Evaluation of Child Growth and

Development

Annisa NurhayatiFebri Hanifa

Deasy Rahmi Apsari

Overview• Child conception – 18 years (Convention of Child

Right /CRC and Indonesian Child Protection Right)

• anatomical growth (epipyphise clossing, reproductive system maturation etc. )

• Psychosocial development (adolescent adulthood)

Child not a miniature of adult !!

Growth

Definition • Growth : Increasing the physical size and

structure of the body so that it can be measured quantitative, such as length or weight

• Determinant factors of growth• Internal:

• Genetic : father, mother, grandpa, grandma

• Intrauterine process : nutrition, disease, drug, polution, toxin ,

• External : nutrition, disease, polution, exercise, emotional support

Indicators • Weight• Body length• Head circumference• Upper arm circumference

Weight • The scales are calibrated to zero• Baby weighed in supine lying or

sitting position without clothes, while the children were weighed in a standing position without shoes with minimal clothing

• Weight is recorded to the nearest until 0.01 in infants and 0.1 in children

Body length• In children who can stand

stadiometer• Measured with bare legs and

minimal clothinga. Look straight aheadb. Relax the shouldersc. Arm stands besided. Legs and knees straightenede. The position of the feet flat

Head Circumference• Measuring tool flexible metal

tape• Head circumference at birth is

35 cm.• It is not good for the nutritional

status of short-term

Upper Arm Circumference• Energy reserves and protein

markers• Do with bows in the middle

point of the upper arm.• In newborns upper arm

circumference was 11 cm

Long

Weight

Long

Weight

Age (month) Age (month)

Percentile Graph BW and BH by Age of CDC 2000(2-20 years)

Boys Girls

INTERPRETATION

BW / A>120% : better nutrition80-120% : good nutrition60-80% : Without edema : less nutritionEdema : malnutrition (kwarsiorkor)<60% : Malnutrition : without edema (marasmus)Edema : (marasmus - kwarsiorkor)

BH / A90-110% : Normal

70-89% : high less

<70% : very less high

>120% : Obesity110-120% : Overweight90-110%: Normal70-90% : less nutrition<70% : malnutrition

BB / TB

WHO Curves Weight 0-5 Years

BMI MEASUREMENT OF AGE• BMI : BB (kg) /TB (M)2• Overweight >P85 -P95 • Obesity >P95

Head Circumference

INTERPRETATION Upper Arm CircumferenceFor 1-5 years<12,5 cm : malnutrition12,5-13,5 cm : less nutrition> 13,5 cm : good nutrition

If age is unknown, nutritional status was assessed by UAC / BH• >85% : good nutrition (normal)• 80-85% : borderline/Protein Less

Calories I• 75-80% : less nutrition/Protein

less calories II• <75% :malnutrition/Protein less

calories III

Child Development• Child development reflects increased maturity of individual functions,

and it is an important indicator in assessing the quality of life of children.

• Therefore, the development of children should be monitored regularly.

• Infants or children with a high risk of developmental disorders, should be a priority, including premature babies, low birth weight, history of asphyxia, hyperbilirubinemia, intrapartum infection, maternal diabetes mellitus, gemeli.

Child Development

Gross Motor

Fine motor

and vision

Speech language

and hearing

Social, emotiona

l, and behaviour

Gross Motor

Fine Motor and Vision

Speech, Language, and Hearing

Social, Emotional, and Behaviour

Denver Developmental Screening Test (DDST) • Assessment is used extensively to examine children aged 0-6 years as

their development progress.

DDST Procedure• The first stage performed in all children:

• 3-6 months• 9-12 months• 18-24 months• 3 years• 4 years• 5 years

• The second stage: Conducted on those suspected developmental delays at the first stage.

Preparation steps1. Preparation place.2. Preparation form: Form Denver II3. Preparation tool:

• Yarn.• Raisins.• Rattle with small handles.• Colored beams 10 inches wide.• Small glass bottle with 5/8 inch hole.• Small bell.• Tennis ball.• Red pencil.• Small doll with a bottle of milk.• Plastic cup with a handle / grip.• Blank paper.

Examination steps• Early detection of developmental disorders of children aged <6 yrs,

containing 125 task force organized in the form into 4 sectors to encompass the following functions:

1. Personal social: Adjustment to the community and attention to individual needs.

2. Fine Motor adaptive: hand-eye coordination, plays, using small objects.3. Language: Hear, understand and use the language.4. Gross motor: Sit, road, jumping and general movement of large muscles.

• Age scale are listed at the top of the form that is divided from the age in months and years, from birth until the age of 6 years.

• Each space between the sign represents one month of age, until the child is 24 months old. Then represent 3 months, until the child is 6 years old.

• In each task development totaling 125, there are limits growth of 25%; 50% and 90% of the population of children pass on the development task.

• 25% of the population of children are able to run well at the age of 11 months or more,

• 50% at age 12 1/3 months.• At the left end of the black area shows that 75% of the population has

been able to run well at the age of 13 ½ months• At the right end of the black areas indicate the 90% population of

children are able to run both at the age of 15 months.

6 9 12 15_______________________________________________

25% 50% 75% 90%Berjalan dg baik

In some there is a developmental task of letters and numbers on the left end of the box:• R (Report): The developmental tasks can be passed based on the

reports of parents / caregivers. However, where possible, the assessor can pay attention to what can be done by children.

Small figure shows a task that must be done in accordance with the existing number on the form.

R1

Steps1. Greet parents / caregivers and child.2. Explain to parents / caregivers development testing purposes, explain that this test is not

to determine the child's IQ.3. Making good communication with children.4. Calculate the age of the child properly.5. Asked whether the child was born prematurely.6. Write the date of examination over the age line.7. Age lines drawn correctly.8. Developmental tasks for each sector at least 3 tasks left lines of age and when passing

through the line continued until age as well as the right until the child fails in 3. Give the developmental task with proper assessment scores.

9. During the assessment, ask the parents / caregivers the typical behavior in their children.

Years Month Day

Date of examine (26/4-12) ........………12….….....…4……….….26

date of birth (20/2-11) ……..……..-11….....…...-2…...……-20

child’s age : …………….…1................2…………..6

.....…………………………………..…………………14

Date of examine(11/3-12) ………….…12…......……3…….…….11

Date of birth (20/7-11) .…………..-11…......….-7…….……-20

child’s age ………………..0…...…….7……...…..21

• When a child is born premature, prematurity factor correction. For children born more than 2 weeks before the expected date and aged less than 2 years, then it should be corrected. (1 year = 12 months; 1 month = 30 days, 1 week = 7 days)

Year Month Day

Date of examine (11/3-12) ………….....…12….….......…3……...…….11

Date of birth (4/2-11) ...………..……11…….......….2……....……..4

Child’s age: ………………..1……..........….1………....…..7

Prematur 6 weeks …..………………...-1……......…-14

correction age ………………......…11…....…..…23

• Pull the line above the age of lines down and write the examination date at the top end of the age line.

9-9-2004 6 9 12 ---------------------------------------------------------------------------------------------------Date of examination 9 Sept 2004

• Perform tasks for the development of each sector began development of the sector easiest and begins with the task of development is located to the

left of the line of age, and then proceed to the right of the line of age.

1. In each sector performed at least three tasks developments closest to the left of the line of duty each age and developmental age of the broken line

2. If the child is unable to perform one test in step 1 ("failed"; "reject"; "no chance"), perform additional tests to the left of the line of the same age in the sector until the child can "pass" 3 task progress .

3. When children are able to do one task progress in step 1, do additional development tasks to the right of the line of the same age in the sector until the child "failed" at 3 development tasks.

• Give assessment scores• Scores of each trial was written on rectangular box.

• P: Pass. Children tested well, or mother / nanny to report child can do it.• F: Fail. Children can not be tested by either or mother / nanny to report child

can not do well• No: No opportunity. Children do not have the opportunity to test because

there are obstacles. These scores should only be used in the experiment with the sign of R

• R: Refusal / reject. Children refuse to perform testing

Interprestasi Penilaian Individual 1. Advanced

When passing the test are located on the right lines of age, expressed on a child's development over these trials.

2. Normal When you fail or refuse to perform the task of development of the right of the line of age, categorized as normal.

• Similarly, if the child pass (P), failed (F) or reject (R) in the task of development where the line lies between the ages 25 and 75 percentile, then categorized as normal.

P

F R

P F R

3. Caution When a child fails (F) or reject (R) development tasks, where the line lies on or between the ages 75 and 90 percentile.

4. Delayed When a child fails (F) or reject (R) test which is located to the left of the line of the life complete.

5. No Opportunity. In the developmental tasks based on the report, the parents reported that their children had no chance to perform tasks they will progress. These results are not included in the conclusions.

F R FRC C C C

F R

NO NO

• During the test development, observe the child's behavior. Is there a typical behavior, compared with other children. If there is a typical behavior ask the parents / caregivers, whether they will conduct the day-to-day behavior of the children they will. When the test is done during the development of a child is sick, hungry. etc. can provide perlaku that inhibit the development tests

ConclusionNormal• If there are no delays and or at most one caution.• Do replicates at the next control.

Suspect• When obtained> 2 caution and / or> 1 delay.• Perform the test again in 1-2 weeks to eliminate momentary factors such as

fear, sickness or fatigueUntestable• If there is a score refuse to> 1 trial is located to the left of the line of age or

refuse to> 1 trial that penetrated the life line in the region of 75-90%• Perform the test again in 1 to 2 weeks.

Follow upDevelopment Screening

SUSPECT NORMAL

EVALUATION FOR DIAGNOSTIC MONITORING/ (Development Assessment) STIMULATION

DEVELOPMENT PROBLEMS NORMAL

EARLY INTERVENTION MONITORING/STIMULATION

Closing• Give credit to the parents / caregivers for their actions bring the child

to do the test development.• Give a description of the development of the test results, when to

return, the suggestion in the house and if there is a follow-up recommendation.

• Thank you for visiting.

Kuesioner Pra Skrining Perkembangan (KPSP)

• KPSP form is a tool / instrument used to determine the development of a normal child or there is deviation.

• From the age of 3 months - 6 years (3 months for 2 years, then every 6 months until the age of 6 years)

• Determine the age of the child to make in a month.• If the child's age is more than 16 days rounded up to 1

month.• Example:Infants aged 3 months to 16 days rounded

up to 4 months, when infants aged 3 months and 15 days rounded up to 3 months.

• After determining the age of the child select KPSP an appropriate with the age of the child.

Steps:

• KPSP consists of two kinds of questions, which is :• Questions answered by the mother / nanny. Example: "Can

a baby eat cake alone?".• Command to the mother / nanny or officer to perform tasks

written on KPSP. Example: "on your baby supine position, pull

the baby on her wrist slowly to a sitting position".

• Questions answered one by one.• Each question has only one answer YES or NO.

• Calculate answer Yes• (if the answer is can or often or sometimes)

• Calculate answer No• (if the answer is has never been or never)

• If the answer is YES = 9-10, child development developmentally appropriate (S)

• If the answer is YES = 7 or 8, child development dubious (M)• If the answer is YES = 6 or less, there may be deviation (P)• Specify NO answer on what numbers only

Interpretation of Results KPSP

3 month

6 month

9 bulan

12 month

15 month

18 month

21 month

24 month

30 month

36 month

42 month

48 month

54 month

60 month

66 bulan

72 month

Thank You