomalies). Asthenic build. (Children are usually healthy.) Marfan syndrome. Progressive lipodystrophy.

Chronic digestion disorders impaired monosaccharide suction, disaccharides. Enough insufficiency enterokinase. Triptophan absorption disorder (Hartnooup syndrome). Enteropathic Akrodermatitis (zinc absorption violation).

Excessive body weight should be considered a mass of body (taking into account the length of the body) by 15% greater than the average indicators, which exceeds 97 percenters. When obesity, the mass of the body exceeds the average indicators for this age by 25% and more.

Causes of excess body mass Constitutional factors. Unreasonable high-calorie nutrition (excess proteins, carbohydrates, fats and liquids). The unfavorable mental and social conditions that are most strongly influenced by children in the state of depression, as well as on non-ferrous and inventive children with a weak self-consciousness, and weakly. Cerebral diseases. Diesefal or diancefral-pituitary obesity, adiposogenital dystrophy.

Causes of excess body weight Endocrine disorders: hypothyroidism, hypercorticism, Cushing syndrome. Primary metabolic disorders: type glycogenosis, Moriak syndrome (diabetes mellitus). Obesity with other syndromes: Pickwick syndrome; Prader-Willy syndrome; Alstrema-Halgren syndrome (obesity + blindness + retinal dystrophy) reduced glucose tolerance with the development of diabetes, hearing loss due to the damage to the inner ear.

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Anomalies of one or more determinants of the formation of the floor can lead both anatomical and functional deviations from the "norm" and various clinical forms of interference of sexual differentiation. The type of sexual differentiation disorders depends on the causes and time of its occurrence in ontogenesis.

In the early stages of embryogenesis, changes in the chromosomal kit, for example, 45 XO - Sherosezhevsky-Turner syndrome (code on the ICB-X - Q96), or violation of the function of the genital chromosoma can lead to the gonad agenesia, that is, to the development of the body without sex glands. In the future, there is a female phenotype with severe hypogonadism.

To the same period of disturbations of differentiation of the gonad and gonadal bonding syndrome (true hermaphroditism - Q99 - on the ICD), when in gonads at the same time occurs

differentiation of both zones of sexual bookmark (eggs and ovary). Most patients with this pathology determine women (46 xx), less often - male (46 xy) karyotype. According to some authors, a mixed gonada arises from the embryo with mosaicism by HY-Antigen.

The result of chromosomal aberrations, gene mutations (Q97 is other anomalies of sex chromosomes, women's phenotype, Q98 - other anomalies of sex chromosomes, a male phenotype on the ICB-X) may be the appearance of dysgenis gonad. Dysgenetic testicles do not fully ensure the regress of muller ducts and normal masculinization of external genitals, which contributes to the development of the derivatives of paramenephral ducts (uterus, uterine pipes, the upper third of the vagina) and is already manifested at the birth of a child in the bisexual structure of external genitalia (gender uncertainty and pseudo-eroditism - Q56 on the ICB-X). Ovarian dysgenesis syndrome with a normal female karyotype and a phenotype can manifest itself only in a pubertal period of more or less pronounced hypogonadism (congenital ovarian abnormalities - Q50

on the ICB-X).

Violation of the normal formation of male outer genitals contributes to the insufficient activating effect of testosterone produced by both fetal testicles and adrenal glands. For example, the incomplete masculinization syndrome (false male hermaphroditism), in which patients with men's genetic and gonadal floors reveal an intersexual structure of external genitals: a split scrotum, hypospadia of urethra, underdevelopment of the penis. In the ICB-X, these diseases are represented by the headings Q54 - hypospadia and Q55 - other congenital abnormalities of men's genital organs.

With the complete absence (monorchism) or aplasia of eggs, the cipher Q55.0 ICB-X is used. In the postnatal life of the disease or state, accompanied by the death of the ovaries (testicles), with a normal karyotype, the structure of internal and external genitals appear in the pubertal period, the absence of secondary sexual traits and respectively reproductive ability.

Congenital dysfunction of adrenal cortex (adrenogenital disorders - E25 - on the ICD) is the most common cause of virilization of girls at an early age (manifestations of any male androgen-dependent signs). This is a hereditary call

levance associated with violation of the biosynthesis of glucocorticoids in the intrauterine period due to the congenital deficit of a number of adrenal enzymatic systems ("congenital metabolism error"). The low level of cortisol in blood according to the feedback principle leads to strengthening the secretion of the adrenocorticotropic hormone (ACTH) pituitary gland and, consequently, the hyperplasia of adrenal cortex, mainly the mesh zone where hormones are strongly produced, the synthesis of which is not disturbed (mainly androgens). This is still in the intrauterine period to the masculinization of the external genital organs in girls (female pseudo-heermifroditis), and in postnatal life is manifested in the heterosexual structure of genitals.

With the intrauterine formation of the male floor, it is necessary to allocate the phase of lowering the testicles into the scrotum (22-32th week), which occurs under the influence of both hormonal and mechanical factors. The uninforcement of the egg (testicles) is called cryptorchism (one-sided or double-sided) and encoded by cipher Q53.

False Pubertat.Differential diagnosis requires the condition of the false pubertate, which is due to diseases with an increase in the production of sex hormones, independent of the gonadotropic function of the pituitary. Hyperplasia of endocrine glands or tumors producing hormonally active substances can cause the development of secondary sexual signs. The gonads remain in the infantile state, neither spermatogenesis does not occur, no ovulation, i.e. there is a violation of the sequence of puberty.

Gonadal false sexual development- relatively rare pathology. The boys are connected with the tumor growing from the interstitial lesidig cells in the testicle. In such cases, children grow faster, they are more muscles, external genitals are rapidly increasing in the amount, there are agriculture, voice mutation. After removing the tumor, false virilization stops. In girls, isosexual false sexual development is most often associated with a tumor in granular cells of ovarian producing estrogens. The first symptom of this state is more often irregular anointulatory menstrual discharge or isolated telecomm (the development of the mammary glands) in the absence (or minor severity) of sexual sip. In such cases, the ICB-X cipher depends on the nature of the tumor.

At the heart of the false sexual development, accompanying the pathology of the adrenal glands (congenital adrenogenital syndrome - E25 CIFR-X), is increased androgen products. A distinct formation of secondary sexual signs is noted only in boys (the testicles always remain underdeveloped), and the girls have a virilization manifestation of a heterosexual pseudopubertat.

Yatrogenous false sexual ripening may occur during long-term intake of glucocorticoids, anabolic genital crossings.

To designate sexual disorders associated with any pathological process, the corresponding encoding of the ICB-X is used. In the primary diagnosis of unspecified sexual development disorders, cipher E30.9

Premature sexual development (PPR)(Pubertas Praecox)- An extensive group of diseases, various etiology, pathogenesis, clinical manifestations and a forecast that combines the emergence of one or a number of secondary sexual signs caused by the impact of sex hormones on the body before physiological pubertata.

In clinical practice, the diagnosis of such a state is resorted to the emergence of secondary sexual signs from the mines to 9.5-10 years, girls are up to 8-9 years old or the appearance of Menarch under 10 years.

True PPR- All forms pubertas Praecoxbased on the increased products of gonadotropic and respectively gonadic hormones. The formation of hormonal correlations in such cases repeats the peculiarities of the formation of hypothelamm-pofizar-gonodnial relationships in healthy adolescents, only in earlier time. Paul ripening always goes on isosexual type.

Cerebral PPR.The reason for the true PPR is usually associated with one or another cerebral pathology. These may be tumors, the consequences of the antenatal pathology, neuroinfection, cranial injuries. For example, premature sexual maturation caused by hyperfunction of the pituitary gland is denoted by the E22.8 ICB-X cipher.

Idiopathic (constitutional) PPR.In addition to cerebral, still idiopathic (constitutional) form

true PPR, when there are no obvious disorders from the CNS. Constitutional PPRs more often register from girls. The premature formation of the menstrual function is denoted by the E30.1 ICB-X cipher (premature menstruation), and the premature increase in the mammary glands - E30.8 ICB-X cipher (other violations of puberty). With idiopathic forms of true PPR, under the influence of increased gonadotropin products, somatic semi-variety can occur very early. Large psychological difficulties are associated with perfect spermatogenesis or abortion to pregnancy, on the one hand, and infantilism of the psyche and social immaturity, on the other. Despite the similarity of external manifestations, the physical and sexual development of such children has a number of features, allowing to reject the point of view on the PPR as "Normal Pulltitat in a non-lasting early time." With the initial manifestations of the PPR, children are usually ahead of peers in physical development. Subsequently, in connection with the early closure of epiphysis, lowness is formed. Features of sexual development in the constitutional form of the PPR in girls include possible violations of the stages of the appearance of estrogen and androgen-dependent secondary sexual signs: late or weakly pronounced sexual comparison compared to the development of mammary glands, internal and external genitals. In this, it is obvious that the autonomicity of the ripening system of the hypothalamus-pituitary-gonady (gonadadhah) system is reflected in the unripe of adrenarche system, which probably begins to function at normal time. A certain feature is in the form of a mammary glands. Their increase mainly occurs due to the growth of iron fabric without prior change of the Areola. With a completely formed mammary gland of Aregol and the nipples remain "children's" - pale painted, flat (obviously, due to violation of the normal effect of estrogen, prolactin and gonadotropins on breast fabric). Menarche as the climax moment of puberty does not depend on the development of other genital signs, sometimes being the first symptom of the PPR. Menstruation can come quite regularly with appreciable development of genitals and uterus, possibly due to increasing receptor sensitivity of endometrial tissue to estrogen effect.

Syndrome delay in sexual developmentdiagnosed in the absence of secondary sexual adolescents in adolescents after 13.5 years and girls in the absence of menstruation by 15 years and older. Clinically and pathogenetic is a heterogeneous group of violations of the development of the reproductive system. You can talk about the three main mechanisms underlying the delay of sexual development:

Later, the ripening of the hypothalamic-pituitary-gonodny system;

Later, the ripening of receptors of germ cells interacting with gonadotropins;

Low sensitivity of the external genital tissues to the effects of genital hormones.

The reasons for the delay of sexual development include the pathology of pregnancy and childbirth, unfavorable conditions for the early development of the child, starvation, obesity, chronic somatic and infectious diseases, endocrinopathy, and the TSS defeat. The delay of sexual development can go both in parallel with the delay in physical, mental maturation, and disharmoniously with a discrepancy in growth rates and development.

We must not forget about the possibility of the presence of a constitutionally conditioned "slow vestitata" (code on the ICB-X - E30.0: delay in puberty). In this case, as a rule, children are noticeably lagging behind the peers and in physical development; But in the future, both growth and sexual maturation pass normally. Obviously, it is impossible to leave adolescents who have no signs of Pubertat two years later and more after the average time of the appearance of these signs in the population.

In violation of the stereotypes of sexual behavior, the following headings of the ICB-X are used: F64 - sexual identification disorders; F65 - sexual preference disorders; F66 - Psychological and behavioral disorders associated with sexual development and orientation.

(In order to reduce the frequency of pathology) the following: constitutional, cerebral-endocrine, somatogenic (chronic diseases of various organism systems with violation of a function of a particular organ), social factors.

In the early age of an early age deflection in the mass of the body less than or more than 10% of the regulatory indicators (with other characteristic features) are called respectively hypotrophy and pacatrophy. An increase in body weight in children of other ages is more than 14% due to excessive. The main causes of deviation in the mass of the body of children are alimentary, constitutional, somatogenic, cerebral endocrine and other factors.

Can manifest themselves in the form of its decrease (microcephaly) or an increase (frequent variant - hydrocephalus). The main causes of deviations in the chairman of the Chairman is the intrauterine violation of the development of the brain, injury and hypoxia of the brain during childbirth, injury, infectious diseases and brain tumors in children after birth.

Breeding deviations May be as towards the reduction and increase. The causes of such violations are anomalies for the development of the chest and lungs, diseases of the respiratory organs, the degree of physical training and development of muscles, the constitutional features like this.

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Description of the presentation of semiotics of violations of the physical development of children of different ages on slides

By definition of WHO, health - - physical, mental and social well-being

The fundamental EE criteria for a comprehensive assessment of the health of the child's health, the presence or absence of chronic (including congenital) diseases functional state of organs and systems Resistance and reactivity of the body level and harmony of physical and neuropsychic development

Under the term "physical development of the child" means a dynamic growth process (an increase in the length and mass of the body, individual parts of the body) and the biological ripening of the child in a particular period of childhood

The most stable indicator of physical development is - the length of the body (height). The body weight is unlike the length of a more changeable feature, due to this body weight, they compare with d ll of a different body. Circle of chest and head - - the third mandatory sign of the assessment of physical development.

Other indicators in deep-ooo uya morphofunctional state of the organism of somatometric - - the length of the body, the growth of sitting, the length of the arms, legs, the width of the shoulders, the pelvis; The circle of the shoulder, hips, legs, abdomen, etc. Somatoscopic - - the shape of the chest, stop, posture, the state of fatty, muscles, sexual ripening functional - - the life capacity of the lungs, the strength of the grip of the brush, the milling force, the shock volume of the left ventricle, etc.

In the assessment of physical development, it is generally possible to verify the biological age or biological maturity, assessing which in children take into account somatoscopic and somatometric data, the deadlines for the appearance of points of the osenation, the timing of teething of dairy and constant teeth and their number, the presence and severity of the signs of puberty.

The leading indicators of the biological development of children of primary school age are the number of permanent teeth, skeletal maturity, body length. When assessing the level of biological development of children of secondary and older age, the degree of severity of secondary sexual characteristics, the ossification of bones, the nature of growth processes, less and the length of the body and the development of the dental system are greater importance.

At birth, a healthy duddy newborn has :: body length from 46 to 56 cm (on average 50, 7 cm in boys and 50, 2 cm in girls) body weight 2700 -4000 g (average 3300 -3500 g) Head circle 34 - 36 SMSM Breast Curl 32 -34 SMSM

Anthropometric indicators of a newborn baby are sufficiently stable, genetic factors at this age are negative. Therefore, even relatively small deviations from the average indicators, as a rule, indicates disadvantaged in a state of a newborn. In the most difficult cases, especially when not only the mass, but also the length of the fetus suffers, have to talk about the delay in the development of the fetus, which is often combined with various defects of development.

This delay can be as symmetrical, that is, with a uniform decrease in the mass and body length, which indicates more severe lesion and asymmetric. When asymmetric delay, if the PR Evaeva LL is the length of the body, we can talk about intrauterine hypotrophy. Excess mass is more often characteristic of edema syndrome or for obesity, for example, in children born from materic diabetes.

The length of the body is an indicator characterizing the state of plastic processes in the body. In the first year of life, a monthly increase in body length :: In the first quarter - - 3 cm in the second - 2, 5 cm in the third - 1, 5 -2 cm in the fourth - 1 cm The total gain for 1 year is 25 cm. You can use Also following formula: child 6 months. . It has a body length of 66 cm, for each missing month from this value, 2, 5 cm is subtracted from this magnitude, for each month after 6 is added 1, 5 cm.

Body mass - - reflects the degree of development of internal organs, muscular and bone systems, fatty fiber. In contrast to the body length, the mass of the body is a rather long indicator, which relatively responds relatively and changes under the influence of various reasons - both endo- and an exogenous nature. Immediately after birth, the mass of the child's body begins to decrease somewhat, that is, the so-called physiological loss of body weight occurs, which by 3 -5 day of life should be approximately 5 -6%, the restoration of body weight should happen to 7 -10 day of life.

These changes in body weight are due to the mechanisms of adaptation of the newborn. After restoration, the mass of the body steadily begins to increase, with the rate of its rise in the first year, the higher the less age

Row. A number of formulas for the estimated calculation of body weight in the first year of Life MM Asse Body (m. T.) can be defined as the sum: mm. . TT. . At birth, plus 800 g of xx nn, where Nn is the number of months. . In for the first half of the year, and 800800 g is the average monthly increase of m. TT. . During the first half of the year. For the second half of the life of the m. TT. . equal: m.. TT. . At birth, the pole increase m. TT. . For the first half of the year (800 x x 6), plus 400 g x (nn -6) - for the second half of the year, where Nn is age in months, and 400400 g is the average monthly increase of m. TT. . For the second half of the year. . Mm. . TT. . The child is 6,000 g, the child is 8,200 g, for each missing month, it is subtracted at 800 g, each subsequent is added to 400 g. But this formula does not take into account individual fluctuations in body weight at birth, therefore less reliable.

The basic rule in assessing the increase in body weight: Funny children, born with a normal body mass, restore it in the second week doubles by 4-6 months after 1 year

Observation of the change in the head of the head is an integral component of medical control over physical development. This is due to the fact that the head of the head reflects the general laws of the biological development of the child, namely the first (cerebral) type of growth; Disturbances of the growth of the skull bones can be reflected or even the cause of the development of pathological conditions (micro and hydrocyphalia). After birth, the head grows quite quickly in the first months and years of life and slows down his height after 5 years.

Approximately the circumference of the head can be estimated according to the following formulas: for children up to 1 year: Circle of the head at birth Plus 1, 5 cm xx n n for the first half of the year and head plus 0, 5 x x nn for the second half of the year. The head of the head of a 6 month old child is 43 cm, on each missing month we take 1, 5 cm, for each subsequent - add 0, 5 cm or an average of 1 cm per month.

Chest circle - is one of the main anthropometric parameters for analyzing changes in the transverse size of the body. The chest circumference reflects both the degree of breast development, closely correlating with the functional performance of the respiratory system, and the development of the muscular apparatus of the chest and the subcutaneous fat layer on the chest. . At birth, the chest circumference, about 2 cm less than the circumference of the head, and then the rate of increasing the chest is ahead of the head growth, approximately 4 months, these circles are compared, after this, the chest circumference is steadily increasing compared to the head circumference.

The formulas of the length of the chest orientation estimate of the breast development rate :: For children up to 1 year, the monthly increase in the first half of the year is 2 cm, in the second half of the year - 0, 5 cm. The circle of the chest 6 month old child is 45 cm, for each missing month Up to 6, it is necessary to subtract 2 cm, and for each subsequent month after 6 add 0, 5 cm.

For children from 2 to 11 5 years old, the body length can be calculated by the formula: the body length is 8 years old - 130 cm, for each missing year to subtract 7 cm, for each exceeding-take 5 cm. Body mass for children from 2 to 12 years old: In 5 years, the body weight of 19 kg, 2 kg is subtracted for each missing year, and 3 kg is added to each subsequent.

Head circumference. At 5 years - 50 cm, 1 cm is subtracted for each missing year, and for each subsequent 0, 6 cm. Breast circle aged 2 to 15 years: up to 10 years 63 cm minus 1, 5 cm (10 - NN) where Nn is the number of years of a child younger than 10 years old, over 10 years old - 63 + 3 cm (NN -10).

Genetic and exogenous factors affect the physical development of children. The effect of heredity affects mainly after two years of life, and two periods are distinguished when the correlation between the growth of parents and children is most significant, it is age from 2 to 9 years and from 14 to 18 years. At this age, the distribution of body weight relative to the length of the body can be significantly different in connection with the pronounced constitutional characteristics of the physique.

Exogenous factors, in turn, can be divided into intrauterine and postnatal. Intrauterine factors - parents' health, their age, the environmental situation in which parents live, professional harm, the course of pregnancy, etc. Postnatal factors - factors that influence the physical development of the child in the process of its life: these are nutrition conditions, education, diseases who transfers the child, social conditions. So, a moderate nutritional deficit delays the rise of body weight, but the body length, as a rule, does not affect. Long-term high-quality and quantitative starvation, unbalanced nutrition with a deficiency of micronutrients lead less frequently to the shortage of body weight, but also to shortness with a change in body proportions.

For young children, high motor activity is characterized, which is an osteogenesis stimulant and cartilage growth. However, physical mobility must be an adequate age of the child. For example, excess vertical load when lifting weights leads to the opposite effect - growth inhibition. The physical development of children is influenced not only by the correct wakefulness, but also sleep, since it is in a dream all the basic metabolic changes are carried out that determine the growth of the children's skeleton (and the growth hormone stands out precisely during sleep).

In early age children, especially in the first year of life, there is a close interdependence of physical and neuropsychic development. The absence or lack of positive, as well as an excess of negative emotions affects the physical condition, and can become one of the causes of growth violations. Climato-geographical conditions relate to environmental factors affecting growth and development. For example, an acceleration of growth in spring, braking in the autumn-winter period is noted. Hot climate and highlands inhibit growth, but can accelerate the ripening of children.

In the postnatal period, the endocrine growth regulation is of great importance. Hormones, contributing to growth, are a somatotropic pituitary hormone, hormones of thyroid gland and insulin. . Growth hormone stimulates hondrogenesis, while thyroid hormones affect osteogenesis. The influence of STGs relatively little affects the growth of the child up to 2 to 3 years and is especially great OO in the period from 7 to 10 years. The greatest growth of thyroxine is determined in the first 5 years of life, and then in prepubertal and pubertal periods. Tyroxin stimulates osteogenic activity and enhancing the ripening of bones. Androgens acting in prepubertate and pubertate periods enhance the development of muscle tissue, endo-ended ossification and chondroplastic bone growth. The effect of androgens as growth stimulants is short-term.

Throughout the childhood, the growth intensity of children is unequal. The phase of intensive growth and primary increase in body weight lasts up to 4 years of age. The most expressed increase in body weight. Normally feeding children acquire rounded shapes. The first phase of rapid growth (pulling) - - age from 5 to 8 years. The body weight increases in proportion, but lags behind the length of the body length. The second phase is - adding body weight - - age from 9 to 13 years. Body mass increases faster than body length. The second phase of rapid growth - between 13 and 16 years. Growth ceases to girls about 17 years old, young men - in 19 years.

Changes in body length with age is characterized by varying degrees of elongation of different body segments. So the height of the head increases only 2 times, the length of the body is 3 times, and the length of the lower limbs is 5 times. The most dynamic changes in the two segments - the upper part of the face and the length of the legs. The growth rate has a pronounced craniocaudal gradient, at which the lower body segments grow faster than the upper. For example, the stop grows faster than the shin, and the shin is faster than hips, it affects the proportions of the body. In practice, various development proportion indices are often used.

The greatest distribution was determined by the determination of the relationship between the upper and lower segments of the body (index by Chulitskaya IIII).). In addition to changing the relationship between long-term body, the age change of proportions is significantly affected by relations between the body length and various transverse dimensions (for example, the circumference of the chest and the body length - the Erisman index) -) - the index of Chulitskoli II (shoulder circle, hip leg and body length) . The decline in the index confirms the failure of the child's nutrition. When using various indices, the idea of \u200b\u200bthe degree of harmony of the child's physique is significantly refined.

In practical work, the physical development of the child is usually assessed by comparing its individual indicators with age standards. . Currently, this goal is used for a central method, which is easy to work, as the calculations are excluded using cignifice tables or graphs. Two-dimensional centers "body length - body weight", "body length - breast circle", in which the body weight is calculated and the busty circumference is calculated to judge the harmonicity of development. Harmonious is considered physical development, in which the body weight and the bustland circumference correspond to the length of the body, i.e. they fall in 25 -75 -Un. With disharmonious physical development, these indicators are lagging behind due (10 -25 - 10 -3) or exceed them (75 -90 - 90 -97) due to increased fat.

Currently, a comprehensive scheme for assessing the physical development of children is becoming increasingly used. It involves both the biological level, so the morphofunctional state of the body. The physical development of children is estimated in such a sequence: first determines the correspondence of calendar age of biological development, which meets the calendar age, if the majority of biological development indicators are in the average age limits (M 11). If biological development indicators are lagging behind the calendar age or ahead of it, this indicates a delay (returation) or acceleration (acceleration) of the pace of biological development.

Then estimate anthropometric and functional indicators. To evaluate the first, the valuable method and functional indicators are used, as already noted, compared with age standards. Functional indicators in children with harmonious development are in the range from M 11 to m 22 or more. In children with disharmonious and sharply disharmonious physical development, these indicators are usually below the age norm. Also, the anthropometric indicators use somatograms.

Modern anthropometric indicators in young people during the completion of growth is much higher than they were 100 years ago. This process, called the acceleration and observed over the past 100 years, affected mainly young populations in developed and prosperous countries. Acceleration is most pronounced among urban children and among the more secured segments of the population. The well-known causes of accelerations are in good effects of more complete nutrition, in a varied set of stimuli (sports, travel, means of communication), as well as in reducing the frequency of infectious diseases that delay the development of the child.

Acceleration is considered as a result of the complex interaction of ECE and endogenous factors :: change of the genotype due to the large migration of the population and the emergence of mixed marriages, changed the nature of the AA of nutrition, clinical conditions, scientific and technical progress AA and its influence on the environment. Acceleration is marked in all age groups, starting with intrauterine. ZZ and the last 40 -50 years - - the body length of newborns increased by 1 -2 cm, children 2 years old - 4 -5 cm. The average height of 15 years of summer for 100 years has become more than 20 cm. There is also a faster development of muscle Forces, accelerated the term of biological ripening. .

Distinguish the harmonious and disharmonious type of acceleration. The first is children who have anthropometric indicators and biological maturity above indicators for this age group. The second belongs to children who have enhanced body growth in length without accelerating sexual development or early puberty without increasing growth in length.

But if earlier the acceleration process was considered only as a positive phenomenon, in recent years there have been information about the more frequent imbalance of development in such children of individual systems of the body, especially neuroendocrine, cardiovascular. According to the evidence of numerous publications, the process of acceleration in economically developed countries is slowed down. There is no reason to believe that in the future there is a significant decrease in the age of puberty, as well as an increase in body length above the average growth rate established for millennia.

If we talk about the assessment of the length of the body length, then low growth is an increase below average, for this age, more than 22 values, or below the third percentile, which corresponds to a deviation from them by 10%. Dwarf growth: growth rates below average by 3 and respectively below 0, 5 percentile. GREAT GROWTH, MACROMIAT: Growth indicators exceed the average per 1 -3, or turn out to be above 97 percentile. Giant growth, giantism: growth rates exceed average more than 3. .

About 3% of 3% of children and boys belong to the category of lowered. Most of them are somatically well healthy. They can detect a mental vanity when it comes to their low growth. Low growth may be due to family, constitutional factors, when both parents or at least one of them have low growth. The constitutional allea dwarf growth is always associated with the special pathology of genes or chromosomes, regardless of whether it is possible to confirm with scientific methods or not.

Causes of pathological shortness: Primary low growth with low body weight at birth Secondary low growth due to disorders of metabolism (including pathology of the internal secretion glands), which are manifested only after the birth of growth disorders associated mainly with the development of long tubular bones

Two. Two main groups of NN isproostslost and: and: proportional low growth with general slow development. The age physiological proportions are preserved (ratio of the sizes of the head to the body, limbs). The newborn ratio of the length of the head and the body corresponds to 1: 4, at the age of 6 years - 1: 5, by 12 years - 1: 7, in adults - 1: 8. Disproportional low growth is usually with isolated disorders in the most active growth zones. Normal relations between the sizes of the head, the body and limbs are violated.

The most frequent causes of proportional low growth constitutional alleal (family) low-rise growth. This group includes healthy children of healthy parents, the growth of which is lower than average values. Such children remain lower than their peers. The mass and length of the body at birth can be normal and, and, ossification of the skeleton (the appearance of the osenation cores) occurs during normal time. The level of growth hormone in the blood is normal.

The most frequent causes of proportional low growth initial lowness. The frequency of the phenomenon is determined by the prevalence of low-speed in previous generations and preferential marriages between the persons of low growth. Its signs already at birth serve as low weight indicators and body length. A child is born with all signs of maturity, pregnancy usually has a normal duration. The proportions of the body in children are observed, the ossification of the skeleton and mental development, as well as the pubertal period flow normally, which makes it possible to exclude the pathology of metabolic processes.

The most frequent causes of proportional low growth is alimentary lowness. The causes of alimentary shortness are either in defective nutrition, or in violation of the digestibility of nutrients. . The most adversely affects the shortage of proteins. Such children are especially susceptible to infectious diseases.

Conscribing I am a quantitative and high-quality malfunctional anorexia with severe mental or physical disorders. Sugar diabetes, difficult to compensate and regulation. Maoria QC AA syndrome (diabetes mellitus, lowness, hepatomegaly, stagnation in the system of gorgeous veins, obesity, chronic acetoneururia, hypercholesterolemia). Nonachar diabetes. Low growth is a consequence of metabolic disorders due to a disadvantage of antidiuretic hormone (adiuretin). At the same time, almost always the defeat of the front proportion of pituitary glands (growth hormone) and Lily GG Ipoipo Talamus (vegetative centers). .

Consequence I am a quantitative and qualitative insufficient nutritional nutritional nutrition in the nestlessness of children, as a manifestation of severe hospitalism (not only in orphanages, but also in some families), with a quashoror, associated with chronic lack of proteins in food. Frequent vomiting on the basis of psychogenic violations or as a result of anatomical anomalies (stenosis of the esophagus or 12-rectory, the hernia of the diaphragm, the disease of the gyrolshprung, the yabyab of the stomach and the 12-rectory). Digestive disorders (Maldigesty), including in cycling and other diseases. Impaired absorption (Malabsorption), partial or complete after extensive resection of the small intestine, PPP and Crohn's disease, celiac disease, etc.

The most frequent causes of proportional low growth of lowerness at the last three reasons are combined into the concept of lowness of intestinal origin. . Low growth due to hypoxy. . It is found in chronic diseases of the lungs and respiratory tract, heart disease, chronic heavy anemia (children attract attention with pallor and constant cyanosis or cyanosis when moving). They suffer shortness of breath, have chronic cough, fingers in the form of drum sticks.

The most frequent causes of proportional low growth is low growth in violation of puberty :: Hypogo OO Supply Hypogonadism, Later Paulic Ripening Adiposogenital Dystrophy Frelich Ovarial Dysgenesia (Sherosevsky-Turner Syndrome)

Low growth on the soil of cerebral and hormonal pathology. . Cerebral reasons :: Slowly growing brain tumors Residual phenomena of stem encephalitis, tuberculosis meningoencephalitis and neurosofilis MICCO terms of its failed, hydrochoch of her fane Alcohol embryochia

Hormonal pathology Popofunctional lowness caused by hypofunction of the front lobe of the pituitary gland primarily by deficiency of the STG, and very significant (growth begins to slow down from 2 years of age, by the end of school age is formed a dwarf growth) Hypopitis II Tarism (B (B - NY Simmonds) - a decrease in all the functions of the pituitary Hypot AI REOs. Important signs - - Struma, Miksdema, Slowed Skeleton Ockeleton, Lyubility Adrenal Lightness (Dysfunction of Adrenal Corn, C - M Kushing, Adrenogenital CC - M, Long Corticosteroid Therapy)

Low disproportional growth of xondrodstrophy (ahondroplasia, xondromblasis). The predominantly hereditary pathology of cartilage cells is manifested by a violation of the growth of long tubular bones and the base of the skull. Imperfect osteogenesis. At the heart of the disease lies the hereditary inferiority of Osteoblasts, leading to increased bone fragments with minimal reasons and shortening limbs due to multiple fractures.

Low imbieldal growth of mucopolysaccharideosis. . Spinal defects. It is characterized by a decrease in the size of the body at the normal length of the limbs. Vitamin D - - RR Esistic forms of Rachita (Rachi-like diseases). . Hereditary hypophosphate (Ratbana syndrome). Cystinia (Abdergalden-Fanconi disease). Rachitic bone change and low growth.

High growth high initial growth. As a rule, the family predisposition to high growth. In many previous generations, there is a significant number of tall people, as in cases of prioritial low-speed. Arachnodactilia (Martan syndrome) - - hereditary (autosomal dominant) Common mesodermal dysplasia: high growth, thin long bones, expressed pattern of leptosomal asthenia, long brushes and feet, often deformation of the chest, general muscle hypotension. Often ectopia lens and aortic expansion.

High growth pituitary giantism (eosinophilic adenoma of the front lobe of the pituitary gland in children). In adults acromegaly. In children, high growth and slender build. High height in the early sexual maturation (early sexual maturation is a strong incentive to growth, but it is temporary, and then growth is stopped). Chromosomal aberrations. Chaninfelter syndrome (chromosomoopathy) with primary testicular underdevelopment. Heller-Nelson syndrome. Huu Syndrome, Khhhhhu.

Deviation in increasing m. TT. . Hypotrophy - - reduced body weight. Eythiffia is a condition in which the increase in body weight and an increase in body length do not go beyond the physiological ratios (i.e. it is a state of normal nutrition). Dystrophy - the condition in children, the mass of the body of which is 15 -20% lower than normal. They attract the attention of thinness, subtle limbs, weak development of muscles and subcutaneous fatty fiber. Atrophy - the child's condition, the mass mass of which is 30% lower than the average or below 3 percentile.

Constitutional factors prematurity, newborns with intrauterine dystrophy (matter and other moments - embrypathics, chromosomal anomalies). . Asthenic physique. (Children are usually healthy.).) Marfan syndrome. . Progressive lipodystrophy.

Exogenous factors Incorrect low-calorie food. . Wrong care. . Heavy (subacute and chronic) infections.

Defeats associated with violation of metabolic processes Malignant tumors. . DCTC PP spastic type. . Cirrhosis of the liver. . Nephrosis (mostly nephronphritis). . Long cytostatic therapy. . Chronic renal failure. . Galaktozhemia.

Chronic disorders of digestion fibrosis, celiac disease, with indround malabsorption, pancreatic insufficiency in chronic pancreatitis, hepatitis, congenital lipase deficiency, Schwachman syndrome - exocrine pancreatic failure, accompanied by neutropenia, thrombocytopenia and low growth. . Malabsorption due to allergies to cow's milk or soy proteins. .

Chronic digestion disorders impaired monosaccharide suction, disaccharides. . Enough insufficiency enterokinase. . Triptophan absorption disorder (Hartnooup syndrome). . Enteropathic Akrodermatitis (zinc absorption violation). .

Excessive body weight should be considered a body weight (taking into account the length of the body) by 15% 15% greater than the average indicators, which exceeds 97 percentages of lion. . When obesity, the mass of the body exceeds the average indicators for this age by 25% and more. .

Causes of excess body mass Constitutional factors. Unreasonable high-calorie nutrition (excess proteins, carbohydrates, fats and liquids). Adverse mental psychic and social conditions that are most influenced by children in the state of depression, as well as on bad and inappropriate children with a weak self-knowledge, and on weakness. Cerebral diseases. Diesefal or diancefral-pituitary obesity, adiposogenital dystrophy.

Causes of excess body weight Endocrine violations: hypothyroidism, hyperk oo rticism, Cushing syndrome. Primary metabolic disorders: type glycogenosis, Maoria QC syndrome (diabetes mellitus). Obesity with other syndromes: PP Ikik Vikksky syndrome; Prader-Willy syndrome; Alstrema-Halgren syndrome (obesity + blindness + retinal dystrophy) reduced glucose tolerance with the development of diabetes, hearing loss due to the damage to the inner ear.