儿科学-培训课件PPT
儿科学-培训课件PPT,儿科学,培训,课件,PPT
ChildhoodNutritionandProtein-EnergyMalnutritionZhong Guo Yu 钟帼钰 Pediatric Department The First Clinical College of Guangzhou Medical UniversitysectiononeChildhoodNutrition小儿营养小儿营养sectiontwoProtein-EnergyMalnutrition营养不良营养不良sectiononeChildhoodNutritionTeachingtarget教学目标教学目标1.1.掌握掌握合理营养原则合理营养原则2.2.掌握掌握婴儿喂养方法婴儿喂养方法3.3.掌握掌握母乳喂养的优点和重要性母乳喂养的优点和重要性4.4.了解小儿物质代谢的特点了解小儿物质代谢的特点5.5.了解小儿消化系统解剖生理特点了解小儿消化系统解剖生理特点sectiononeChildhoodNutrition一、小儿营养基础一、小儿营养基础二、婴儿喂养方法二、婴儿喂养方法三、幼儿营养与膳食安排三、幼儿营养与膳食安排四、营养状况评价的原则四、营养状况评价的原则Definition repairtissuesbuilduptissuesrationaldietgiveenergykeepphysicalactivitygrowthanddevelopmentThebasisofChildhoodNutritionThebasisofChildhoodNutrition一、小儿营养基础一、小儿营养基础小儿营养供给的小儿营养供给的基本要求基本要求:vgrowingupvavoidinglackofnutrientThebasisofChildhoodNutritionFoodPyramid食物金字塔食物金字塔ThebasisofChildhoodNutritionThebasisofChildhoodNutrition一、小儿营养基础一、小儿营养基础energymacronutrientscarbohydratefatproteinmicronutrientsmineralvitamindietarycomponentsdietaryfiberwaterThebasisofChildhoodNutritionEnergy能量能量givedbymacronutrients能量的单位:千卡能量的单位:千卡(kcal)千焦耳千焦耳(Kj)1 kcal=4.184 Kj 1 Kj=0.239 kcalThebasisofChildhoodNutritionEnergymetabolisminchildren儿童能量代谢儿童能量代谢ThebasisofChildhoodNutrition儿童儿童特有特有Energyintakeinfant 95 kcal/kg.dThebasisofChildhoodNutritionCarbohydrate糖类糖类ThebasisofChildhoodNutrition主要供能物质主要供能物质总能量总能量55-65%55-65%80%80%或或40%40%不利健康不利健康lactose 乳糖乳糖saccharose蔗糖蔗糖starch 淀粉淀粉Fat脂脂类类ThebasisofChildhoodNutrition热能主要来源热能主要来源essentialfattyacid必需脂肪酸必需脂肪酸6 6月以下月以下45-50%45-50%7 7岁以上岁以上25-30%25-30%linoleicacid亚油酸亚油酸linolenicacid亚麻酸亚麻酸Protein蛋白质蛋白质ThebasisofChildhoodNutrition供给热能供给热能essentialaminoacid必需氨基酸必需氨基酸总能量总能量8-15%8-15%adult 8 8infant 9 9premature1313Micronutrients微量营养素微量营养素mineral矿物质矿物质:vitamin维生素维生素:ThebasisofChildhoodNutritioncalcium、iron、iodine、zincA A、D D、C C、B B1 1Dietaryfiber膳食纤维膳食纤维主要来自植物的细胞壁,为不被小肠主要来自植物的细胞壁,为不被小肠酶消化的非淀粉多糖酶消化的非淀粉多糖.功用功用:吸收大肠水分吸收大肠水分 软化大便软化大便 促进肠蠕动促进肠蠕动ThebasisofChildhoodNutritionWater 水水intakeinfant 150ml/kg.dper3yearsreduce 25ml/kg.d15 yearsold 50ml/kg.dThebasisofChildhoodNutrition小儿消化系统功能发育与营养小儿消化系统功能发育与营养口腔口腔胃胃消化腺消化腺肠肠ThebasisofChildhoodNutrition小儿消化系统功能发育与营养小儿消化系统功能发育与营养消化酶与宏量营养素的消化吸收消化酶与宏量营养素的消化吸收1 1、蛋白质、蛋白质2 2、脂肪、脂肪3 3、糖类、糖类与进食技能有关的发育与进食技能有关的发育1 1、食物接受的模式、食物接受的模式2 2、挤压反射、挤压反射3 3、咀嚼、咀嚼ThebasisofChildhoodNutritionInfantFeeding二、婴儿喂养方法二、婴儿喂养方法InfantFeeding喂奶阶段喂奶阶段 全部母乳喂养全部母乳喂养 部分母乳喂养部分母乳喂养 人工喂养人工喂养过渡阶段过渡阶段 辅助食品添加辅助食品添加改制成人改制成人 儿童儿童 饮食阶段饮食阶段 少年膳食少年膳食Breastfeeding 母乳喂养母乳喂养Breastmilkisthebestfoodforbabies.纯母乳喂养纯母乳喂养:生后:生后4-64-6月,除母乳外,月,除母乳外,不给婴儿喂其他任何液体或固体食物不给婴儿喂其他任何液体或固体食物 。InfantFeedingenergycarbohydrate41%fat50%protein9%产能比适宜产能比适宜Nutrientcomposition 营养成分营养成分InfantFeedingNutrientcomposition 营养成分营养成分macronutrientscarbohydrate -lactose 乙型乳糖乙型乳糖 bacillus bifidus 双歧杆菌双歧杆菌 enterocinesia 肠蠕动肠蠕动 calcium 钙吸收钙吸收InfantFeedingNutrientcomposition 营养成分营养成分macronutrientsfat small molecul 小分子小分子 unsaturated fatty acid不饱和脂肪酸不饱和脂肪酸 cholesterol 胆固醇胆固醇 InfantFeedingNutrientcomposition 营养成分营养成分macronutrientsprotein small molecul essential amino acid lactalbumin 乳清蛋白乳清蛋白 taurine 牛磺酸牛磺酸InfantFeedingNutrientcomposition 营养成分营养成分micronutrientsmineralCa:P 2:1 iron zincInfantFeedingNutrientcomposition 营养成分营养成分micronutrientsvitaminabundant VitDVitKInfantFeedingNutrientcomposition 营养成分营养成分immunologicfactors免疫因子免疫因子secretoryIgA分泌型分泌型IgAlactoferrin乳铁蛋白乳铁蛋白bifidusfactor双歧因子双歧因子macrophages巨噬细胞巨噬细胞lysozyme溶菌酶溶菌酶alexin补体补体oligosaccharide低聚糖低聚糖InfantFeedingNutrientcomposition 营养成分营养成分digestiveenzyme消化酶消化酶giyceridase脂酶脂酶protease蛋白水解酶蛋白水解酶InfantFeedingAdvantageofbreastfeedingforinfants1 1、母乳最适合于婴儿消化,经济、方便、温母乳最适合于婴儿消化,经济、方便、温度适宜、不易污染。度适宜、不易污染。2 2、含有丰富抗感染物质,提高防病力。、含有丰富抗感染物质,提高防病力。3 3、含多种免疫物质,预防过敏性疾病。、含多种免疫物质,预防过敏性疾病。4 4、吸吮肌肉运动,促进面部和牙齿的发育吸吮肌肉运动,促进面部和牙齿的发育5 5、有利婴儿的智力发展。、有利婴儿的智力发展。6 6、促进母婴感情交流,增进母婴身心健康。、促进母婴感情交流,增进母婴身心健康。InfantFeedingAdvantageofbreastfeedingformothers1 1、有利于母亲产后的复康。、有利于母亲产后的复康。2 2、是一种天然的避孕方法。、是一种天然的避孕方法。3 3、减少母亲患乳腺癌和卵巢癌的危险。减少母亲患乳腺癌和卵巢癌的危险。InfantFeedingAdvantageofbreastfeedingforsociety 1 1、有助于降低婴儿发病率和死亡率,、有助于降低婴儿发病率和死亡率,提高人口素质。提高人口素质。2 2、增进家庭感情,稳定家庭关系。、增进家庭感情,稳定家庭关系。InfantFeedingTheinfantmortalityrateandfeedingpatternsP 水消耗水消耗全身总液全身总液量相对量相对钠钠泵泵运转运转ATPATP合成合成细胞外细胞外液低渗液低渗低钠低钠低钙低钙低钾低钾Thermoregulation热能不足热能不足皮下脂肪皮下脂肪血糖血糖体温调节体温调节能力能力氧耗量氧耗量Systemdysfunction 系统功能紊乱系统功能紊乱digestivesystemcirculatorysystemurinarysystemnervoussystemimmunesystemDigestivesystem消化液消化液消化酶消化酶肠肠蠕动蠕动菌群失调菌群失调消化功能消化功能腹泻腹泻Circulatorysystem心肌纤维心肌纤维肿胀肿胀心肌心肌收缩力收缩力心心搏出量搏出量血压血压脉搏细弱脉搏细弱Urinarysystem肾小管细胞肾小管细胞混浊肿胀混浊肿胀重吸收重吸收功能功能尿量尿量尿尿比重比重Nervoussystem蛋白质消耗蛋白质消耗能量供应不足能量供应不足头围小于正常,头围小于正常,智商减低智商减低精神抑制、精神抑制、表情淡漠、表情淡漠、反应迟钝、反应迟钝、记忆力减退、记忆力减退、条件反射不易建立条件反射不易建立Immunesystem胸腺、淋巴胸腺、淋巴组织萎缩组织萎缩细胞免疫细胞免疫体液免疫体液免疫免疫功能免疫功能全面全面极易感染极易感染Clinicalmanifestationtheearliest:noweightgain weightlossmarasmus:subcutaneousfatloss vanishsequence:abdomen torso buttocklimbscheek判定皮下脂肪消失的程度判定皮下脂肪消失的程度方法方法:1 1、腹部脐旁乳线、腹部脐旁乳线 上上 2 2、拇指和食指相、拇指和食指相 距距3cm3cm将皮肤将皮肤 捏起捏起 3 3、量其上缘厚度、量其上缘厚度测测 量量 工工 具具Clinicalmanifestationnormalheight heightlowerthannormalnormalmentalstate mentalfatiguemulti-organdamageComplication 并发症并发症infectionspontaneoushypoglycemiaalimentaryanemiamultipleavitaminosisdeficiencyoftraceelementsComplication 并发症并发症infection感染感染recurrentrespiratorytractinfection 反复呼吸道感染反复呼吸道感染thrush 鹅口疮鹅口疮otitismedia 中耳炎中耳炎tuberculosis 结核病结核病urinarytractinfection 尿路感染尿路感染Complication 并发症并发症spontaneoushypoglycemia自发性低血糖自发性低血糖面色苍白、神志不清、脉搏减慢、呼面色苍白、神志不清、脉搏减慢、呼吸暂停、体温不升吸暂停、体温不升严重者死亡严重者死亡Complication 并发症并发症alimentaryanemia营养性贫血营养性贫血microcytichypochromicanemia 小细胞低色素性贫血小细胞低色素性贫血iron-deficiencyanemia 缺铁性贫血缺铁性贫血Complication 并发症并发症multipleavitaminosis多种维生素缺乏多种维生素缺乏vitaminAdeficiencyvitaminDdeficiencydeficiencyoftraceelements微量元素缺乏微量元素缺乏iron、zinc、calcium、iodineLaboratoryfindings1.seralbumin:themostimportantchange2.plasmaproteins:earlydiagnosis3.insulin-likegrowthfactor:sensitive4.RBChemoglobin5.enzymeactivity6.electrolytedisturbancesDiagnosis thediagnosisofmalnutritionagefeedingweightlosssubcutaneousfatlossmulti-organdamageetiologicaldiagnosis Diagnosis measure:height、weightclassification(under5yearsold):underweight:weight、age、sexstunting:height、age、sexwasting:weight、height、sex符合一项即可诊断符合一项即可诊断Diagnosis classifyseverity(under5yearsold)mild:-2SDmoderate:-2SD-3SDsevere:-3SDTreatmentprinciple:积极处理各种危及生命的并积极处理各种危及生命的并发症、去除病因、调整饮食、促进发症、去除病因、调整饮食、促进消化功能。消化功能。Treatment1、complication并发症并发症severedehydration严重脱水严重脱水electrolytedisturbances电解质紊乱电解质紊乱acidosis 酸中毒酸中毒shock休克休克spontaneoushypoglycemiainfectionTreatment2、etilogicaltreatment病因治疗病因治疗curetheprimarydisease治疗原发病治疗原发病improvefeedingpatterns改进喂养方法改进喂养方法Treatment3、antisecosis 调整饮食调整饮食principle:stepbystep循序渐进循序渐进逐步充实逐步充实stepbystep(1 1)热量及蛋白质供给)热量及蛋白质供给 轻度轻度:供给足够热量:供给足够热量 中度中度:浮肿型多补充蛋白质:浮肿型多补充蛋白质 消瘦型多补充热量消瘦型多补充热量 重度重度:首先处理危及生命的并:首先处理危及生命的并 发症,供给同中度发症,供给同中度stepbystepprotein1.5-2.0g/kg3.0-4.5g/kgstepbystep(2(2)饮食选择)饮食选择 易消化、高热量、高蛋白质易消化、高热量、高蛋白质 适量维生素、矿物质适量维生素、矿物质 流质流质半流质半流质软食软食普食普食stepbystep(3 3)喂养方法)喂养方法 进食困难:鼻饲进食困难:鼻饲 病情好转:滴管或直接进食病情好转:滴管或直接进食Treatment治疗治疗4 4、promotedigestion促进消化促进消化药物药物 B B族维生素、消化酶族维生素、消化酶 苯丙酸诺龙苯丙酸诺龙 胰岛素胰岛素中医治疗中医治疗 中药、针灸、推拿中药、针灸、推拿Treatment治疗治疗5、theothers成分输血成分输血静脉点滴脂肪乳、氨基酸、葡萄糖静脉点滴脂肪乳、氨基酸、葡萄糖充足睡眠充足睡眠适当活动适当活动良好护理良好护理Preventions 预防预防reasonablefeedingreasonablehabitspreventionandtreatmentofinfectiousdiseasescorrectionofcongenitalmalformation 纠正先天畸形纠正先天畸形growthanddevelopmentsurveillance 应用生长发育监测图应用生长发育监测图生生长长发发育育监监测测图图选择题1、下列哪项与母乳抗感染作用无关A.SIgAB.乳铁蛋白C.双歧因子D.乳白蛋白E.溶菌酶正确答案:正确答案:D D选择题2、母乳中哪些成分含量低(多选题)A.乳清蛋白B.铁C.不饱和脂肪酸D.VitDE.VitK正确答案:正确答案:B B、D D、E E3、婴儿人工喂养基本要求(多选题)A.每天需总热量是95kcal/kgB.每天需水量约150ml/kgC.牛乳喂养需加糖8%D.不需另加维生素E.饮食中热量构成比是蛋白质:脂肪:糖=3:2:1选择题正确答案:正确答案:A A、B B、C C选择题4、营养不良的早期临床表现是A.面色苍白B.精神萎靡C.发育迟缓D.食欲减退E.体重不增正确答案:正确答案:E E5、营养不良患儿皮下脂肪消失的顺序A.腹部躯干臀部四肢面部B.躯干腹部四肢臀部面部C.四肢腹部躯干臀部面部D.自上而下E.自下而上选择题正确答案:正确答案:A A思考题1、母乳为何具有增进婴儿免疫力 的作用?2、试述小儿辅食添加原则3、应怎样为中、重度蛋白质-能量营养不良患儿调整饮食?谢谢 谢谢 婴幼儿营养不良分度婴幼儿营养不良分度 度度 度度 度度体重低于正常体重低于正常15-25%25-40%40%皮下脂肪皮下脂肪0.8-0.4cm0.4cm消失消失消瘦消瘦不明显不明显明显明显皮包皮包骨骨精神萎靡精神萎靡无无轻微轻微严严重重肌肉松弛肌肉松弛轻微轻微明显明显肌张肌张力力低下低下皮肤皮肤正常正常苍白苍白多皱多皱纹纹弹性差弹性差弹性消弹性消失失3 3岁岁以上营养不良分度以上营养不良分度3-7岁岁7-14岁岁轻度轻度重度重度轻度轻度重度重度体重体重15-30%30%皮下脂肪皮下脂肪减少减少明显明显消瘦消瘦轻微轻微严重严重精神萎靡精神萎靡轻微轻微明显明显皮肤皮肤苍白苍白苍白明苍白明显显弹性差弹性差弹性很差弹性很差20-30%30%减少减少明显明显轻微轻微严重严重轻微轻微明显明显苍白苍白苍白明苍白明显显弹性差弹性差弹性很差弹性很差mildmalnutrition轻度营养不良轻度营养不良moderateandseveremalnutrition中、重度营养不良中、重度营养不良PEDIATRICSChen Dehui(1030412)Chen Dehui(1030412)Pediatric Department Pediatric Department The first Affiliated Hospital of The first Affiliated Hospital of Guangzhou Medical UniversityGuangzhou Medical UniversityOVERVIEWCHAPTER 1The Scope of PediatricsPediatrics is concerned with the health of infants,children,and adolescents;their growth and development;and their opportunity to achieve full potential as adults.It is the science and art of prevention,diagnosis,and treatment of the diseases of children from birth through adolescence,whether these disturbances be physical,mental,or emotional.儿科学是一门关于从出生到青春期儿童疾病预防、诊断与治疗的科学和艺术,这些儿童期的疾病可以是肉体的,也可以是精神方面的。The Scope of PediatricsThe most characteristic feature of pediatrics is that it deals with the growth and development of the child,comprising all those changes in size and form and in complexity of function that constitute growing up.儿儿科科学学最最主主要要的的特特征征是是要要研研究究儿儿童童的的生生长长发发育育,儿儿童童的的生生长长发发育育造造成成了了其其形形体体方方面面的的变变化化,也也是其功能复杂性的基础。是其功能复杂性的基础。Subspecialty of PediatricsSubgrouped by the emphasis of health care:Developmental Pediatrics(发育儿科学)(发育儿科学)Preventive Pediatrics(预防儿科学)(预防儿科学)Clinical Pediatrics(临床儿科学)(临床儿科学)Rehabilitation in Pediatrics(儿童康复医学)(儿童康复医学),etcSubgrouped by age:Perinatology(围生医学)(围生医学)Neonatology(新生儿学)(新生儿学)Adolescence Medicine(青春医学)(青春医学),etcThe Goal Of PediatricsTo be certain of the health of children.To promote the life quality of children.Difference between Child and Adult A child is in continuous growth and development.“A CHILD IS NOT A LITTLE MAN”Functions of various organ systems 各系统功能差异各系统功能差异Degree of immunity to disease 机体免疫反应程度机体免疫反应程度Response to the effects of disease 对疾病的应激反应对疾病的应激反应Dosage of drugs and tolerance to drugs 对药物剂量及耐对药物剂量及耐受性受性Mental and motor ability 精神运动的能力精神运动的能力Patten of emotional response 心理反应心理反应Disparity in Occurrence and Progression of Disease between Children and AdultDisparity in anatomy,physiology,and immunologic function between children and adultThe younger,the more differentDisparity in occurrence and progression of disease between children and adultDisparity in spectrum of disease 不同的疾病谱不同的疾病谱Congenital anomalies、inborn errors of metabolism(more common in children)先天畸形、先天代谢性疾先天畸形、先天代谢性疾病多见病多见 Newborns and infants is vulnerable to infection 新生儿、婴儿易发生感染新生儿、婴儿易发生感染 Sinusitis is rare in infancy 鼻窦炎在婴儿相对少见鼻窦炎在婴儿相对少见Infants and young children are vulnerable to obstruction in respiratory tract 婴幼儿易发生气道阻婴幼儿易发生气道阻塞塞Disparity in Occurrence and Progression of Disease between Children and AdultDisparity in type of diseasePneumoniaChildren:bronchial pneumonia 支气管肺泡炎症支气管肺泡炎症Adult:lobar pneumonia 大叶性肺炎大叶性肺炎 Vit D DeficiencyChildren:rickets(佝偻病佝偻病)Adult:malacosteon(骨软化骨软化)Disparity in occurrence and progression of disease between children and adultDisparity in manifestation of diseasediarrhea dehydrationdiarrhea dehydration;fever seizurefever seizureDisparity in occurrence and progression of disease between children and adultStages Of A Child By AgeEmbryo period(胚胎期)(胚胎期):the first 8 weeks of gestation,the formation of tissues and organs 怀孕8周Fetus period:from the 9th week of gestation to the delivery of the neonatal infant,the growth and development of the fetus第9周分娩出生pFetus(胎儿期)(胎儿期):from conception to the birth of the neonate,40 weeks.从受精卵形从受精卵形成成出生为止,出生为止,40周。周。Early neonates:Early neonates:the first week after birthPerinatalPerinatal period period(围产期)(围产期):from the 28th weeks of gestation to the 7th day of the neonate after birth.pNeonates(新生儿期)(新生儿期):from delivery and cutting off the umbilical cord of the newborn to the 28th day after birth 从胎儿娩出脐带结扎从胎儿娩出脐带结扎时开始时开始28天天Birth injury,apnea,infections,hemorrhage,hyperbilirubinemia,etc are common medical problems in this stage.Carefully taking care of the neonatal infant is of great importance.pInfantsInfants(婴儿期)(婴儿期):the 1 the 1st st year after birth year after birth Infectious diseases,malnutrition,and indigestion Infectious diseases,malnutrition,and indigestion are common in this period are common in this period 感染、营养不良、消感染、营养不良、消化不良多见化不良多见Health care:Health care:Proper feeding Proper feeding 合理喂养合理喂养 Vaccination in time Vaccination in time 按时预防接种按时预防接种pYoung child(toddlers age,幼儿期,幼儿期):from 1 year old to 3 years oldBegin to walk,quick linguistic and intelligence development,strong curiosity学习行走,语言、动作、思维发育迅速,强烈的学习行走,语言、动作、思维发育迅速,强烈的好奇心好奇心 Health care:Prevention of accidents and infectious diseases 防意外、感染防意外、感染 Proper nutrition 合理营养合理营养pPreschool(学龄前期)(学龄前期):from 3 years old to 67 years oldGrowth rate slows down but language and emotion,as indicators for intelligence,continue to develop quickly.Health care:Encouraging good behaviorSuitable timing to begin early educationDisease prevention:rheumatic fever,acute glomerulonephritis,etc.pSchool age(学龄期)(学龄期):aged 67 to pre-adolescenceSystem and organs development have been almost reached to the level of adults(except for sexual organs).Self-esteem plays very important role in the psychological development.Health care:Encouraging good attitude and habits for study and behaviors.Prevention of nearsightedness(近视),decayed teeth(龋齿),etc.pAdolescence(early youth,青春期,青春期):from 10 yrs old to 20 yrs old.The adolescence of a girl may begin and end about 2 yrs earlier than that of a boy.女孩青春期 的开始与结束时间均比男孩的早2年左右。Children in this period undergo rapid changes in body size,shape,physiology,and psychological and social functioning.The second peak of physical growth rate after birthHealth care:nutrition,exercises and normal psychological development.DEVELOPMENT AND FUTURE OF CHILDRENv18yr in total populationdeveloped countries 22.4%developing countries 35.7%china 30%(UNCF 1999)18yr 400 million(china)Infant Mortality in China and Developed Country1949199920002003City15%1.18%0.55%Rural area20%3.7%Developed Countries0.40.7%yearareaMortality of Children under Age 5 in China and Developed Country1949199920002003city2.1%1.4%0.7%Rural area7.1%4.6%Developed Countries0.40.8%yearareaThe Change of Mortality of Children in ChinaMortality Comparison of China with Other CountriesChildren account for a high percentage in the total population.In our country,the health care of children has been in great progression.Analysis of Death under Age 5 in China(2000)Death 5 yrs:93%in ruralInfant death:accounting to 80newborn death 65 of total infant death Leading death cause:Pneumonia(肺炎)、asphyxia(窒息)、prematurity(早产儿)、diarrhea(腹泻)、congenital anomalies(先天畸形)The World Summit for Children in 1990“T The World Declaration on the Survival,Protection and Development of Children in the 1990s”Plan of Action for Implementing of the declaration 中国政府制定中国政府制定中国政府制定中国政府制定“九十年代中国儿童发展规划纲要九十年代中国儿童发展规划纲要九十年代中国儿童发展规划纲要九十年代中国儿童发展规划纲要”“(20012001200120012010201020102010)中国儿童发展纲要)中国儿童发展纲要)中国儿童发展纲要)中国儿童发展纲要”“(2011201120202020)中国儿童发展纲要)中国儿童发展纲要”The Children Are Often Among the Most Vulnerable or Disadvant-aged in Society and Their Needs Require Special Attention.Principles and Objectives A World Fit For Children-2002Put children firstEradicate poverty Leave no child behind Care for every childEducate every childProtect children from harm and exploitationProtect children from warCombat HIV/AIDSListen to children and ensure their participationProtect the Earth for childrenControl of infective diseaseFocus on psycho-behavior problemManagement of Accidence and injuryPrevention and treatment of congenital anomaliesPreventive measures in childhood for adult diseaseTasks of pediatrician in 21 CenturyReferences:References:KEY POINTS IN THIS CHAPTERCharacteristic features of pediatrics Stage of children by ageQuestionAn infant can move his head from side to side while following a moving object,can lift his head from a prone position 45 degrees off the examining table,smile when encouraged,and makes cooing sounds.He cannot maintain a seated position.The most likely age of the infant isa.1 monthb.3 monthsc.6 monthsd.9 monthse.12 monthsThank You for Your Attention!Thank You for Your Attention!PEDIATRICSChen Dehui(1030412)Chen Dehui(1030412)Pediatric Department Pediatric Department The first Affiliated Hospital of The first Affiliated Hospital of Guangzhou Medical UniversityGuangzhou Medical UniversityStages Of A Child By AgeGROWTHAND DEVELOPMENTCHAPTER 2Growth And DevelopmentGrowth The changes of form and increases in size of the body and organs of a child 儿童各器官、系统的长大Development Maturation of cells,tissues and organs 组织、器官、功能的分化成熟Growth and development is a continuous and staged process 是一个连续的、分阶段的过程Patterns of Growth and DevelopmentPatterns of Growth and development Different rate of development in various systemsPatterns of Growth and DevelopmentIndividual variation in growth and developmentPatterns of Growth and DevelopmentGrowth and development show Cephalocaudal(从头到尾)从头到尾)pattern 生长发育通常遵循生长发育通常遵循由上到下、由近到远、由粗到由上到下、由近到远、由粗到细、由低级到高级、由简单到复杂细、由低级到高级、由简单到复杂的规律的规律Factors Influencing Growth And DevelopmentGenetics 基因遗传基因遗传Nutrition 营养状况营养状况Health status during pregnancy 母体怀孕时母体怀孕时的健康状况的健康状况Living environments 生活环境生活环境Effects of diseases 疾病影响疾病影响Indicators For Assessment of Growth And DevelopmentBody Weight 体重体重Height 身高身高Sitting Height 坐高坐高Head Circumference 头围头围 Chest Circumferenc 胸围胸围Upper Arm Circumference 上臂围上臂围Subcutaneous Fat 皮下脂肪皮下脂肪Body Weight Body Weight A sensitive indicator for growth and nutritional status 评估生长及营养状况评估生长及营养状况An important variable for calculation of drug dosage,energy and fluid supplement 用于计算儿童用药剂量、能量及液体治疗用于计算儿童用药剂量、能量及液体治疗Examination Baby balance for infants(accuracy in 50g),),weighing scale for children(accuracy in 100g)婴儿测体重精确:婴儿测体重精确:50g;儿童;儿童:100gInfants and children should be weighed without their clothes on.需要去掉衣服的重量需要去掉衣服的重量Normal Weight Gain AgeAge Normal BW Normal BW(kgkg)NewbornNewbornMaleMale3.33.30.40.4FemaleFemale3.23.20.40.43 34months 4months Double body weight after Double body weight after birth birth of birth(of birth(出生体重的出生体重的2倍倍)1 year old1 year old10(10(出生体重的出生体重的3倍倍)2 year old2 year old1212Average body weight for children of 1Average body weight for children of 112 old12 old:BWBW(kgkg)Age(years)2Age(years)28 8Physical Weight Loss生理性体重下降生理性体重下降A newborns weight may decrease 10%below birthweight in the 1st week as a result of excretion of excess extravascular fluid and possibly poor intake.生后生后1周生理性体重下降,水分丢失、胎粪排出、摄入不足周生理性体重下降,水分丢失、胎粪排出、摄入不足 有关,下降约有关,下降约3%9%Intake improves as colostrum is replaced by high-fat milk and the amount of milk infant suck increase,Infant should regain or exceed birthweight by 710 days of age and should grow at approximately 30g/day.及时喂养,生后及时喂养,生后710天体重恢复出生时体重,后体重增长约天体重恢复出生时体重,后体重增长约30g/天天Weight Is a sensitive indicator for growth and nutritional status Height The length from the top of the head to the planta pedis 测量方法:头顶测量方法:头顶平足底部平足底部An parameter for body growth and growth velocity,an assessment for skeleton growth 评估儿童生长、生长速度骨骼生长评估儿童生长、生长速度骨骼生长Measurement3 years oldMeasuring in recumbent position(Body length)3岁以下卧位测量岁以下卧位测量3 years old Measuring in standing position(Height)Body Length ScaleNormal Height GainAgeNormal Height(cm)Gaining Height(Length)by AgeNewborn503 months after birth 1113cm are increased and 1213cm during the following 9 months,so in the 1st year the height will increase 25cm.1012cm in the 2nd year.From age 210,57cm/year will be gained.年龄(年龄(y)7+751 year old752 years oldAfter 2 yrs old85Some Concepts About Height Setting Height(坐高):(坐高):The length from the top of head to ischial tuberosity which means the length of the head and spinal column 头顶部头顶部坐骨结节的距离坐骨结节的距离Upper Length(上部量):(上部量):The length from the top of head to the upper edge of symphysis pubis 头顶部头顶部耻骨联合上缘的距离,评估扁骨的生长耻骨联合上缘的距离,评估扁骨的生长Lower Length(下部量):(下部量):The length from the upper edge of symphysis pubis to dorsal decubitus.耻骨联耻骨联合上缘合上缘脚底,评估长骨的生长。脚底,评估长骨的生长。Upper Length&Lower Length新生儿的上部量占身长的新生儿的上部量占身长的60%,下部量占身长的,下部量占身长的40%,12岁以前各年龄期有一定的比例。岁以前各年龄期有一定的比例。对矮小症患儿,除测量身长外,尚需测量上、下部量,如对矮小症患儿,除测量身长外,尚需测量上、下部量,如下部量过短表示长骨发育障碍,见于克汀病(甲状腺功能下部量过短表示长骨发育障碍,见于克汀病(甲状腺功能低下)及软骨营养障碍。低下)及软骨营养障碍。Head/Head/Trunk+legTrunk+legUpper length in Upper length in body lengthbody lengthMidpointMidpointLower Lower length length in in body lengthbody lengthNewborn1/460%Above navel40%Age 2Below navelAge 6Between navel and the upper edge of symphysis pubisAge 1250%the upper edge of symphysis pubis50%Adult1/8Lower lengthUpper lengthContinuous and Staged Process in Height Gain of Children出生出生1 岁,青春期是身高增长的两个高峰期岁,青春期是身高增长的两个高峰期Head Circumference&Chest CircumferenceHead Circumference(头围):(头围):Indicator for growth and development of brain and cranium 评估脑与颅骨的发育。出生时约评估脑与颅骨的发育。出生时约3334cm,1岁时岁时46cm,2岁时岁时48cm。Chest Circumference(胸围)(胸围):Indicator for growth and development of thorax and lung.评估肺与胸廓的生长。出生胸围约评估肺与胸廓的生长。出生胸围约32cm,1岁时岁时约等于头围,约等于头围,2岁岁48cm,215岁仅增加岁仅增加67cm。1岁岁青春前期胸围青春前期胸围=头围头围+年龄年龄-1cmHead Circumference MeasurementMeasuring the greatest occipitofrontal circumference 眉弓上缘、枕骨结节环绕一周的长度眉弓上缘、枕骨结节环绕一周的长度Reflecting the volume of intracranial contents as well as the thickness of the skull and scalpChest Circumference ExaminationMeasuring the thoracic circle around nipples and inferior angle of scapula and taking the average value between inspiration and expiration 平乳头下缘经肩胛骨下缘平绕胸一周平乳头下缘经肩胛骨下缘平绕胸一周Normal Values of Head Circumference&Chest CircumferenceAgeAge HC(cmcm)CC(cmcm)HCHCCCCC(cmcm)Newborn323432 121 year old4646 01 year later48(age 2)HC+(age-1)(age-1)qHC:During the 1st 3 months of life HC will increase about 6cm which will the amount of increase during the following 9.HC grows about 67cm from age 2 to 15.Growth Curve of Head Circumference&Chest Circumference(cm)年龄AgeHCCCAssessment of GrowthASSESSMENT OF GROWTH 均值(Mean)标准差Standard(SD)正常分布1SD+2SD+3SD68.3%95.4%99.7%ASSESSMENT OF GROWTH 百分位数(Percentile)P3P9795%表格与生长曲线(Growth chart)多参数指标年龄别体重年龄别体重(Weight for age)年龄别身高年龄别身高(Height for age)体重别身高体重别身高(Weight for height)Developments of Skeleton and TeethCranial BonesThe mature of cranial bones(颅骨)(颅骨)can be reflected by:Head circumference 头围头围Fontanel 囟门囟门Closing of suture 骨缝闭合骨缝闭合Bone,Fontanels,Sutures Of Cranial Frontal boneOccipital boneParietal boneNormal Fusion of Cranial BonesPosterior fontanel(后囟门)(后囟门):68wks after birth 出生时很小或已闭合,出生时很小或已闭合,68周闭合周闭合Sutures of cranial bones(颅骨缝)(颅骨缝):34 months after birthAnterior fontanel(前囟门)(前囟门):12 cm in newborn,The anterior fontanel usually tends to enlarge during the first few months of life,lessen after 6 months old.It closes completely in 11.5 years old.出生时出生时12cm,11.5岁闭合岁闭合Spinal Column正常情况正常情况 During the first year of life,spinal grow up faster than extremities.Later on,the situation is reversed.新生儿的脊柱弯曲不新生儿的脊柱弯曲不明显,呈轻度后凸,明显,呈轻度后凸,3 3个月的婴儿能抬头时出个月的婴儿能抬头时出现凸向前的颈曲,现凸向前的颈曲,6 6个个月后会坐时,出现凸向月后会坐时,出现凸向后的胸曲,后的胸曲,1 1岁开始走岁开始走路时,出现凸向前的腰路时,出现凸向前的腰曲。曲。Ossification Center骨化中心骨化中心The appearance of ossification center(endochondral ossification)is one of the marks for skeletal.长骨的生长主要由长骨干骺端的软骨骨化,骨膜下成长骨的生长主要由长骨干骺端的软骨骨化,骨膜下成骨,使长骨长长、增粗,当骨骺与骨干融合时,标志骨,使长骨长长、增粗,当骨骺与骨干融合时,标志长骨停止生长。长骨停止生长。骨化中心的出现评估长骨的生长成熟程度。骨化中心的出现评估长骨的生长成熟程度。Bone Age 骨龄骨龄Bone age is the measurement of skeletal matura-tion.A radiograph of the left hand and wrist is obtained and compared with the published standards of Greulich and Pyle.Knee films are sometimes added for younger children.用用X线检查测定不同年龄儿童长骨干骺端骨化中线检查测定不同年龄儿童长骨干骺端骨化中心的出现时间、数目、形态的变化,并标准化,心的出现时间、数目、形态的变化,并标准化,为骨龄。为骨龄。Bone Age 骨龄骨龄Reference standards for bone maturation facilitate estimation of bone age.骨龄反映长骨的生长成熟程度骨龄反映长骨的生长成熟程度 The bone age is low and is comparable to the height age:Constitutional growth delay,Endocrinologic short stature,Undernutrition.骨龄延迟:生长发育迟缓,生长激素缺乏症,营养不良骨龄延迟:生长发育迟缓,生长激素缺乏症,营养不良等等The bone age is normal(compared to chronological age):Familial short stature.骨龄正常:家族性身材矮小骨龄正常:家族性身材矮小Development of Ossification Centers腕骨骨化中心的出现时间 年龄年龄骨化中心骨化中心 3M3M 头骨、钩骨头骨、钩骨 1 1岁岁 下桡骨下桡骨 2 23 3岁岁 三角骨三角骨 3 3岁岁 月骨月骨 3.5 3.55 5岁岁 大、小多角骨大、小多角骨 5 56 6岁岁 舟状骨舟状骨 7 79 9岁岁 豆状骨豆状骨骨骨龄龄测测定定在在临临床床上上有有重重要要意意义义,骨骨龄龄落落后后见见于于生生长长激激素素缺缺乏乏症症、呆呆小小病病、肾肾小小管管酸酸中中毒毒等等;骨骨龄龄超超前前见见于于中中枢枢性性性性早早熟熟、先先天天性性肾肾上上腺皮质增生症等。腺皮质增生症等。3 3月头、钩骨;月头、钩骨;1 1岁下桡骨(够,骼);岁下桡骨(够,骼);加加了了2 2与与3 3(三三角角骨骨)等约(月骨)多少?等约(月骨)多少?答答案案:大大小小多多(骨骨)3-53-5岁岁周周(舟舟)5 5舟舟6 6下下尺尺骨骨(6-76-7岁岁);逗逗狗狗(豆豆9 9)1010全都齐全都齐舟、月、三角、豆,大小、头、桡、钩舟、月、三角、豆,大小、头、桡、钩DentitionPrimary dentition(乳牙)(乳牙)Time of eruption of primary teeth:About 6 months(410 months)of age,all primary teeth should be erupted at 22.5 years oldNumber of primary teeth:20 in totalCalculation of eruption of primary teeth:Number of primary teeth=Age(month)-6Time And Order of DentitionDentitionPermanent teeth(恒齿)(恒齿)Time of growing permanent teethBeginning:at 67 years old Finish:at 2030 years oldNumber of permanent teeth:2832(depending on whether the wisdom tooth are erupted or not and how many they are erupted.NEURO-PSYCHOLOGICAL DEVELOPMENTDevelopments Of Brain And SpinalDevelopment of brainDevelopments of spinal cord and spinal columnSpinal cord is almost matured at birth and by age 2 it is similar to that of adult.At birth the end of spinal cord can reach to the lower edge of the second lumbar vertebra and to the first lumbar vertebra at age 4.NEURO-PSYCHOLOGICAL DEVELOPMENT(MOTOR)Gross motor3mon6mon9mon15monLift headSittingCreep Standing with supportWalk aloneNEURO-PSYCHOLOGICAL DEVELOPMENT(MOTOR)Gross motor3mon6mon9mon15monLift headSittingCreep Standing with supportWalk alone 3抬头,抬头,6独坐,独坐,9扶站,扶站,7滚滚8爬,周会走。爬,周会走。3卟卟6坐坐8会爬,会爬,12行走,行走,2(岁)会跑。(岁)会跑。Fine motor3mon6mon12mon10monGrasp objectTransfer objectThumb-finger graspScribbleNEURO-PSYCHOLOGICAL DEVELOPMENT(MOTOR)Vision3-4yr1yrNewborn6yr3mon20cm180level3m0.71.0NEURO-PSYCHOLOGICAL DEVELOPMENT(SENSATION AND PERCEPTION)HearingNewborn3mon1yr2yr4yrHearingTurning head to soundKnowing his/her nameFollowing simple directionHearing matureNEURO-PSYCHOLOGICAL DEVELOPMENT(SENSATION AND PERCEPTION)Linguistic DevelopmentAGELANGUAGE6 Monthschuckle,babbles10 MonthsVocalising,da-da,ma-ma12 Months 12words18 Months23 word sentences思考题小儿各年龄阶段如何划分?小儿各年龄阶段如何划分?衡量小儿体格发育的指标主要有哪衡量小儿体格发育的指标主要有哪些?些?生长发育的规律?影响因素生长发育的规律?影响因素??各系统器官生长发育不平衡各系统器官生长发育不平衡生长发育头尾规律生长发育头尾规律(CephalocaudalCephalocaudal pattern pattern)一般规律性一般规律性举例举例由上至下由上至下由近至远由近至远由粗至细由粗至细由简单至复杂由简单至复杂由低级至高级由低级至高级抬头抬头-抬胸抬胸-坐坐-站站-行行四肢运动发育:先臂后手、先腿后脚四肢运动发育:先臂后手、先腿后脚手的动作发育手的动作发育:一把抓一把抓-手指取物手指取物语言发育:咿呀作声语言发育:咿呀作声-字字-词词-句句思维发育:直觉行动思维思维发育:直觉行动思维-具体形象具体形象思维思维-抽象逻辑思维抽象逻辑思维QuestionAn infant can move his head from side to side while following a moving object,can lift his head from a prone position 45 degrees off the examining table,smile when encouraged,and makes cooing sounds.He cannot maintain a seated position.The most likely age of the infant isa.1 monthb.3 monthsc.6 monthsd.9 monthse.12 monthsHow Old Is He/She?How Old Is He/She?How Old Is He/She?Thank You for Your Attention!Thank You for Your Attention!Welcome to Join Us After 2 Year!Welcome to Join Us After 2 Year!
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