01 绪论 生长发育 儿童保健.ppt

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1、Introduction,Physical and emotional health of infants、children、and adolescents；their growth and development；their disease prevention;and treatment.Development、Prevention、Clinic pediatrics Perinatology(围生医学)、Neonatology(新生儿学)、Adolescent medicine(青春期医学)Principles:protect childrens health,improve the l

2、ife quality,Pediatrics(儿科学),Three differences:individual,age and sexGood recovery ability Weak self protection,Characteristics,Pediatrics is not the miniature of internal medicineDifferent development regulations in different agesDifferent normal data about physiology and biochemistry in different a

3、gesImmune system is not as perfect as adultsBigger water and nutrition requirementDifferent pathological changes between adult and childrenSingle child policy(China),Children,Clinical Manifestation and Diagnosis,Infective Diseases,Children,SevereCant be limitedmultisystem involvement,Neonate,Not spe

4、cificLosing definite location,Dose being connected with different agesTreating the primary and the complications Nursing and supporting Changing quicklyGood capacity of restore Less sequelae(后遗症)than that of adult except nervous systemEmphasize guarding of younger,weakness and critically ill,Treatme

5、nt and Prognosis,Monitoring of perinatal period Planned immunization Four of the most ordinary disease(malnutrition,anemia,diarrhea and pneumonia)Preventing the adult disease(obesity,hypertension,diabetes or coronary heart disease),Prevention,GOBI Growth,Oral rehydration,Breastfeeding,ImmunizationIM

6、CI(integrated management of childhood illness)Pneumonia(19%)Diarrhea(18%)Malaria(8%)Measles(4%)HIV/AIDS(3%)Neonatal diseases(37%):preterm,asphyxia,infection,Principles of childrens health care,Infectious diseasesMental problems in childrenPrevention of adult diseases in childrenAccidental injury in

7、childrenEnvironmental pollutionAdolescent medicine and other subjects immersion into the Pediatrics Genetic diagnosis and prevention of childrens diseases,Challenges and futures,Fetal period From fertilization to the birth of the baby,Stages of Development(First),Stages of Development(Second),Newbor

8、n period From umbilical cord ligation to 28th day(Early newborn period is younger than 7 days),Bad ability of adjusting and adapting High morbidity and mortality Importance of health protection,nursing and planned immunization Perinatal period:from 28 weeks of pregnancy to 7th day after birthPerinat

9、al mortality(死亡率)is an important guide line of judging developing degree of one country.,Characteristic,MouthSkinApgar scoreMother/infant binding(rooming in)Rule out congenital genetic and metabolic diseases Function analysis,Nurse at birth,Immunization should be postponed if the child has an acute

10、febrile illness.Premature babies can be immunized following the recommended schedule according to chronological age,i.e.immunization should not be postponed.,Contraindications,Being treated with chemotherapy or radiotherapy for malignant diseaseOn immunosuppressive treatment after organ or bone marr

11、ow transplant.On high-dose systemic steroids.With impaired cell-mediated immunity,e.g.severe combined immunodeficiency syndrome or Di George syndrome.,Live vaccines are contraindicated in immunocompromised children,Stages of Development(Third),Infancy period After delivery to 1 year old,Characterist

12、ic,Rapidest period of growth Larger requirement of nutrition and energy Too much:obesity,diarrhea Deficiency:anemia,malnutrition Breast milk Planned immunization Susceptive to the infectious disease in the latter 6 months Physical examination:age 6 months:every 2-3 months,Stages of Development(Fourt

13、h),Toddlers age From 1 year to 3 years,Characteristic,Faster intelligence development Elementary education Poorer ability of identifying danger Thunderbolt injury Changing of food Malnutrition,disorders of digestion Immune deficiency Being apt to infective disease Physical examination:every 6 months

14、,Stages of Development(Fifth),Preschool age From 3 years to 6-7 years,Characteristic,Slower growth More mature development of intelligence plasticity culture(可塑性培养)Training of good habit and independent ability(sleeping,eating,stool,health habit)Prevention of infectious diseases and accidents(learn

15、self protection 119,110,120)More immune disease,Stages of Development(Sixth),School age From 6-7 years to 12-14 years,Characteristic,Physical growth being similar as adults Except genital system Comprehensive development of the morals,intelligence and bodies Lower morbidity Cultivation of the sanita

16、tion habit,Stages of Development(Seventh),Adolescence Girl：11-12y17-18y Boy：13-14y18-20y,Characteristic,The second peak of development and growth.The peak development of the genital system-health care The instability of neuroendocrine system-psychology;behavior;spirit,Scientific breeding:newborns an

17、d infantsSuitable breeding:later stagesEarly education:infants and toddlersInjury prevention:toddlers,pre-schools and school ages Psychiatric education:pre-schools,school ages and pubertySex education:school ages and puberty,Health Care,Growth and Development,Growth Morphological growth of organs an

18、d systems Quantitative changeDevelopment Differentiation and mature function of cells,organizations and organs Qualitative change,Definition,Continued process and segmental,Rules,Unbalance development of systems and organs,抬头（3m）,General rules(First):UpDown,独坐（6-8m）,扶站（9-11m）,独走（13-15m）,独坐持物（12月）翻身（

19、6-7个月）,General rules(Second):NearFar,探身取物（6个月）,General rules(Third):CarelessCareful,单手持物（9个月）,General rules(Fourth):EasyComplex,General rules(Fifth):LowHigh-grade,Individual Difference,Influencing Factors,Inheritance,Sex,Nutrition,Disease,Pregnancy,Environment,Physique Development,Weight Total weigh

20、t of all organs,systems and liquid in body Reflecting conditions of growth and nutrition Calculating the dose of drug and transfusion,Weight of birth Boy:3.3 0.4 kg Girl:3.2 0.4 kg,Normal weight loss Weight loss during the first 10 days(3 to 9 percent),Two peaks From birth to 6 months 3m:700 800g/m

21、46m:500 600g/m 712m:300 400g/m Adolescence 45 kg/y 23y,3/(03月),1,3/(312月),2,3,3/(12岁),Growth on weight,6m W：W at birth（Kg）+m0.7（Kg）712m W：6（Kg）+m0.25（Kg）2ypre-puberty：age2（Kg）+7(or8)（Kg）or312m：age（m）+9/2(Kg)16y：age（y）2+8（Kg）712y：age（y）7-5/2(Kg)W=weight;m=months;y=years,Equilibrium,Standing Height,Le

22、ngth from the top of head to the bottom of foot 3y:Lying on back(recumbent length)At birth：50 cm 1y：75 cm 2y：87cm 2 12y：age 7+70cm(75),Two Peaks of Height,Infants The first 3 months Increasing 11 12cm Adolescence Peak height velocity PHA(生长高峰)Two times of child period speed Lasting 2-3 years Girls b

23、eing higher than boys,Pars Superior and Pars Inferior,At Birth Pars Superior(0.60)Pars Inferior(0.40)(上部量)(下部量)12 years old Pars Superior=Pars Inferior,Sitting Height,Height from the top of head to hucklebone tuber Representing the development of skull and spine 3y:Crown-rump length when lying on ba

24、ck,Finger Distance,Distance between two middle fingers when two arms lying at level Representing the development of long bone of the upper limbsNormal:height 1 2cm,Head Circumference,At birth：3334cm 1 y：46 cm(the first 3m=latermcm)2 y：48 cm 5 y：50 cm 15y：5458cm,Chest Circumference,At birth：32cm head

25、 circumference 12cm 1y：Head Circumference y：Head Circumference,Age CC（cm）comparing with HC（cm）,Chest circumference,At birth 32 12,1y 46 equal,1y HC+（age-1）（age-1）,CC=chest circumference,HC=head circumference,Growth curve of CC and HC,cm,Upper Arm Circumference,y:Reflecting childrens nutrition condit

26、ions 13.5cm：Fine 12.513.5cm：Medium 12.5cm：Malnutrition,Proportion of Body,Proportion of the head and height:infants(1/4)-adults(1/8)Weight by Stature（体形匀称）Weight-For-Height（身高的体重）Chest Circumference/Height（身高胸围指数）EMI/age（年龄的体块指数）Trunk-Leg Ration（身材匀称)Sitting Height/Standing Height.At birth:0.6714 ye

27、ars:0.53 Span and Standing Height,常用的统计学表示方法,界值点的选择（cut-off point）（1）均值离差法：2SD（2）百分位法：P3rd P97th,X,测量值的表示（1）表格（2）生长曲线,生长曲线,评价结果表示,均值离差法：百分位法：,等级法,Growth and Development of Systems,Closing of bone sutures and fontanelles,Bone gap,Posterior Fontanelle,Frontal Fontanelle,Spinal development,78m:Primary

28、Teeth appears 2y:Deciduous Teeth=moons age(46)It is unusual if no teeth at 1 year.2.5y:Completed The first molar at 6y，the second at 12y，the third after 18y.,Teeth,Sensory and Perceptual,Behavioral Development,Development of Brain weight,Development of brain function：Get closed to the adults level:3

29、yrs oldObtain adults full functions:8yrs old,Summary Development of morphology is earlier than the function in the cerebral cortex；Lower excitement in cerebral cortex and higher in subcortical center；Unconditioned reflex；Incomplete myelinization of nerve fibers,Sensory and Perceptual Development,Abi

30、lity of obtaining information from environment through sensor organs and is essential to other areas development.,Newborns The best focus distance is 20cm.Eyes and heads are capable of following the focused objects.Distinction of size and shape is also possible.,听感知的发育,皮肤感觉的发育,Skin sensation,Sense P

31、erception Development,Sense of Taste（味觉）At birth:Rather mature of taste 4 5 months:Key period of development,Sense Perception Development,Sense of Smell（嗅觉）At birth:Looking for nipples when smelling milks taste 3 4m:Differentiation odor 7 8m:Response to sweet-smell,Sense Perception Development,Tacti

32、le Sensation（触觉）Newborns are very sensitive in multiple areas 23y Distinct property56y Distinct objects of different size and weight,Sense of painNewborns are not sensitive to the pain because of incomplete myelinization of nerve fibers which will be improved after 2 months.,Motor Development,Lift h

33、ead2m Lift head3m Stable4m Very stable,freely rotation,Roll over,12m 侧卧至 仰卧45月 仰卧至 侧卧68月 仰卧至 俯卧,12m,Newborn,68m,Walk、Run、Jump6月 扶站912月 扶物走1岁 独走几步1.52岁 跑2岁 双足跳34.5岁 独足跳,大运动发育,二抬 lifts head 十站 stands alone 四翻 rolls over 周岁走 walks alone 六坐 sits 二岁跑 runs well 八爬 creeps 三岁独足跳 hops,Fine Motor Development,

34、三玩手 plays hands 一岁乱画 scribbles 五抓 grasps object 二岁折纸 folds paper七换手passes object 三岁搭桥 builds bridge九月对指 picks up with thumb-index finger,Speech and Language Development,Conditions of lingual development,Hearing CNS Pronouncing organs|Acceptance Understanding and expression pronunciation,Advanced con

35、ditions：Adequate language Environmental irritation,16m Pronounce single syllable711m Pronounce repeated syllables1013m Say:“mom”13y Say vocabularies,simple sentences and sing short songs45y Say compound sentences and sing nursery rhyme,724m lingual interpret,23y lingual expression,Suspicious delayed

36、,14m problems with single word24m problems of combining 2 words30m difficulties of speaking simple sentences,Screening standard,24m Vocabulary 30 Disability Vocabulary50 Suspicious,个人-社会能力的发育（Personal Social Skill）,personal social skill,二笑 smile responsively 六认生 shy with strangers 九月做再见 wave bye-bye

37、 一岁示需要 indicate wants 二岁做游戏 play interactive games 三岁会穿衣 put on T-shirt,Lists the worrying signs at ages given,Never Reflex Development(),Appears at birth and never disappears Corneal reflex(角膜反射)Conjunctival reflex(结膜反射)Papillary reflex(瞳孔反射)Pharyngeal reflex(吞咽反射),Never Reflex Development(),Appear

38、s at birth but disappears at 3 4 months Rooting reflex（觅食反射）Sucking reflex（吸吮反射）Grasping reflex（握持反射）Embrace reflex（拥抱反射）,Never Reflex Development(),Not exist at birth but appears gradually and be stable at 1 year Abdominal reflex（腹壁反射）Cremasteric reflex（提睾反射）Tendon jerk（腱反射）,Pathologic Reflex,4 mon

39、ths Kernig sign(+)2 years Barbinski sign(+),The Song of Growth and Development,一哭二笑三伊呀 四月哈哈望妈妈 五抓六坐握足玩 七翻八爬九叫爸 十站对指十二走 看图说话在十八 两岁能用勺吃饭 喜怒分明命令发 三岁学穿鞋和袜 长成大娃别娇他,Psychological development,Beginning of the cognition processAlternative reactions to environment and stimulationUnconscious attention Conscio

40、us attentionThe stability of the attention,Attention,Nerve action process that depositing and“reading out”the informationFeeling memory Temporary memory repeated recognition repeated reproduce Mechanical memory Conscious memory Logical memory,Memory,Long term memor,Abilities of understanding,memory

41、and comprehensive analysisKey to the intelligence actionConcrete thinking of imagesAbstract thinking of logic and generalization,Thinking,Imagination Formation of figures that never existed or only arise in the future1 to 2 years old:nascent period 3 years old:unconscious imaginationpreschool period

42、:conscious and creative imagination,Imagination,Objective expressions and subjective reflections to scenes or sensePositive mood Negative mood,Mood,Experiences of the relation between humans and objects on the basis of moodEmotion of trust,safety,friendship and honor,Emotion,Psychological actions to

43、 the environmentThinking ways Mood response Action styleInteresting Ability Character Temperament,Personality,Stable,frequent personality and psychology characteristic Formed in post natal periodComparative stability,Character,First formed character after birth,which is always evident and stableVery

44、 important to infants in their mood and sociability improvementEasy child Difficult child Slow warm-up child(启动缓慢）Intermediate type,Temperament,Psychological process of conquering difficulties and reaching expected aimsPositive will:conscious,perseverance,consciously resolute,good continenceNegative

45、 will:reliance,bigotry,impulse,Will,Democrat-Independent,Brave,Intelligent,sociableStrictCruel,Stubborn,Lack of confidenceSpoilCocky,Selfish,Headstrong,Lack of ability in living aloneDifferent education patternsTry to please both sides,Opportunistic,Lying,Parents education may affect childrens character formation,Psychological Disorders,DevelopmentalBehavioral Problems(发育行为问题）Breath holding（屏气发作）Biting thumb（咬指甲癖）Enuresis（遗尿）Children wipe legs syndrome（儿童擦腿综合征）Defiance（违抗）、Temper tantrums（发脾气）Lying（说谎）Sleep disorders（睡眠障碍）Attention-deficit hyperactivity disorder(ADHA)(注意力缺陷多动症）,