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Growth and Development

B. Marciniak

Published 2019 in A Practice of Anesthesia for Infants and Children

ABSTRACT

Abstract Growth is the quantitative increase in physical development of the body, whereas maturation includes the genetic and biologic development of the child; both phenomena advance during pregnancy and continue after birth. All organ systems undergo maturation changes and most are complete within the first few years of life. Normal physiological variables in infancy and childhood are quite different from adults. Physical growth can be assessed by changes in weight, height and head circumference. These can be readily plotted over time to determine disparities between normalcy and those indicating disease onset or other effects compromising growth. Cerebral immaturity and plasticity impacts on sensitivity to drugs, pain responses, behaviour and increases potential harm from apoptosis with anesthesia. The heart undergoes transition from fetal to adult circulation during the first few weeks of life. Undiagnosed congenital defects are not uncommon. Respiratory anatomy and mechanics affect propensity to apnea, airway maintenance, artificial ventilation modalities, uptake of inhalational agents and endotracheal tube sizes. Metabolic rate and oxygen requirements decrease with age. This physiology influences diverse aspects that include the rate of desaturation during apnea, hypoglycaemia during starvation, cardiac output, drug metabolism, fluid requirements and heat production or loss. It is incumbent upon the anesthesiologist to understand the developmental changes that occur in the neonate and infant over time, and how these changes affect physiologic responses to diseases, drug pharmacokinetics and pharmacodynamics.

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