). First 3 months. 2 Cm per month (av. 39 cm) 4-6 monts: 1 cm per month (av. 42 cm) 6-12 months.

measure of brain growth. Maximal in first year, reaches 90-95% adult size by 4 years. Birth 32-35 cm (less than 30 cm microcephaly). First 3 months. 2 Cm per month (av. 39 cm) 4-6 monts: 1 cm per month (av. 42 cm) 6-12 months. 1/2 cm per month (av. 46-47 cm) 2nd year 2 cm [48-49 cm) 3rd year. 2 cm (50-51 cm) 4th year 2 cm (52-53 cm) Adult 53-56 cm Upto 13 months use formula 1/2 x length (cm) + 10cm +25cm (4) Surface area. It bears constant relation to nutritional factors affecting growth. Best calculated from nomograms involving average weight and height. Crude methods are Lowe's formula. Surface area (m2) -Simpler formula 1-5 kg m2 = (0.05xkg) + 0.056-10kg m2 - (0.04x kg) + 0.10 11-20kg m2 = (0.03x kg) + 0.2021-40 kg M2 = (0.02 x kg) + 0.40 (5) Upp to lower segment ratio: Upper segment measured from vertex to pubic symphisis. Important in assessment of growth distarbances - proportionate or disproportionate dwarfs. Ratio changes with age and height. Marginal difference between males and females. Ratio retarded for age in - hypothyroidism, achondroplasia and other short-limbed dwarfism, rickets with lower limb deformilities. Ratio advanced for age in - Short trunk dwartism, aquired spinal disease. with hyposis or scoliosis, e.g. tuberculosis, hypogonadism (Klinefelter's syndrome). Marfan's syndrome. (6) Chest circumference. Smaller than head circumference by 2-3 cm Cross-over of head and chest circumferences takes place in Indian children at about 2 years of age (about 1 year in white races. (7) Mid-upper arm circumference taken at midpoint of acromion and olecranon index of mainutrition constant at 1-5 years at 16-17 cms. Mild (9) Ossification centre apperances in infancy and childhood Birth. Distal famoral. proximal tibial, cuboid 3 wks. Head of humerus 2-4 mths. Hamate, capitate 4-6 mths: Head of femur 1 year. Distal radial 2 years. Distal tibia and fibula, capitellum of humerus. 3 years. Triquetral bone, treads of metacarpals and phalanges of hand 4 years. Lunate, navicular of foot,. greater trochanter of femur. 5-6 years. Scaphoid, trapezoid, trapezium.
lower ulnar epiphysis, upper epiphysis of radius, medial epicondyle of humerus. 7-8 years. Lower epiphysis of ulna 9-10 years. Olecranon, trachiea of humerus, pisiform 11-12 years. Lateral epicondyle of humerrus. (10) Milestones of development importance, (a) Assessment of step by step age-wise physicomotor and montal development. (b) Early detection of motor disorders, cerabral palsy, mental retardation, speech, auditory andividaual defects. (c) Assessment of etiology of developmental delay -congenital if poor milestones envelopment from beginning, acquired or heraditary/acquired degenerative neuromuscular or CNS disease if arrest occurs after certain stage is reached. (d) Assessment of approximate in time when pathology began,m e.g. age at which malnutrition set in to cause development retardation. Classification (Continued on next page) 1. Motor 2. Adaptive -(a)Fine motor (b) Visual (c) Auditory 3. Social 4. Language-(A) I Parceptive. (b) Expressive. (11) Saxual maturity 2. PREMATURITY AND LOW BIRTH WEIGHT Defination -Babies born before 37 weeks of gestation are called preterm (PM) Those weighing less than 2500 gm (10th percentile for gestational age) are called low birth weight (LBW) babies Low birth waight may be due to prematurity or intra-uterine growth retardation. The latter group are called small for date (SFD) Pramature babies may be small for date also. Clinical picture -1. Length is short (less than 46cm) in preterm. it is relatively normal for weight in SFD babies. 2. Head appears large compared to the rest of the body, particularly in SFD babies 3. Only one of the two transverse creases on sole of the foot upto 37-38 weeks. 4. Breast nodule absent upto 33-34 weeks. 5. Scalp hair tends to be short and fuzzy upto 37 weeks. 6. Ear carilage is poorly developed and the folds of the helix and antii-helix do not stand out till 36 weeks. 7. Taestes descended and the scrotal rughae develop after 36 weeks. 8 Sucking and synchronized deglutition develop after 33 weeks. 9 Moro's reflex develops after 32 weeks 10. Pupillary reaction to light develops after 31 weeks 11. Blink response to glabellar tap develops after 31. weeks. 12. Strong texor response to extension of forearm develops after 35. weeks. Complications. 1. Hypothermia - because of poor subcutaneous fat insulation, increased surface area compaired to weight. immature hypothalamus and lack of brown fat that can be readily burnt for energy 2. Infection - Septicemia. maningitis and sclerema neonatorum. Baby appears Table showing brief classification of milestones - Age 5. Hypoglycemia -Baby becomes lethargic, develops convulsions or cyanosis. 6. Retrolental fibropiasia - due to excess oxygen in the environment, 7.Anemia
developes within 4 weeks in preterm, SFD have polycythemia.8. Hypocalcimia in SFD.9.Pathological jaundice in PM due to liver
immaturity.10. Intraventicular-periventricular haemorrhage - More common in PM Can be spontaneous in babies less than 34 weeks. Aggravated or precipitated by asphyxia. Severe grades die or survive with mental handicap palsy incidence reduced by loading dose of 25 mg/kg. Phenobarbitone in very small prematures. 11. Patent ductus arterious - Higher incidence in