G:\Děti II\sejmout0038.jpg PEDIATRIC PHYSIOLOGY Psycho-motor development •Gross motor control •Fine motor control •Language •Personal – social control G:\Děti II\sejmout0036.jpg (pevné uchopení předmětu) (plazení se) (tahá za věci) ---------Crawl on their knees – lézt po kolenou G:\Děti\sejmout0020.jpg GROWTH PERIODS •INFANCY: üNewborn: 0 –28 days after born (1 month) üSuckling: 2 – 12 month •EARLY CHILDHOOD ü1 – 4 years old ü(Toddler 1 –3 years old) GROWTH PERIODS •LATE CHILDHOOD ü5 – 12 years old üOther special terms: üPre-school period 5 – 7 years üSchool period – younger, older GROWTH PERIODS •ADOLESCENCE ü13 – 20 years old üThe other special terms: üTeenager -19 years üPubertas 11-15 years WEIGHT •Weight loss in first few days : 5-10% of birthweight •Return to birthweight: 7-10 days of age •Double birthweight: 4-5 mo •Triple birthweight: 1yr •Quadruple birthweight: 2 yr Examination of newborn at the delivary room •Apgar score • Signs Points • 0 1 2 üHeart rate: 0 <100 /min >100/min ü üRespiration: none weak cry vigorous cry ü üMuscle tone • reflex irritability: none some motion cry, withdrawal • üColor of body: blue pink body, pink all over • blue extremities TRANSITION FROM FETAL TO NEONATAL PHYSIOLOGY •Specialities of fetal circulation: üPlacenta, where deoxygenated blood becomes oxygenated ü1 Umbilical vein – well-oxygenated blood ü2 Umbilical arteries – deoxygenated blood üForamen ovale üDuctus arteriosus Botalli üDuctus venosus G:\Děti II\sejmout0032.jpg TEMPERATURE •In utero thermoregulation of the fetus is performed by the placenta, which is as an efficient heat exchanger •Fetal temperature is higher than the mother´s temperature: about 38.5 °C •After birth, the newborn infant begins life covered by amniotic fluid and situated in a cold environment: 20-25 °C •An infant´s skin temperature may fall 0.3 °C/min and the core temperature may decline 0.1 °C/min in the delivery room • •Because the body surface area is large in relation to body mass, heat is readily lost from the body •The ideal environmental temperature is called as the neutral thermal environment: the ambient temperature resulting in the lowest rate of heat production and the lowest consumption of oxygen by the infants while maintaining normal body temperature •1 hour after birth: 33-34 °C •1 day after birth: 31-33 °C •1 weeks after birth: 27-33 °C G:\Děti II\sejmout0034.jpg G:\Děti II\sejmout0041.jpg GIT and NUTRITION •In general, the ability of the neonate to digest, absorb, and metabolize foods is not different that of the older child, with the following 3 exceptions: ü1. Secretion of pancretic amylase is deficient ü2. Absorption of fats from the gastrointestinal tract is somewhat less than that in the older child (milk with a high fat content - such as cow´s milk, is inadequately absorbed) ü3. The liver function during at least the 1st week of life, the glucose concentration in the blood is unstable and low • Nutritionale needs during the early weeks of life •Need for calcium and vitamin D •Necessity for iron in the diet • •The correct and natural nutrition: ü breast milk and is necessary supported breast feeding G:\Děti III\sejmout0044.jpg G:\Děti III\sejmout0045.jpg The breast and its mammary gland Lactiferous duct Lactiferous sinus -ampulla G:\Děti III\sejmout0046.jpg •Period of non-milk additions in children nutrition: 5th – 7th month •5th month: vegetable soup – meat-vegetable supplement, boiled egg yolk 2/week (not eggwhite-albumen), vegetable oil 5-10g •Replacement of breast milk (e.g. SUNAR, other products (Nutrilon, Hipp…) •6th month: fruits-milk supplement , cottage cheese, yoghurt, mixed fruits, sugar free •7th month – cereals with gluten, pap, biscuits •milk period 0-6 month •non-dairy period and transition period to a mix diet (lunchtime is replaced with the soup) •transition period to a mix diet 8th – 12th month •The same diet as in the previous slide •+ from 9th month – a piecemeal, grainy diet •important fiber (fruit juices, juices, oat flakes ...) - increases the water content of the intestinal contents - slows the passage time through the intestines - has a beneficial effect on microbiology (microecology) in the large intestine • •fibrous indigestible material in vegetable foodstuffs that aids the passage of food has a good influence to intestine function State screening for metabolic disorder in neonate •Congenital hypothyroidism: usually arises as a sporadic mutation which causes an insufficient production of thyroxine üThe expected incidenceof the disorder is as 1: 5 000 births üThe initial screening test is teh thyroxine radioimunoassey, which may be done on a heel stick blood spot at the first week after birth •Phenylketonuria (PKU) üthe annual incidence of this inborn error of metabolism is 1:16 000 live births. If the condition is not detected and treated during the first few month of life, severe or profound mental retardation occurs üScreening provide by Guthri inhibition assey test – blood spots specimen obtained from a heel stick üAs soon PKU is detected, a low phenylalanine diet is begun