1、General of Introduction of Pediatrics,汕头大学医学院第一附属医院儿科 林霓阳,Pediatric Foundation,Infantile Growth & Development,Nutrition & Feeding,General of Introduction of Pediatrics,Pediatric Foundation,Pediatrics: A kind of clinical medicine for infantile growth-development, health care and disease prevention.,P
2、ediatric Nursing: Includes clinical nursing, prevention, health care, nursing study,etc.,儿科学基础,Age Group,Specially, the “child” refers to those aged less than 14 and we divide the “child” period into different age group according to physiology, anatomy, pathology and disease feature, to guide the ch
3、ild health care and disease prevention.,Fetus: pregnancybirth Neonate: birth28d Infant: 28d1y Early child: 13y Preschool age: 37y School age: 714y,儿科学基础,Emphasis,Age group,Features of different age: physiologic, pathologic and disease features,Common diseases of different stages,儿科学基础,Preclinical Me
4、dicine,Anatomicophysiological Feature,Delivery Adult,Apperance change body height, weight, head circumfenrence, close of fontanelle, tooth eruption & tansition,Organs change heart volume, kidney, liver, spleen; organs location have a certain law: the younger the faster of development, e.g. Heart,儿科学
5、基础,grow up,Immunity feature 1.Few Ab from mother (IgG disappears 36mo), lack of SIgA 2.No perfect autoimmunity-immunologic inadequacy (humoral & cellular immunity ),so the infants are easy suffering from respiratory and digestive tract disease.,儿科学基础,Preclinical Medicine,Pathologic feature The same
6、pathogen may cause different pathologic change in different stage.,Streptococcus. Pneumoniaeinfant: lobular pneumoniaadult: lobar pneumonia,VitD infant: rickets adult: osteomalacia,儿科学基础,Preclinical Medicine,Disease Categories differ from adult,e.g. Cardiovascular diseaseinfant: congenital heart dis
7、ease(CHD)adult: acquired heart disease (RHD),Tumors infant: leukemia adult: carcinoma,儿科学基础,Clinical Medicine,Clinical Manifestation,E.g. Hyperthemia (T39) 3yadult: fever, headache,Neonatal pneumonia: may no fever, no cough, no ralesCM-milk refusal, paroxysmal cyanosis, shallow or irregular breath,
8、or apnea, differ from adult.,儿科学基础,Clinical Medicine,Clinical Manifestation,Bacillary dysenteryinfant: toxic symptoms (toxic type)adult: gestroiintestinal symptoms (common type),Infants, neonates: atypical septicemia,儿科学基础,Clinical Medicine,Diagnostic feature different age group express different ca
9、tegories and CM,e.g. Infantile convulsion neonate: birth trauma, intracranial hemorrhage, asphyxia 3y: afebrile convulsion,儿科学基础,Clinical Medicine,Infantile Growth & Development,Growth: refers to the changes of body shape- quantity,Development: refers to the mature of organic function-quality,Going
10、on in the same time, relate to each other,小儿生长发育,Patterns of Growth & Development,1. Continuous process:,小儿生长发育,% 200 180 160 140 120 10080604020,0 2 4 6 8 10 12 14 16 18 20 年龄（岁）,生长发育与年龄的关系,Patterns of Growth & Development,1. Continuous process:,小儿生长发育,身高增长曲线,Patterns of Growth & Development,1. Con
11、tinuous process:,小儿生长发育,Patterns of Growth & Development,2 .Imbalance of differentsystems and organs,小儿生长发育,Patterns of Growth & Development,3.General law:,小儿生长发育,From Head Down,Patterns of Growth & Development,3.General law:,小儿生长发育,From Close to Distant,Patterns of Growth & Development,3.General la
12、w:,小儿生长发育,From Gross to Fine,Patterns of Growth & Development,3.General law:,小儿生长发育,From General to Specific,Patterns of Growth & Development,3.General law:,From junior to senior,Patterns of Growth & Development,4. individual difference：relate to heredity, sex, environment, graduation and nutrition.
13、,小儿生长发育,Influence Factors,Genetic factor,小儿生长发育,Influence Factors,Sexual factor,小儿生长发育,Influence Factors,Endocrine factor,小儿生长发育,Influence Factors,Pregnant mother,小儿生长发育,Influence Factors,nutrition,小儿生长发育,Influence Factors,environment,小儿生长发育,Influence Factors,disease,小儿生长发育,Physical development,weig
14、ht,height (length),head circumference,chest circumference,Index for physical development,小儿生长发育,Physical development,1.clinical significancerepresents the body nutritionthe basis for dosage and infusion count,2.increasing pattern (formula) Birth wt：male3.3kg female3.2kg 6mo： wt= Birth wt +month age
15、0.7(kg) 712mo: wt=6 (kg) + month age 0.25 (kg) 212y: wt= age 2+7(or8 ) (kg),Weight (wt),mon disease: Chronic wasting disease, malnutrition, endocrine disease,小儿生长发育,Physical development,小儿生长发育,Weight (wt),体重测量法,Physical development,1.clinical significance important index for skeleton development,2.i
16、ncreasing pattern (formula) Average birth length 50cm, 1y 75cm, and 2y 85cm 212y height (cm) = age 7+70(cm) measure the length (child lying down) in those 3y, and height (child standing) after that.,Height (Length),3.influence factors: Heredity, endocrine, nutrition, exercise, diseases (hypothyroidi
17、sm, loss of growth hormone, malnutrition, rickets, etc.),小儿生长发育,Physical development,Height (Length),小儿生长发育,身高测量法,Physical development,Height (Length),小儿生长发育,胎儿至成人身体各部分比例图,Physical development,1.clinical significance Represent the development of brain & skull,2.increasing pattern birth 3234cm 6 mo 4
18、4cm 1 y 46cm 2 y 48cm 5 y 50cm 15y 5458cm(as adult),Head Circumference,3.influence factors:smaller than normalatelencephalia, microcephalylarger than normal hydrocephalus, rickets,小儿生长发育,Physical development,Head Circumference,小儿生长发育,头围测量法,Physical development,1.clinical significance Represent the d
19、evelopment of lung, thorax, skeleton, muscle and lipid.,2.increasing pattern birth 32cm (12 cm smaller than head circumference) 1y 46cm (=head circumference) 2 y head circumference (cm=age 1),Chest Circumference,3.Influence factors: Nutrition, less exercise, diseases (rickets, pulmonary emphysema, h
20、eart disease),小儿生长发育,Physical development,Chest Circumference,小儿生长发育,胸围测量法,Skeleton development,Skull development,Represents: brain development (fastest within 1y after birth) cranial bone development,小儿生长发育,Skeleton development,Skull development,小儿生长发育,额骨,前囟 （Anterior fontanelle）,顶骨,后囟 （Posterior f
21、ontanelle）,枕骨,矢状缝,冠状缝,对边中点连线,额缝,小儿颅骨与囟门,Skeleton development,Skull development,clinical significance: advanced closemicrocephaly, atelencephalia delayed closerockets, hypothyroidism plump fontanelle intracranial hypertension (hydrocephalus, encephalitis, meningitis, brain tumor), Vit A intoxication.
22、 Depressed fontanelledehydration, serious malnutrition,Anterior fontanelle:rhomboid space made of frontal bone & parietal bone.1.52cm close time: 11.5y,小儿生长发育,Skeleton development,Skull development,Posterior fontanelle,triangle space made of parietal bone & occipital bone, close 68 weeks after deliv
23、ery latestly.,Close of cranial seam 34 months after birth,小儿生长发育,Skeleton development,Spine development,Stands by the development of skeleton.,Newborn slightly posterior prominent,3 mo raise head : anterior prominent of cervical spine 1st incurvation,6 mo sit: osterior prominent of thoracic spine 2n
24、d incurvation,1 y walk: anterior prominent of lumbar spine 3rd incurvation,小儿生长发育,Skeleton development,Ossification center development,Stands by the development of skeleton (bone age), is the important signs for skeleton development,Neonate (at birth): calcaneus (跟骨）， talus （距骨）, femus （股骨）center ,
25、and no carpal （腕骨）center.,9y (19y) No. of carpal center=age +1,abnormal bone age：common in hypothyroidism, rickets or endocrine disease.,小儿生长发育,Skeleton development,Tooth development,deciduous teeth,permanent teeth,小儿生长发育,Skeleton development,Tooth development,deciduous teeth: eruption： 68 mo stop：
26、22.5ytotal number： 20,number of deciduous teeth = month age (46) (2y),小儿生长发育,Skeleton development,Tooth development,deciduous teeth:,Teeth eruption order,Delayed tooth eruption: more than 12 mo rickets, hypothyroidism, mongolism,小儿生长发育,乳牙萌出顺序,6个月,九个月,十二个月,十八个月,二岁,二岁半,1,2,3,4,5,6,Teeth eruption order
27、,Skeleton development,Tooth development,permanent teeth: 67ystop 2030ytotal number 2832,Teeth development depends on Vit D, Ca, P, dental health and care.,小儿生长发育,Neuropsychologic development,Includes sense organs, neurological reflex, exercise function, language & thought, reaction to outside and ps
28、ychological development, etc (motion ability, language ability, reaction ability to things or people and psychological development),小儿生长发育,Neuropsychologic development,小儿生长发育,神经系统的发育,Neuropsychologic development,Infantile neuropsychological development process -behavior,小儿生长发育,1mo 2mo 3mo 4mo 5mo 6m
29、o 7mo 8mo 9mo 10mo 11mo 1214mo 15mo 18mo 3y,小儿生长发育,1mo 2mo 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11mo 1214mo 15mo 18mo 3y,小儿生长发育,1个月：俯卧位时试抬头,1mo 2mo 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11mo 1214mo 15mo 18mo 3y,小儿生长发育,2个月：直立时能抬头,1mo 2mo 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11mo 1214mo 15mo 18mo 3y,小儿生长发育,3个月：俯卧时
30、抬胸,1mo 2mo 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11mo 1214mo 15mo 18mo 3y,小儿生长发育,4个月：手能握持玩具,1mo 2mo 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11mo 1214mo 15mo 18mo 3y,小儿生长发育,5个月：扶前臂可站直,1mo 2mo 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11mo 1214mo 15mo 18mo 3y,小儿生长发育,6个月：能独做坐一会儿,1mo 2mo 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11m
31、o 1214mo 15mo 18mo 3y,小儿生长发育,7个月：将玩具从一只手换入另一只手,1mo 2mo 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11mo 1214mo 15mo 18mo 3y,小儿生长发育,8个月：会爬,1mo 2mo 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11mo 1214mo 15mo 18mo 3y,小儿生长发育,9个月：试独站,1mo 2mo 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11mo 1214mo 15mo 18mo 3y,小儿生长发育,10个月：能推车走几步,1mo 2mo
32、 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11mo 1214mo 15mo 18mo 3y,小儿生长发育,11个月：能牵手走,1mo 2mo 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11mo 1214mo 15mo 18mo 3y,小儿生长发育,1214个月：能独走,1mo 2mo 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11mo 1214mo 15mo 18mo 3y,小儿生长发育,15个月：能蹲着玩,1mo 2mo 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11mo 1214mo 15mo
33、 18mo 3y,小儿生长发育,18个月：能爬台阶,1mo 2mo 3mo 4mo 5mo 6mo 7mo 8mo 9mo 10mo 11mo 1214mo 15mo 18mo 3y,小儿生长发育,3岁：能跑，会骑三轮车,Neuropsychologic development,Infantile neuropsychological development process -language,neonate,3 mo,4 mo,12 mo,3y,18 mo,小儿生长发育,Neuropsychologic development,Infantile neuropsychological dev
34、elopment process -thought,小儿生长发育,Neuropsychologic development,2. Infantile neurological reflex,Congenital reflex: rooting reflex, sucking reflex, palatal reflex, embrace reflex, grasp reflex disappeared 34months later: grasp, embracethe first conditional reflex,小儿生长发育,Neuropsychologic development,2.
35、 Infantile neurological reflex,Life time reflex:abdominal reflex, cremasteric reflex, corneal reflex, pupilary reflex, palatal reflex,小儿生长发育,Neuropsychologic development,3. Positive reflex ( 2y) as follows,may be physiological :Babinskis sign, Oppenheims sign, Gordons signPositive Brudzinskis sign o
36、r Kernigs sign have no pathologic significance 34 months after birth.,小儿生长发育,Nutrition & Feeding,Energy & Nutrients Need,1. Energy need For basal metabolism, growth & development, motion needs, specific dynamic action and excretion loss.,Total energy need 1y 100120 (average 110) Kcal / kg / d 13y 10
37、0 Kcal / kg / d 15y 5060 Kcal /kg / d,营养与喂养,Energy & Nutrients Need,2. Nutrient need,Include: protein, lipid, carbohydrate and Vitamin, mineral substance (K, Na, Ca, P, Mg, Fe, etc.) as well as element Zn.,营养与喂养,Energy & Nutrients Need,3. Assign quality of heat,营养与喂养,Infantile Feeding,Breast Feed,Ad
38、vantages of breast feeding (5 points),1) rich of nutrition and easy to digest; 2) rich of antibody, which will enhance the immunity; 3) increase maternal love, easy to take care of the baby; 4) stimulate uterine contraction, benefit for recovery; 5) hygiene, no bacilli, cheap and simple.,营养与喂养,Infan
39、tile Feeding,Breast Feed,Feeding Methods (5 points),(1) early contact and feed, less than 30 min after delivery; (2) mother-baby in the same room, to feed of needed, but the feeding interval shouldnt be more than 3 hrs; (3) from one side to the other breast, to stimulate the milk secretion; (4) put
40、the nipple and most areola of mamma into the babys mouth; (5) erect the baby with his head on mothers shoulder, pat the baby on his back, to release the air and prevent from milk overflow.,营养与喂养,Infantile Feeding,Breast Feeding,Weaning,(1) weaning at 1012 months old is suitable; (2) gradually add co
41、food before weaning; (3) evade weaning in summer (for diarrhea) or ill time.,营养与喂养,Infantile Feeding,Bottle Feeding,Categories of milk products: Fresh cow milk, fresh sheep milk, and milk powder, etc.,How to make up milk from milk powder:Milk powder ： water Volume way 1 ： 4 Weight way 1 ： 8,营养与喂养,In
42、fantile Feeding,Bottle Feeding,Notes of Bottle-feeding,(1) select ilk product of optimal concentration for certain age and weight, hyperconcentration or hypoconcentration is forbidden; (1-week old neonate: 1/21/3 pure milk) (2) feeding frequency and interval are like breast feeding; (3) lean the mil
43、k bottle, full the nipple with milk to avoid sucking air; (4) drip the milk on your hand before feeding to test the temperature.,营养与喂养,Infantile Feeding,Bottle Feeding,Adding principle for cofood,from less to more, from thin to thick, from fine to rough, from simple to diversify gradually.,营养与喂养,Inf
44、antile Feeding,Bottle Feeding,Milk quality counting,Several basic concepts daily fluid needed = 150 ml / kg daily quality of heat needed = 110 Kcal / kg 8% sugar milk 100 ml 100 Kcal quality of heat (pure milk 1ml 1 Kcal),营养与喂养,Infantile Feeding,Bottle Feeding,Milk quality counting,e.g. 3 mo infant weight 5kg daily fluid volume = 150 5 = 750 ml daily quality of heat = 110 5 =550 kcal(equals to 8% sugar milk = 550ml) water quality except milk = 750550 = 200 ml So 550ml of 8% sugar milk and 200 ml of water are needed, feeding 8 times.,
