Definition

Disturbances in children's growth and development or what is often called Global growth and developeral delay (GDD) is an individual condition where there are problems in growing and developing according to the age group. Actually, the child was born for quite a month, but in subsequent growth and development there was a failure of physical growth, namely malnutrition and retardation of social or motor development.

The number of disruptions to growth and development in the world in 2016 is estimated to be 52.9 children, especially in low-income countries, so the incidence of growth and development disturbances will increase. Since 2007, the Ministry of Health in collaboration with the Indonesian Pediatrician Association (IDAI) has compiled stimulative instruments, early detection and intervention to develop for children aged 0 to 6 years, which is outlined in Guidelines for the Implementation of Stimulation, Detection and Intervention of Early Growth and Development (SDIDTK) Children at the Basic Health Service Level.

The problem of developing and developing is still very vulnerable and this is determined from the first 1000 days of life.

Cause

There are several causes of disturbances in children's growth and development. The following are the causes of children's growth and development disorders:

Antental

• Derivative diseases, such as Fragile X syndrome, Down syndrome, or microdelesy disorder and chromodynamic duplication
• Infections in the early trimester of pregnancy, this can also cause impaired growth and development of children. Infections in the early trimester of pregnancy were rubella, citomegalovirus, toxoplasmosis
• Infections in the final trimester of pregnancy, these infections are in the form of variella, HIV, malaria and others.
• First child pregnancy
• Pregnancy with a small distance
• Pregnancy in adolescents
• DISTRIBUTION of blood vessels such as bleeding and blockages
• The use of drugs such as anti-epilection and cytoxy drugs
• Poisons such as smoking, alcohol and the use of opioids
• Poverty, This is a problem, including in Indonesia which is a developing country

If you want to know more about rubella disease, you can read it here: Rubella - Definition, Cause, Symptoms And Treatment

Perintal

• Intrauterine Growth Restriction (IUGR), premature birth, and periventricular leukalasia disease
• Hypoxic-Ischemic Encephalopathy (HIA)
• Metabolic disorders such as hypoglycemia, increased bilirubin and others
• Poverty

Christmas Post

• Metabolic disorders such as hypoglycemia, hypothremia or hypovolemia
• built-in metabolic disorders
• Poisoning, such as Asymptomatic poisoning
• Poverty
• Malnutrition is mainly multivitamin and mineral deficiency such as iron, folic acid, vitamin D, and calcium

Read more about folic acid, here: Vitamin B9 (Asam Folat) - Contraindication, Side Effects And Drug Interaction

Risk Factors

In general, children have a normal pattern of growth and development which is the result of interactions of many factors that affect children's growth and development. Factors that must be viewed comprehensively so that children can grow and develop well. These factors include:

Factors from Internal (Internal)

• There is a tendency for families who have a tall, short, fat or thin posture
• The rapid growth rate is during prenatal, the first year of life and youth
• Gender. The reproductive function in girls develops faster than boys, but after passing retirement, the growth of boys will be faster
• Genetics. There are several genetic disorders that affect children's growth and development such as dwarfs (dwarfism)

Factions From Outside (External)

• Prenatal Factors
  • Nutrition. Nutrition of pregnant women, especially in the final trimester of pregnancy, will affect fetal growth.
  • Mechanics. The position of an abnormal phitus can cause congenital abnormalities such as club foot.
  • Toxine/chemical factors. Some medicines such as Aminopterin and thalidomide can cause congenital abnormalities such as palatoskisis.
  • Endocrine. Diabetes mellitus can cause macrosomia, cardiomegali, adrenal hyperplasia.
  • Radiation. Exposure to radiation and X-rays can cause abnormalities in the fetus such as microcephali, spina bifide, mental retardation and deformity of the motional members, congenital abnormalities of the eye, heart disorders.
  • Infections. In the first and second trimester by TORCH (Toksoplasma, Rubella, Sitomegalo virus, Herpes symplectics) can cause abnormalities in the fetus: cataracts, deaf muteness, microcephalia, mental retardation and congenital heart disorders.
  • Immune disorder. The fetalis Eritobaltosis arises on the basis of blood type differences between the fetus and the mother so that the mother forms antibodies to the fetal red blood cells, then through the placenta it enters the fetal blood circulation and will cause hemolysis which further results in hyperbilirubinemia and ikterus kern which will cause damage to brain tissue.

You can read more fully about the microcephalia, here: Microcephali - Definition, Cause, Symptoms And Treatment

• Post-Government Factors
  • Nutrition. Nutrition is the most important thing for the baby's growth and development, a strong food substance is needed.
  • Endocrine. Hormonic disorders, for example in hypothyroid diseases, will cause children to experience growth barriers.
  • Socio-economics. Poverty is always associated with food shortages, poor environmental health and ignorance, which will hinder child growth.
  • Care environment. In the environment of care, mother-child interactions greatly affect children's growth and development.
  • Stimulation. Development requires stimulation/stimulation, especially in the family, for example the provision of toys, child socialization, involvement of mothers and other family members in child activities.
  • Medicines. The use of long-term corticosteroids will hamper growth, as will the use of an obat on the neural arrangement which causes inhibition of growth hormone production.

Symptoms

There are symptoms with major signs and minors for disruption of growth and development disorders including:

Major's Sign

• There are typical behavioral skills disorders according to age (physical, language, motor, and picosocial), as well as disturbed physical growth where they are high based on age below < 2 SD (standard deviation) according to WHO

Minor Signs

• Afek (emotion) flat
• Unable to carry out age-appropriate self-care
• Social response is slow
• Limited eye contact
• Food Lust decreases
• Lesu
• Anger
• Regression
• Bed patterns are disturbed in babies

Diagnosed

In enforcing the GDD diagnosis, doctors will conduct an anamnesis examination or medical interviews, physical examinations and supporting examinations.

Medical Interview

Medical interviews are interviews conducted between doctors and patients. Doctors will ask about:

• Symptoms currently experienced
• Previous history of disease
• History of pregnancy and birth
• Child growth history especially on the first 1000 days of life (HPK)
• History of immunization and nutrition
• Family history of disease

The doctor will also look at KIA's book or Mother and Child Cards to see comprehensively about the history of ANC patients, prenatal, post-Christmas and other disease histories. Children are different from adults. Therefore, the doctor will see comprehensively what is the factor causing the child's growth and development failure.

Physical Examination

After conducting a medical interview, the doctor will conduct a general and special physical examination. At general physical examinations, doctors will assess weight, height, head circumference, and body mass index (BMI). Furthermore, in a special physical examination, the doctor will examine all the physical status of the child and also the neurological status.

Supporting Examination

Doctors will conduct supporting examinations if necessary. Examinations that can be carried out are in the form of:

• Laboratory Examination
  • Complete Blood
• Radiological Examination
  • X-ray X-ray
  • CT Scan
  • MRI (Magnetic Resonance Imaging)

Laksana Procedure

Treatment for children who experience growth and development disorders according to the causes and factors that influence them. Doctors will do it catch up for the growth and development of the child. However, parents are the most important factors for child growth and development. Doctors will provide the right education to pursue the child's growth and development.

Complications

Most of the growth disorders and development of children are pursued without complications. However, if not well pursued, the child will experience:

• Decreased academic quality in the future
• Stunting
• Bad Nutrition

Prevention

To prevent growth and development disruptions, there are several things that must be considered:

• Conduct routine checks for pregnant women
• Children get enough breast milk
• Children get immunizations according to the doctor's advice
• Monitoring the child's head circumference, good growth is 2 cm in the first three months, 1 cm in the second three months and 0.5 cm in the next 6 months
• Communication and interaction relationships between children and parents must be monitored
• Don't use drugs without the doctor's permission
• If the child is cared for by a nanny, then the caregiver should be healthy and trained

When Do You Have To Go To A Doctor?

A child must be checked regularly and periodically to detect growth and development disorders. In Indonesia, guidebooks for mothers and children must really be implemented properly and correctly. If there are growth and development disorders in children, immediately consult a pediatrician who specializes in developing.

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