Sep 21 2013.

Physical development of the child. Somatomometry. Methods for assessing physical development. Semiotics of disorders of physical development.

Mіnіsternship Okoroni Healthy Ukraine

National Medicine University

ІМ. Acad. O.O. Bogomolts

For independent work of students

Academic discipline	propaedeutics of childhood diseases
Module No.
Thematic module number
Theme lesson	Physical development of the child. Somatomometry. Methods for assessing physical development. Semiotics of disorders of physical development.
Course	3
Faculty	2

1. Specific goals.

Master the skills and technique for conducting somatometry: measurement of body weight, growth (body length), heads of head and chest children of different ages;

Be able to evaluate the metrics of breeding children of different age groups;

Analyze the factors that affect the physical development of children;

Explain the patterns of changes in anthropometric parameters by age of the child;

Familiarize yourself with the basic methods of assessing the physical development of children of different ages;

To learn the types of violations of the physical development of children and the tactics of a pediatrician doctor.

2. Basic knowledge, skills, the skills necessary for studying the topic (interdisciplinary integration)

3. Organization of the content of the educational material.

Physical development -this is a dynamic process of increasing growth, mass, the development of individual parts of the body and the biological ripening of the child;

• one of the main characteristics of the child's health;
• at an early age, physical development reflects the status of the power;
• a set of indicators, which indicate the "Fortress" of the health of the individual, "the reserve of its physical forces";
• a set of signs that reflect the level of age development.

Many factors affect physical development:

• Age;
• Body mass at birth;
• Type feeding (breast or artificial);
• Constitution of parents;
• Environment and health care levels;
• Congenital pathology;
• Chronic diseases

The five indicators of the level of physical development are determined:

• body mass;
• body length (growth);
• head circumference;
• the ratio of body weight to the length (growth);
• body mass index.

Anthropometry -the combination of methods and techniques for measuring the human body as a whole and its individual parts. Allows you to give a quantitative characteristic and assessment of the physical development of a person.

Anthropometric assessment is very widely used in medicine. One of the first procedures, which is carried out after the birth of a newborn baby is an anthropometric study. Many serious diseases can be diagnosed on time on the basis of physical development disorders. This causes attention to anthropometry not only from medical professionals, but also in wide segments of the population.

Mass bodybreast child is determined on special children's scales with the maximum allowable load of up to 10 kg and accuracy of measurement 1g. Weighing is carried out in the morning, after urination and defecation, in the underwear. When weighing a child up to 1 year, first on the tray of the scales put a diaper, then the child's head on a wide part of the tray. The testing of the body's body weight is noted along with a diaper, after which the mass of the diaper should be taken away.

Definitions of the mass of the body of older children are carried out in the morning on an empty stomach on special medical scales up to 50 g.

Body length.Under the length is understood as the size of the child from the legs to the head when measured in a horizontal position, horizontally. Vertical measurement of the same size, standing is called growth. The body's length to a certain extent reflects the level of the body's maturity.

The body length in the horizontal position of the child (lying) is measured in children by age 0-2 years, height in the vertical position of the child (standing) in children over the age of 2 years.

The length of the body in the children's first 2 years is measured in the lying position using a special growth in the form of a board with a centimeter scale. The baby's macushkin must fit tightly to the stationary stap. The head is fixed so that the lower edge of the orphanage and the top edge of the outer auditory passage was on the same level. The feet of the child straighten with a slight pressure on her knees. The movable plate of the growth is tightly pressed against the heels of the child.

If the child is less than 2 years old and there is no possibility to measure the body length in a horizontal position, in which case the growth is measured in a vertical position and the measurement result is required to add 0.7 cm.

In older children, growth is measured using a vertical wagon with a folding stool. The child stands on the player of the header back to the scale. The child concerns the scale of the head, blades, a sacrum and heels. The head is fixed so that the lower edge of the orphanage and the top edge of the outer-dry passage was on the same level. The movable bar is fixed on the scalp.

If the child is over 2 years old and there is no possibility to measure growth in a vertical position, in which case the measurement is carried out lying and from the measurement result, it is necessary to take 0.7 cm.

Circle of head and chestmeasure with a centimeter tape. To determine the circle of the head, the centimeter tape is overlapped at the most speaker point of the backbone, in front of the abnormal arcs.

To measure the circumference of the chest, the centimeter tape is imposed from behind under the bottom corners of the blades and in front - at the level of nipples.

It is also possible to use the measurement of the circles of the shoulder, hips and lower legs.

On April 27, 2006, new norms of indicators of the physical development of children developed by

New growth rates of children developed by WHO confirm the fact that every child, regardless of which part of the world he is born, under the optimal conditions in the first stages of life, has potential opportunities for development within the same range of growth and weight. Naturally, there are differences between children, but the average growth rates of children in large populations at the regional and global level are strikingly similar. New norms indicate that the basis of different growth of children under the age of five is largely nutrition, feeding practices, environmental and health, than genetic and ethnic reasons.

The assessment of physical development is carried out with each compulsory medical review of the child under the age of 3 years. For this, a medical sister is carried out measuring body length / growth, body weight, child head circumference. Measurement results are entered into the corresponding graphs. This makes it possible to see the tendency of the physical development of the child during the time period and timely detect problems. In the overwhelming majority of cases of deviations from the standard pace of increasing body weight and length / growth indicate a violation in a child's health state and require careful analysis of the situation and relevant events.

Body Length Schedule / Growth / Age

Depending on the age of the child, the standard length or growth rate is measured. The value of the indicator body Length / Age For this age, it shows which length of the body / growth acquired a child of this age at the time of inspection. This indicator helps to detect children with a height delay and too high children.

High growth rarely is a problem, with the exception of cases of endocrine disorders.

On the graph, the values \u200b\u200bof the age are laid on the horizontal axis, and on the vertical axis - the length / height of the body in centimeters. The child's age is determined in full weeks under 3 months; in full months - from 3 to 12 months; In full years and months - in the future.

In order to apply body Length / Age For this age, it follows:

1) on the horizontal axis to postpone the value of full weeks, months or years and months. The values \u200b\u200bshould be put on the vertical line (and not between vertical lines). For example, if a child is 5.5 months, values \u200b\u200bare applied to division of 5 months (and not between 5 and 6 months).

2) on the vertical axis to postpone the value of the body length / growth. Dot values \u200b\u200bshould be put on or between horizontal lines. For example, if the child's body length is 60.5 cm, apply a value to a cell between horizontal lines.

3) After applying points on the results of two or more inspections, it is necessary to connect the points of the straight line to build a curve and see the dynamics.

4) Check if there are points to the chart correctly, and, if necessary, repeat the anthropometric measurements. For example, the child's body length should not be less than the value of the body length in the previous review. In this case, one of the measurements was incorrect. Therefore, it is necessary to clearly adhere to the technique of conducting anthropometry.

Graphs body weight / age

The body weight for this age shows which weight of the body scored a child of this age at the time of inspection. This indicator is used to determine whether the child has insufficient or too low, but not used to determine overweight or obesity.

In order to apply a body weight for this age follows:

1) on the horizontal axis to postpone the value of age in full weeks, months or years and months. The points of the value should be put on the vertical line (but not between vertical lines).

2) on the vertical axis postpone the body weight value. Value points should be placed on the horizontal line.

3) After applying points on the results of two or more inspections, connect them between themselves straight line to build a curve and see the dynamics.

Body Mass Ratio Charts / Body Length / Height / Age

Schedule of body weight ratio to body length / growth it helps in identifying children with a very low mass body and children with a high mass ratio to body length / age, which may indicate the risk of overweight or obesity.

On this schedule, the length of the child's body length or growth in centimeters is postponed on the horizontal axle, and on the horizontal axis - the weight of kilograms.

In order to act on the chart, the value of the body weight ratio to the body length / growth should be:

1) on the horizontal axis to postpone the length of the body length or growth. Value points should be put on the vertical line. It is necessary to round the value to the nearest integer centimeter.

2) on the vertical axis apply the mass value. Points of value to put on or between horizontal lines.

3) After applying the ratios of body weight to the body length / growth over the results of two or more examinations, connect the points of the straight line to build a curve and see the dynamics.

Schedule body mass index / age

The body mass index (BMI) is used to perform abundance and obesity screening.

As a rule, the CMT graph for this age shows the results similar to the results of the graph of the mass ratio to the body length / growth of the child.

At this schedule on the horizontal axis, the values \u200b\u200bof age are postponed in full weeks, months, or years and months.

The vertical axis is postponed by BMI.

The body mass index is determined by the formula: the value of body weight in kg is divided into growth in a square (kg / m²).

Growth indicator must be translated into meters. The result of calculations is rounded to the tenths.

In order to apply a child body index index for this age, follows:

1) on the horizontal axis to postpone the value of age in full weeks, months or years and months. The values \u200b\u200bshould be put on the vertical line (and not between vertical lines).

2) on the vertical axis to postpone the value of the BMI. Value points should be placed on the horizontal line or between the lines.

3) After applying the results of two or more inspections, connect their straight line to build a curve and see the dynamics.

Interpretation of indicators of physical development

The interpretation of indicators of physical development depends on where the indicator of physical development on the schedule is.

The value of physical development indicators that are above or below the standard deviation lines (CO) are interpreted as follows:

1) the values \u200b\u200bthat are between the lines of standard deviations "-2" but "-3" are considered below the standard deviation line "- 2"

2) The values \u200b\u200bthat are between the lines of standard deviations "2" and "3" are considered above the standard deviation line "2".

If, the indicator is directly on the standard deviation line, it is believed that this value falls into the category of smaller gravity. For example, if the mass index for this age is on the line "-3", it is believed that the child has insufficient weight, but not extremely insufficient weight.

The following table provides information about the definition of physical development problems, given the standard deviation.

It is necessary to compare the indicators applied to the chart of the physical development of the child, with the CO lines

to determine where the index of physical development is located in relation to the standard deviation lines. Measurements that fall into painted cells are within the normal range.

Interpretation of standard deviations of physical development

standard deviations	indicators of physical development
	Body Length / Growth for this age	Mass for this age	Mass ratio towards body length / growth	BMI for this age
Above 3.	Cm. Note 1.	Cm. Note 2.	Obesity	Obesity
Above 2.	Norm		Excess weight	Excess weight
Above 1	Norm		Excess weight is possible (See Note 3)	Excess weight is possible (See Note 3)
0 (Mediana)	Norm	Norm	Norm	Norm
Below -1	Norm	Norm	Norm	Norm
Below -2	Rose delay (Cm. Note 4)	Insufficient weight	Depletion	Depletion
Below -3	Excessive height delay (Cm. Note 4)	Excessive lack of weight	Significant exhaustion	Significant exhaustion

Notes:

1. Child, whose growth indicators fall into this category is very high.

High growth is rarely a problem, with the exception of cases when it may indicate the presence of an endocrine disorder (for example, a tumor that produces growth hormones). If you have a suspicion of endocrine disorders, the child should be sent to a consultation to a specialist (for example, if a child is too high for his age parents).

2. Child, whose mass rate for this age falls into this category, may have a problem of physical development, but such conclusions are better to do on the basis of analyzing the ratio of the mass ratio to the length of the body / growth or BMI for this age.

3. The indicator that is above line 1 of the standard deviation means a reliable risk. Rising dynamics in the direction of the standard deviation line 2 indicates the presence of risk.

4. There is a possibility that a child with a delay or significant increase in growth will have overweight.

To make a conclusion about the physical development of the child, you need to evaluate all the graphs of physical development and the results of the child's observation.

The previous table demonstrates the problems that can be detected by considering only one indicator of physical development. However, it is very important to take into account all the graphics of the physical development of the child. The assessment of all the charts of the physical development of the child together helps determine the nature of the problems. It is also necessary to look at the dynamics of indicators for the observation period of the child.

For example, if a child has an insufficient body weight according to a body weight schedule for this age, a chart of the body length / growth for this age and the mass ratio to the length / growth should also be considered.

Body Length Indicator / Height / Ageshows an increase in the growth of the child. The delay in physical development (the indicator of the body length / growth for this age below the line "-2" may indicate that for a long period of time, the child received nutrients in an amount, insufficient to ensure normal growth of the child, such / or that the child often sick. Child with The delay in physical development may have normal indicators of the body weight ratio to body length / growth, but have low body weight indicators for this age due to low growth.

Ratio Indicator Body Mass / Body Length / Growthbelow the line "-2" of the standard deviation may indicate a significant malnutrition of the child of the case, which caused a sharp loss of mass.

Indicator body mass index for this age.

BMI, as a rule, does not grow with age, in contrast to mass and growth. BMI is growing sharply when the child quickly picks up a mass in relation to growth in the first six months of life. BMI decreases later under the age of year and remains stable from 2 to 5 years of life. The indicator of BMI for this age is similar to the indicator of the mass ratio to the length of the body / growth and is used as screening for excess body and obesity. In the interpretation of the risk of overweight, it is worthwhile to take into account the weight of the child's parents. A child who has one of the parents is obesity, has a 40% risk of overweight, if the child both parents suffer from obesity, the risk of excess weight increases to 70%. It must be remembered that excessive mass and obesity can exist in parallel with the delay of growth.

Interpretation of the dynamics of the charts of the physical development of the child

To determine the dynamics of the physical development of the child, analyze the dynamics of physical development indicators that are applied to the schedule based on the results of several inspections. The dynamics may indicate a good physical development of a child, or that the child has the risk of problems, and it should be expressed again.

"Normally," the graphics of the physical development of the child will take place in parallel with the median (line that is indicated on each graph) or parallel to the standard deviations.

When interpreting the charts of the physical development of the child should be aware of the following situations that may indicate the problem or risk:

• The physical development curve of the child crosses the standard deviation line;
• In the graph of physical development of the child there is a sharp rise or a decrease;
• The lack of positive dynamics on the charts of the physical development of the child (the mass or growth of the child does not increase).

Assessing the aforementioned cases depends on when changes in charts began and what direction are their direction. For example, if the child was sick and lost weight, rapid weight gain (demonstrated by a sharp rise in the chart) can be a positive sign that the child "caught up in development."

It is important to analyze the situation as a whole when interpreting the dynamics of the graphics of the physical development of the child.

Standard Deviation Line

The intersection of the physical development curve of the child's standard deviation line indicates a potential risk. The risk interpretation is based on where, in relation to the median, changes began, the dynamics of these changes, with compulsory accounting of anamnesis:

• If the physical development curve crosses the standard deviation line, it means that significant changes took place in the development of the child.
• If the physical development curve has acquired a direction to median, it means that changes have a positive trend.
• If the physical development curve has acquired a direction from median, this is a testimony of risk or problems.
• If the physical development curve of the child runs next to the median, it is crossing it from time to time, this is normal.
• If the physical development curve grows or falls, while crossing the standard deviation line, the analysis should be carried out, since this trend can be evidence of the problem.

For example: with timely identification of the trend towards redundant or insufficient mass, it is possible early interference with the aim of correction and warning problems

A sharp rise or reduction of the physical development curve

Any sharp rise or reduction in the physical development curve requires attention. If the child has a sick or not enough, during the period of restoration of normal nutrition, a sharp rise in the curve is expected, since the child "catchies" in development. In another case, a sharp rise in physical development curve indicates a change in the nature of the child's nutrition, which led to overweight.

• · If the child quickly gained mass, it should be estimated its length / height.
• · If only the child's mass increased, this indicates a problem.
• · If the weight and growth of the child increased in proportion to, it means that the child "catch up in development" due to improving nutrition or the child recovered after the disease. In such a situation, the curve of the mass indicators for this age and the body / growth curve for this age should take place, while the graph of the mass ratio to the length of the growth body will have a constant dynamics parallel to the standard deviation line.

• · A sharp decline in the curves of the physical development of a healthy child or child who has undergone, testifies to the problem of development that requires interference and treatment.
• · If a child has an excessive mass, a sharp reduction in body mass curve is not normal. There should be no sharp drops in the physical development schedule, since a sharp weight loss is undesirable. A child with overweight must hold his weight, increasing growth.

No dynamics of physical development curve

The absence of the dynamics of the physical development curve (stagnation), as a rule, indicates the problem:

• If the mass of the child remains unchanged for a certain period of time, while the child's growth increases, the child is most likely a violation.
• If the growth of the child remains unchanged throughout a certain period of time, it means that the child does not grow. The exceptions are situations where a child with overweight or obesity holds its weight throughout a certain period of time, achieving a healthier mass ratio to an increase or body mass index for this age.
• If a child with overweight loses weight, and the mass loss is moderate, the child's growth must continue to increase. However, if the growth of the child does not increase over time, it indicates a violation.
• No dynamics in children of the first 6 months of life (i.e., those who need to grow rapidly), even for 1 month, indicates a potential problem.

Tactics when identifying deviations in the physical development of the child

1) It is necessary to establish the cause of deviation in physical development:

• eliminate the states threatening to the child's life;
• conduct nutrition;
• to conduct a survey, if necessary, with the involvement of specialist doctors (doctor-endocrinologist of children's, genetics, neurologist of children's, others for testimony).

2) Conduct consulting from feeding and nutrition.

3) appropriate treatment in case of detection of the disease.

Deviations in physical development need consultations of specialist doctors and should be taken into account when establishing a clinical diagnosis. In any case, the assessment and interpretation of the indicators of the physical development of the child is necessarily carried out in dynamics.

Semiotics of disorders of physical development

Possible causes of increasing growth

• initial high growth (family predisposition)
• hypophyseal giantism
• hypogonadotropic hypogonadism, idiopathic eunuchoidism
• high height with adrenogenital s - me (Pseudopubertas Praecox)
• giantism in obesity (a special form of puberty or prepubertate obesity; C-M Laurence-Moon; Barda-Bidla; cerebral giantism (s-m sotos))
• chromosomal aberrations, hereditary diseases (C-M Calinefelter, C-M Martha).

Possible reasons for increasing growth

• Constitutional (family) low growth;
• Alimentary lowness (glycogenesis, insufficient nutrition, with quasororecore, frequent vomiting as a result of anatomical anomalies, digestive disorders and suction).
• Low growth due to hypoxemia (chronic diseases of the lungs and respiratory tract, heart disease, chronic heavy anemia).
• Low growth in intermediate exchange violations: kidney pathology, liver cirrhosis, glycogenosis, lipidose; Rachi-like diseases, pseudogopoparatyosis.
• Low growth on the soil of cerebral pathology (slow brain tumors, residual phenomena of stem encephalitis, microencephalia, porencephalia, hydrocephalus, alcohol embryochia).
• Against the background of hormonal pathology, the pituitary lowness caused by the pituitary depth of the pituitary gland, primarily the insufficiency of the somatotropic hormone, often with a simultaneous decrease in gonadotropin products and thyrotropic hormone; PHIPPOPUTUTARISM (reducing all the functions of the pituitary gland, the disease of Simmononds); Low height in hypothyroidism, adrenal lowness - C-M Kushing, long-term corticosteroid therapy, adrenogenital s-m.
• Other reasons for shortness: C-M Feline Creek, Whether (C-M Guteinson-Gilford), S-M Russell, C-M Alstrema.

Possible causes of increasing body weight

• Physiological predisposition for obesity
• Macro of newborns
• Children from materna patients with diabetes
• Bekvita-Vidman Syndrome
• Obesity caused by many factors (constitutional, unreasonable high-calorie food, adverse mental and social conditions, physical disadvantages)
• Obesity as a characteristic sign of the main disease
• Obesity under cerebral diseases (diancefal or diancefral-pituitary obesity, adiposogenital dystrophy)
• Obesity for endocrine disorders (hypothyroidism, hypercorticism)
• Obesity with chromosomal anomalies (Mongoloidism, Turner syndrome)
• Obesity for primary metabolic disorders (type 1 glycogenosis)
• Obesity with other syndromes (Laurence Muna; Barda Bidla, Prader-Willie, Alstrema)

Possible causes of body weight

• Constitutional factors (presence, newborns with intrauterine hypotrophy, marfan syndrome, progressive lipodystrophy)
• Exogenous factors (incorrect low-calorie nutrition, incorrect care, severe infections)
• Other lesions associated with infringement of metabolic processes (malignant tumors, nephrisus, long-term cytostatic therapy, children's cerebral paralysis, liver cirrhosis, chronic renal failure, galactosemia)
• Chronic digestive disorders
• Disorders of vascularization walls of the intestine
• Failure failure (cystic fibrosis, pancreatic failure, shvachman syndrome, hepatitis, atresia or stenosis of biliary tract, congenital lipase deficiency)
• Cropped preliminary digestion. Condition after resection of the small intestine.
• Impaired suction in the intestinal wall (Malabsorption; celiac disease; impaired suction of monosaccharides, disaccharides, vitamin B12, tryptophan; congenital insufficiency enterocinate; enteropathic acrodermatitis)
• Heavy anatomical digestive tract anomalies
• Hormonal violations
• Psychogenic reasons

Applications.

Questions for self-control:

1. Give the definition of the concept of "physical development."
2. What factors affect physical development?
3. What are the parameters of physical development?
4. How should interpret the dynamics of the mass ratio to the body length?
5. How should I interpret the dynamics of the body mass index?
6. How should interpret the dynamics of physical development indicators?
7. What does the intersection of the graphic of the physical development of the standard deviation line indicate?
8. What does the lack of positive dynamics on the physical development schedule?
9. What does the sharp rise or a decrease in physical development schedule?
10. What tactic pediatrician when identifying deviations in the physical development of the child?
11. What factors may be causes of body weight increases?
12. What factors may be causes of body weight reduction?
13. What factors can be the causes of increasing growth?
14. What factors can be reasons of growth delay?

Practical tasks.

1. holding the weighing of children of early and older.

2. Measuring the growth of children of different ages.

3. Measuring the length of the body's body of young children.

4. Calculation of body mass index to children up to 3 years.

5. Application of physical development indicators for relevant graphics

6. Measurement of the circles of the head and chest.

7. Assessment of the physical development of children of different ages.

Literature.

Main:

1. Maidannik V.G. Propaedeutic pediatric
2. Captain T. Propaiety of Diatychychiki Zhvorob is a bark for d_timi. - Vіnnitsya. 2006.
3. Order No. 149 of 03/20/2008 "About the hardening of the Klіnіny Protocol of the Medical Bottom for Healthy Dithinum Vіkom up to 3 Rokiv"

Additional:

1. Propaedeutics of children's diseases. - Ed. Acad. A.A. Baranova. - Moscow. 1998.

Patterns and current trends in the physical development of children of different ages

The physical development of each child and the children's population as a whole is determined by genetic factors, social and hygienic living conditions and is an indicator of the quality of medical support by the healthcare system. Deviations in physical development are associated with genetic factors, nutritional condition, chronic diseases, motor activity, climate, place of residence and other influences of the external environment.

The concept of physical development is interpreted in domestic literature very ambiguous. In a wide wholebiological sense, physical development is considered as the process of the formation and change of morphofunctional properties

But the most successful definition of the concept of physical development is such. Physical development understand the process of becoming the formation and change of morphofunctional

the properties of the body, physical qualities and abilities, which are carried out under the influence of living conditions and education during the life and from generation to generation.

In clinical pediatrics, the term "physical development" understands the dynamic growth process (an increase in body length and mass, the development of individual parts of the body, etc.) and the biological ripening of the child in different periods of childhood. The pace of physical development at each stage of ontogenesis depends on the individual characteristics, social factors, the region of residence, etc.

The level of physical development in childhood is one of the objective indicators of health status. This is due to the fact that physical development indicators are closely interrelated with numerous factors that influence the health of children, and is the result of the interaction of genetic factors and environmental factors (sanitary and hygiene conditions, feeding and nutrition, physical education, day, etc. ) .. In addition, physical development is a fairly sensitive indicator, which is easily changing under the influence of various adverse factors, especially environmental conditions. Therefore, this assessment of the level of physical development of the child is an integral element of control over its health and occupies an important place in the practical activity of a pediatrician.

Assessing the physical development of children, it is necessary to know the mechanisms and patterns in different periods of childhood.

As already noted, the growth processes are deterministic near the endo and exogenous factors, including food. The main growth regulators is the growth hormone (gr) and rillation hormone growth hormone (RG-OS). It is known that the OS does not stimulate the growth of bones or cartilage in vitro. Under the influence of GR in the liver, one of the somatomedine is synthesized - insulin-like growth factor-1 (IFR-1), which stimulates the cartilaginous plates and controls the неходранна СОссифии. It is believed that the IFR-1 stimulates the proliferation and differentiation of bone and cartilage cells by increasing the absorption S04 and the inclusion of it into chondroitin sulfate, stimulating the synthesis of proteins and mitotic activity.

At the stage of intrauterine development, the most intensive increase in the length and mass of the body is observed. But it happens unevenly. In the first two months, the length of the body of the embryo increases little, while in the 2nd-4th of the month increases significantly. On the 9-10th month of intrauterine development, the growth of the fetus is slowed down.

The introduction of an ultrasound scanning method (UZD) in the obstetric practice is significantly expanding and complements the possibilities of researching the state of the fetus and its physical development. Echography allows you to conduct visual observation of the physical development of the fetus in the early stages of its gestation, provides timely tactics in the treatment of various violations in the mother-placental-fruit system.

Features of the growth of the fetus in healthy women in the dynamics of pregnancy in modern conditions are studied using sonography to assess the development of the fetus in the physiological course of pregnancy. Using a real-time ultrasonic apparatus, the following indicators are measured: up to 20 months. Pregnancy - Copchikova-Damp Size (CRT), Biparic Head Size (BPD), Middle Abdominal Diameter (SJD) and Hip Length (DS), after 20 weeks. - BPR, average diameter of the chest (SDH), SJ, DS, lower leg length (DG), shoulder bone (DP) and forearm (DPER), indices BPR ratio to ADH (BPD / SDH) and to SJD (BPD / SDG) . The average weekly increase in the specified parameters is also defined. /

The results of the Sonography indicate that the chairman of the embryo begins to be visualized at the sonogram after 7 months. Pregnancy, its diameter does not exceed the transverse size of the body. The embryo CRT during this period is equal to (19.9 ± 0.42) mm. Up to 10 months It is possible to clearly visualize and measure the DS, which is (10.0 +0.51) mm. BPR in this period of pregnancy is (17.5 +0.40) mm, CTR - (36.0 +0.50) mm. After 13-14 weeks. Pregnancy is clearly visible many anatomical formations of the fetus. It is easy to measure the BPR, SJ, DS and various attitudes of these indicators, u ° allows you to obtain important information about the growth and development of the fetus and establish possible deviations in embryo and fetogenesis. CRT to 15 weeks. Pregnancy reaches (91.5 ± 0.41) mm.

The relationship between pregnancy (\\ c) and the CTR is determined using the equation:

\\ B \u003d 13,9664 kP - 4,1993 + d + 2,155,

where D is the number of days from the beginning of the last menstruation to the exactly known date of conception or calendar middle cycle; \\ B - the term of pregnancy, week; CRT, see

With an increase in the period of pregnancy, an increase in the absolute values \u200b\u200bof echographic parameters is observed, but the growth intensity of the anatomical formations of the fetus in different times of its gestation is non-etinakov (Table 5.6). The weekly increase in BPR gradually decreases from 3.5 mm at the 15th month. pregnancy up to 1.9 mm end of it; Intensity of the increase in the SDG up to 20 weeks. Pregnancy increases from 2.8 to 5 mm. The rate of increment of DS increases at the 18th week to 3.9 mm, and then decreases and at the 20th week is 3 mm.

In the second half of pregnancy, the growth rate of the anatomical formations of the fetus is also different (Table 7). There is a gradual slowdown in the weekly increase in the BPR and the length of tubular bones. The speed of increasing the SJ and SDH decreases to the 32nd week of pregnancy, then increases and from the 33rd week exceeds the BPR. Weekly increments of the chest diameter of the end of pregnancy (37-40 weeks) slowed down significantly.

It should be noted that important indicators for the diagnosis of violation of the development of the fetus are not only absolute values, but also a weekly increase and different relations, especially the BPR / SDG (Crane Change Index) and the BPD / SJD (Campbell Index). The course of pregnancy occurs a systematic decrease in the relationship between the BPR / SJ and the BPD / SDH. Starting from the 33rd week of pregnancy, these indicators are aligned. At the end of pregnancy, the SJ and SDH exceed the BPR, and their ratio is less than 1. in the second half of pregnancy, despite the absolute increase in the length of the tubular bones of the fetus, there is a slowdown of their growth rate. Moreover, on the 29-32th week, the growth rate of the bones of the lower limbs exceeds such the upper. Attention should also be paid to the fact that starting from this period of pregnancy, the growth rate of the shoulder bone is most slow.

Thus, when analyzing the echographic indicators of the fetus, healthy women identified the features of the growth of its individual anatomical entities in the case of physiological course of pregnancy, it is necessary to take into account, assessing the physical development of the fetus.

In clinical practice, the empirical formula of Haase is used to estimate the body length of the fetus depending on the period of pregnancy:

a) During the first 5 months. The intrauterine development of the fetal body length is equal to the square of the month of pregnancy: b \u003d p2 (cm);

b) after 5 months. Fetal body length is equal to the number of months multiplied by 5: b \u003d p 5 (cm).

The mass of the fetus body increases as much as possible at the 34th week of pregnancy. Between the 36th and 40th weeks of pregnancy, the intensity of body weight increase slows down.

To determine the body mass of the fetal, use such an approximate calculation: the mass of the fetus body at the 30th week of pregnancy is 1300 g, for each subsequent week it is necessary to add 200 g, and for each previous week, to make 100 g. In such a calculation can be used in the period between 25 42nd weeks of pregnancy.

Before birth, the body of the fetus reaches 3000-4000 g. The average body weight of boys at birth is 3200-3400 g, and girls are somewhat less - 3100-3300 g.

It should be noted that in the first half of the XX century. There was a significant spread increase in the mass and growth of newborns. In the 60s, the tempo of this process slowed down noticeably. When studying the dynamics of indicators of the physical development of newborns in Almaty, from 1946 to 1976, some periodicity was revealed. Thus, in the second half of the 40s and in the first half of the 50s, there was an increase in indicators, then a stabilization period was occurred, and since the beginning of the 70s, there was an increase in the indicators.

In particular, when studying the dynamics of body weight of newborns, it was concluded that over the past decade the number of children with a body weight at birth more than 4000 g decreased from 9.1 to 6.6% and, accordingly, the number of children with a mass of 3501 - 4000 g from 28 3 to 31.1%. In tab. 8 shows the distribution of newborns by groups depending on the body weight at birth.

During the first four days of life, the newborn shows a decrease in the initial body weight, that is, the so-called physiological decrease is happening. The maximum reduction in body weight is celebrated on the 3rd day of the child's life and is an average of 6-8% of the initial mass. Reducing the initial mass of the body over 10% is considered pathological, which indicates the presence of a child from a child or disruption of it.

physiological decrease in body weight is due to: large extra-renal losses of fluid by evaporation through the skin and lungs with breathing (regheurigago icpviaisis), the yield of initial urine and semination, the vomiting of the sinking fluid, drying out the umbilical residue, as well as fasting, since during 6 -12 hour. The child usually does not get food. At the same time, premature feeding of the child (after 2 hours after birth) does not prevent the physiological decrease in body weight, but only reduces its degree.

The next increase in body weight occurs in newborns is not the same. Distinguish two main types:

a) "The perfect type" (type of bud) - with it, the restoration of the initial body weight is observed on the 7-8th day after birth. It occurs in 20-25% of newborns;

b) Slow type (type of pussy) - is characterized by a slow gradual restoration of the initial mass of the body for 11-15 days. This type of curve is observed in 75-80% of newborns.

In premature babies and newborns with a large body weight at birth (more than 4000 g), the initial mass of the body is significantly slower.

After restoring the initial mass of the body, it continues to grow and for the first month of life increases on average for 600 g. During the first half of life, the average monthly increase in body weight is 800 g, the second half of the year - 400 g.

Taking into account this, for the estimated calculation of the mass of the body of children in the first and second half of life, it is possible to use in accordance with such empirical formulas:

a) T \u003d T + 800 P;

b) T \u003d T + 800 6 + 400 (P-6),

where M is the mass of the child at birth, G P is the age of the child, month.

As a rule, up to the year, the mass of the child's body reaches 10 kg, that is, roughly increases. However, in children after the first year, the energy increase in the mass of TSH is noticeably weakened. In the second year of life, the child adds on average 3-3.5 kg, and from the third year of life - annually on average 2 kg.

Approximately body weight of children from 2 to 10 years can be calculated by the formula:

t (kg) \u003d 10 + 2p,

where n is the age of the child, the year, 10 is the mass of the child at the age of 1 year 2 - the summer gain in body weight.

The calculation formula can be used to 10 years. The middle mass of the child's body at the age of 10 is 30 kg. In the future, the summer gain in the weight of children over 10 years is 4 kg. It is possible to calculate it by the formula:

t (kg) \u003d 30 + 4 (P-10), where N is the age of the child, the year.

As for the length of the body, it is in the middle of the birth at birth at the average equal to 50-52 cm, and the boys are 2 cm more than girls. In the first 3 months. His growth in his life increases on average on with cm monthly, in the second quarter (4-6 months) - by 2.5 cm, in the third (7-9 months) - 2 cm and in the fourth quarter (10-12 Mon.) - 1-1.5 cm per month. Thus, during the first year of the child's life, its growth increases by an average of 25-27 cm or, accordingly, until the end of the year - by 50% of the initial one. The doubling of the initial growth of the child is observed in 4 years, tripling - in 11-14 years.

It is the growth of a child in 4 years is the initial for indicative calculations. It is believed that at 4 years old, the growth of the child is average 100 cm. Therefore, growth (b) in children over a year can be determined according to the following empirical formulas:

a) in children up to 4 years old: b \u003d 100 - 8 (4 - n);

b) in children over 4 years old: b \u003d 100 + 6 (P - 4),

where n is the age of the child, the year.

The above laws of physical development to the infant children, but, according to statistical data, 5-6% of all newborns are premature

children who are inherent in their features of psychomotor and physical development, organism reactivity. The development of prematurely in the postnatal period depends on the duration and conditions of intrauterine development, as well as on environmental conditions (care, feeding, education). All of these factors determine the adaptive capabilities of a premature child to new existence.

For premature children, higher rates of physical development are characteristic. In particular, children born with a body weight of 2001-2500 g, at the age of one year had such a lot of body: girls - 105751596, boys - 10 164 +398

The premature children of the second group (body weight at birth within 1501-2000 g) had a body weight in the summer, respectively, 9076 ± 211 g and 9650 ± 211 g, in the third group 8650 ± 264 g and 8960 +289

The average monthly increase in weight in premature children in the first year of life is given in Table. nine.

Thus, if the injured children have a body weight over the course of the year, it turns out of times, then in the prematurest children of the first group until a year, the body weight rises by 4.6 times, the second - in 5 and third - by 6.5 times. Especially intensively grows by the mass of premature babies with a body weight at birth to 1000 g. In children, the body is primary at birth increases 8-10 times. However, despite the high rates of body weight gain, children born with a mass, less than 2000 g, up to the year do not catch up with their diligent peers in this indicator.

The growth of premature babies with a body weight at birth more than 1000 g during the first year of life increases by 26.6-38 cm; In the first half of the year, it is 2.5-5.5 cm monthly, in the second half of the year - by 0.5-3 cm. Middle growth of the premature child one year reaches 70.2-77.5 cm.

The growth of premature children in the first year of life increases by an average of 27.1-32.1 cm. In the first half of the year, a monthly increase in growth is 3-3.75 cm, in the second - 1.5-2.1 cm. Children of the first group with Body long at birth 44.1 -44.8 cm up to year have height: girls - 71.9 ± 1.26 cm, boys

74.6 ± 1.37 cm, the second - with an increase of 42.1-42.8 cm -, respectively, 73.4 ± 0.9 cm and 74.2 +1.3 cm, the third - with an increase of 42.8-38 , 1 cm -, respectively, 68.9 ± 2.27 cm and 70.1 ± 3.42 cm. The acquisition of the mass and the length of the body of premature children is significantly dependent on the floor of the child.

Interesting data were obtained with a remote examination of children born with a body weight of 900-1500 g. Analysis of the results shows that even in 8-9 years after birth, deeply premature children differ in their physical development from the ended peers (Table 10).

An important indicator of the physical development of the child is the proportionality of body sizes. The child at birth is different from an adult relatively short legs, a long torso, a big head (Fig. 5). As the child grows and the development of the child, the proportions change: the sizes of the head relative to the length of the body are reduced, and the length of the hands and the legs increases. This is explained by speed

growth of individual body segments. Starting from the prenatal period, speed

foot growth relative to the body and hands are higher. So, in the period of growth with a change in body length per 1 cm. Only 1/4 of this increase is on the length of the body, 3/4 is the increase in the length of the legs.

The transverse dimensions of the child (the perimeter of the head, chest, etc.) also increase unevenly. The newborn perimeter of the head is on average 34-36 cm. In the future, it increases intensively in the first months and years of life, and from 5 years - slows down. To determine the perimeter of the head in breast-age children, the data of the head perimeter at a six-month-old child is used - 43 cm. For each missing month from 43 cm, 1.5 cm is torn to each subsequent - 0.5 cm.

As a rule, in the first year of life, the perimeter of the head is 46-47 cm, in 5 years - 50 cm, at 10 years - 55 cm.

Another important indicator for assessing the physical and harmonious development of the child is the perimeter of the chest. its magnitude closely correlates with functional

respiratory and cardiovascular systems. The perimeter of the chest at birth is 2 cm less than the head circumference, and averages 32-34 cm. In the future, the perimeter of the chest increases more intensively than the perimeter of the head, and in 4 months of age, the "intersection" occurs, i.e. . The magnitudes of the perimeters of the head and the chest are equalized.

Perimeter of chest at 6 months. It is 45 cm. For each insufficient month, with 45 cm, 2 cm is calculated, for each subsequent - 0.5 cm. The empirical formulas to determine the perimeter of the chest have the following form:

a) for children up to 6 months: 45 - 2 (6 - n),

b) over 6 months: 45 + 0.5 (P - 6),

where n is the age of the child, month.

For children from 1 to 10 years, the formula is used:

63 - 1.5 (10-P),

for children over 10 years old:

63 + 3 (P -10),

where N is the child's age, of the year, 1.5 or 3 cm - the average increase in the busty circumference for the year; 63 cm - the middle circle of the baby's chest at 10 years.

The magnitude of the perimeter of the chest end of the first year of life is 47-48 cm, at 5 years - 55 cm, at 10 years - 63 cm.

An anthropometric indexes, reflecting the relationship between the linear dimensions of the individual parts of the body, are also used to characterize proportionality, indicate the features of the form (constitution) of the body and complement the characteristic of the physical development of the child.

Physical Development Indices are divided into mass-growth, breast-growth and more. They can be arithmetic, if the actions when calculating the index are limited to adding and subtraction, and geometric, if divisions and multiplications are used.

Prior to more than 50 mass-growth indices, but only those that meet the following criteria have practical significance: a) closely correlated with a body weight b) minimally correlated with growth in) are easily calculated.

Anthropometric indexes that are called "form maturity indices" are simple, available and have such a pronounced age dynamics and close relationship with the functional characteristics of the body, which grows, giving information about the rates of biological maturity of children. However, despite the widespread use of these indices, it is necessary to take into account their certain convention. This is due to the fact that the basic in the development of indices is the concept of a proportional mass-growth ratio, which many researchers are not supported. It has been established that the ratio of the size of the parts of the body is more complicated. Many sizes varies not proportionally, but heteromorphic. Therefore, it is necessary to take into account the complex of anthropometric indicators and indices, allowing to improve the overall result of the assessment of the physical development of children.

Among numerous indices are often used.

Dadchulitko index, th, which is calculated: 3 shoulder circumference (cm) +

hip Circle (CM) + Surplug of Blood (CM) - Body Length (cm). This index characterizes the degree of respancies of the child (the development of fat subcutaneous fiber), and also evaluates the development of muscles in relation to growth. The index value is normal: up to a year - 20-25 cm, 2-3 years - 20 cm, 6-7 years - 15-10 cm, up to 6 cm gradually decreased to 6 cm. Reducing the index confirms the lack of fatness of the child .

Index F. F. Erisman (IE), which characterizes the development of the baby's chest cell and partially its randomness \u003d chest circumference (cm) - height / 2 (cm). In healthy children of the first year of life, the magnitude of this index is + 13.5-10 cm, in 2-3 years - + 9-6 cm, in 6-7 - + 4-2 cm, at 7-8 years - 0, but better if up to 15 years of the index value is within + 1-3 cm. In adults, there is an average of 5-6 cm. The value of IE should be positive up to 6-8 years, and the better physically developed child, the later The chest circumference is equal with a drinks.

Index O.F.Tura, which characterizes the ratio of the circle of the head and the chest. At the age of 1-7 years, the circle of the chest exceeds the head circumference to so many centimeters, how old is the child.

The calculation of anthropometric indexes and studying the proportions of the body in different age periods of childhood indicate that the predominance of the growth rate of one part of the body is characterized by the predominance of the growth rate of one part of the body over others (hetero-dynamic growth). In childhood, against the background of continuous growth rate, which decreases from birth to maturity, children appear in children.

In pediatric literature, it is customary to enjoy the classification of periods of growth proposed in 1903 by the Phatetell and in 1911. Weissenberg. The maximum speed increase in all indicators of physical development is registered by the fetus and children of the first year of life. Further observed

two periods of increasing body length. The first period of "pulling" ("jump") falls for 5-8 years, the second - for 11-15 years. At the same time, the second "pulling" in girls is observed at an earlier age - in 10-12 years, the boys - at 13-15 years old (Fig. 6). At the age of 1 -4 and 8-10 years, a more intensive increase in transverse dimensions and muscle increase is the so-called "rounding" periods.

But this point of view on the dynamics of growth of children has recently requires clarification. An analysis of anthropometric indicators, in particular body length, found that an existing look on the peculiarities of the dynamics of body length in preschool age may probably be revised .. so, it was believed that at the age of 3-4 years, a decrease in growth rates to 4-5 cm per year and a sharp increase in 6-7 years. Our data show that intensive growth rates of body length are observed from 3 to 4 years (boys - 8.88 cm, girls - 8.65 cm). The growth rates are relatively slowed down in 6-7 years (respectively - 7.08 and 5.44 cm), which indicates the "rejuvenation" of the age of the second growth "jump". This is probably due to the acceleration process. In most age groups, the boys were slightly higher and harder from girls, but the difference is statistically not significant. Starting from 6.5 years of age, body weight indicators are reliably higher in girls. The age-wide dynamics of the circumference of a difficult cell corresponds to changes in body weight. Intensive summer increase in the circumference of the chest and body weight is observed at 6-6.5 years.

In contact with

Federal State Budgetary Educational Institution
higher education
"Bashkir State Medical University"
Ministry of Health of the Russian Federation
Department of Propedeutics of Children's Diseases
Physical development of children.
Factors affecting physical development.
Laws of Physical Development and Principles
Estimates. Semiotics of disorders.
Lecture for students
Specialty - 05/31/02. - Pediatrics
Discipline - propaedeutics of children's diseases
Professor Hairedinova T.B.
2016

Physical development is a dynamic process of growth and biological ripening of a child in a particular period of life

Physical development is a totality
Morphological and functional
signs in their relationship and dependence on
ambient conditions characterizing
The ripening process in each given
moment of time
WHO determines the figures of physical
development as one of the fundamental
Criteria in a comprehensive status assessment
Child health.

Criteria for assessing physical development:

Body mass
Body Length
Head circumference
Circle chest
Cells
Proportionality
These indicators

Assessment of the physical development of children is necessary, since:

physical development violation may be the first
clinically detected signs of chronic
diseases, chromosomal and genetically determined
pathology;
The emergence of the lag in physical development can
be a sign of insufficient nutrition
improper education and disorders of hygiene in the family;
Anthropometric examination is necessary for
establishing the biological age of a child, the pace of his
biological ripening.

Medical factors are directly related to the growth and development of the child.

Power factor
Irrational feeding maybe
lead to blocking the genetic program.
Growth rate is directly proportional to the number
Protein in the diet, the presence of vitamins
and trace elements.
Mode
- Adequate Son.
- Properly organized waking mode
Psycho-emotional stimulation
Climato - Geographical Conditions
Chronic diseases

Basic Children's Growth Laws

The law of absolute growth - the law of the steady
Growth and development of the body.
The law of steady braking energy of growth
- slowing down growth rates with age,
defining its maximum in intrauterine
Period and further in the first months of life.
The law of a jump-shaking speed change
Growth.
Growth rates are intermittent
Character and, along with a reduction in speed
Growth, there are periods when this speed
Increases.

Change of body proportions (2nd month of intrauterine development - 25 years)

Patterns of changes in the main anthropometric indicators in the process of growth and development of children

In the intrauterine period there is the most intense
Building and length, and body weight. Only between first and
The second month the fruit increases in length almost 3 times, and in
Most of 10 times.
The length of the body of the Funny Newborn varies from 46 cm to
56 cm, and on average, boys - 50.7 cm, in girls - 50, 2 cm.
It is believed that if a newborn baby has a length
45 cm and less, then he is not a bottom.
The mass of the body of a daddy newborn can average
for boys 3494 g, for girls - 3348 permissible
Body mass fluctuations are considered to be 2500-4000.

Body Length

In the first days after birth, the body length is a bit
decreases because Come on the head generic tumor
Sleeping for 2 days.
In the first year of life, the length of the body increases by 3 cm
Monthly (in the first quarter), then 2.5 cm per month (in II
quarter), and then 1.5 -2 cm per month (III quarter), 1 cm (IV
quarter).
By the year, the growth of the child is 75-76 cm.
During the second year, growth increases by 12-13 cm.
For the third year of life -7-8 cm, followed by 5-6 cm per year.
Absolute body growth during prepubertate growth
The jump in boys reaches 47-48 cm, in girls 36-38 cm.
Doubling the length of the body of the newborn comes to 4 years,
Morning to 12 years.

10. Body mass

Maximum mass loss is celebrated in most
Children by 3-5 days of life and amounts to 6-8%.
Monthly in the first half of the year, the weight increases on
800 g, in the second half of the year - at 400
By half of the year, the mass of the body of children reaches an average of 8200 g,
and by year 10-10.5 kg, further gain weight gain
It is 2 kg per year.
After the breastside under the age of 10 years, the indicator
Body masses are calculated:
10.5 kg (middle weight of the child 1 year) + 2xn
In the puberty period, the body weight gain is
5-8 kg.

11. Chest circumference

Breast Circle of a Funny Newborn
is 34 cm.
By year, it reaches 48 cm.
Mid-sized breast circumference rate on
The first year of life is 1.25-1.3 cm in
Month, in the next 2-3 years - 2-3 cm per year.

12. Head Circle

Circle of donoshenic head
The newborn is 34-36 cm.
By the year of life, the circle of the head is 46-47 cm.
By 5 years - 50-51 cm.

13. Empirical formulas and nodal points for calculating somatometric data in children

Measured sign
Method of calculation
Body Length
Funny newborn
Middle Girls Girls
Boys
46-56 cm
50.2 cm
50,7cm
In the first year of life:
Birth growth + quarterly increases:
1 Quarter -3 cm Monthly (9 cm / Quarter)
2 Quarter -2.5 cm Monthly (7.5 cm / Quarter)
3 Quarter -1.5 (2.0) cm Monthly (4,56.0 cm / Quarter)
4 quarter - 1.0 cm monthly (3.0 cm / quarter)
Middle height of 6 months
If birth rarely is not known:
66 cm
2.5 cm - 66 cm in 6 mec. + 1.5 cm (for each month to 6 months. 2.5 cm is subtracted,
for each subsequent - added 1.5
cm)
average gain for the 1st year of life
25 cm
Middle growth in 1 year
75 cm
PDC *
± 4 cm

14. Empirical formulas and nodal points for calculating somatometric data in children

Older year:
average gain for the 2nd year of life
12-13 cm
average gain for the 3rd year of life
7-8 cm
Middle growth in 4 years (doubling)
100 cm (doubling the growth of the newborn)
8 cm - 100 cm + 6 cm (for each missing year
Up to 4 years is subtracted 8 cm, for each
Subsequent - 6 cm is added)
Middle growth in 5 years
110 cm
8 cm - 110 cm + 6 cm (for each missing up to 5
years of age will deduct 8 cm, for each subsequent
6 cm is added)
Middle growth in 8 years
from 2 to 15 years:
130 cm
7 cm - 130 cm + 5 cm
(for each missing up to 8 years is going
7 cm, each subsequent 5 cm is added)
from 8 to 15 years:
90 + 5 p, where n is the age of the child in the years
Middle height of 10 years
140 cm
Morning indicator
Newborn
12 years
PDK.
1-5let ± 6.0 cm

15. Empirical formulas and nodal points for calculating somatometric data in children body weight

Funny newborn
Middle Mass of Girls
The middle mass of boys
In the first year of life:
2501-4000 gr.
3348 gr.
3494 gr.
1 Method: Mass at birth +
Monthly
Accessive:
1st months - 600 gr.
2nd months - 800 gr.
3rd months - 800 gr.
Then 50 gr. Less than previous
month
2 way: on average monthly increases:
1 half year - 800 gr. / Month.
2 half year - 400 gr. / Month.
Calculation up to 6 months: m. + 800N.
Calculation after 6 months: m. + 800 x 6 +
+400 (N-6), where N is the age of the month

16.

middle Weight in 6 months. If the battle is not
Known:
8200 gr.
800 gr. - 8200 gr. + 400 gr. (for each month to 6
Executed 800 grams, for each month over 6
Available at 400 gr.)
Doubling the mass of the newborn
4-5 months.
average gain in mass for the 1st year
7150 gr.
Middle Weight per year
(Multi-Born Mass Multi)
PDK
10.0-10.5 kg
1-3 months. ± 850 gr. 4-6mss. ± 1000 gr. 7-9mss. ± 1200 gr.
10-12 months. ± 1500 gr.
Older year:
from 2 to 11 years
10 (10.5) kg + 2n, where N- age in years
average weight of 5 years (doubling mass of one year old
child)
19 kg
2 kg -19 kg + 3 kg (2 kg perdition for each year to 5 years, for each subsequent after 5 years
3 kg is added)
Average mass of 10 years (mass tripling
a year old child)
30 kg
Older 10 years:
1. 30kg + 4 (N-10), where N-age in years
2. Formula Vorontsova:
Morning age + last digit in years:
From 12 to 18 years old:
5p-20 kg, where N is age in years
PDK
1-5 lay ± 3 kg
6-10 years ± 6 kg
11-18 years ± 10 kg

17. CENTAL METHOD OF EVALUATION OF PHYSICAL DEVELOPMENT

- Zone 1 (up to the 3rd valuable) - "very low" level;
- Zone 2 (from the 3rd to the 10th Central) - "Low"
level;
- Zone 3 (from 10th to 25th centuries) - the level "below
medium ";
- Zone 4 (from 25 to 75th Central) - "Medium"
level;
- Zone 5 (from the 75th to the 90th Central) - level
"above average";
- Zone 6 (from the 90th to 97th Central) - "High"
level;
- Zone 7 (from the 97th cent) - "very high"
level.

18. Comprehensive assessment of physical development

BIOLOGIST. LEVEL
Morphofunc.
STATE
"Complies
Age "
Harmonic
"Fingering
AGE"
Disharmonic
"Loose from
Age "
SHARP
Disharmonic
General
DELAY
Physical
Development
HEIGHT
Mass, ok.
Chest
FUNCTIONAL.
INDICATORS
Any
middle,
above
medium
below
average.
Any
middle,
above
medium
below
average.
M ± σ r and more
Account developed
musculature
M + 2.1 Σ R and
above
From m ± l, l σ r
to m ± 2 σ r
by raise
or lower.
grease
from m + 1.1 σ r
to M + 2 Σ R
from M-2, L Σ R and
below
to m + 2.1 σr and
above
from M-2, L Σ R and
below
Height
low
with any MT, o g
M-2,1σ R
And lower

19. Assessment of the level of age development (for "dentist")

Age
in years
Floor
Slow
development
Correspond to
Age
Accelerated
development
5,5
M.
-
0-3
\u003e 3 posts. teeth
J.
-
0-4
\u003e 4th post. teeth
M.
0
1-5
5
J.
0
1-6
6
M.
0-2
3-8
8
J.
0-2
3-9
9
M.
Less than 5.
5-10
10
J.
Less 6.
6-11
11
M.
8
8-12
12
J.
8
8-13
13
6,0
6,5
7,0
7,5

20. Algorithm for assessing the physical development of the child

Determine the passport age of the child
Determine the age group of the child
Conduct anthropometric measurements on generally accepted
Methods (Mass, Length of Body, Breast Circle, Head Circle)
Find the position of the obtained measurements in the centers
intervals on standards tables for each indicator in
Depending on the age of the child
Evaluate the harmony of physical development
With harmonious development to determine somatotype
With non-harmonic development (disharmonious or sharply
disharmonic) determine, at the expense of which criterion is due
disharmony

21. Form of the final entry of anthropometric research

1.
2.
3.
4.
5.
6.
7.
Date of measurement
Date of Birth
Passport age child
Age group
The result of each measurement in cm, kg, in brackets - numbers
Central zones
For body weight, it is recommended to record both the second rating -
Accordingly, the length of the body
The overall assessment of anthropometric data is formulated:
The degree of harmonicity of physical development
The pace of physical development (somatotype) in harmonious development
In case of non-harmonic development, the most rejected
a sign indicating how many age intervals he is lagging behind
or ahead of the passport age of the child

22. Medical development variability

Hypotrophy is a violation of physical
Development of the child I-II of the Year of Life Chief
by reducing the actual mass
Bodies compared to the must.
The diagnosis of congenital hypotrophy is raised immediately
After the birth of the child. To do this is carried out
Calculation of the mass - growth coefficient (IRK).
MRK \u003d Non-Body Body Mass (D) / Body Length
Newborn (cm)
Normally MRK \u003d 60-80.

23. Hypostatic is the same lag of growth and body weight in children of the first year of life compared to the average regulatory indicators with

Hypostatic is the same growth of growth and
body masses in children of the first year of life
comparison with medium regulatory
indicators of relevant age.
Painrophy - result
Chronic violation
Feeding children
first year of life
which is characterized
increasing body weight
compared to C.
Regulatory data
by 10% and more.

24. Nanice (dwarfism) - a violation of physical development, expressing behind the rise in growth compared with the average norm for age, gender

Nanism (dwarfism) - violation of physical
development expressed by the lag in growth
compared with the average norm for age, gender,
Populations, races.
Giantism is a clinical syndrome, based on
which is a hyperproduction of somatotropic
hormone, which leads to an excessive increase
Growth.

• 1. The main stages of development and the formation of pediatrics in the country. The role of S.F. Hotovytsky, N.F. Filatova, N.P. Gundobin, K.A. Ruhfus and others. In the development of domestic pediatrics.
• 2. The most important decrees, laws and regulations for the protection of maternity and childhood. ROLE A.A. Kiel, V.I. Molchanova, M.S. Maslova, A.F. Tour and others in the development of Soviet pediatrics.
• 3. Phone medical care. The structure of children's medical and preventive institutions, features of organizing their work / hygienic and anti-epidemic regime.
• 5. The structure of children's clinic. The volume and forms of the operation of the precinct pediatrician and the medical sister. The patronage of the newborn and baby of the breastside.
• 7.And. Features of collecting anamnesis of a healthy and sick child: children of early and older. Methods of questioning parents on the history of the present disease and the history of the child's life.
• 8. A general inspection. General view of a healthy and sick child, position (active, passive, forced), facial expression. Criteria for gravity of the state. The degree of violation of consciousness.
• 9. childhood / characteristics, interconnection of morphology and function /. The role of hereditary factors and conditions of the external environment for the proper development of the children's body.
• 10.Trutrice development of the fetus. Embryonic and placental phase of development. "Critic-sky" periods. Factors affecting organogenesis and fetal development.
• 12. Physical Development / Definition, Signs. Factors affecting physical development.
• 14. By changing the proportions of the body in the postnatal period of the development of children. The concept of the average point of body length, the value of body proportions for clinical pediatrics.
• 15. Related anthropometric studies and methods for assessing the physical development of children / parametric and non-parametric /.
• 16. The most frequent deviations of the physical development of children, violation of weight-growth ratios, their causes. The concept of giantism, the nomenose, hypostatic, hypotrophy and patrofy.
• 17. Power development in children. Features of puberty. Methods for assessing the formation of secondary genital signs in boys and girls.
• 19. Features of the structure of the nervous system in children. Anatomical ratio of the development of the spinal cord and the spinal canal. Selection of the level of spinal puncture
• 20. Spinal fluid and its composition. Semiotics of liquor changes in hydrocephalus, serous and purulent meningitis, meningoencephalitis, hemorrhages.
• 21. Wallpaper and posture of a newborn baby. The concept of chaotic and spontaneous movements. The main reflexes of the newborn, their subsequent evolution.
• 22.Ororem for the development of locomotions and statics in the child of the first year of life. The value of massage and gymnastics.
• 23. Development of speech in children, its features. The role of the environment, care and education in the formation of speech.
• 25. Cyriculture assessment of the neuropsychic development of children of early and older. The concept of leading development lines.
• 26. The excellent feeding, its importance for the proper development of the child.
• 27.The mental development / instinct theory and genetic determination /.
• 28. General patterns of the psychic development of the child.
• 29. Development of emotions / manifestation, forms, temperament /.
• 30.RIKOR. Types of dust. Rules for the introduction of feeding. Technology preparation dishes feeding.
• 31. Morphological and functional features of the skin in children. Semiotics of its main changes / color, elasticity, humidity, rash.
• 33.Stave and distribution of the subcutaneous fat layer in children. Semiotics of distribution, concept of hypotrophy, patrofy, sclermers, sclare, scleroders.
• 34.Shumina system in children. Tone, muscle mass in different periods of childhood. Features of the study of the muscular system and muscle tone in children.
• 36. The possibilities of phosphorous calcium metabolism in children, its regulation. Normal indicators of phosphorus and calcium content. Bone semiotics Rahita.
• Congenital heart defects
• Features ECG.
• 40.Tery morphological features of the oral cavity; Devices for sucking newborns. Semiotics of the main changes in the oral mucosa / stomatitis, gingivitis, angina, thrush /.
• 41.The check and mixed feeding. The classification of dairy blends for artificial feeding and a mixed feeding record.
• Types of milk mixtures
• Adapted dyers
• Partially adapted dairy mixes
• 42. The availability of water-mineral exchange in children, age-related characteristics of water in the body. The role and value of off-and intracellular fluid. Semiotics of violation of fluid distribution.
• 44.Anato-physiological features of the endocrine glands. The role of hormones in the growth and development of the child. Research methods.
• 45.Turiods and features of embryonic blood formation / annecial, liver, bone marrow periods. Blood newborn baby. Methods of research of the blood formation system.
• 46. \u200b\u200bInstallation of the immunity system in children (differentiation of cellular and humoral links in the intrauterine period; the immune system of the newborn, the development of it in the postnatal period).
• 47. The benefits of thermoregulation in children. The temperature regime of surrounding air indoors and when walking for children of different ages. Requirements for child clothes.
• 48.Lifstice. Types of fever at a temperature height, by character in a temperature curve. Graphic image. Clinical meaning. Care of fevering patients.
• 49.exist manifestations of hemorrhagic syndrome. Vasopathy.
• 50. The modern principles of rational nutrition of children older than the year and the value of vitamins for the proper development of the child.
• 51. Clinical manifestations of the lesion of the central nervous system: the syndrome of intracranial hypertension, meningeal syndrome, oligophrenia.
• 52.ad, method of its definition, change blood pressure with age. Diagnostic value changed control. Arterial hypertension and hypotension syndrome.
• 53.Functional samples of the cardiovascular system, methodology, assessment, clinical value. Syndrome of acute vascular failure. Emergency assistance in fainting.
• 54.The pectoral features of the chest. Segmental structure of the lungs in children. Infiltration syndrome.
• 55. The degradation and signs of the functional insufficiency of the Nephron of the glomerular apparatus. Diagnostics.
• 56. Loccitution formula. Leukocytosis: diagnostic value. Proliferation disorder syndrome and differentiation of leucon cells.
• 57.Sinth of inflammatory damage to urinary tract. Laboratory and instrumental diagnostics.
• 58. The most frequent hyper-and hypofunction syndromes of the domestic secretion glands.
• 59.The features of the projection of the heart departments on the front surface of the chest. Semiotics of the main changes in the boundaries of cardiac stupidity / expansion of the left, right and upper boundaries.
• 60. Developing a lymphoid system in a child. The diagnostic value of the multiple hyperplasia of lymph nodes and localized increases. The concept of leukemia.
• 61. Normal character of respiratory noise in children of different ages. Methods of research of intragenic lymph nodes, semiotics of their increase.
• 62.The information of the chest, changing the shape of the head. Diagnostic value. Estimation of the state of the joints / deformation, defiguration, swelling, contracture, ankylosis /.
• 63.Casting in young children. The dynamics of erythrocytes and hemoglobin, the evolution of the leukocyte formula in the postnatal period. Anemic syndrome.
• 64. The modern ideas about blood formation. Cutting and antoslude blood system in children. Coagulopathy.
• 65. Silent failure. Classification. Clinical picture of various forms of day.
• 66.The main stages of the formation of the bronchopulmonary system and the malformations of the lungs. Syndrome respiratory disorders.
• 67.The bottom syndromes of the lesion of the respiratory system. Syndrome of the cluster of fluid and air in the pleural cavity.
• 68. Introduction of iron in the body. Anemic syndrome in children.
• 69.The heart of the heart in children. Their origin. Auscultative and phonocardiographic characteristics. Differentiation of functional and organic sound noise.
• 70. cough aceyotic. The concept of the stenosis of the larynx and its clinical diagnosis. Obstructive syndrome.
• Symptoms
• The reasons
• 71. The possibilities of protein metabolism in children. Semiotics of its basic violations. The syndrome of quantitative and high-quality protein deficit, its value for the growing organism.
• 72. Treatment features of the pulse in children. Diagnostic value of frequency, rhythm, filling, pulse voltage. Semiotics of rhythm disorders.
• 73. The degradation and signs of the functional insufficiency of the tubing apparatus of the nephron. Tobulopathy.
• 74. Expustrial and renal symptoms of kidney damage.
• 75.Arge to the lesions of myocardium, endocardium and pericardium. The concept of punkard.
• 76. Muscular hyper and hypertension, hyper-and atrophy. Muscle pseudogipephy. The value of physical education and permissible physical exertion of children of various WHO raster.
• 77.Ton of hearts in children, the mechanism of their formation, age characteristics. Registration of tones on FKG. Semiotics change the sound of tones.
• 78.Semiotics of hemorrhagic diathesis and changes in laboratory indicators. Thrombocytopenic hemorrhagic syndrome.
• 79.Anato-physiological features of respiratory organs in children. Syndrome defeat the upper respiratory tract.
• 80.The concept of renal failure / OPN, CPN, stage, clinical manifestations /.
• 81.Things and clinical signs of the syndrome of acute and chronic insufficiency of blood circulation in children.
• 82.Gluble exchange. Causes and clinical manifestations of hypo-and hyperglycemia in children. Laboratory diagnostics.
• 83. The system of liver in various types of exchange. Biochemical label function indicators. Hepatic insufficiency syndrome.
• 85. Character hemodynamics and semiotics of congenital heart defects.
• 86.Gelrere iron. Its role in the process of digestion. The composition of the duodenal juice. Pancreatic syndrome. Assisting the patient with vomit
• By the nature of the flow.
• The reasons
• Diagnostics
• 87. Features of fat metabolism. The concept of hyperlipidemia syndromes. Primary and secondary ketosis in children ("acetonemic" vomiting).
• 88. Nity and urine composition in children of different ages. Diuresis and semiotics of oligulia, polyuria, dizuriy and pollakiuria. Care for patients with enuresis.
• 89.Functional and instrumental diagnosis of digestive diseases. Screenshots and bereal impairment syndrome. Functional methods:
• 90. Immunodeficiency (definition, classification, general clinical manifestations).
• 91.Subjective and objective symptoms of damage to the cardiovascular system, their clinical significance. Instrumental methods for studying the circulatory system.
• 92. Difficult excretion of various substances with urine. Semiotics of microscopic changes of blade of blade (proteinuria, hematuria, leukocyturia, cylindruria, saluria).
• 92. Difficult excretion of various substances with urine. Semiotics of microscopic changes of blade of blade (proteinuria, hematuria, leukocyturia, cylindruria, saluria).
• 93 Digestiveness in children. Opening disorder syndrome and digestive insufficient syndrome in the 12thistanchine.
• 94.Ceprogram: its disorders under the defeats of various departments of the gastrointestinal tract. Enitrite and colitis syndrome.
• 95.Anato-physiological features of the esophagus and stomach (their sizes in children). Syndrome insufficiency of gastric digestion. Care for patients with gastrointestinal bleeding.
• 96.Anato-physiological behavior features. Surrender function. The composition of bile. Clinical meaning of duodenal sensing.

• Reasons for the delay of growth and body weight:

  1. Nutritions of power supply, reducing appetite or digestion.

  2. Diseases with chronic tissue hypoxia. - Extane diseases of the lungs, heart defects, severe anemia.

  3. Endocrine apparatus, internal secretion glands, which produce hormones - growth stimulants. This is a pituitary with insufficient growth of growth hormone, thyroid gland, less often - glands regulating phosphoric calcium exchange, or pancreas.

  The most severe deviation in physical development is children's cerebral paralysis - cerebral palsy. Microcephaly.

  Hypotrophy- Violation of the FR child of the first lifestyle, in which there is a decrease in the actual body weight

  Congenital -Prenatal put after birth. The mass-growth coefficient is calculated: MRK \u003d mass, g / length, see Nor: 60-80. Degrees: 1st. - MrK \u003d 59-56; 2 st.-MRK \u003d 55-50;

  3 st. - MRK \u003d 49 and less

  If a child is with a normal mass at birth, after 1 month, a deficiency has been identified - postnatal. Of its degrees: 1 degree of a mass of mass 11-20%; 2-AA -21-30%; 3 - more than 31%.

  Clinical signs of hypotrophy: reducing the thickness of the subcutaneous fiber,

  Hypostatic- proportional lag length and body weight in comparison with regulatory indicators. It is based on heavy neuroendocrine disorders, UPU, encephalopathy.

  After 1 year, such a state is an alimentary subnanism. Older than 1 year is a state of obesity, obesity. Food is parallel to the delay and growth and mass.

  Paraphraphy Chronic food disorders, in which there is an increase in body weight by more than 10%. 1 st - 11-20%; 2 st.-21-30%; 3 st.-31% or more.

  Nanism (dwarf) - Violation of the FR, in which there is a lag in growth in comparison with the average values \u200b\u200bin the population. Based on genetic growth disorders.

  White race: Dwarfs - women - less than 120 cm, men - less than 130 cm;

  Clinic: - Dry wrinkled skin with a yellowish tint; - Children's features; Insufficient muscle development, low blood pressure, infertility. The reason is the sensitivity of tissue receptors to a somatotropic hormone or insulin-like growth factors.

  Gigantism - Excessive increase in growth related to excess production of STGs in the pituitary

  17. Power development in children. Features of puberty. Methods for assessing the formation of secondary genital signs in boys and girls.

  The period of puberty is the achievement by the body of sexual maturity and is called a transitional or puberty. The activity of the hypothalamic-pituitary system (the highest centers of the endocrine system in the brain increases), stimulate the function of the genital glands - the testicles in boys and ovaries in girls. The secretion of sex hormones - androgens and ethane increases. Production of growth hormone and hormone, which stimulates the production of hormones thyroid gland.

  The combined effect of growth hormones, genital and thyroid glands, causes changes - acceleration of physical development, the development of genital organs and the emergence of secondary sexual signs.

  The timing of the offensive of puberty depend:

  Hereditary features

  Household, socio-climatic conditions,

  Health status, nutrition character.

  The delay in puberty is considered the absence of signs of girls older than 13 years old, and boys over 14 years old.

  Girls enter in puberty in 10-12 years.

  But already at 8-10 years old, the rounding of the hips and buttocks, expansion of the pelvis;

  in 9-10, the nearby circle protrudes over the skin of the chest;

  in 10-11 - a -idine hair on the pubic and in the armpits, the development of the mammary glands (the beginning of growth);

  in 12-14 first menstruation

  in 15-16, regular menstruation, exhaustion on the pubis and in the armpits, the dairy glands increase.

  In parallel with sex ripening, there is an intense growth, peak for 12 years and reaches 9 cm per year.

  At the age of 16-18, a gradual growth stop comes.

  Boys start in 12-14 years old.

  10-11 years - an increase in the size of the eggs and the penis;

  11-12 years old - the pigmentation of the scrotum, the beginning of the label;

  12-13 years old - hair growth on the pubic, an increase in the penis and testicles;

  18-20 years - Completion of puberty, male type exhaust.

  Growth peak for 14 years and reaches 10-12 cm per year. In 18-20 years there is a gradual stop of growth.

  Poland is estimated by the severity of secondary sexual signs. In girls, it is an increase in the hair cover on the pubic (P) and in the armpits (a), the development of the chest glands (MA) and the age of the first menstruation (ME). For boys, in addition to the growth of hair cover on the pubic and in the armpits, the mutation of the voice (V) is estimated, the fragmentation of the face (F) and the formation of Kadyk (L).

  Development of hair cover on pubis:

  no hair - P0;

  single - P1;

  hair on the central plot of pubis is more dense, long - P2;

  on the entire triangle of the pubis Long, curly, thick - P3;

  located throughout the area of \u200b\u200bthe pubic, go to hips-P4.

  The development of the hairproof in the axillary depression:

  absence - a0;

  single- A1;

  rare in the central section of the depression - A2; in

  thick, curly throughout the depression - A3.

  The development of the mammary glands:

  glands are not issued above the surface of the chest - Ma0;

  somewhat issued, the near-block circle together with the nipple forms a single cone - MA1;

  significantly issued, together with a nipple and a nearby circle, have a cone form - ma2;

  the body of the gland is rounded the nipples, the nipples are raised over the near-block circle - MA3.

  18. "Biological" acceleration of children's development / definition, signs, main theories /, the value of acceleration for pediatrics.

  Acceleration - acceleration of age-related development by shifting morphogenesis on earlier stages of ontogenesis. An earlier achievement of certain stages of biological (physical and sex) development and the completion of the organism ripening.

  As the main manifestations:

  An average of 4-5 cm on average by an average of 4-5 cm, and a body weight is 1-2 kg more than 50 years ago

  An earlier teething of the first teeth, the change of them for permanent 1-2 years earlier;

  The earlier appearance of the cores of the boys and girls;

  An earlier increase in the length and mass of the body of children of preschool and school age;

  The sexual development of boys and girls ends 1.5-2 years earlier than at the beginning of the 20th century, for every 10 years, the occurrence of menstruation in girls is accelerated by 4-6 months.

  Based on anthropometric indicators and levels of biological maturity, harmonic and disharmonic types are distinguished. The first are those children who have anthropometric indicators and level of biological maturity above average values, to the second type - children who have enhanced body growth in length without sexual development or early puberty without enhanced growth.

  theories (Lisitsyn):

  Physical and chemical:

  1) the effect of solar radiation, lengthening the light day;

  2) the effect of the magnetic field

  4) increased concentration of carbon dioxide caused by the growth of production.

  Theories of individual factors of living conditions:

  improving life, nutrition and medical care

  Genetic:

  1. Set of populations

  Natural consequences: Jolea rapid aging, rejuvenation of diseases, disharmoniousness, lag in the development of inside orans.

  "

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.