SCENARIO 1

IMPAIRMENT IN CHILDREN
GROWTH & DEVELOPMENT
GROUP 3

Scenario
A boy was taken to Puskesmas in Desember 5th 2009 due to overnight fever. He born in
February the 25th, 2009; supported by a midwife, hardly breathing when he was first
delivered, with weak muscle tonus, birth weight (BW) 3000 grams, birth length (BL) 49 cm,
head circumference (HC) 35 cm. The last 2 months consequtive weighing records: 6100
grams and 6300 grams and 6500 grams, with HC 44 cm. For daily meal the baby was fed with
rice and vegetables, tofu, tempe, and sometimes egg. Starting from the age of 3 months, he
consumed formula milk, bananas and baby porridge because he cried most of the time.
He got BCG immunization when he was 2 months old; 4 times polio vaccine; B Hepatitis
vaccine twice, in the age of 40 days and 3 months; DPT when he was 2 and 6 months old.
The baby was able to crawl, but not yet sit and stand by him self. Sometimes mumbled, not
able to hold jingling toys with his hands. He responded to sound, and able to show the
direction of the sound source, can not feed him self with biscuits, and do not know how to
play peek-a-boo. His mother was elementary school graduate only. Toys available at home:
jingling toys, dolls, a three wheel bicycle. The mother never talked much.

Keywords

History of
birth
Hardly
breathing

Weak muscle
tonus
BW is 3000 g
BL is 49 cm
HC is 35 cm

Age of 3
months
Start
consume
formula
milk,
bananas,
baby
porridge

Age of 7
months

Age of 8
months

BW is
6100g

BW is
6300g

HC is 44cm

HC is 44cm

Age of 9
months
BW is
6500g

BL is 70cm
HC is 44cm

Our objectives

1. Comprehending the growth and development bases

2. Factors influencing the growth and development
3. Explaining the existence of disturbance/delay of growthdevelopment
4. Able to application and interpret the body weight, body length,
circumference head at curve
5. Determining status of nutrition

6. Knowing the types of immunize and the schedule of immunize

7. Explaining the existence of disturbance/delay of development

Comprehending the growth and

development bases
GROWTH An increase in mass and height
- body weight, body length, bone age, circumference head, circumference
of the arm
DEVELOPMENT A gradual change in abilities, emotions and skills as
people get older
The periods of postnatal (after birth)
1. The periods of neonatal (0-28 days) adaption to environment, the
change of blood circulation, start to the function of body organ
2. The periods of baby
- The periods of early baby (1-12 months) rapid growth, maturation
process take place continue, the increasing of nerve system function
- The periods of final baby (1-2 years) speed of growth start
decrease, progress of growth of motor & function of escretion

Factors influencing the growth and

development
Determinant factors of growth
Internal :
genetic : father, mother, grandpa, grandma
intrauterine process : nutrition, disease, drug, polution,
toxin ,
External : nutrition, disease, pollution, exercise, emotional
support
Determinant factors of child development
Internal : genetic + intrauterine processes
External : nutrition, diseases, quality of family, baby sitter (caregivers), playmates, school

Explaining the existence of disturbance/delay

of growth-development

Gender
Pollution
Ethnicity
Diet
Genetic Inheritance
Housing conditions
Life Experiences (birth, marriage, death and divorce)
Employment / unemployment
Family relationships
Educational experiences
Access to health and welfare services
Experience of illness or disease

CASE ANALYSIS

Delivery History

Aspect

Normal delivery

case

Interpretation

Body weight

2,5 kg 4,0 kg

2,6 kg

normal variation

50 cm

Normal variation

Body length

Head circumference

BCB : 50 cm

BKB : 45 cm

33 cm 38 cm

30 cm

Abnormal
variation

Growth History
Instrument of measurement : Growth Chart

Aspect

Normal growing

(9-10 month)

case

Interpretation
< Percentile-5

Body weight

10 kg

6 ,5 kg

Body length

74 cm

70 cm

Percentile-25

45 cm

44 cm

Mean

Head

circumference

(less BW)

Developmental History
Instrument of measurement : Denver II
Aspect

Normal condition

Case

Interpretation

Gross motor

Roll over,
Sit without support (6-9 month)

Cant

disturbance

Fine motor

Palmar grasp, transfer hand-tohand

6 month
Reaches out for toys (4 month)
Mature pincer grasp (9 month)

Cant

disturbance

Language

Responded to sound

Can

normal

Social & personal

Plays peek-a-boo (6 month)

Eat biscuit (9 month)

Cant

disturbance

Immunization History
reference: Rekomendasi oleh Ikatan Dokter Anak Indonesia
(IDAI 2010)

Immun PPI
BCG

Polio

Hep B

DPT

Measles

Immun until 11 month

1x
(< 3 bulan)
4x
(birth, 2, 4 & 6 month)

Case

Interpretation

since 2 month

Normal

4x

Normal

3x

2x

(12hours, 1 & 3-6 month)

(40 days & 3 month)

3x

2x

(2 , 4 & 6 month)

(4 & 6 month)

1x

(9 month)

never

less

less

less

DISCUSSION
reference: Rekomendasi oleh Ikatan Dokter Anak Indonesia
(IDAI 2010)

Nutrition History

Nutrition in our case:

1) For daily meal the baby was fed with rice and vegetables, tofu, tempe,
and sometimes egg.
2) Starting from the age of 3 months, he consumed formula milk, bananas
and baby porridge because he cried most of the time.

Ideal nutrition:
o
ASI exclusive for 6 month!
o
By 9 months, babies are usually eating two solid meals in a day

Nutrition Status
Instrument: Rumus waterlow & Growth
Status
Obesity

Percentage
>120%

Overweight

110% - 120%

Mild malnutrition

90% - 110%

Moderate
malnutrition

70% - 90%

Severe malnutrition

>70%

Our case:
BW/A= 6.5/9.2= 70.65% (moderate malnutrition)
BL/A= 70/72= 97.2% (normal)
BW/BL= 6.5/8.8= 73.86% (moderate malnutrition)

Nutrition Status
Age (months)
1-3
4-6
7-9
10-12

Calorie (kcal)
110
100
100
100

Calorie requirement
Calorie requirement is depends on the body weight that suitable with
current body length of the baby.
According to the scenario:

Calorie = 100kcal X 8.8 = 880kcal per day

Conclusion
Early management

Improving nutrition status by giving the appropriates

nutrition.
Give the enough immunization and on time.
Optimalize of parents responsibility in stimulation of
infant in order to development of infant achieving the
appropriates ASUH, ASIH and ASAH.
Controls the fever and give appropriate treatment
based on diagnosis if need
Monitoring is very important and helpful!