1、兒童體格生長發(fā)育,.,1,年齡分期 生長發(fā)育的指標 影響生長發(fā)育的因素,.,2,.,Age Group 年齡分期,Human development progresses through a sequence of events,these landmarks should occur at approximately the same age.It is easier to grasp development by focusing on specific key age group. 兒童的生長發(fā)育既循序漸進又有階段性，某些里程碑式的事件應在某一年齡出現(xiàn)。注意關鍵年齡段更易于把握生長規(guī)律。

2、,.,3,.,The fetal period 胎兒期40周,The most dramatic events in growth and development occur before birth.The transformation of a single cell into an infant. 生長發(fā)育過程中最令人激動的事件發(fā)生在出生前：單個細胞發(fā)育成胎兒。,.,4,.,Embryonic period:8wk The rudiments of all major organ systems have developed.weight:9g,length:5cm 胚胎期8周 各主要器

3、官系統(tǒng)雛形初現(xiàn)。重量：9克，長度：5厘米。,.,5,.,Fetal period:9-40wk Increase in cell number and size,structural remodeling of several organ systems.During the third trimester,weight triples and length doubles.Term weight:3250g,length:50cm. 胎兒期9-40周 細胞數(shù)量與體積增加，器官系統(tǒng)結構重組，孕晚期發(fā)育迅速：體重增加3倍，身長增加2倍。孕末期體重平均3250克，身長50厘米。,.,6,.,The

4、 neonatal period 4wk新生兒期,Adaptation to extrauterine life requires rapid and profound physiologic changes,including aeration of the lungs,rerouting of the circulation,and activation of the intestinal tract.To obtain nourishment,to avoid hypothermia or hyperthermia,and to ensure safety,neonates must r

5、eact appropriately to an expanded range of sensory stimuli. 適應宮外生活時，新生兒在生理上需要經歷快速而深刻的變化，包括肺泡擴張充氣、循環(huán)徑路改變、腸道功能激活等。為了獲取營養(yǎng)物質、避免體溫過低或過高并保障安全，新生兒需要對紛繁的外界刺激做出適當?shù)姆磻?.,7,.,A newborns weight may decrease 10% below birthweight in the 1st wk as a result of excretion of excess extravascular fluid and possibly p

6、oor intake.Infants should regain or exceed birthsweight by 2wk of age and should grow at approximately 30gday during the 1st month. 生后第一周，由于多余的細胞外液被排出體外及攝入不足，新生兒的體重會比出生體重減少10。生后兩周時應恢復或超過出生體重，此后至滿月，體重每日增加30克左右。,.,8,.,Limb moves purposelessly,smiling occurs involuntarily,eye gazing,head turning,and su

7、cking under conscious control. 新生兒有無目的的肢體運動、無意微笑，可凝視及轉頭，會有意識地吸吮。,.,9,.,Basic trust develops as infants learn that their urgent needs are meet regularly.Infants does not consistently experience feeding as the pleasurable reduction of tension often show increased irritability and physiological instabi

8、lity(spitting,diarrhea,poor weight gain)as well as behavioral problem. 由于基本需求得到規(guī)律的滿足，新生兒期會建立基本信任感。饑餓時不能規(guī)律地體驗到喂奶快樂的嬰兒，常顯示煩躁不安和生理不適（嘔吐，腹瀉，體重不增）及行為障礙。,.,10,.,The infant period嬰兒期0-12月,Normal children follow a trajectory of increasing physical size and complexity of function. 嬰兒期體格發(fā)育步入了快速增長的軌道，各項功能也日趨復雜

9、。,.,11,.,3m:lifts head 6m:sits alone for a short period 9m:stands alone 12m:walks independently,.,12,.,The primary emotions of anger,joy,interest,fear,disgust,surprise,and tantrums appear,separations become difficult. 初級感情出現(xiàn)：表現(xiàn)生氣、高興、感興趣、害怕、討厭、吃驚和發(fā)脾氣等，與父母難以分離。,.,13,.,The toddler 幼兒期2-3歲,The growth ra

10、te slowers further in the 2nd year of life,then at a steady rate,weight gain:2kg/yr,length:5-7cm/yr. 第二年生長速度減慢，然后較為恒定，體重每年增加2公斤，身高每年增加5-7厘米。,.,14,.,Walks alone,crawls up stairs,walks up and down stairs,run stiffly,then runs well,jumps and opens doors.18mo:10words;24mo:puts 3words together;36mo:known

11、 full name,age and sex,counts 3 objects,repeats 3numbers. 可以獨自走動，上下樓梯、跑步跳躍、開門等。18個月時會說10個單詞；24個月會把3個單詞連在一起說；36個月時知道自己名字、年齡、性別，會數(shù)3種物品，重復3個數(shù)字。,.,15,.,Preschool years學齡前期4-6歲,Gains 2kg in weight and 7cm in height per year. Throwing,catching,and kicking balls,riding on bicycles and dancing. Tower 9 cube

12、s,imitates gate,copy cross,circle,and square. Language occurs most rapidly.Vocabulary increases from 50-100 words to more than 2000. 體重每年增加2公斤，身高每年增長7厘米。學會扔球、接球、踢球，會騎車、跳舞。會壘9塊積木，模擬壘門、畫十字、圓圈和方塊。語言發(fā)展迅速，詞匯量從50-100個單詞增加都2000個以上。,.,16,.,Early School Years 學齡期6-12歲,Growth during the period averages 3-3.5k

13、g and 6cm per year. Child is judged according their ability to produce socially valued outputs,such as good grades and home runs.Attention and receptive language affect each oyher as well as every other aspect of learning. 學齡期體重平均每年增加3-3.5公斤，身高增長6厘米。對學齡期兒童的評價開始注重其社會化表現(xiàn)，如在學校的成績和家務勞動能力。注意力和語言能力互相影響并關系

14、到學習的其他方面。,.,17,.,Adolescence青春期12-20歲,Foster the transition from childhood to adulthood.Between the ages of 10 and 20yr,children undergo rapid changes in body size,shape,physiology,and psychologic and social functioning.Adolescence proceeds across three distinct periods:early,middle,and late.However

15、,individual variation is substantial. 從兒童到成人的轉型期。從10歲到20歲，兒童經歷了身體上，生理上、心理上，及社會角色的快速轉變。此期又可分為早、中、晚三期，個體差異很大。,.,18,.,Physical growth indicators,Growth assessment is an essential component of pediatric health surveillance because almost any problem within the physiologic,interpersonal,and social domain

16、s can adversely affect growth.,.,19,.,Weight,Useful Numbers and Formulas,.,20,.,Length/height,.,21,.,Sitting height,Sitting is the length of head to tuberosity.Body proportions follow a sequence of regular changes with development.Proportionality can be assessed by measuring the lower body segment,a

17、nd the upper body segment.The ratio of upper body segmengt divided by lower body segment(U/L ratio)equals approximately 1.7 at birth,1.3 at 3yr,and 1.0 after age 7yr.Higher U/L ratio are characteristic of short-limb dwarfism or bone disorders such as rickets.,.,22,.,Head circumference頭圍,Since the he

18、ad circumference is eyebrow on the edge of the external occipital protuberance around the hightest point of maximum diameter of the first week. 新生兒的頭圍平均為34cm，1歲時平均為46cm,2歲時48cm，5歲時約為53-54cm，與成人相近。,.,23,.,Chest circumference 胸圍,Chest circumference refers to the circumference of the lower edge of the nipple and the two corners of the lower limb.It represents the development of the chest and lungs. 出生時胸圍平均為32cm，嬰兒期胸圍增長最快，1歲末胸圍與頭圍相等，大約為46cm，第二年約增加3cm，3-12歲胸圍平均每年增加1cm，胸圍超過頭圍的厘米數(shù)約等于周歲數(shù)減1.,.,24,.,Arm circumference上臂圍,The arm circumference represents the development of the arm muscl