Growth and Development

Published on 22/03/2015 by admin

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Chapter 664 Growth and Development

Lawrence Wells, Kriti Sehgal, John P. Dormans

Growth patterns and development in children are often unique to the individual child. Statistically, normal is defined as 95% of a population that falls within 2 standard deviations of the mean from any given measurement.

Terms to describe some common deviations from normal are listed in Table 664-1. Congenital anomalies can be categorized into production problems and packaging problems. Production problems include abnormalities caused by malformation, dysplasia, or disruption that will not spontaneously resolve. Packaging problems include deformations caused by mechanical causes including in utero positioning and molding, and they usually resolve with time.

Table 664-1 TERMINOLOGIES FOR DEVIATIONS

TERMINOLOGY DESCRIPTION
Congenital Anomaly that is apparent at birth
Deformation A normally formed structure that is pushed out of shape by mechanical forces
Deformity A body part altered in shape from normal, outside the normal range
Developmental A deviation that occurs over time; one that might not be present or apparent at birth
Disruption A structure undergoing normal development that stops developing or is destroyed or removed
Dysplasia A tissue that is abnormal or wrongly constructed
Malformation A structure that is wrongly built; failure of embryologic development or differentiation resulting in abnormal or missing structures

In Utero Positioning

In utero positioning produces temporary joint and muscle contractures and affects the torsional alignment of the long bones, particularly those of the lower extremities. Normal full-term newborns can have up to 20-30-degree hip and knee flexion contractures. These contractures tend to resolve by 4-6 mo of age. The newborn hip externally rotates in extension up to 80-90 degrees and has limited internal rotation to ∼0-10 degrees. The lower leg often has inward rotation (internal tibial torsion). The face may also be distorted; the spine and upper extremities are less affected by the in utero position. The effects of in utero positioning, therefore, are physiologic in origin and resolve by 3-4 mo of age.

Growth and Development

Consideration of growth and development helps to formulate treatment strategies designed to preserve or restore normal growth potential. Growth is subject to many variables including genetics, nutrition, general health, endocrine status, mechanical forces, and physiologic age. Growth also varies between 2 anatomic regions and even between 2 bones of the same region.

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