Incidents 

The delay in the physical development of the child causes. Lagging behind in physical development or an individual norm - what parents need to know. Risk factors for the development of ADHD include


Mothers are very worried when children put on less weight than expected. In most cases, it turns out that the child is perfectly healthy, and the mother’s anxiety is generated by her high expectations. First of all, it is necessary to establish whether the child is gaining enough weight. The lag in weight indicates a delay in physical development, the cause of which must be clarified. (See Chapter 15 for registration and evaluation of anthropometric indicators.)
Normal weight dynamics Children of undersized parents
Weight and head circumference at birth usually correspond to the same percentile - in children of tall parents close to 98, in children of short parents - to 2. Many people anthropometric indicators remain within the same percentile throughout life. To make sure that the child is growing normally and does not require nutritional changes, it is enough to plot his weight and head circumference on a standard map. Short parents who think that their child is not growing well because he does not eat enough is a common phenomenon.
Displaying a child's anthropometrics on a standard map based on the norms for children in a given geographic area helps the clinician reassure parents that the child is growing normally and will be the same height as they are by adulthood. The standard card is better than simple registration anthropometric indicators, reflects the growth trend.
Preferential inheritance of the physique of one of the parents
A child can inherit the physique of predominantly one of the parents. If, in such cases, relying only on weight indicators, it may seem that the child is lagging behind in physical development or, on the contrary, gains weight excessively (see card B - the child of a short father and card C - the child of a tall father). When plotted on a standard map, not only the weight, but also the circumference of the head, it is clear that both indicators correspond to the same percentile and the child has the same body type as one of the parents.
Low weight at birth
Low birth weight may be due to prematurity, prenatal development or both given reasons. Most children born with low weight, there is a growth spurt in the first months of life, but in some of them the anthropometric indicators do not reach the 2nd percentile in adulthood (see map D). Apparently, this is related to IUGR.

weeks
Card B. A child who inherited the physique of a tall father

Causes of delayed physical development
The transition of body weight to a lower percentile, while head circumference corresponds to the previous percentile, indicates a delay in physical development. In healthy children whose parents have asthenic physique, with a single measurement, it may also turn out that weight corresponds to a lower percentile than height and head circumference. Multiple registration of anthropometric indicators on a standard map helps to eliminate the influence of constitutional features.
The reason for the delay in physical development may be malnutrition, loss nutrients due to malabsorption or hereditary metabolic disorders. Undernutrition often appears to be at the root of physical retardation due to psychosocial factors.
When collecting anamnesis Special attention give to heredity, perinatal factors, food. They find out in detail what worries the mother, whether the child has vomiting, diarrhea, bloating. The physical examination necessarily includes an assessment psychomotor development and subcutaneous fat layer, in particular on the buttocks and inner surface hips.
Malnutrition
In those countries and geographic areas where it is widely practiced breastfeeding, meet

Weeks Weeks
Chart D. Low birth weight Chart E. Hypogalactia
cases of malnutrition due to unrecognized hypogalactia. If a child is regularly weighed from birth, hypogalactia is usually detected in a timely manner (see Map E), although with sufficient milk supply, birth weight before 2 weeks of age is not always restored. Assessing the dynamics of weight in the first days of life, it should be borne in mind that the timing of the establishment of lactation varies widely (see Chapter 16).
At artificial feeding malnourished babies who suckle poorly (see chapter 16).
In cerebral palsy, poor suckling and growth retardation due to malnutrition are often detected earlier than movement disorders. However, usually a delay in physical development is accompanied by a delay in mental development.
Physical developmental delay in CHD can be associated with both weak sucking and high level metabolism. As a rule, the child has typical symptoms of CHD (cyanosis, heart murmur).
IN differential diagnosis reasons for the delay in physical development should also be borne in mind the infection urinary tract and to exclude it, send for analysis the average portion of urine collected after thorough washing.
Big weight loss
With gastroesophageal reflux with persistent vomiting, the baby loses weight if he is not supplemented to compensate for the amount of regurgitation (see Chapter 12).
Congenital pyloric stenosis (pyloric stenosis) manifests itself up to 3 months of life. For persistent vomiting occurring before this age, it should be ruled out first (see Chapter 15).
Major Causes of Malabsorption Syndrome in the UK - Protein Intolerance cow's milk, cystic fibrosis, and celiac disease (see Map E). With all these diseases, there is a frequent liquid stool, but inexperienced mothers do not always notice this. It is necessary not only to carefully find out all the features of bowel function in a child, but also to examine the feces.
With a large weight loss, it is also necessary to exclude diabetes mellitus by examining the urine with a test strip.
Psychosocial causes of delayed physical development
Delay in physical development in children in families where there are psychological and social difficulties can also have somatic causes. The exclusion of the latter helps to convince parents that the delay in physical development is mainly due to psychosocial factors - discord or lack of order in the family, depression in the mother, sometimes her poor nutrition (complete exclusion
milk and dairy products or unjustified and uncontrolled dietary restrictions leading to starvation).
Action psychological factors sometimes hard to see. So, with depression and anxiety in the mother, the child suckles worse, and the mother underfeeds him. Some children have a weak emotional reaction for breastfeeding. In such cases, the mother does not feel if the baby has enough milk. As a result, the volume of sucked milk falls to a relatively low level, which is enough for the child not to show signs of hunger. There are cases when a mother, who is on a diet for the purpose of losing weight, restricts her child's diet for the same purpose.
If the reason for the delay in physical development is bad care, the child begins to put on weight as soon as he is provided with attention and care.
To ensure them, the concerted efforts of workers are needed. medical care at home, family doctor and other professionals, careful dietary adjustments under the supervision of a home care worker or a trained nutrition nurse.
Research
The choice of laboratory and instrumental research methods is determined by the anamnesis and physical examination data. If the history and clinical picture do not make it possible to suggest the cause of the delay in physical development, glucose is determined in the urine, general analysis blood, sweat test, analysis and culture of urine, determination of serum creatinine level.

In this article:

It is possible to talk about the lag in the physical development of the child only after the doctors have carried out a series of necessary examinations and make a diagnosis. Up to this point, parents can only draw preliminary conclusions based on observations of the baby, but in no case on comparison with other children of his age.

It is important to understand that every child grows and develops at their own pace. Some are ahead of their peers in physical development, while others, on the contrary, demonstrate some lag, which, nevertheless, cannot be considered a serious deviation from the norm.

So, when do you need to start thinking about the fact that the physical development of the baby does not correspond to his age? After a year, you can already observe the crumbs' attempts to take steps, pronounce the first words. The norm is the development of walking skills up to 14 months and initial speech skills up to two years. Naturally, small deviations from the norm cannot be a reason for excitement, but even in this case it will be necessary to strengthen the observation of the baby, fixing the slightest progress.

What is developmental delay?

It is customary to talk about a delay in the physical development of a child in cases where there is a lag behind him in a number of anthropometric
indicators. Quite often, the problem is exacerbated by a lag in the formation of cognitive and motor skills.

Experts talk about a delay in physical development in cases where anthropometric indicators fall below the 3-5th percentile or noticeably decrease over time. short term. It is customary to divide the lag in physical development into those caused by diseases and provoked by social conditions.

Causes of delayed physical development

A variety of reasons affect the delay in the physical development of children:

When it comes to pedagogical neglect, then imply serious gaps in the upbringing of the baby, not related
with brain activity. In such cases, children are completely healthy, while being unable to absorb simple information They don't know basic things.

Parents and teachers are simply obliged to introduce children to mental work, encouraging them even minor achievements. Otherwise, their ability to learn and assimilate new information will noticeably decrease. As a rule, a problem of this nature can be solved if you correctly build a scheme for working with a baby.

The situation is somewhat different with the delay mental development which can also cause developmental delays. Typically, such children are characterized by age-inappropriate behavior, despite the fact that the work of the brain is carried out without significant disturbances. Children with mental retardation quickly get tired, unable to concentrate for a long time and complete the task to the end.

The lag in the physical development of the child can also be influenced by biological factors associated with the difficult course of pregnancy, violation of the rules healthy lifestyle life during the childbearing mother, difficult childbirth,
pathologies, as well as serious infections transferred inside the womb or in the first months of life.

And, finally, social factors that entail a lag in physical development imply total control on the part of adults, inadequate attitude towards the child, as well as stress suffered at a young age.

How to determine that the child is lagging behind in development?

How is the lag of children in physical development manifested? External signs can vary from growth retardation and mass gain to loss of subcutaneous fat, baldness and protein depletion. Most often, a delay in physical development is manifested precisely by a lag in growth and weight gain.

Specialists
determine the level of delay by analyzing all anthropometric indicators corresponding to the age of the child. The process takes into account the characteristics of the child, the degree of full-term maturity, possible diseases he has recently suffered that can affect the development process. In babies who were born prematurely, some deviations in physical development are allowed, which are affected by the duration of their prematurity.

The lag in physical development can be of several types:

  • light;
  • moderate;
  • heavy.

Most often, the first sign of developmental delay is a slow weight gain, over time, you can notice changes in growth rates.

Features of the diagnosis of physical developmental delay

It is important to understand that laboratory studies do not give a complete picture, therefore, they are carried out rather to supplement it. To distinguish diseases of an endocrine nature from family short stature, bone age must be determined. Additionally examined thyroid gland child, conduct an MRI and a number of additional studies.

It is possible to diagnose a delay in the physical development of a child on the basis of the clinical data obtained as a result of the examination, as well as the results of observations of family relationships and a survey of parents.

It is very important that the baby grows up in a calm, friendly atmosphere, receives sufficient nutrition for his age, and also does not have difficulties with his assimilation.

Most often, the baby does not receive enough nutrition due to the incompetence of parents in this matter, due to low material wealth due to parental negligence. In the first months of life, the baby should receive enough breast milk or a mixture adapted to it every 2-3 hours. Doctors are obliged to find out what kind of food the child received in the first months, after which
time intervals and what was the reaction of the parents to the anxiety of the crumbs between feedings.

Quite often, the inability of the baby to absorb required amount milk in the first months of life is associated with anatomical anomalies: enlarged palatine tonsils, adenoids, contractions of the muscles of the oral cavity. That is why, when diagnosing a lag in physical development, doctors are simply obliged to take into account the age of the baby and the general clinical picture, recreated on the basis of a detailed conversation with parents.

Treatment of growth retardation

In order for the treatment to be successful, it is necessary to identify the underlying cause that led to the developmental delay. So, for example, if the cause is a disease that causes growth retardation, then it is necessary to focus therapy on it. If a child is slowly growing and gaining weight due to family genetics, it is worth stopping trying to influence the process, because as a result, growth rates will be somehow related to the growth rates of parents.

If the underlying cause of growth retardation is growth hormone deficiency, then appropriate therapy with its inclusion may be the solution. Correctly selected
therapy will help the baby in the first year to add from 8 to 13 cm, and in subsequent years - up to 6 cm per year.

Regardless of what reason had the main impact on the delay in growth and weight gain of the child, care must be taken to ensure that the family has a daily routine, practiced proper nutrition calm atmosphere prevailed.

If we are talking about babies of the first year of life with a pronounced delay in physical development associated with social reasons, after 6 months they must be fed mainly with thick food for half an hour. At this time, it is important that the child is not distracted. Children after a year can eat for common table with adults.

It is extremely important not to force the baby to eat against his will. Water, juices and other low-calorie foods in the diet should be in the minority, while high-calorie foods such as butter, cheese, cream should be included in the daily diet.

What consequences to fear?

In many ways, complications will be associated with a disease that caused a lag in physical development. So, for example, if growth retardation is associated with Itsenko-Cushing's disease, then
problems with the cardiovascular system, pressure. In addition, complications may appear as diabetes or osteoporosis, stomach ulcers, etc.

If a child suffers from hypothyroidism, then consequences are possible in the form of arrhythmia, an increase thyroid gland, as well as a general decrease intellectual activity, complexes caused by inconsistency of growth with norms.

In order for the child to have normal growth, it must grow in conditions conducive to development, receiving good nutrition the amount of vitamins and minerals necessary for his age. Noting the short stature of children, it is important to contact specialists in a timely manner, who will help identify the cause and prescribe a program to correct the lag.

When should you think about hospitalization?

It makes sense to talk about hospitalization in cases where children are diagnosed complex shape emaciation, marked stunting. In the hospital, the child is examined for true reason lag in physical development, appoint adequate treatment. As a rule, the period of hospitalization in this case does not exceed 10 days, during which doctors control the diet of children, monitor their daily routine.

The main purpose of hospitalization is to teach children and parents how to proper diet balanced nutrition and stick to it to stimulate growth, regardless of the cause of the lag in physical development.

About forecasts

The most dangerous lag in the physical development of a baby is considered to be in the first year of life, regardless of what the cause of the problem is. It should be understood that postnatal brain growth is most active in the first six months, so the child must have suitable conditions for full development precisely during this period. Many babies diagnosed with developmental delay have developmental delays. emotional sphere and difficulties in social adaptation.

If the cause of the delay is a disease, the prognosis can only be announced after determining the severity of the disease and the effectiveness of the method of its treatment. Children with developmental delay, regardless from the cause, it is necessary to constantly keep under supervision, controlling the process of emotional and cognitive development, if necessary, applying corrective methods of influence.

In conclusion, it is worth noting that it is possible to solve problems with delayed physical development in children, but not in all cases. If it's a genetic predisposition to small stature and age-inappropriate mass, then, most likely, you will have to live with it all your life.

IN individual cases can help surgical intervention, massage, physiotherapy sessions, classes with specialists practicing work on early development brain. Especially important is the atmosphere in the family. Parents should be confident in the strength of the baby, calm and responsible, practice regular classes as part of early development programs.

It is important to understand that slow physical development cannot put an end to future life and the fate of the child. Often, it is the timely determination of the cause of the lag that will help to more effectively eliminate the problem and allow the baby to catch up and even overtake peers with faith in themselves, their strengths and skills.

- group of diseases various etiologies, accompanied by a deviation of the indicators of the physical development of the child from age norms. It is more often manifested by growth retardation, diseases leading to accelerated growth are much less common. Growth disorders in children are almost always accompanied by symptoms from of cardio-vascular system And gastrointestinal tract(depending on etiology). An assessment of physical development is carried out on the basis of specially designed tables, as well as complex laboratory diagnostics. Treatment is etiotropic, substitution is used hormone therapy, neurosurgical and other operations.

    Growth disorders in children are accompanied by a huge number of various endocrine and somatic diseases. Difficulties in timely diagnosis and expensive hormonal therapy put the problem of the physical development of the child in one of the first places in pediatrics. In addition, diseases of this group have a direct impact on the demographic situation in the future. Of particular danger are intrauterine growth retardation and congenital endocrine pathologies, in which timely correction is practically impossible, and for this reason the child remains undersized. Growth disorders in children can, to a certain extent, reduce the quality of life of an already adult person, and also often affect fertility in the future.

    Causes and classification of growth disorders in children

    Some diseases are associated with endocrine disorders. These may be pathologies of somatotropin metabolism, its insufficient or excessive formation, or a change in the sensitivity of peripheral receptors to this hormone. Disorders of growth hormone metabolism can be caused by tumors of the hypothalamic-pituitary region, genetic defects of any enzymes involved in the formation of somatotropin, etc. In addition, growth disorders in children occur with pathologies of the metabolism of other hormones, in particular, thyroid hormones, adrenal glands, sex hormones, and some central hormones such as ACTH and releasing factors.

    Some somatic pathologies can also cause growth disorders in children. First of all, this is a group of skeletal dysplasia and chromosomal diseases, accompanied by short stature. Pathologies of the kidneys, liver and gastrointestinal tract are also sometimes accompanied by growth retardation. This is usually due to malnutrition (irrational diet, starvation) or food absorption. At the same time, the liver indirectly participates in the growth process of the child, since it is here, under the influence of somatotropic hormone, that insulin-like growth factors are formed that directly affect target cells, triggering anabolic reactions.

    There are two main principles on the basis of which all nosologies are divided into subgroups. The first principle is quantitative, in this case one speaks of either growth retardation or premature and accelerated growth. The second principle is related to the causes of pathologies. In accordance with it, growth disorders of endocrine and somatic genesis are distinguished. In the structure of general morbidity, the latter subgroup significantly prevails. In addition, growth disorders in children include some hereditary forms of pathology, for example, family short stature.

    Symptoms of growth disorders in children

    It should be noted that growth retardation is much more common than accelerated growth and development. In the case of intrauterine growth retardation, immediately after the birth of a child, one can notice that the parameters of his physical development to one degree or another lag behind the norm. However, more often it is possible to suspect growth disorders in children from about 3-4 years old, when it is possible to trace the dynamics of growth. As a rule, from now on, the lag is determined not only by the pediatrician, but also by the baby's parents. This can be a proportional growth retardation (the trunk and limbs evenly lag behind in size from the age norm) and a disproportionate shape (the limbs are either short or long in relation to the body).

    Chromosomal syndromes, in the clinic of which there are growth disorders in children, are also manifested by specific changes in appearance (for example, Down syndrome or). Additional symptoms are characteristic of all somatic diseases that affect the physical development of the child. With malformations of the cardiovascular system, cyanosis is detected skin and other signs, violations are confirmed by ECG. Pathologies of the gastrointestinal tract are accompanied by dyspeptic symptoms, changes in stool, bloating and other symptoms.

    As for endocrine diseases, growth disorders in children are also not their only manifestation. If the changes are related to growth hormone produced by the pituitary gland, growth rates will deviate markedly from age norms, unlike other diseases in which this may not be so obvious. Insufficiency of the hormonal function of the thyroid gland, in addition to short stature, is manifested by the characteristic lethargy of the child, low blood pressure and bradycardia, with hyperfunction of the gland, the symptoms are opposite, growth is accelerated.

    Sex hormones to some extent potentiate the physical development of the child. They are involved in the formation of ossification nuclei and the closure of growth zones in the epiphyses of bones at the end puberty. Thus, congenital and acquired diseases of the adrenal glands, as well as defects in the metabolism of sex hormones, inevitably lead to growth disorders in children. In some cases, growth retardation may be associated with severe psycho-emotional stress. In addition, constitutional features also play a role in physical development. These children usually have a family history of growth retardation, more often on the paternal side.

    Diagnosis of growth disorders in children

    There are certain standards that a pediatrician is guided by when assessing the physical development of a child, in particular, centile tables containing quantitative limits for height, weight and other indicators for children different ages. If the patient's performance for one or two years goes beyond the limits indicated for a particular age, we can talk about acceleration or delay in physical development. Compliance with a certain column of centile tables in order to diagnose growth disorders in children is always evaluated over several years.

    Algorithms have been developed on the basis of which differential diagnosis of the causes of growth disorders in children is carried out. The need for them arises due to the fact that the study of the function of the pituitary gland is expensive and represents a serious burden on the child's body, therefore, it is performed only according to strict indications. On the initial stage exclude any somatic pathologies that can cause growth disorders in children.

    ECG and EchoCG diagnostics are performed to assess the state of the cardiovascular system. Pathologies of the gastrointestinal tract are diagnosed based on the results biochemical analysis blood, abdominal ultrasound and X-ray examination (according to indications).

    Next, perform laboratory research functions of the thyroid and other peripheral glands, since peripheral glands are technically easier to examine than central ones. Determine the level of thyroxine, glucocorticoids, sex hormones. This allows you to detect a possible decrease or increase in the function of any of these glands. internal secretion and start appropriate therapy. If the child has no abnormalities, screening for deficiency or excess of somatotropic hormone and insulin-like growth factors is carried out. Apart from laboratory diagnostics, on the this stage carry out the determination of bone age (R-gram of the hand and wrist joint), MRI of the brain of the child and the study of the karyotype.

    If there is a suspicion of growth disorders in children associated with the metabolism of somatotropin, a single measurement of the level of its basal secretion is performed, as well as several stimulation tests. Growth hormone deficiency is confirmed at stimulated secretion levels below 7 ng/mL. A concentration of 7-10 ng / ml indicates a partial deficiency of somatotropin. This result usually speaks in favor of a point mutation in the growth hormone gene. Along with this, the concentrations of prolactin and thyroid-stimulating hormone are determined, since with some tumors and genetic mutations there is a multiple insufficiency of pituitary hormones. The tests are highly informative and allow the doctor to decide on the tactics of treatment.

    Treatment and prognosis of growth disorders in children

    Etiotropic therapy of diseases is carried out. If growth disorders in children are associated with hormonal reasons, hormone replacement therapy is prescribed, or hormone antagonists are used, which are synthesized in excess. For the treatment of somatotropic insufficiency, synthetic somatotropin is used. Most hormone-producing tumors can be removed surgically. As a rule, relapses of such neoplasms are rare. Growth disorders in children with somatic diseases are corrected according to indications, however, in most cases, the treatment of the underlying disease leads to the normalization of physical development. All children must be prescribed a complete diet and vitamin therapy.

    The prognosis is often favorable. In most cases, it is possible to compensate for the insufficiency of somatotropic and other hormones. One of critical factors successful treatment is timely diagnosis growth disorders in children, and it is very often impossible due to the weak severity of deviations from the norm or the presence of other, more dangerous symptoms. The slightest delay in the therapeutic correction of physical development can lead to a sharp decrease in the body's sensitivity to treatment. In addition, some causes of growth disorders in children, such as chromosomal diseases, cannot be eliminated.

Expectant mothers always experience fear for an unborn child - what if something goes wrong in its development? And these fears are not unfounded. Modern environmental conditions have a negative impact on the child when he is still in mother's womb. But it is not always possible to determine this during pregnancy. In most cases, violations appear after the birth of a child.


The sooner you pay attention to the delay in the physical development of the baby, the sooner doctors can prescribe treatment and determine its cause. Often, physiological failures occur due to some kind of upheaval in the life of babies - moving, stress, climate change, artificial feeding, lack of vitamins and microelements, family situation. If the cause lies in these events, it is not necessary to treat it, since everything forms by itself.

We can distinguish the following diseases that affect the delay in the progress of the child: genetic disorders, lag in intrauterine formation, anemia, poisoning with toxic substances, endocrine disorders, low levels of somatotropic hormone, Laron syndrome, malfunctioning of the thyroid gland or adrenal glands.

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How the delay manifests itself


The delay occurs in babies who are often sick and also suffer from psycho-emotional stress. This category includes children with low level social adaptation (this applies to babies to whom parents pay little attention).

Delay symptoms physiological development should not be confused with a lack of weight or height. These are serious failures in the formation of the skeleton, constant infections, dermatitis, and even exhaustion. Babies up to a year old need to visit a pediatrician every month. The doctor fills out a medical record based on the results of the examination and analyzes the growing up of the baby.

Children with developmental delay often do not have enough milk and need to be supplemented. Their appetite is usually absent, the state is lethargic and apathetic. Later than their peers, they begin to walk, talk, sit and stand. Teeth erupt much later too.


In addition to the above signs, there are a few more:

  • Poor sleep, frequent cries and screams.
  • Susceptibility to infections due to weak immunity.
  • Skin diseases (dermatitis, inflammation, hypersensitivity).
  • The lag in the parameters of height and body weight.
  • Distracted attention, inability to concentrate.
  • Low achievement rates.
  • Constant feeling of tiredness.
  • Spinal deformity or chest at severe forms ailment.

Diagnosis and treatment


In order to determine the presence of the disease, the doctor collects an anamnesis, is interested in the course of pregnancy, examines the baby and sends for testing. If there is a suspicion of genetic anomaly, the child is sent to a special medical Center to eliminate the possibility of chromosomal failures.

Developmental delay is not always treated. You can get rid of infections with the help of antibacterial drugs, strengthen the immune system with the help of stimulants and vitamins, and endocrine disruptions are treated with hormones. If anomalies occur during fetal development, the treatment process will be much more difficult. Then the child needs basic therapy and treatment of symptoms.