PHYSICAL DEVELOPMENT OF CHILDREN IN VARIOUS AGE GROUPS

Keywords : сhildren, physical development, hypotrophy, anomalies.

Introduction

Physical development (PD) is the dynamic process of growth and biological maturation of a child at different ages. In a narrow sense, PD refers to body size and shape and their compliance with age norms. Physical development is one of the most important criteria in assessing children's health, closely linked to motor development and sexual maturation. Patterns of growth and development, as well as changes in body proportions, are largely programmed by hereditary mechanisms. Growth is the quantitative increase in the body's biomass.

Development is a qualitative transformation in a multicellular organism that leads to qualitative and quantitative changes in bodily functions. All physiological functions are linked to body parameters. Certain stages of development can only occur once the child reaches the appropriate size. However, exposure to adverse factors, especially during the prenatal period and early childhood, can lead to significant, sometimes irreversible, impairments to physical development.

All factors influencing a child's growth and development are conventionally divided into endogenous and exogenous. Endogenous factors include the health of the parents, the course of pregnancy and childbirth, the mother's nutrition, the presence of congenital anomalies, etc. The main factors regulating and determining fetal growth are uterine blood flow and placental perfusion. Maternal health problems during pregnancy and a wide variety of pregnancy and childbirth pathologies can have an adverse effect on the child's physical development.

The endocrine glands have a significant impact on a child's physical status after birth. In the earliest stages, the thymus gland plays a major role, followed by the thyroid gland at the end of the first year of life, and the pituitary gland at 3-4 years of age. In the early stages of puberty, growth is controlled primarily by growth hormone, while in the final stages of puberty, sex hormones (androgens in boys, estrogens in girls) become most active. Pituitary growth hormone (GH) stimulates chondrogenesis, while thyroid hormones have a greater effect on osteogenesis. Many of the effects of growth hormone are mediated by a complex of insulin-like growth factors 1, 2, and 3. Thyroxine's greatest growth effect is observed in the first 5 years of life, and then during prepuberty and puberty. The action of androgens as growth stimulators determines the onset of the prepubertal "growth spurt" and is short-lived. Following the pubertal growth spurt, androgens influence the closure of the epiphyseal growth plates, thus facilitating the cessation of growth. The levels of hormones involved in the growth process and the sensitivity of tissues to their effects are determined by genotype. It is believed that over 100 genes regulate the rate and limit of human growth. Genetic factors. A large group of hereditary diseases and syndromes cause impaired physical development in children. Heredity determines the rate and possible limit of growth, as well as body composition characteristics under optimal living and upbringing conditions. Exogenous factors, such as climatic and geographical conditions, nutrition and child care, illnesses, physical and mental activity, etc., can have a significant impact on the intensity of growth factors. Growth reflects the specific developmental processes occurring in the human body, which necessitates high-quality nutrition, particularly one containing sufficient amounts of balanced, complete protein and B vitamins, as well as vitamins A, D, and E. Deficiencies in certain dietary components—vitamin A, zinc, and iodine—selectively disrupt growth in children. Malnutrition primarily inhibits weight gain, followed by growth. While moderate nutritional deficiencies only affect the rate of growth and maturation, severe nutritional deficiencies lead to short stature and decreased central nervous system and reproductive function. On the other hand, WHO experts note that the biological clock accelerates with increased nutrition. Adequate nutrition, both quantitatively and qualitatively, is essential for the harmonious development of children and influences life expectancy. Among other factors, adequate sleep is crucial – it is during sleep that the key metabolic and differentiation processes that determine the growth of a child's skeleton occur. Physical activity, especially age-appropriate active play, is a crucial growth stimulant essential for proper skeletal development. A child's emotional state—mental stress, trauma, depression, and anxiety—can lead to stunted growth. Chronic illnesses adversely affect a child's growth and development. Thus, a child's physical development depends on their genotype, nervous and endocrine systems, climatic, geographical, and environmental factors, nutrition, and a complex array of social conditions.

Methods

The following parameters are used to assess growth factors in children: 1) somatometric parameters – body length (height), body weight, head, chest, and waist circumferences; 2) somatoscopic parameters – chest, back, and foot shape, posture, body fat, and sexual development; 3) physiometric parameters – vital capacity, hand dynamometry, and standing strength. Parameters such as skinfold thickness, circumferences of individual body parts (hip, upper arm, and lower leg) can also be used to calculate specific anthropometric indices. HEIGHT. Body length, or height, is one of the main indicators of overall body size and bone length. Childhood height is the most stable indicator of growth factors and reflects the body's systemic development. Significant growth disturbances are typically associated with pathologies of other organs and systems. Thus, when skeletal growth slows, the growth and differentiation of the brain, skeletal muscles, myocardium, and other internal organs are simultaneously slowed to a relatively greater or lesser degree. Body height can be average (normal), short, short, long, or tall. Children's height in the first year of life is measured using a stadiometer, which is a board 80 cm long and 40 cm wide. The left side of the board is marked with a centimeter scale, a fixed crossbar at the beginning of the scale, and a movable crossbar at the end of the scale, easily sliding along the centimeter scale. Measurement technique. Infant height is measured lying down. To do this, the infant is placed on their back with their head firmly against the fixed crossbar of the stadiometer. The infant's head should be positioned so that the lower edge of the eye socket and the upper edge of the tragus are in the same vertical plane. The mother or an assistant firmly supports the infant's head. The measurer straightens the infant's legs by applying gentle pressure with the palm of their left hand on the knees, and with their right hand, brings the movable crossbar of the stadiometer firmly to the heels, bending the feet to a right angle with the shins. The distance between the fixed and movable crossbars will equal the infant's height. Length should be measured with an accuracy of 1 mm. Measuring the height of older children. A stadiometer for older children consists of a wooden block 2 m 10 cm long, 8–10 cm wide, and 5–7 cm thick, mounted vertically on a wooden platform measuring 75 x 50 cm. Two centimeter scales are marked on the front vertical surface of the block: the one on the right is for standing height, and the one on the left is for sitting height. A sliding bar 20 cm long is attached to the vertical block. A folding bench for measuring sitting height is attached to the vertical block at a height of 40 cm from the wooden platform. Measurement technique. The child stands on the stadiometer platform with their back to the vertical post, touching it with their heels, buttocks, shoulder blades, and the back of their head, with their arms at their sides. The head is positioned so that the lower edge of the eye socket and the upper edge of the tragus are in the same horizontal plane. The sliding bar is placed against the head; its level will correspond to the child's height. The time of measurement is always noted. Children aged 1 to 3 years are measured using the same stadiometer as older children, except that a folding bench is used instead of the lower platform, and the reading is taken from the scale on the left. The head and body position is the same as in older children. BODY WEIGHT (the child's nutrition) is the primary anthropometric indicator. Body weight, unlike length, is a more labile indicator, reflecting the degree of development of the skeletal and muscular systems, internal organs, and subcutaneous fat tissue. It depends on both the child's constitutional characteristics and environmental factors (nutrition, physical and mental stress, etc.). Measuring body weight is usually straightforward. Body weight may be low (malnutrition), low (undernutrition), high (overnutrition), or high (overnutrition). Deviations from the average calculated values ​​are allowed within ±10%. Weighing children under 3 years of age weighing up to 20 kg is performed on a pan scale. The scale consists of a tray and a balance beam with two division scales: the lower scale is in kilograms, the upper scale is in grams. The measurement accuracy reaches 10 grams. The balance beam has a counterweight with a washer, which is gently turned toward or away from you to balance the scale, using the balance indicator as a guide. Weighing technique: First, place a diaper on the tray so that its edges don't hang over or obscure the scale scale. Then, perform the actual weighing. To do this, close the balance beam. The baby is placed head first on the wide part of the tray and feet first on the narrow part. If the baby can sit up, they are placed on the wide part of the tray (buttocks first) and feet first on the narrow part. The person weighing stands directly in front of the scale beam (not to the side!). The weight reading is taken from the side of the weight with notches or cutouts. On the lower scale, the weight should only be placed in the slots or notches provided on the scale. After weighing the baby, the scale beam is closed and the baby is removed. The weight data is then recorded and the weights are reset to the "0" mark. To determine a child's weight, subtract the weight of the diaper from the scale reading. Body weight is determined with an accuracy of 100 g. Weighing on an electronic scale allows for quick and accurate weight determination for young children. Children over 3 years of age are weighed using a beam scale. The undressed and shoeless child stands motionless in the center of the scale. The balance beam is released. The balance beam has two scales and is accurate to 50 grams. Weighing should be done in the morning on an empty stomach, preferably after defecating and urinating. The scale should be calibrated (using objects of known weight) at least once a month and after any movement. CIRCUMFERENCE MEASUREMENT is an important technique that provides additional data on a child's developmental potential. Circumferential measurements alone or in combination with skinfold thickness measurements characterize a child's developmental potential and are included in the calculation of various indices.

As the severity of prenatal malnutrition increases, the severity of skin trophic disorders increases, tissue turgor and muscle mass progressively decrease, and the risk of complications in the neonatal period increases. Mixed-genesis (prenatal-postnatal) malnutrition is diagnosed if a low birth weight is detected at birth and persists throughout the following months of life. If a child with normal birth weight develops a weight deficit of more than 10% in the postnatal period, the malnutrition is considered acquired.

The degree of hypotrophy depends on the degree of deficit of the actual body weight (ABW) in comparison with the expected body weight (EBW): Grade I - weight deficit of 10-20%; Grade II - weight deficit of 20-30%; Grade III - weight deficit > 30%. During examination of the child, external signs of hypotrophy are revealed: decrease in the thickness of subcutaneous fat tissue initially only on the trunk - grade I, then on the limbs - grade II and on the face - grade III. Hereditary syndromes that cause hypotrophy Gaucher disease (synonyms: glucocerebroside lipidosis; glucocerebrosidosis) is a disease caused by a disorder of glucocerebroside metabolism. There are three forms, distinguished by the age of onset and the prevalence of certain symptoms. In the infantile or acute form, symptoms appear at 2-3 months of age, with neurological impairments being the primary symptoms. Children present with a "pseudobulbar palsy" with strabismus, difficulty swallowing, laryngeal spasm, opisthotonos, and delayed psychomotor development. Hypotrophy and a weak cry are characteristic. The second cardinal sign is significant enlargement of the liver and spleen, appearing at 3-6 months. Bronchopneumonia may result from aspiration. Death occurs from respiratory failure in early childhood. In the juvenile form, neurological symptoms also predominate: seizures, extrapyramidal and cerebellar changes, as well as dementia and behavioral changes. Visceromegaly is moderate. The most common form is chronic or adult-onset (90% of all cases). The disease manifests in the first year of life. Symptoms include abdominal distension due to hepatosplenomegaly, bone pain, pathological fractures, and aseptic necrosis of the femoral head (due to severe expansion of the medullary cavity). Secondary changes include thrombocytopenia with hemorrhagic syndrome and anemia. Yellow spots on the sclera and abnormal pigmentation of the face, neck, hands, and shins are detected. The population frequency is unknown. The sex ratio is 1:1. The inheritance pattern for all three forms is autosomal recessive. Differential diagnosis: Niemann-Pick disease; gangliosidosis, type I; other sphingolipidoses. Minimal diagnostic features: hypotrophy, splenomegaly; neurological impairment; bone lesions; Gaucher cells in the bone marrow; β-glucosidase deficiency. Dubowitz syndrome was first described in 1965 by V. Dubowitz. Clinical symptoms: congenital hypotrophy with severe hypoplasia. Delayed physical development persists, with weight loss predominating. Characteristic symptoms include vomiting, poor appetite, and diarrhea. Progressive microcephaly is an obligatory feature. Facial abnormalities include a sloping forehead, hypoplastic superciliary ridges, a wide nasal bridge, ptosis (usually unilateral), epicanthus occlusion, telecanthosis, blepharophimosis, short palpebral fissures, micrognathia, and a high or cleft palate. A hoarse, rough voice is a common symptom. Hair and eyebrows are sparse. Disturbed tooth eruption and multiple dental caries are noted.

An important diagnostic feature is scaling of the skin, particularly on the face and flexor surfaces of the extremities, which is often mistaken for eczema. Clinodactyly, flat feet, pilonidal pits, cryptorchidism, hypospadias, and labia hypoplasia have been reported in some cases. Internal organ defects are uncommon. Children experience mental retardation. The population incidence is unknown. The sex ratio is 1:1. The inheritance pattern is autosomal recessive. Differential diagnosis: Seckel syndrome; fetal alcohol syndrome. Minimal diagnostic features: prenatal and postnatal growth retardation; hypotrophy, microcephaly; unusual facies; peeling skin. Fetal alcohol syndrome (synonym: alcoholic embryofetopathy). Clinical features: prenatal hypotrophy is characteristic. Children with this syndrome have low birth weight and length, moderate microcephaly, small palpebral fissures, ptosis, and microgenia. Characteristic skeletal anomalies (funnel chest, shortening and curvature of the fifth fingers, congenital hip dislocation, limited joint mobility), heart defects (most often atrial septal defect); in boys - cryptorchidism and scrotal hypoplasia. Mental retardation is noted (IQ - 63). The syndrome develops in connection with the woman's consumption of ethyl alcohol during pregnancy. The population frequency is unknown. Sex ratio is M 1 : F 1. Minimal diagnostic features: prenatal hypotrophy; microcephaly; mental retardation, chronic alcoholism of the mother.

Conclusion

Dystrophy is a chronic malnutrition syndrome in children over 1 year of age whose body weight is 15–29% below normal for height. On examination, subcutaneous tissue and muscles are poorly developed, and the limbs are thin. The skin folds easily but quickly straightens out, and turgor is maintained. The causes may be hunger, severe infections (in Fig. 5, a 2.5-year-old boy with immunodeficiency, next to him is a healthy 1.5-year-old girl), cerebral palsy, chronic heart failure, liver cirrhosis, malignant tumors, prolonged cytostatic therapy, chronic renal failure, galactosemia, celiac disease, cystic fibrosis, chronic pancreatitis, Shwachman syndrome (hereditary exocrine pancreatic insufficiency accompanied by neutropenia, thrombocytopenia and short stature), hormonal disorders (diabetes mellitus, hyperthyroidism, Addison's disease). Atrophy is a condition in which a child's body weight is more than 30% below average. Signs include rapid weight loss ("skin and bones"), loss of fat tissue, an aged-looking face, and slow-growing skin folds. Causes may include starvation, protein deficiency (kwashiorkor), and severe congenital gastrointestinal anomalies (esophageal stenosis, malrotation syndrome, pyloric stenosis, Hirschsprung's disease, etc.) (Fig. 6). 2.1.2. Overweight. Macrosomia in newborns: children are born excessively large and excessively obese, weighing over 4.5 kg. They have a normal build, and pathological predispositions are generally not detectable. Overweight children born to diabetic mothers are characterized by pasty appearance (Cushingoid facies), seizures (hypoglycemia, hypocalcemia), suffocation, and apneic episodes. Paratrophia is a chronic nutritional disorder in young children, the primary cause of which is usually... Fig. 6. Atrophy 34 is a feeding disorder (Fig. 7). The following types of atrophy are distinguished: a) with a predominance of weight over height; b) with an equal excess of weight and height; c) with normal weight and height. Depending on the magnitude of excess body weight, three degrees of severity of atrophy are distinguished: Grade I - body weight exceeds age indicators by 10-20%; Grade II - by 20-30%; Grade III - by more than 30% (according to the central tables, this indicator goes beyond the VI corridor). Based on clinical and biochemical parameters, paratrophy is divided into two types: lipomatous and lipomatous-pasty. The lipomatous type is based on nutritional factors and a hereditary hyperliposynthetic metabolic pattern, accelerated intestinal absorption, and increased fat digestion. The child has a healthy appearance, normal skin and mucous membrane coloration, satisfactory tissue turgor, and rarely gets sick. Pasty appearance in infants is indicated by the appearance of pronounced doughy or soft fatty pads on the cheeks. The child appears pale and edematous. The lipomatous-pastotic type of paratrophy is characterized by pastosity, decreased tissue turgor, pallor, latent iron deficiency, or the development of iron deficiency anemia. During the first year of life, such children often experience allergic reactions, rickets, recurrent acute respiratory infections, and obstructive bronchitis. A physiological predisposition to obesity occurs in the second half of a child's life and at the onset of puberty Depending on the type of fat deposition, obesity can be abdominal (android) or gluteal-femoral (gynoid). Abdominal obesity is most often associated with a range of hormonal and metabolic disorders. When assessing body weight, it is necessary to use the average norms established for boys and girls of different ages, taking into account height.