<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <!-- saved from url=(0041)file://\\Nazi\e\sol-end\eng-maghale-2.htm --> <HTML><HEAD> <meta http-equiv="Content-Language" content="en-us"> <TITLE>Professor Solttanzadeh</TITLE> <META http-equiv=Content-Type content="text/html; charset=unicode"> <META content="Microsoft FrontPage 5.0" name=GENERATOR> <META content=FrontPage.Editor.Document name=ProgId> <style> <!-- h1 {margin-bottom:.0001pt; page-break-after:avoid; font-size:14.0pt; font-family:"Times New Roman"; margin-left:0cm; margin-right:0cm; margin-top:0cm} h2 {margin-top:0cm; margin-right:18.0pt; margin-bottom:0cm; margin-left:0cm; margin-bottom:.0001pt; text-indent:-18.0pt; page-break-after:avoid; tab-stops:list 18.0pt; font-size:14.0pt; font-family:"Times New Roman"; } --> </style> </HEAD> <BODY text=#000000 vLink=#ff0000 aLink=#0000ff link=#0000ff bgProperties=fixed bgColor=#ffffff leftMargin=0 background="foriegnarticle2_files/bg4 copy.gif" topMargin=0> <DIV align=left> <TABLE height=61 cellSpacing=0 cellPadding=0 width=706 border=0> <TBODY> <TR> <TD vAlign=bottom align=justify width=166 height=1><IMG height=140 src="foriegnarticle2_files/toppage3.gif" width=166 border=0></TD> <TD width=673 background=foriegnarticle2_files/bgew.gif height=1> <DIV align=left> <TABLE height=136 cellSpacing=0 cellPadding=0 border=0 width="613"> <TBODY> <TR> <TD colSpan=4 height=46 width="290"> <P align=center><IMG height=36 src="foriegnarticle2_files/Toptext7.gif" width=255 border=0></P></TD> <TD height=46 width="50"></TD> <TD height=46 width="45"></TD> <TD height=46 width="120"></TD> <TD colSpan=2 height=46 width="118"><IMG height=40 src="foriegnarticle2_files/inkscroll.gif" width=65 align=right border=0></TD></TR> <TR> <TD height=36 width="40"><a href="tamas.htm"><IMG height=30 src="foriegnarticle2_files/But8copy.gif" width=40 border=0></a></TD> <TD height=36 width="80"><a href="karhay.htm"><IMG height=30 src="foriegnarticle2_files/But7copy.gif" width=80 border=0></a></TD> <TD height=36 width="115"><a href="tarh.htm"><IMG height=30 src="foriegnarticle2_files/b1.gif" width=115 border=0></a></TD> <TD height=36 width="55"><a href="maghale.htm"><IMG height=30 src="foriegnarticle2_files/b2.gif" width=55 border=0></a></TD> <TD height=36 width="50"><a href="kongereh.htm"><IMG height=30 src="foriegnarticle2_files/But4copy.gif" width=50 border=0></a></TD> <TD height=36 width="45"><a href="talifat.htm"><IMG height=30 src="foriegnarticle2_files/But3copy.gif" width=45 border=0></a></TD> <TD height=36 width="120"><a href="moarefi.htm"><IMG height=30 src="foriegnarticle2_files/But1copy.gif" width=120 border=0></a></TD> <TD vAlign=bottom height=36 width="84"><a href="index.htm"><IMG height=30 src="foriegnarticle2_files/But10copy.gif" width=80 border=0></a>&nbsp;</TD> <TD height=36 width="34">&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR> <TR> <TD align=left colSpan=9 height=54 width="623"> <p class="MsoNormal" style="text-autospace: none"> &nbsp;</TD></TR></TBODY></TABLE></DIV></TD></TR> <TR> <TD vAlign=top align=justify width=166 height=180><IMG height=174 src="foriegnarticle2_files/toppage1.gif" width=114 align=top border=0></TD> <TD width=673 height=180> <DIV align=left> <TABLE cellSpacing=0 cellPadding=4 width=587> <TBODY> <TR> <TD width="579"> <p align="left"><b> <span style="font-size: 16.0pt; font-family: Times New Roman">GROWTH AND DEVELOPMENT</span></b></p> <TR> <TD width="579"> <h1 dir="LTR">&nbsp;</h1> <table border="0" cellpadding="2" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber1" bgcolor="#4D7565"> <tr> <td width="100%">&nbsp;<font color="#FFFFFF"><b>1&nbsp;&nbsp; IDENTIFICATION OF THE PROBLEM</b></font></td> </tr> </table> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">If a child is to develop <b>normally</b> , certain conditions must apply and his/her essential needs must be met.</p> <p class="MsoBodyText" dir="LTR">Growth and development are , therefore excellent criteria for evaluating the child s state of health and well-being.</p> <table border="0" cellpadding="2" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber2" bgcolor="#4E7864"> <tr> <td width="100%">&nbsp;<font color="#FFFFFF"><b>2</b><span style="font-style: normal; font-variant: normal; font-weight: 700; font-family: Times New Roman">&nbsp;&nbsp; &nbsp; </span><b><span dir="LTR">CRITERIA OF EVALUATION</span></b></font></td> </tr> </table> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">The child s growth and development should be:</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed"><b>&nbsp;1.&nbsp;Close to the mean value ,</b> between limits (for age) within which 95% of healthy <b>reference</b> children are found. When one says a measurement is on the <b>50th percentile</b> (50 pc), this means that 50% of children of the same age in the reference population measure more than that amount (e.g. taller or heavier) and 50% are below (e.g. shorter or lighter).</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">If a measurement is on the 97 th percentile , this means that 97% of children in the reference population fall below this level, and 3% are above. Conversely , a measure on the 3 rd percentile will be below the values for 97% of normal children of the same age and above those for only 3% of normal children.</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">&nbsp;<b>2.</b><span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span> <span dir="LTR"><b>Progressing at a normal rate:</b></span> a curve is normal only if it is similar (parallel) to the normal percentile curve. If , for example , the weight curve crosses the percentile curve downwards (see figure 1,.) , a cause must be sought (e.g. malnutrition ,chronic disease); if , no the other hand , it rises more rapidly than the percentile curve (see figure 1.), this may indicate , for example , a  catch-up growth after a period of illness or malnutrition , or oedema from any cause , or developing obesity.</p> <table border="0" cellspacing="1" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber3"> <tr> <td width="53%"> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: -18.0pt; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <b>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 3</b>.<span style="font-family: Times New Roman; font-size: 7pt"> </span><span dir="LTR"><b>Without any substantial discordance</b></span> between the <b>various aspects of development</b> (e.g. weight, height and sexual maturation ).The child s <b>psychomotor </b> and <b>intellectual development</b> can be evaluated by many tests of which we will give only a few examples.</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">As for physical growth, these parameters can be compared with those from a healthy reference population of the same age.</p> <p>&nbsp;</td> <td width="47%"> <img border="0" src="abnormal/tropical2.jpg" width="300" height="290"></td> </tr> </table> <p class="MsoNormal" dir="LTR" style="text-align: right; direction: ltr; unicode-bidi: embed"> &nbsp;<b><font size="2" color="#008080">Fig.1-Growth curve (weight-for-age); example of abnormal growth.</font></b>&nbsp;&nbsp; </p> <table border="0" cellpadding="2" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber4" bgcolor="#4E7864"> <tr> <td width="100%">&nbsp;<font color="#FFFFFF"><b>3</b><span style="font-style: normal; font-variant: normal; font-weight: 700; font-family: Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b><span dir="LTR">PHYSICAL GROWTH</span></b></font></td> </tr> </table> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp; </span></span><span dir="LTR">The standards most commonly used for evaluating physical growth are those of the </span>National Center for Health Statistics (NCHS) , derived from studies of a&nbsp; large number of children of different races in the United States. They are recommended by WHD.</p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp; </span></span><span dir="LTR"><b>Weight </b></span>(Fig.2): an easy measurement to make with a few elementary precautions (child naked, balance tared). The significance of weight-for-age is , itself , of limited value , but the rate of weight gain (the growth rate) is a very sensitive index of good health.</p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed"><b>N.B. :</b> when a child is weighed , check that there is no <b><u>oedema</u></b> (see also <b><u>malnutrition</u></b> and glomerulo-nephritis) , which affects the measurement.</p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed">&nbsp;<img border="0" src="abnormal/tropical3.jpg" width="424" height="205"></p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed"><b><font size="2" color="#008080"> Fig.2-Weight-for-age.</font></b></p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed">&nbsp;<span style="font-family: Symbol"><span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp; </span></span><span dir="LTR"><b>Height</b></span> (Fig. 3) : This measurement demands more care and precision than weight , but still represents  good health when it is adequate. Height develops too slowly for it to be an efficient indicator of acute malnutrition. However , it is a good index of <b>chronic</b> conditions (manutrition or disease); it is also a good index of the general state of health of populations.<b> Growth rate</b> varies according to the different periods of a child s life. It is maximal in the first five months, then declines and later goes through a  spurt at adolescence. The growth rate slows during acute or chronic episodes of malnutrition or disease; precise and closely spaced measurements of height allow the demonstration of periods of <b>slowing</b> and <b>acceleration.</b> The measurement of supine height (length) requires an accurate measuring board and two helpers; standing height can be measured after 24 months of age, needs only one helper and is about 10-30 mm less than supine height.</p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed"><span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp;</span></span><span dir="LTR"><b>Weight/height ratio:</b></span>&nbsp; the ratio of these two measurements can help assess <b>&nbsp;&nbsp;  wasting </b> and give reasonable indication of growth independent of age, for example when age is difficult or impossible to determine precisely.</p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed"><span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp; </span> </span><span dir="LTR"><b>The wasting diagram</b></span> (Fig.4) is a way of expressing the weight/height ratio which allows one to detect wasted children quickly. Each column is marked with a weight , with three colored areas in the upper part. These show the relation between the child s weight-for-height and the standard weight-for-height (NCHS standards). The child stands against the chart in front of the column representing his weight. The color shows the <b>degree of wasting.</b>  Very wasted children are detected by <b>red</b>;&nbsp; yellow indicates  wasted , and <b>green</b> shows normal weight-for-height(90-110% of the&nbsp; NCHS standard).</p> <p class="MsoNormal" dir="LTR" style="text-align: center; direction: ltr; unicode-bidi: embed"> &nbsp;<img border="0" src="abnormal/tropical4.jpg" width="420" height="190"></p> <p class="MsoNormal" dir="LTR" style="text-align: center; direction: ltr; unicode-bidi: embed"> <b><font size="2" color="#008080">Fig. 3-Height-for-age</font></b></p> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber5"> <tr> <td width="42%"><b><font size="2" color="#008080"> Fig.4-Weight-for-height ratio (P.J.Lamotto ,(Documents Scientifiques Guigoz N 126, 1989)</font></b></td> <td width="58%"> <p align="center"> <img border="0" src="abnormal/tropical7.jpg" width="200" height="188"></td> </tr> </table> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp; </span></span><span dir="LTR"><b>Head circumference</b></span> (Fig.5) is an easy measurement to take (maximum circumference), may reflect the development of the brain and can help with the diagnosis or monitoring of neurological conditions.</p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp; </span></span><span dir="LTR"><b>Arm circumference:</b></span> to be measured on the left arm. It can be used to help assess nutritional state and muscle mass. It is quite stable (14-16 cm) between 1 and 5 years of age (Table 1).</p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span></span><span dir="LTR"><b>Arm circumference/head circumference ratio:</b></span>a quick and helpful index of nutritional state which is independent of age and sex and which is useful between the ages of 1 and 5 years:</p> <table border="0" cellspacing="1" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber6"> <tr> <td width="50%"> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed"><b><font size="2" color="#000080">Ratio = &lt;0. 25&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;severe protein-energy</font></b></p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed"><b><font size="2" color="#000080">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp; malnutrition;</font></b></p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed"><b><font size="2" color="#000080">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp; &gt; 0. 25 - &lt; 0. 32&nbsp; moderate protein-energy</font></b></p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed"><b><font size="2" color="#000080">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; malnutrition;</font></b></p> <p class="MsoNormal" dir="LTR" style="margin-left:14.4pt;text-align:left; direction:ltr;unicode-bidi:embed"><b><font size="2" color="#000080">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp; &gt; =0. 32&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; normal.</font></b></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;&nbsp;&nbsp; </span></span><span dir="LTR">growth retardation in the <b>absence of severe</b> malnutrition or chronic disease requires detailed investigation in depth, for which the child should be REFERRED.</span></p> <p>&nbsp;</td> <td width="50%"> <img border="0" src="abnormal/tropical5.jpg" width="300" height="268"><center> <b><font size="2" color="#008080">Fig. 5-Head circumference for age </font></b><br> <b><font size="2" color="#008080">(Adapted from the NCHS standards)</font></b></td> </tr> </table> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed"><font color="#008080"><b>Table-Arm circumference (cm)</b></font></p> <table border="1" cellspacing="1" style="border-collapse: collapse" bordercolor="#FFFFFF" width="77%" id="AutoNumber7" bgcolor="#D5D5FF"> <tr> <td width="35%">&nbsp;</td> <td width="32%" colspan="3"> <p align="center"><b>Boys</b></td> <td width="33%" colspan="3"> <p align="center"><b>Girls</b></td> </tr> <tr> <td width="35%">&nbsp;</td> <td width="11%" align="center">5pc</td> <td width="10%" align="center">50pc</td> <td width="11%" align="center">95pc</td> <td width="11%" align="center">5pc</td> <td width="11%" align="center">&nbsp;50pc </td> <td width="11%" align="center">95pc</td> </tr> <tr> <td width="35%" align="center"><b>1 to 2 years</b><p><b>2 to 3 years</b></p> <p><b>3 to 4 years </b></p> <p><b>4 to 5 years</b></td> <td width="11%" align="center"> <p align="center">14.2</p> <p align="center">14.1</p> <p align="center">15.0</p> <p align="center">14.9</td> <td width="10%" align="center">15.9<p>16.2</p> <p>16.7</p> <p>17.1</td> <td width="11%" align="center">18.3<p>18.5 </p> <p>19.0</p> <p>19.2</td> <td width="11%" align="center">13.8<p>14.2</p> <p>14.3 </p> <p>14.9 </td> <td width="11%" align="center">&nbsp;15.6<p>16.0</p> <p>16.7</p> <p>16.9</td> <td width="11%" align="center">17.7<p>18.4</p> <p>18.9</p> <p>19.1</td> </tr> </table> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </p> <table border="0" cellpadding="2" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber8" bgcolor="#4E7864"> <tr> <td width="100%"><font color="#FFFFFF">&nbsp;<b>4</b><span style="font-style:normal; font-variant:normal; font-weight:700; font-family:Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b><span dir="LTR">PSYCHOMOTOR DEVELOPMENT</span></b></font></td> </tr> </table> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">This includes <b>motor development</b>, i.e. development of tone and prehension movement and stages in the <b>development of affect and social relationship</b>, i.e. all that which concerns relations with others (adults and children), and the acquisition of language. The same stages are always followed, usually in the same order. It is helped by close contact between mother and child and by the family environment. The process of weaning , the birth of another child and separation from the mother may retard this aspect of development.</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">The neonate shows truncal hypotonia,hypertonia of the limbs and primitive reflexes; the child progressively acquires truncal tone, which permits it to:</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed"><font color="#000080"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;"> </span></span><span dir="LTR">hold up its head at months;</span></font></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <font color="#000080"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span></span><span dir="LTR">maintain a sitting position between 6 and 8 months;</span></font></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <font color="#000080"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span></span><span dir="LTR">walk on hands and feet at about 8-9 months;</span></font></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <font color="#000080"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp;</span></span><span dir="LTR">stand upright at 9-10 months;</span></font></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <font color="#000080"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;"> </span></span><span dir="LTR">walk at about 1-2 years of age.</span></font></p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">These different milestones are passed progressively (Fig. 6).</p> <p class="MsoNormal" dir="LTR" style="text-align:center;direction:ltr;unicode-bidi: embed"><img border="0" src="abnormal/tropical6.jpg" width="412" height="222"></p> <p class="MsoNormal" dir="LTR" style="text-align:center;direction:ltr;unicode-bidi: embed"><b><font size="2" color="#008080">Fig. 6- Important stages in psychomotor development.</font></b></p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed">Between 9 and 12 months, the child also begins to hold objects between thumb and forefinger, and speaks its first words. Sphincter control begins between 15 and 18 months; at this time , the child can say several words and combines two words to from short phrases. After 2 years of age, he becomes clean day and night; language becomes more elaborate with complete phrases.</p> <p class="MsoNormal" dir="LTR" style="text-align:left;direction:ltr;unicode-bidi: embed"><font color="#800000">Certain warning signs should alert the mother and the observer:</font></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <font color="#000080"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span></span><span dir="LTR">a child who does not play, is not interested in his surroundings and sleeps a great deal;</span></font></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <font color="#000080"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span></span><span dir="LTR">a child who is restless and cries without reason, and who does not sleep at night;</span></font></p> <p class="MsoNormal" dir="LTR" style="text-align: left; text-indent: 0cm; direction: ltr; unicode-bidi: embed; margin-right: 18.0pt"> <font color="#000080"> <span style="font-family: Symbol">&nbsp;&nbsp;&nbsp; <span style="font:7.0pt &quot;Times New Roman&quot;">&nbsp; </span></span><span dir="LTR">a child who makes no or only slow progress. When this occurs , one should take a history and make a complete examination; if it is confirmed that there is psychomotor retardation, REFER for diagnosis and management.</span></font></p> </TR></TBODY></TABLE></DIV> <table cellSpacing="0" cellPadding="4" width="587"> <tr> <td width="579"><hr> <font color="#FF0000"><b>TROPICAL PAEDIATRICS </b></font>&nbsp;<font color="#800000" size="2"><b>(HANDBOOK)</b></font><hr></td> </tr> </table> <DIV align=left> <TABLE height=67 cellSpacing=0 cellPadding=0 width=599 border=0> <TBODY> <TR> <TD width=579 height=65> <P class=MsoNormal dir=rtl style="MARGIN-BOTTOM: -15px; DIRECTION: rtl; unicode-bidi: embed; mso-pagination: none; mso-layout-grid-align: none" align=center><a href="index.htm">Home page</a>&nbsp; |<a href="eng-moarefi.htm">&nbsp;Introduction</a>&nbsp;|&nbsp;<a href="eng-tarh.htm"> Research Studies</a>&nbsp; |&nbsp;<a href="eng-talifat.htm"> Editorships</a>&nbsp; |&nbsp;<a href="eng-translate.htm"> Translations</a>&nbsp; |&nbsp;<a href="eng-kongereh.htm"> Conferences</a>&nbsp; </P> <P class=MsoNormal dir=rtl style="MARGIN-BOTTOM: -15px; DIRECTION: rtl; unicode-bidi: embed; mso-pagination: none; mso-layout-grid-align: none" align=center><a href="eng-tamas.htm">Contact Information</a>&nbsp; |<a href="eng-maghale.htm">&nbsp; Articles&nbsp;</a> |&nbsp;<a href="news.htm"> Scientific meets &amp; events&nbsp;</a> |&nbsp;<a href="research.htm"> Research projects&nbsp;</a> |&nbsp; Theses</P></TD></TR></TBODY></TABLE></DIV></TD></TR></TBODY></TABLE></DIV></BODY></HTML>