Childs Growth Development and Geriatry System

Medical Faculty
Makassar, April 28 rd, 2016

Muslim University of Indonesia

1st MODULE REPORT

Child Growth and Development Disorder

TUTOR :
dr. Nevy
GROUP 14:
Lailatul Faizah

110 213 0005

Nurfi Resni Fitra Ramda

110 213 0016

H. Ahmad Frenrengi R

110 213 0025

M Lutfi Syahadatin Irwan

110 213 0026

Nurfatriani

110 213 0038

Yuni Susantri

110 213 0052

Wahyuni Sartika Dewi.S

110 213 0062

St. Giranti Adilia Gunadi

110 213 0074

Rahmawati S

110 213 0087

Annisa Rachma Muliani

110 213 0096

Fadhilah Rufaidah

110 213 0116

MEDICAL FACULTY
MUSLIM UNIVERSITY OF INDONESIA
MAKASSAR
2016

A. Scenario
Mrs. Asni Brought her boy to community health care on 15th April 2016 to have
regular checkup. The identity was born on March 23, 2015 referenced by Doctor.
Gestation age week 32, births weight 1800 gram, body length 46 cm, head
circumference 28cm, immediately crying, incubator care, and have yellow skin (K4),
according to his mother , also have phototheraphy care.
On physical examination, weight 7100 gram (3 consecutive months ago 6300 grams,
6700 grams, 6900 grams, respectively) based on KMS data, body length 70cm, head
circumference 36cm,. while the child is still breastfeed, milk porridge since the age of
6 months, the refined pulp porridge, fruit and refused to drink bottle-feeding.
The development sits with handle, rambling, papapapapa, mamamama, waving hands,
imitating sound.
The child is playing with baby walker, tricycle, playing tennis ball and rattles. History
of immunization was DPT, Hep B, Hib, Polio 1x period at 2 times.
B. Difficult Word
-

C. Key words
- was born on March 23, 2015
- Mrs. Asni Brought her boy to community health care on 15th April 2016
- Gestation age week 32
- births weight 1800 gram
- body length 46 cm
- head circumference 28cm
- immediately crying
- incubator care
- have yellow skin (K4) also have phototheraphy care.
- On physical examination, weight 7100 gram (3 consecutive months ago 6300
-

grams, 6700 grams, 6900 grams, respectively)

KMS data : body length 70cm, head circumference 36cm
Milk porridge since the age of 6 months, the refined pulp porridge, fruit and
refused to drink bottle-feeding.
The development sits with handle, rambling, papapapapa, mamamama,
waving hands, imitating sound.
The child is playing with baby walker, tricycle, playing tennis ball and rattles.
History of immunization was DPT, Hep B, Hib, Polio 1x period at 2 times.

D. Questions
1. Whats the characteristic of normal baby?
2. What the babys can do normally according to scenario?
3. How is the interpretation of babys growth and development?

4.
5.
6.
7.
8.

How to calculate the babys nutrition status?

Whats factor can be affect to growth and development?
Whats the requirement for fototheraphy?
Whats the connection between immunization with the babys condition?
Why the baby refuse to drink bottle feeding and the correlation between jaundice

to baby's growth and development?

9. How the treatment for the baby and education for the mother?
10. How about the Islamic perspective?
E. Answer
1. Whats the characteristic of normal baby?
Answer :
Weight : 7100 gram
( 3 consecutive months ago 6300 gram, 6700 gram, 6900 gram respectively)
Babys weight gain occurred in 4 quarters :
Quarters I : 700 1000 gram/month
Quarters II : 500 6000 gram/month
Quarters III : 350 450 gram/month
Quarters IV : 250 350 gram/month
After we made a calculation :
The babys age is 11 months, so the babys weight gain : 6950 7850 gram until the
day arrived. The babys weight is normal.

a. KMS CHART
Length : 70 cm
Babys length grow occurred in 4 quarters :
Quarters I

: 2,8 4,4 cm / month

Quarters II

: 1,9 2,6 cm / month

Quarters III

: 1,3 1,6 cm / month

Quarters IV

: 1,2 1,3 cm /month

After we made a calculation :

The babys age is 11 months, so the babys length grow : 63,8 74,4 cm until the day
arrived. The babys length is normal.

b. CDC CHART
Head circumference : 36 cm

HC = 2cm/months
HC = 1 cm/months
HC =0,5 cm/monts

honestly, the babys head is grow. But unfortunately the babys head cant turn into normal
category.

Based on this two chart ( chart a and b), we can see the babys head circumference is very
small. Under the normal line. It means the babys turn into microchepaly.

The babys still breast-feeding : normal ( until 2 years )

Since 6 months the babys eat pulp porridge, fruit : normal (since 6 months)
Refused to drink bottled-feeding : abnormal (the babys should drink bottled-feeding
since 10 months)

The development :
-

Sits with handle : late-development (cause in 11 months the babys should stand up by
him self and walk)
Rambling : normal
Papapapa : normal
Mamamama : normal

Waving hands : normal

Imitating sound : normal

2. What the babys can do normally according to scenario?

Gross Motoric Development
Supine from the prone position

3.5 months

Prone from supine position

4.5 months

Sitting with help

5.5 months

Sitting without help

6 months

Creeping

6.5 months

Sitting with their own

7.5 months

Crawling

7.5 months

Standing

8 months

Moving

9 months

Walking

12 months

Running

14 months

An 11 months baby can moving their body and start to walking.

Fine Motoric Development

Fixation of sight

Neonatal

Follow things from midline

2 months

Detect small things

5 months

Open the palms

3 months

Unite the palms

4 months

Moving things

5 months

Grab unilateral

6 months

Pincer grasp matur

9 months

Pincer grasp mature with finger

11 months

Release things

12 months

An 11 months baby can pincer grasp mature with finger.

Languange Development
React to the sound

2 weeks

Cooing

2 months

Looking for the sound source

2 months

Laughing and crying with reason

4 months

Babbling

6 months

Dadada Mamama (not specific)

9 months

Saying 2 syllable word

9 months

Mama papa (specific)

12 months

Saying 1 or 2 other words

12 months

An 11 months baby can saying 2 syllable word and calling their parents
specifically.

3. How is the interpretation of babys growth and development?

4. How to calculate the babys nutrition status?

5. Whats factor can be affect to growth and development?

Answer :
Factors affecting growth and development
A. Genetics
Parental size has a direct influence on a childs growth potential and
their predicted adult height; more so for height than weight. A child with
short stature may be of concern because of possible illness or poor
nutrition, but for a short child with short parents they are possibly
genetically small. Extreme shortness may be due to a combination of
genetic and non-genetic factors. Complex calculations can be performed
to predict the childs height potential based on their parents heights.
Calculate mid-parental height by adding both parents heights together
and dividing by two. Charts are available to determine the predicted
height based on mid-parental height. A child whose adjusted stature is still
low should be investigated further for illness or poor nutrition. It is normal
that five percent of all children will grow below the 5th centile on height
for age charts and be healthy.
B. Ethnicity
It was traditionally believed that different ethnic groups show
different patterns of growth; on average African-Caribbean groups are
taller and heavier, and Asian and Chinese groups are shorter and lighter
when compared with Caucasians. More recently, the Multicentre Growth
Reference Study group refuted this belief showing that variability in infant
growth was greater within population groups than between the different
country groups.
C. Birthweight
Small

birth

size

may

be

associated

with

increased

risk

of

cardiovascular diseases, suggesting that foetal under-nutrition may

increase susceptibility to diseases occurring later in life. Evidence from
animal studies suggests that the foetus may adapt to an adverse
intrauterine environment by slowing down growth and metabolism,
whereas large birth size may predict increased risk of obesity, diabetes
and some cancers.

Birthweight is one of the most accessible and reliable indicators and

universally measured In general, lower birth weight is associated with
higher risk or morbidity. At a population level, groups with lower mean
birthweight often have higher infant mortality (eg infants of mothers who
smoke, or of mothers from lower socioeconomic background). Asthma,
lower developmental outcomes and hypertension have all been reported
to be more common among small birth weight infants.
A babys weight at birth is strongly associated with mortality risk
during the first year, and to a lesser extent, with developmental problems
in childhood and the risk of various diseases in adulthood, including
cardiovascular disease and some cancers according to a recent systematic
review.
D. Prematurity
A child born before 37 completed weeks gestation is considered
preterm. Weight is plotted on an appropriate intrauterine growth chart. In
Victoria, these charts are based on data from Kitchen and used until the
expected birth date plus 2 weeks. Growth of premature infants is
monitored by a paediatrician.
E. Hormones
Anomalies in circulating hormones such as growth hormone, insulin
like growth factor, testosterone, oestrogen, thyroid hormone, cortisol,
insulin affect birth weight and growth. For example, children who are large
for gestational age at birth following exposure to an intrauterine
environment of either maternal diabetes or maternal obesity are at
increased risk of developing metabolic syndrome. Given the increasing
obesity prevalence, these findings have implications for perpetuating the
cycle of obesity, insulin resistance and their consequences in subsequent
generations
F. Nutritional
The direct impact of Inadequate nutrition including energy, protein
and micronutrients caused by illness, neglect, or food insecurity. Breastfed
infants have been long-recognised to have different growth in the first
year of life compared to non-breastfed babies. Significant difference

between the growth rates of formula and breast fed infants was first
reported in the DARLING (US) study showing that BF infants grow more
quickly initially, for the first 3 -6 months, and then more slowly over the
next 6 9 months. At the end of 12 months, breastfed infants were
generally 0.5 0 6 kg lighter than formula fed infants. Data from seven
longitudinal studies of infant growth were pooled and this confirmed that
infants breast fed for at least 12 months grew more rapidly in the first 2
months and less rapidly from 3 12 months. This provided the rationale
for formation of a working group to develop new standards.
G. Environment
General health and maternal age, parity, socio-economic status and
substances such as smoking affect birth weight and growth whilst infants
born at high altitudes are known to be smaller babies believed due to
lower oxygen.

6. Whats the requirement for fototheraphy?

Table 1. Phototherapy indication is based on total serum bilirubin

Age (day)
Healthy term infants
Infants with risk factors*
mg/dl
umol/dL
mg/dl
Umol/dL
1
Yellow seen on any body part
2
15
260
13
220
3
18
310
16
270
>4
20
340
17
290
*) Risk factors terdiri dari little baby (<2500 gram), premature (<37 weeks), hemolysis,
sepsis
Source: Pudjiadi AH, et al.PPM IDAI: Hiperbilirubinemia. Jakarta: IDAI; 2011
Tabel 6. Phototherapy indication is based on low birth weight infants1
Weight (gram)
Levels bilirubin (mg/dL)
< 1000
Phototherapy start in the 24 jam first
1000 -1500
7-9
1500-2000
10-12
2000-2500
13-15
Source: Pudjiadi AH, et al.PPM IDAI: Hiperbilirubinemia. Jakarta: IDAI; 2011

7. When the immunization should give to the normal baby?

1. Vaccines hepatitis B. It is best given within 12 hours after birth and was
preceded giving an injection of vitamin K1. Babies born to mothers positive
for HBsAg, hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) at
different extremities. Hepatitis B vaccination can then use monovalent
hepatitis B vaccine or vaccine combination.
2. Polio vaccine. At birth or when the baby is discharged should be given the
oral polio vaccine(OPV-0). Furthermore, for the polio-1, 2-polio, polio-3 and
can be given polio vaccine booster OPV or IPV, but you should at least get one
dose of IPV vaccine.
3. BCG vaccine. BCG vaccine is recommended before 3 months, optimal age
of two months. If given after 3 months of age, needs to be done tuberculin test.
4. DTP vaccine. The first DTP vaccine is given as early as 6 weeks of age. can
be given DTwP or DTaP or in combination with other vaccines. For children
over 7 years Td vaccine is given, dibooster every 10 years.
5. Measles vaccine. The second measles vaccine should not be given at age 24
months, when the MMR already given at 15 months.
6. Pneumococcal vaccine (PCV). When given at the age of 7-12 months,
given PCV 2 times with intervals of 2 months; at the age of over 1 year is
given one time, but both need booster first time at the age of more than 12
months or a minimum of 2 months after the last dose. On children aged over 2
years of PCV given sufficient one.
7. Rotavirus vaccine. Monovalent rotavirus vaccine given 2 times,
pentavalent rotavirus vaccine given 3 times. Monovalent rotavirus vaccine
first dose given 6-14 weeks of age, 2nd dose given at intervals of at least 4
weeks. Monovalent rotavirus vaccine should finish given before the age of 16
weeks and does not exceed the age of 24 weeks. rotavirus vaccine
pentavalent: 1st dose given 6-14 weeks of age, dosing interval of the 2nd and

3rd, 4-10 weeks; 3rd dose given at age less than 32 weeks (minimum interval
of 4 weeks).
8. Varicella vaccine. Varicella vaccine may be given after the age of 12
months, the best on age before entering elementary school. If given the age
over 12 years, need 2 doses with a minimum interval of 4 weeks.
9. Influenza vaccine. The influenza vaccine given at least 6 months, repeated
every year. For the first immunization (primary immunization) in children
aged less than 9 years given twice with a minimum interval of 4 weeks. For
children 6 - <36 months, a dose of 0.25 mL.
10. Vaccine human papilloma virus (HPV). HPV vaccine can be given from
the age of 10 years. Vaccine HPV bivalent given three times at intervals of 0,
1, 6 months; HPV vaccine is tetravalent with 0,2,6-month intervals.
Information: Since 2013, the Ministry of Health of Indonesia has formally
adopted the use of pentavalent vaccine. Pentavalent vaccine consists of a
combination of several vaccines are: Haemophilus influenza (Hib), DTP
(Diphtheria, Tetanus, Pertussis), Hepatitis B. The five antigens are given in a
single injection, making it more efficient.
8. Whats the connection between immunization with the babys condition?

9. Why the baby refuse to drink bottle feeding and the correlation between
jaundice to baby's growth and development?
10. How the treatment for the baby and education for the mother?
11. How about the Islamic perspective?
The obligation of parents of newborns , namely :
- Azan on the right ear and the left ear iqomat , due to first penetrate existing child's hearing is a sentence
tayyibah ( divine ) or sentence appeal of the Most High , and also the teaching of Islamic Shari'ah when he
entered the world . Tayyibah sentence will also keep the nature of the temptation of Satan
- Shave the hair on the seventh day
- aqiqoh
- Gave a good name

QS. Al-Baqarah ayat 233:

This means:
Mothers shall suckle their children for two full years , namely for those who want to enhance breastfeeding.
And the obligation to feed and clothe the father to the mother in a way that ma'ruf. Someone not burdened
but according to levels of ability . No mother suffered misery for her son , and a father for his son , and heir

shall be chargeable case. If both want wean ( before 2 years ) with both willingness and consent , then
there is no blame on either. And if you want your son disusukan by others , then there is no sin on you if
you make the payment according to the worth. Your fear Allah and know that Allah is Seer of what ye do.

Nabi saw sesuai sabdanya :

: :
:
.
:This means
Said Anas ; The Prophet said ; Child on the seventh day of the birth disembilihkan aqiqah and named and "
his head shaved , then after the age of six years are educated civilized , after nine years split his bed ,
when you're 13 years old was beaten for leaving prayer . After the age of 16 years married by her parents
( her father ) , his father shook hands and said ; I have educated you , teach and marry you. I ask the Lord
" . to be kept away from siksamu fitnahmu in the world and in the hereafter