MINISTRY OF HEALTH OF UKRAINE

Ukrainian Medical Stomatological Academy

”Approved”
at the meeting of the Department of Pediatrics №1
with Propaedeutics and Neonatology
“ ___” ___________ 20__ year
Protocol No._____ from________
Chief of the department, assoc. prof.
______________ S.M. Tsvirenko

Methodical instructions for independent work of

students during preparation to practical (seminar) сlasses
and on the classes

Education discipline Propaedeutics of Pediatrics

Module № 1 Development and feeding of children.
Topic of the class The physical development of children and
anthropometry. The concept of physical
development, the importance of its evaluation.
The concept of accelerated development of
children, the main hypothesis and the
acceleration mechanisms.
Year of education ІІІ
Faculty Foreign students training faculty

Poltava – 2019
I. Actuality of the theme: Growth rate and its characteristics at each age stage
determined enshrined in the genetic apparatus of cells complexes hereditary
properties acquired in the long process of evolution, as well as acting on the body of
environmental conditions. Genetic, climatic and social factors determine the high
variability of biological processes of growth and maturation. Anthropometric
characteristics reflecting primarily the biological age of the child. Assessment of
biological age is very important to not only static, but in dynamics, while it is
necessary to note the quality and rate of development of the child, a change in body
proportions, appearance and muscle strength. Assessment of the children physical
development in different age is important for preventing and detecting disease by
recognizing overt deviations from normal patterns.

II. The training aims of the classes: to master the knowledge of factors’
number influence growth and development, basic criteria for assessment of physical
development. Students should know the rules and technique of measurement body
weight, body length, head circumference, chest circumference and should be able to
estimate results of measurements.
1. Student has to know:
 Factors’ number influence growth and development of child.
 Basic criteria for assessment of physical development.
 The methods and technique of measurement body weight, body length,
head circumference, chest circumference.
2. Student has to be able:
 To use the knowledge about factors influence growth and development
of child.
 To interrogate of the healthy and sick children in different age periods
and their parents.
 To master to measure body weight, body length, head circumference,
chest circumference of healthy and sick children in different age periods .
  To estimate results of body measurement of the healthy and sick
children in different age periods .
III. Interdisciplinary integration processes:

Disciplines To know To be able

 The main principles  Students should be able
to use the main
of Medical etiquettes and
principles of Medical
deontology
etiquettes and
1. Previous disciplines  The main rules of
deontology
- Medical ethics and communication between
deontology the doctor and patient,  Students should be able
doctor and parents to use the knowledge
- Human Anatomy
about the peculiarity of
- Medical Biology  Anatomical structure
anatomical structure of
- Physiology of body
body in different age.
- - Medical Histology  Peculiarity of
and Embriology  Students should be able
children metabolism in
to use the knowledge
different age periods
about the genetic
 Genetics factors
apparatus of cells
which impacts to
complexes hereditary
physical development of
properties
children
 Students should be
able to interrogate of
the children of
different age and their
 The main rules of parents
communication  Students should be able
between the doctor to use the knowledge
and patient, doctor about intrauterine
and parents development of child
2. Following disciplines
 The intrauterine  Students should be
- Pediatrics;
development of child able to measure body
- Nutriciology
 Peculiarity of of the healthy and sick
nutrition, diet balance children in different
and feeding of age periods
different age children  Students should be
able to estimate results
of measurements for
proper diagnostics of
the physical
development
variability .
  Students should be
 Principe of
able to use the of
pediatrics etiquettes and
3. Inside discipline etiquettes and
deontology.
- topics: deontology in pediatric
 Peculiarity of
 Pediatrics etiquettes and practic
district pediatric doctor’s
deontology.  Students should be
work. Medical
 Structure of children's able to use the
documents of district
medical and preventive knowledge about
pediatric doctor (History
establishments, features of the medical documents of
of Children
organization of their work. district pediatric doctor
Development).
 The organization of the  Students should be
 The organization of
balanced diet for the healthy able to use the
the balanced diet and
infants and toddlers knowledge about
feeding of the healthy
balanced diet and
children
feeding of the healthy
children

IV. The argument of the topic:

Growth and development represent a continuous interaction of biologic
processes that begin at birth and terminate at death. The integrity and the quality of
these processes are influenced by a myriad of variables, including genetic,
physiologic, biochemical, psychological, and socio-economic factors. Physicians are
uniquely responsible for safeguarding and enhancing growth and development. The
traditional medical role focuses on preventing, detecting, and treating the noxious
influences that can impair these processes.
Among physicians the challenge is particularly demanding for the pediatricians
because much of growth and development is completed during the first few years of
life. Professionals providing health care for children must be aware of the various
genetic, nutritional, hormonal, emotional, and economic impediments (among others)
that can severely disturb the milieu for normal growth and development. Failure to
recognize antecedent high-risk factors and signals that herald disturbed patterns of
growth and development may result in serious and permanent disabling sequel.
Students of pediatrics, regardless of their level of training, should be familiar with the
complex processes that constitute growth and development.
 Knowledge of the normal growth and development of children is essential for
preventing and detecting disease by recognizing overt deviations from normal
patterns. Although the processes of growth and development are not completely
separable, it's convenient to refer to "growth" as the increase in the size of the body
as a whole or the increase in its separate parts, and to reserve "development" for
changes in function, including those influenced by the emotional and social
environments. The development of the human organism is a large, complex topic. To
identify and treat underlying disorders, all who care or children must be familiar with
normal patterns of growth and development so that they can recognize abnormal
variations.
Within the broad limits that characterize normal development, every
individual's path of growth and development through the life's cycle is unique, with a
range of complex, interrelated changes occurring from the molecular to the
behavioral level. One goal of pediatrics is to help each child achieve his or her
individual potential for growth and development and thus become a mature adult,
periodically monitoring each child for the normal progression of growth.
Physical development is a dynamical process of growth and biological
maturation of a child usually referred to as a unit, express the sum of the numerous
changes that take place during the different periods of childhood.
Growth implies a change in quantity and results when cells divide and
synthesize new proteins. This increase in number and size of cells is reflected in
increased size and weight of the whole or any of its pans.
Maturation, which literally means to ripen, is described as aging or as an
increase in competence and adaptability. It is usually used to describe a qualitative
change, that is, a change in the complexity of a structure that makes it possible for
that structure to begin functioning or to function at a higher level.
Very simply, growth can be viewed as a quantitative change, and development
as a qualitative change. Children "grow" by maintaining a positive balance of
increase over loss in size; they "'grow up" by maturing in structure and function.
 The main criterions of assessment of physical development are:
• weight;
• height (stature, head-to-heel length);
• head circumference (HC);
• chest circumference (CC);
• proportionality of these measurements.
To determine whether or not growth and development have taken place, the
child can be compared to a representative group of children at the same point in time
(cross-sectional method), or the same child can be measured and compared at
different points in time (longitudinal method). Standards or norms for the study of
developmental progress have been established by these two contrasting methods. The
most commonly employed technique for assessment of child's physical development
is measurement of height and weight. When compared with standardized norms, a
child's developmental progress can be determined with a high degree of confidence.
Factors influence growth and development:
 Genetic factors
 Nutritional factors
 Socioeconomic factors
 Chronic diseases
 Growth potential
 Prenatal and intrauterine factors
 Emotional factors
 Hormonal factors.

Knowledge of the developmental sequence allows the doctor to assess normal

growth as well as minor or abnormal deviations. Knowledge of developmental
milestones helps parents to gain realistic expectations of their child's ability and
provides guidelines for suitable play and stimulation. Emphasizing the child's
developmental age rather than chronologic age strengthens the parent-child
relationship by fostering trust and lessening frustration. Therefore, one cannot
overemphasize; the importance of a thorough understanding and appreciation of the
growth and developmental process of children.
The maximum growth in length and weight occurs before birth in prenatal period.
Body weight of fetus of 25 to 42 weeks of gestation can be calculated according to
the empirical formula: in average the body weight of 30-weeks fetus is 1300 g, for
each previous week minus 100 g, for each next add 200 g.
For example:
• Body weight of 26-weeks fetus equals 1300 - 100x4 = 900 g;
• Body weight of 35-weeks fetus equals 1300 + 200x5 = 2300 g.
Body length of fetus of 25 to 42 weeks of gestation can be calculated according to
formula:
L = gestation age (in weeks) + 10 cm; or body length of fetus of first 5 months of
gestation equals:
L = (gestation age (in months)) x 2. For fetus of 6 to 9 months of gestation:
L= gestation age (in months) x 5. For example:
• Body length of 32-weeks fetus equals 32+10=42 cm;
• Body length of 3 months fetus equals 32=9 cm;
• Body length of 7 months fetus equals 7x5=35 cm.
Newborns.
At birth weight is more variable than height and to a greater extent is a
reflection of the intrauterine environment. The average newborn weighs 3200 to 3400
g (7 to 7.5 pounds). Admissible limits of the norm ranges from 2700 to 4000 g.
Babies, which birth weight equals more than 4000 g, are called huge. Birth length is
influenced considerably by the prenatal environment and gestation age. It is of great
value as a sign of maturity of newborn organism. Its normal rate in neonate is 50 to
52 cm. Admissible limits of the norm ranges from 46 to 56 cm. Head circumference
at birth is equal 34 to 36 cm. Chest circumference equals 32 to 34 cm.

Anthropometrical measurements and their assessment

Weight (Technique of procedure).
Weigh infants nude on platform-type scale; protect infant by placing hand above
body to prevent falling off scale. Weigh young children (by 2 years) nude on
platform-type scale in sitting position. Weigh older children in underwear (no shoes)
on standing-type upright scale. Check that scale is balanced before weighting. Cover
scale with clean napkin or sheet of paper for each child. Measure to the nearest 10 g
or 0.5 ounce for infants and 100 g or 0.25 pound for children. To have exact results
weigh children in the morning before first meal, after urination and defecation.
During first days of child's life there appears to be a small decrease of body weight
that is called physiological loss of weight. The maximum weight decrease is 6 to 8 %
of birth weight. After the third day of life an increase begins, and the renewal of birth
weight is observed by the seventh (eighth) day of life. But only 20 % of children
show this ideal type of physiological weight loss. For others it takes more time
(approximately till 10th to 14th day of life) to regain birth weight. This physiologic
weight loss represents a loss of excessive extracellular fluid and meconium, in
addition to relative lack of food and fluids intake. The rate of weight gain increases
rapidly for a shot time after birth but soon decreases markedly. By the time the
individual reaches maturity the birth weight has only increased about 20 times (to 68
kg). In general the birth weight doubles by 4 to 4.5 months of age and triples by the
end of the first year (See Table 1). By the end of the second year it usually
quadruples. After this point the "normal" rate of weight gain, just as the growth in
height, assumes a steady annual increase of approximately 2 to 2.75 kg per year until
the adolescent grows spurt. Boys may add 20 kg and girls 15 kg during the growth
spurt (See Table 2).
Weight gain is usually considered to be an indication of satisfactory growth progress
in a child and is probably the best index of nutrition and growth. However, it may be
difficult to determine if this increase in weight is caused by healthy tissue
development or by an unhealthy deposition of fat or accumulation of fluid.
Table 1 General Trends in Weight and Height Gain during Infancy
Weight gain (grams)
Age Height gain (cm)
Monthly For the whole period Monthly For the whole period
1. 600 600 3 3
2. 800 1400 3 6
3. 800 2200 3 9
4. 750 2950 2.5 11.5
5. 700 3650 2.5 14
6. 650 4300 2.5 16.5
7. 600 4900 2 18.5
8. 550 5450 2 20.5
9. 500 5950 2 22.5
10. 450 6400 1-1.5 23.5-24
11. 400 6800 1-1.5 24.5-25
12. 350 7150 1-1.5 25.5-27

Height (Technique of procedure).

Measure recumbent length in children below 12 months. Place supine with head in
midline, pinna of the ear must be on an imaginary vertical line with lower eyelid of
the eye. Grasp knees and push gently toward table to fully extend legs. Measure from
vertex (top) of head to heels of feet (toes pointing upward).
Measure standing height (stature) in children over 12 months. Remove socks and
shoes. Have child stand as tall as possible, back straight, head in midline, lower
eyelid and pinna of the same side ear on one imaginary horizontal line. Check for
flexion of knees, slumping shoulders, rising of heels. Measure from top of head to
standing surface. Measure to the nearest cm or 1/8 inch.
Linear growth occurs almost entirely as a result of skeletal growth and is considered
to be a stable measure of general growth. Growth in height is not uniform throughout
life, but when maturation of the skeleton is complete, linear growth ceases. The
maximum growth in length occurs before birth, but the newborn continues to grow at
a rapid, though slower, rate (See Table 1). As the month pass, the growth rate rapidly
decelerates. By 2 years of age the child normally has achieved 50 % of his adult
height. In average yearly height gain at age 2 or 3 years is 8 cm.
Table 3.2 General trends in weight and height gain during childhood
Age Weight Height
Toddlers (1-4 Birth weight Height at age 2 is
years) quadruples by age approximately 50 % of
2.5 years yearly eventual adult height Yearly
gain: 2 kg gain: 8 cm

Preschoolers (4-6 Yearly gain: 2 kg Birth length doubles by age 4

years) Yearly gain: 6 cm
School-age 10 years old child Yearly gain: 6 cm birth
children weighs in average 30 length triples by about age
kg yearly gain: 2 kg 13
Pubertal growth spurt

Females- 10-14 Yearly gain: 4 kg Height gain: 16 cm

years
Males- 11-16 Yearly gain: 4 kg Height gain: 20 cm
years
Empirical 2-10 years: 1-4 years: H=100-8x (4-n); 5-
formulas: W=10+2n; 10-16 15 years: H= 100+6x (n-4),
years: W=30+4x (n- or H=6n+80 (cm), where n —
10), or W=2n+8 age of child in years
(kg), where n - age
of child in years

Thus by age 4 birth length has usually doubled and is equal to 100 cm. Then the child
begins a relatively stable and steady growth rate of 5 to 6 cm per year that continues
for the next 7 to 8 years. (Occasionally a child will exhibit a transitory midgrowth
height increase at age 6 or 7). This long midgrowth period is ended by a sudden and
marked acceleration - the adolescent growth spurt. Although there is wide variation,
this increase, which begins about 10.5 to 11 in girls and 12.5 to 13 in boys, lasts
approximately 2 to 2.5 years. During this time a boy may add 20 cm to his height and
a girl 16 cm. Usually, 98 % of the terminal height is reached by age 16.5 in girls but
not until age 17.5 in boys.
Head circumference (Technique of procedure).
Measure head circumference (HC) with paper or steel tape at greatest circumference,
from slightly above the eyebrows and pinna of the ears to occipital prominence of
skull.
General trends in head circumference gain during childhood are the next:
Age circumference Chest
Infants Birth-6 months Monthly gain: 1.5 cm
6-12 months Monthly gain: 0.5 cm
Children 1-5 years Yearly gain: 1 cm
6-15 years Yearly gain: 0.6 cm

If anthropometrical measurements at birth are unknown it is comfortably to

use such empirical formulas:
• Head circumference for children from birth till 6 months:
HC=43-1.5x(6-n), where n - age of child in months.
• Head circumference for children from 6 till 12 months:
HC=43+0.5x(n-6), where n - age of child in months.
• Head circumference for children from 1 till 5 years:
HC=50-lx(5-n), where n - age of child in years.
• Head circumference for children from 5 till 15 years:
HC = 50+0.6x(n-5), where n - age of child in years.

Chest circumference (Technique of procedure).

Measure chest circumference with paper or steel tape around chest at nipple line and
under tips of scapulas at back. Ideally, take measurements during inhalation and
expiration; record the average of the two values.
General trends in chest circumference gain during childhood are the next:
Age Chest circumference
Infants Birth - 6 months Monthly gain: 2 cm
6-12 months Monthly gain: 0.5 cm
Children 1 - 10 years Yearly gain: 1.5 cm
11-15 years Yearly gain: 3 cm
If anthropometrical measurements at birth are unknown it is comfortably to use such
empirical formulas:
• Chest circumference for children from birth till 6 months:
ChC=45-2x(6-n), where n - age of child in months.
• Chest circumference for children from 6 till 12 months:
ChC=45+0,5x(n-6), where n - age of child in months.
• Chest circumference for children from 1 till 10 years:
ChC = 63-1.5 x (10-n), where n - age of child in years.
• Chest circumference for children from 10 till 15 years:
ChC=63+3 x (n-10), where n - age of child in years.
It is necessary to compare head circumference and chest circumference. At birth HC
exceeds chest circumference by 2 to 3 cm.-At age 4 months HC equals chest
circumference. Later, the rate of chest circumference increases rapidly, at the same
time HC continues to grow at a slower rate. So, during childhood chest
circumference exceeds HC by about 1 to 7 cm.
Growth disorders
Nanism. If the length of body is less than 3 percentiles, they speak about
nanism, if it is in interval 3-10 percentiles – about subnanism.
The growth inhibition can be caused:
1. Quantitatively or qualitatively incomplete nutrition, protein-energy
failure.
2. Diseases and lesions of skeletal system: chondrodystrophia,
osteodysplasia, etc.
3. Endocrine pathology, hypothyroidism, pituitary nanism at decreased
level of somatotropine, diabetes, infringement of function of adrenal glands, etc.
4. Malabsorption and maldigestion syndrome in result of ensimopathyas
(cystic fibroses of pancreas, phenylketonuria, fructosemia, glycogenoses, etc.).
5. Chronic somatopathies, such as diseases of liver, kidneys, heart, lungs.
6. Inheritable diseases (Down syndrome, Sheryshevsky-Turner’s
syndrome, etc.).
 7. Chronic exogenous intoxications (heavy metals, etc.).
8. Constitutional factors
Gigantism
If the length exceeds 97 p, the gigantism takes place and if it is in limits 90-97
p, it testifies about a subgigantism.
Reasons:
1.Constitutional
2.Hyperproduction of somatotropine
3.Hypoactivity of sexual glands
4.Inheritable diseases: Marfan’s syndrome (spider’s fingers)
5.Genetical anomalies: additional X or Y- chromosome
Children with constitutional gigantism have a proportional body and their
puberty descends in usual terms. Children - giants of a pituitary parentage have
unproportional development, clumsiness, weak musculation, flat thorax, fast
fatigability, acromegaly.
Pathological changes of mass
Hypotrophy or exhaustion
Hypotrophy is a state of decreasing nutrition in children till 1.5 years, further a
state refers to exhaustion.
Attributes of hypotrophy
1. Decrease of mass of body:
- on 10-20 % at hypotrophy of 1st degree
- on 20-30 % at hypotrophy of 2nd degree
- more than on 30 % at hypotrophy of 3rd degree
2. Disappear of a fatty layer:
- only on a trunk at hypotrophy of 1 degree
- on a trunk and extremities at hypotrophy of 2 degree
- on a trunk, extremities and on the face at hypotrophy of 3 degree
3. Decrease of tissue turgor and elasticity of skin
4. Decrease of immune response
 5. Decrease of tolerance to nutrition (decrease of enzyme activity,
infringement of appetite)
6. Change of functional state CNS: infringement of emotional tone, muscle
tone, regimen of sleep
The reasons of hypotrophy and exhaustion
1. Nutritional deficiency
2. Diseases in mother during the pregnancy
3. Infringement of feeding and care
4. Somatopathies and infectious diseases
5. Anomalies of an digestive system (pylorostenosis)
6. Malabsorption syndrome
7. Anorexia nervosa
8. Cancer diseases
Hypostatura - is a proportional decrease of mass and lengths of body in
children of the first year of life, for older children such state names alimentary
subnanisn. More often the causes are long serious diseases, infringements of
digestion and nutrition, nutritional deficiency.
Paratrophy and an obesity
Paratrophy is the state of children till 1.5 years, after that age one can say about
obesity.
1 degree of paratrophy – excess of mass of 11-20 %
2 degree – 21-30 %
3 degree – 31 and more %
Obesity:
1 degree – excess of mass of 11-29 %
2 degree – 30-49 %
3 degree – 50-99
4 degree - 100 and more %
Causes:
 1. Constitutional. Thus the proportional distribution of fatty layer takes
place
2. Endocrinopathyes, more often there is hyperproduction of
corticotropin, thus disproportionate obesity, arterial hypertension and
hyperpigmentation are observed
The acceleration is a complex organic process which is characterized by
acceleration of mental and physical development, elongation the period of normal
functional ability of the person in all age groups. Process of acceleration of age
development occurs by shift of a morphgenesis on earlier stages of an ontogenesis.
On the part of physical development it is shown first of all by fast
augmentation of length of a body and as a result - the big body height. Thus rates of a
gain of a circle of a thorax it is much less, than lengths and masses of a body.
Astenisation of body builds due to failure of perimeter of a thorax relative length of a
body conducts to infringement of harmonicity developments.
Theories of acceleration
1. physical and chemical theories:
- heliogenic (influence of solar radiation);
- radiowave, magnetic (influence of a magnetic field);
- space (influence of space radiation);
- rising of concentration of the carbon dioxide connected to expansion of
manufacture;
2. theories of influence of separate factors of conditions of life:
- nutritional;
- increased information;
3. genetic theories:
- cyclic biological changes;
- heteresis (appreciable population shift of a planet and wedding of persons of
different races);
4. theories of complex influence of factors of conditions of life:
- urbanistic influence;
 - influence of social - biological factors.
It is obvious, that the phenomenon of an acceleration is caused by complex
influence of a way of life and various factors among which follows to note the
reasons of the social plan, change in a life, culture, the organizations of work, a
condition of training and education.

V. Control material for the preparatory stage of lesson:

1. Test control:
1. The head circumference of newborn is:
A. 30-32 cm.
B. 32-34 cm.
C. 40-42 cm.
D. 34-36 cm.*
E. 38-40 cm.
2. What is monthly increase of body weight of the child in the first half of the 1
year of a life (2-6 month)?
A. 500 g.
B. 400 g.
C. 700 g.
D. 600 g.
E. 800 g.*
3. Which formula does the body weight after 1 year determine? (n - number of
years old):
A. 10 x n.
B. 10 + 2n.*
C. 10 - 2n.
D. 10 + n.
E. 10 + 4n.
4. What is the body weight of healthy mature newborn?
A. 2700-4000 g.
 B. 2000-2500 g.
C. 1500-2000 g.
D. 4500-5000 g.
E. 1000-1500 g.
5. Within the first year of a life the body weight of the child increases in:
A. 3-3.5 times*.
B. 2-2.5 times.
C. 4-4.5 times.
D. 5-5.5 times.
E. Does not change.
6. The head circumference of the child in 5 years is:
A. 48 cm.
B. 49 cm.
C. 50 cm*.
D. 51 cm.
E. 52 cm.
7. The body height of the 4th years old child is equal:
A. 100 cm*
B. 80 cm
C. 110 cm
D. 120 cm
E. 90 cm.
8. At what age is the head circumference equal to a chest circumference?
A. 1 month.
B. 2 months.
C. 4 months*
D. 5 months.
E. 6 months.
9. Due body weight of the mature (full-term) born child in 1 year is:
A. 8- 8.5 kg.
B. 9 – 9.5 kg.
C. 10 – 10.5 kg*
D. 11 – 11.5 kg.
E. 12 – 12.5 kg.
10. The increase of the body length in the 4 th quarter (9-12 month) of the first
year of a life on the average in a month makes:
A. 2 cm
B. 3 cm
C. 4 cm
D. 5 cm
E. 1 cm*
11. The increase of a head circumference till 6 months on the average in a month
makes:
A. 0.2 cm
B. 0.5 cm
C. 1.0 cm
D. 1.5 cm*
E. 2.0 cm.
12. Which hormones do on growth of the child influence?
A. Thyroxine.
B. Insulin.
C. Growth hormone.
D. All of thr above.*
E. None.
13. The head circumference of the child in 5 months old should be:
A. 40.5 cm.
B. 41.5 cm*.
C. 42.0 cm.
D. 42.5 cm.
E. 43.0 cm.
 14. Calculate body weight of the 7 months child, if his weight at 6 months was
8000 g?
A. 8800 g
B. 8700 g
C. 8600 g
D. 8500 g
E. 8400 g*
15. The increase of the body length in the 1 st quarter (1-3 month) of the first year
of a life on the average in a month makes:
A. 3.0 cm*
B. 2.5 cm
C. 2.0 cm
D. 1.5 cm
E. 1.0 cm.
16. What is the body weight of the healthy child is 5 years old?
A. 15 kg
B. 20 kg*
C. 25 kg
D. 30 kg
E. 35 kg
17. Which method/s is/are used for an estimation of physical development of the
child:
A. Anthropometrical standards.
B. Percentile tables.
C. Formulas.
D. All of the above.*
E. None.
For measurement of a body length of children till 2 years old use:
A. Vertical height meter.
B. Horizontal height meter*.
C. Centimeter tape.
D. Special compasses.
E. Medical scales.
19. The head circumference of the child in 8 months old should be:
A. 41 cm.
B. 42 cm.
C. 43 cm.
D. 44 cm*
E. 45 cm.
20. The chest circumference of the child in 4 months old should be:
A. 40 cm.
B. 41 cm*
C. 43 cm.
D. 45 cm.
E. 46 cm.

Task# 1. Ali is 3 months old. At birth the child had following parameters:
body length was 50 cm, weight – 3000 g, head circumference – 34 cm, and chest
circumference – 33 cm. Calculate parameters of child at 3 months.

Ali, L3=50+3x3=59 cm
3 months W3=3000+600+800x2=5200g=5.2 kg
Lb = 50cm HC3=34+1.5x3=38.5 cm
Wb=3000 g CC3=33+2x3=39 cm
HCb=34 cm
CCb =33 cm Conclusion: L3=59cm, W3=5,2 kg, HC3=38,5 cm,
L3, W3, HC3, CC3 - ? CC3=39 cm

Program of self-preparation of students to the theme:

 1). To learn basic criteria and indexes of psychomotor development of children
of a different age.
2). To be able to estimate psychomotor development of child of 1th life and
children of pre-preschool age.
3). To pay attention to organization of the mode of day and basis of
neuropsychical education of children of early age (development of emotions,
aesthetically beautiful, moral and mental education).
VII. Materials for the methodical providing of the independent work of the
students:
1. David Candy, Graham Davies, Euan Ross Clinical Paediatrics and Child
health. - Reprinted W.B. Saunders, 2006. – P. 207-238.
2. Tom Lissauer, Graham Clayden Illustrated textbook of Paediatrics. –
Mosby International Limited. – 2009. – P.169-188.

VIII. LITERATURE
A) The main literature:
1. Ghai O.P., Vinod K.Paul, Arvind Bagga Essential Pediatrics. Seventh
edition. – All India Institute of Medical Scences, New Delfi, 2009. – P. 1-3, 4-17.
2. Kapitan T. Propaedeutics of children’s diseases and nursing of the child:
Textbook for students of higher medical educational institutions. Fourth edition. –
Vinnitsa: The State Cartographical Factory, 2010. – P. 107-142.
3. Nelson Essential of Pediatrics. Fifth edition. Kliegman R.M. et all. –
Saunders: Imprint of Elsevier, 2016. – P. 15-22.

Methodical recommendations for practical lesson were prepared by the assistant of

the Department of Pediatrics №1 with propedeutics and neonatology
Soloviova H.O.