This article provides an overview of what constitutes a healthy child, including nutritional requirements, growth and development.
Neonate: 0-28 days
Viewed in terms of height and weight.
Considers hyperplasia, hypertrophy and differentiation of tissues.
A child’s growth is thought to have 4 phases, which are dependent on a variety of factors:
1. Foetal – dependent on the uterine environment
2. Infantile – dependent on nutrition, general health, emotional wellbeing and thyroid function
3. Childhood – dependent on thyroid hormones, growth hormones, general health, emotional wellbeing and genetics
4. Pubertal – dependent on sex hormones (especially testosterone and oestrogen) and growth hormones
Newborn/ infant feeding and nutrition
- Average birth weight ~ 7lb (3.5kg)
- Breastfeeding takes up to 7 days to establish – babies often lose a little weight in this time (>15% loss is worrying)
- Micturition should occur within 24h and meconium within 48h
- Infants tend to double their birth weight by 5 months and be ~10kg by 1 yr
- Exclusive breast or bottle-feeding is advised until 6 months
- Formula milk – whey-based (important to use the correct age range powder)
- Nutramigen: partially hydrolysed cow’s milk
- Neocate: just amino acids
- Enfamil: thickened, used in GORD
- Infants need 150ml/kg feed per day until weaning(30ml=1oz)
- Weaning should not occur before 17 weeks (chewing and swallowing mechanisms)
- When weaning – avoid egg and wheat until ~6m. Avoid honey. “Full-fat” milk advised until 5 years.
0-1 year: 110kcal/kg/day
1yr +: 1000 + (100 x age) kcal/day
There are 2 main ways to calculate the maintenance fluid needs of a child. Either are generally accepted.
1st 10kg = 100ml/kg/day
2nd 10 kg = 50ml/kg/d
Subsequent = 20ml/kg/d
To work out an hourly rate, this can be divided by 24
1. 14kg child – (10 x 100) + (4 x 50) = 1200ml/day
2. 8kg child – 8 x 100 = 800ml/day
3. 21kg child – (10 x 100) + (10 x 50) + (1 x 20) = 1520ml/day
First 10kg – 4ml/kg/hr
2nd 10kg – 2ml/kg/hr
Every subsequent kg – 1ml/kg/hr
1. 14kg child – (10 x 4) + (4 x 2) = 48ml/hr
2. 8kg child – 8 x 4 = 36ml/hr
3. 21kg child – (10 x 4) + (10 x 2) + (1 x 1) = 61ml/hr
- Interaction of heredity and environment.
- Measured in 4 domains: gross motor, fine motor and vision, speech & language, social.
- Development is most rapid in the first 4 years.
- Warning signs for developmental delay – family history, maternal concerns, persisting primitive reflexes, discordant development in the 4 domains, regression.
- Urine continence: dry by day age 2-3yrs. Dry nights 3-4 years. 10% of children aged 5 suffer nighttime eneuresis.
- Encopresis: passage of faeces onto clothes. Considered abnormal after 4 years.
Screening to check growth and development
- Neonatal examination: heart, eyes, hips, hearing test
- 1 week – Guthrie test: PKU, MCAD, hypothyroidism, CF, haemoglobinopathies
- 6-8 week check: heart, eyes, hips, general.
- 4-5 y – orthoptist: Colour vision and acuity. Eyesight should be 6/6 by 5yrs.
Development: See Developmental Stages post
Normal Paediatric Observations
|Respiratory rate (/min)||30-40||25-35||20-30||15-20||12-16|
|Heart rate (bpm)||110-160||100-150||95-140||80-120||60-100|
- Neonates sleep ~16hrs a day.
- 14h by 6m
- 13 h by 2 years
- 12h at 4 years
- Common sleep problems: night terrors (4-7 years), nightmares (8-10 years), sleep walking (5-10 years), sleep onset delay, night awakening, daytime sleepiness.