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David A. Levine 2
The frequent office visits for health maintenance in the first 2 years of life are more than physicals. Although a somatic history and physical examination are important parts of each visit, many other issues are discussed, including nutrition, behavior, development, safety, and anticipatory guidance.
Disorders of growth and development are often associatedwith chronic or severe illness or may be the only symptom ofparental neglect or abuse. Although normal growth and development does not eliminate a serious or chronic illness, in general, itsupports a judgment that a child is healthy except for acute, oftenbenign, illnesses that do not affect growth and development.
The processes of growth and development are intertwined. However, it is convenient to refer to growth as the increase in size and development as an increase in function of processesrelated to body and mind. Being familiar with normal patternsof growth and development allows those practitioners whocare for children to recognize and manage abnormal variations.
The genetic makeup and the physical, emotional, and socialenvironment of the individual determine how a child grows anddevelops throughout childhood. One goal of pediatrics is to helpeach child achieve his or her individual potential through periodically monitoring and screening for the normal progressionor abnormalities of growth and development. The AmericanAcademy of Pediatrics recommends routine office visits in thefirst week of life (depending on timing of nursery discharge) at 2weeks; at 1, 2, 4, 6, 9, 12, 15, and 18 months; at 2, 2½, and3 years;then annually through adolescence/young adulthood (Fig. 9-1).
Deviations in growth patterns may be nonspecific or may be important indicators of serious and chronic medical disorders. An accurate measurement of length/height, weight, and head circumference should be obtained at every health supervision visit and compared with statistical norms on growth charts. Table 5-1 summarizes several convenient benchmarks to evaluate normal growth. Serial measurements are much more useful than single measurements to detect deviations from a particular growth pattern, even if the value remains within statistically defined normal limits (percentiles). Following the trend helps define whether growth is within acceptable limits or warrants further evaluation.
Growth is assessed by plotting accurate measurements on growth charts and comparing each set of measurements withprevious measurements obtained at health visits. Please seeexamples in Figures 5-1 to 5-4. Complete charts can be found at www.cdc.gov/growthcharts/who_charts.htm for birth to 2 years and www.cdc.gov/growthcharts for 2 to 20 years. The body massindex is defined as body weight in kilograms divided by height inmeters squared; it is used to classify adiposity and is recommendedas a screening tool for children and adolescents to identify thoseoverweight or at risk for being overweight (see Chapter 29).