Physical Development of the ChildBolaning jismoniy rivojlanishi
Factors affecting physical development, the technique of anthropometric measurements, standards and criteria for assessing growth and development, the anatomical-physiological characteristics of the newborn, borderline and transitional conditions in newborns, the preterm newborn, examination methods (inspection, palpation, percussion, auscultation), and the Apgar and Silverman scores. Jismoniy rivojlanishga ta'sir qiluvchi omillar, antropometrik o'lchovlar texnikasi, bolalarda o'sish va rivojlanishni baholash standartlari va mezonlari, yangi tug'ilgan chaqaloqning anatomik-fiziologik xususiyatlari, chaqaloqlardagi chegara va o'tish holatlari, chala tug'ilgan chaqaloq, tekshirish usullari (ko'rik, palpatsiya, perkussiya, auskultatsiya) hamda Apgar va Silverman shkalalari.
Definition and the Four Groups of SignsTa'rif va to'rt guruh belgi
Physical development (PD) is the set of morphological and functional characteristics that reflect the process of growth and maturation, shaped by heredity and environment. In clinical pediatrics it is understood two ways at once: as a dynamic process (increase in length, weight, and the growth of individual body parts over time) and as the child's biological maturity level at a given age. Jismoniy rivojlanish (JR) — irsiy omillar va atrof-muhit sharoitlari tufayli yetilish va rivojlanish jarayonlarini tavsiflovchi morfologik va funktsional xususiyatlar to'plami. Klinik pediatriyada JR ikki ma'noda tushuniladi: o'sishning dinamik jarayoni sifatida (uzunlik, tana vaznining ko'payishi, tananing alohida qismlarining rivojlanishi) va bolalikning ma'lum bir davridagi biologik kamolot sifatida.
AnthropometricAntropometrik
Body length, body weight, head/chest/shoulder/thigh/lower-leg circumference.Tana uzunligi, tana massasi, bosh, ko'krak, yelka, son, boldir aylanasi.
FunctionalFunksional
Vital lung capacity, muscle strength, physical work capacity.O'pkaning tiriklik sig'imi, mushak kuchi, jismoniy mehnat qobiliyati.
SomatoscopicSomatoskopik
Spinal shape, muscle development, leg shape.Umurtqa pog'onasi shakli, mushaklarning rivojlanishi, oyoq shakli.
BiologicalBiologik
Dental formula, body proportionality, linear growth, secondary sexual characteristics.Tishni aniqlash formulasi, tana tuzilishi proportsionalligi, chiziqli o'sish, ikkilamchi jinsiy belgilar.
Factors Affecting Physical DevelopmentJismoniy rivojlanishga ta'sir qiluvchi omillar
Factors are conventionally split into genetic, environmental, and unclassified. Genetic: over 100 genes regulate growth rate and ceiling; parental height correlates most with the child's own height at ages 2–9 and 13–18. Omillar shartli ravishda genetik, atrof-muhit va tasniflanmagan turlarga bo'linadi. Genetik: 100 dan ortiq gen o'sish tezligi va chegarasini tartibga soladi; ota-ona va bola bo'yi o'rtasidagi bog'liqlik 2-9 va 13-18 yosh oralig'ida eng aniq ko'rinadi.
| PeriodDavr | Dominant hormonal influenceAsosiy gormonal ta'sir |
|---|---|
| In uteroHomila ichi davri | Maternal hormones (via placenta)Ona gormonlari (yo'ldosh orqali) |
| Infancy (breastfeeding)Ko'krak yoshi | Maternal hormones (via milk)Ona gormonlari (ona suti orqali) |
| 1–6 years1-6 yosh | Pituitary (GH), pineal, thyroidGipofiz (STG), epifiz, qalqonsimon bez |
| AdolescenceO'smirlik davri | Pituitary (GH), sex hormones (androgens, estrogens)Gipofiz (STG), jinsiy gormonlar (androgen, estrogen) |
Environmental: nutrition is the single most important factor — deficits in amino acids, vitamins (A), zinc, or iodine slow growth. Physical activity stimulates osteoblasts; excessive axial loading suppresses growth. Adequate sleep, spring growth-peak seasonality, and psychological stress (which activates the sympathoadrenal system) all play a role. Atrof-muhit: ovqatlanish eng muhim omil — aminokislotalar, vitamin A, sink, yod yetishmovchiligi o'sishni sekinlashtiradi. Jismoniy faollik osteoblastlarni faollashtiradi; ortiqcha vertikal yuk o'sishni tormozlaydi. Yetarli uyqu, bahorgi o'sish cho'qqisi va ruhiy stress (simpatoadrenal tizimni faollashtirib, o'sishni bloklaydi) ham rol o'ynaydi.
Unclassified (least studied): birth order, parental age, fetal weight, season of birth. Tasniflanmagan (kam o'rganilgan): homiladorlik/tug'ilish tartib raqami, ota-onalar yoshi, homila vazni, tug'ilish mavsumi.
Technique of Anthropometric MeasurementsAntropometrik o'lchovlar texnikasi
Correct technique matters as much as the number itself — a poorly measured child produces a misleading growth curve. To'g'ri texnika sonning o'zi kabi muhim — noto'g'ri o'lchangan bola chalg'ituvchi o'sish egri chizig'ini beradi.
Formulas for Estimating Physical Development by AgeYoshga oid jismoniy rivojlanish formulalari
Curriculum reference formulas — use only when direct measurement or a WHO growth chart is unavailable. First-year growth: ~3 cm/month in months 1–3, 2.5 cm/month in Q2, 1.5–2 cm/month in Q3, 1 cm/month in Q4 → total ≈25 cm in year 1. Age 1–4: 4-year height = 100 cm (±8 cm per year short); age 8+: 8-year height = 130 cm (±5–7 cm per year difference). O'quv dasturi formulalari — faqat to'g'ridan-to'g'ri o'lchash yoki JSST jadvali mavjud bo'lmaganda ishlatiladi. Birinchi yil o'sishi: 1-3 oyda oyiga ~3 sm, II chorakda 2,5 sm, III chorakda 1,5-2 sm, IV chorakda 1 sm → 1-yilda jami ≈25 sm. 1-4 yosh: 4 yoshli bo'y = 100 sm (har yetishmagan yiliga ±8 sm); 8 yoshdan katta: 8 yoshli bo'y = 130 sm (har yil farqiga ±5-7 sm).
| Age (mo)Yosh (oy) | Weight gain/mo (g)Oylik vazn qo'shilishi (g) | Cumulative (g)Jami (g) | Length gain/mo (cm)Oylik bo'y qo'shilishi (sm) | Cumulative (cm)Jami (sm) |
|---|---|---|---|---|
| 1 | 600 | 600 | 3 | 3 |
| 3 | 800 | 2200 | 3 | 9 |
| 6 | 650 | 4300 | 2.5 | 16.5 |
| 9 | 500 | 5950 | 2 | 22.5 |
| 12 | 350 | 7150 | 1 | 25.5 |
Weight: 6-month weight = 8000 g (−800 g per month short of 6, +400 g per month past 6). Age 1–11 yr: 1-year weight = 10.5 kg; 5-year weight = 19 kg (±2–3 kg/yr). Age 11+: weight (kg) = age×5 − 20. Head circumference: 6-month value = 43 cm (±1.5 cm/mo before 6 mo, +0.5 cm/mo after); +1 cm/yr age 1–5, +0.6 cm/yr age 5–15 (5-year value = 50 cm). Chest circumference: 6-month value = 45 cm (±2 cm/mo before 6 mo, +0.5 cm/mo after); 10-year value = 63 cm (±1.5 cm/yr short, +3 cm/yr beyond). Vazn: 6 oylik vazn = 8000 g (6 oygacha har yetishmagan oyiga −800 g, 6 oydan keyin har oyiga +400 g). 1-11 yosh: 1 yillik vazn = 10,5 kg; 5 yillik vazn = 19 kg (±2-3 kg/yil). 11 yoshdan katta: vazn (kg) = yosh×5 − 20. Bosh aylanasi: 6 oylik qiymat = 43 sm (6 oygacha ±1,5 sm/oy, keyin +0,5 sm/oy); 1-5 yoshda +1 sm/yil, 5-15 yoshda +0,6 sm/yil (5 yoshda 50 sm). Ko'krak aylanasi: 6 oylik qiymat = 45 sm (6 oygacha ±2 sm/oy, keyin +0,5 sm/oy); 10 yoshda 63 sm (±1,5 sm/yil yetishmasa, +3 sm/yil ortiq bo'lsa).
Proportionality IndicesProporsionallik indekslari
Indices are supplementary, not primary, criteria of physical development — mathematical relationships between two or more anthropometric traits. Indekslar jismoniy rivojlanishning asosiy emas, qo'shimcha mezonlari — ikki yoki undan ortiq antropometrik belgi orasidagi matematik munosabat.
| IndexIndeks | FormulaFormula | Normal / interpretationNorma / talqin |
|---|---|---|
| Birth weight–length ratioTug'ilishdagi vazn-bo'y nisbati | Weight(g) ÷ Length(cm) | ≈60–65; <60 suggests intrauterine growth restriction≈60-65; 60 dan kam bo'lsa homila ichi rivojlanish kechikishini bildiradi |
| BMI (Quetelet)TVI (Ketle indeksi) | Weight(kg) ÷ Height²(m²) | Grades nutrition/obesity, mainly school-age; age-specific BMI charts preferred in practiceOvqatlanish/semizlikni baholaydi, asosan maktab yoshida; amaliyotda yoshga mos BMI jadvallari afzal |
| Erisman indexErisman indeksi | Chest circ. − (½ × height) | <1 yr: +10 to +13.5 cm; 2–3 yr: +6 to +9; 4–7 yr: +2 to +4; 8–15 yr: +1 to +31 yoshgacha: +10 dan +13,5 sm; 2-3 yosh: +6 dan +9; 4-7 yosh: +2 dan +4; 8-15 yosh: +1 dan +3 |
| Chulitsky (fullness) indexChulitskiy (to'lalik) indeksi | 3×shoulder circ. + thigh circ. + calf circ. − height | ≈20–25 at age 1, falling to ≈10–15 at age 3–5; a falling index signals undernutrition1 yoshda ≈20-25, 3-5 yoshda ≈10-15 ga tushadi; pasayishi noto'g'ri ovqatlanishdan dalolat beradi |
| Tur index (newborn)Tur indeksi (chaqaloq) | Head circ. − chest circ. | Newborn: +1.5–2 cm; 3–4 mo: 0; 1 yr: −1.6 to −2 cmChaqaloqda: +1,5-2 sm; 3-4 oyda: 0; 1 yoshda: −1,6 dan −2 sm |
WHO Growth Standards and Assessment CriteriaJSST o'sish standartlari va baholash mezonlari
Growth is plotted over time as growth curves on WHO-derived charts (adapted for Uzbekistan, separate boy/girl charts, birth–5 years), using weight-for-age, length/height-for-age, weight-for-length/height, and BMI-for-age. The median (Z=0) is the population average; deviation is expressed in Z-scores at ±1, ±2, ±3. O'sish vaqt bo'yicha JSST asosidagi jadvallarda (O'zbekiston uchun moslashtirilgan, o'g'il/qiz alohida, tug'ilishdan 5 yoshgacha) egri chiziqlar sifatida qayd etiladi: yoshga nisbatan vazn, yoshga nisbatan bo'y/uzunlik, bo'y/uzunlikka nisbatan vazn, yoshga nisbatan TVI. Mediana (Z=0) — populyatsiya o'rtachasi; chetlanish Z-qiymatlarda (±1, ±2, ±3) ifodalanadi.
| Z-scoreZ-qiymat | Length/height-for-ageYoshga nisbatan bo'y | Weight-for-ageYoshga nisbatan vazn | Weight-for-length/heightBo'yga nisbatan vazn |
|---|---|---|---|
| > +3 | — | — | ObesitySemizlik |
| > +2 | — | — | OverweightOrtiqcha vazn |
| 0 (medianmediana) | |||
| < −2 | StuntedPast bo'ylik | UnderweightKam vaznlik | Wasted (moderate)OOEYe/ozish (yengil) |
| < −3 | Severely stuntedJuda past bo'ylik | Severely underweightJuda kam vaznlik | Severely wastedOOEYe/ozish (og'ir) |
A normally growing child's curve runs roughly parallel to the median. A flat curve (stagnation) always signals a problem. A curve that crosses Z-score lines signals increasing risk. A sharp rise after illness ("catch-up growth") is healthy if weight and length rise together; if only weight rises, it signals overfeeding. Me'yorida o'sayotgan bolaning egri chizig'i medianaga taxminan parallel bo'ladi. Tekis chiziq (stagnatsiya) doim muammoni bildiradi. Z-qiymat chiziqlarini kesib o'tuvchi egri chiziq ortib boruvchi xavfni bildiradi. Kasallikdan keyingi keskin ko'tarilish ("quvib yetuvchi o'sish") vazn va bo'y birga ortsa sog'lom; faqat vazn ortsa — ortiqcha ovqatlantirishdan dalolat.
Anatomical-Physiological Features of the Newborn: Full-Term vs. PretermChaqaloqning anatomik-fiziologik xususiyatlari: yetuk va chala tug'ilgan
A full-term (mature) newborn: birth weight 2600–4200 g (typical mean 3200–3600 g), length 46–56 cm (lower normal limit 45 cm / 2500 g — below this the infant is classified preterm). Weight >4000 g = large-for-dates infant. Head circumference 33–37.5 cm at birth, exceeding chest circumference by only 1–2 cm. Yetuk (mature) chaqaloq: tug'ilish vazni 2600-4200 g (odatiy o'rtacha 3200-3600 g), bo'yi 46-56 sm (pastki me'yor chegarasi 45 sm / 2500 g — bundan past bo'lsa chala tug'ilgan hisoblanadi). Vazni 4000 g dan ortiq bo'lsa — yirik chaqaloq. Tug'ilishda bosh aylanasi 33-37,5 sm, ko'krak aylanasidan atigi 1-2 sm katta.
| SignBelgi | Full-termYetuk tug'ilgan | PretermChala tug'ilgan |
|---|---|---|
| SkinTeri | Pink-red, smooth, elastic; lanugo only on shoulders/backPushti-qizil, silliq, elastik; tukchalar faqat yelka/orqada | Very thin, cyanotic tinge or shiny/greasy or dry; lanugo on face, chest, shoulders, backJuda yupqa, sianotik soya yoki yaltiroq/quruq; yuz, ko'krak, yelka, orqada tukchalar aniq |
| CryQichqirig'i | Loud, resonantBaland, jarangdor | Weak, toneless, lowKuchsiz, jarangsiz, past |
| Movement/toneHarakat/tonus | Active but uncoordinated, hypertonicAktiv, lekin koordinatsiyalashmagan, gipertonusda | Weak movement, hypotonicKuchsiz harakat, gipotonik |
| Subcutaneous fatTeri osti yog'i | Well developed, good turgorYaxshi rivojlangan, turgor saqlangan | Poor or absent (degree-dependent); skin folds visibleSust rivojlangan yoki yo'q (darajaga bog'liq); teri burmalari bilinadi |
| Skull / ear cartilageKalla suyagi / quloq tog'ayi | Firm skull; firm ear cartilage, stands off headQattiq kalla suyagi; qattiq quloq tog'ayi, kalladan ajralib turadi | Soft skull; soft ear cartilage, flattened against headYumshoq kalla suyagi; yumshoq quloq tog'ayi, kallaga yopishib turadi |
ThermoregulationTermoregulyatsiya
Hypothalamic and peripheral (skin) centers immature; relatively huge body surface (2–3× the adult ratio). Temperature can drop to 32–35 °C in cold, or rise to 40 °C in heat — needs external control without overheating.Gipotalamus va periferik (teri) markazlari yetilmagan; tana yuzasi nisbatan juda katta (kattalardan 2-3 marta ko'p). Sovuqda 32-35°C gacha tushishi, issiqda 40°C gacha ko'tarilishi mumkin — qizib ketmasdan sun'iy nazorat kerak.
RespirationNafas olish
Shallow, irregular breathing, often Cheyne–Stokes pattern; apnea spells, cyanosis, predisposition to atelectasis.Yuzaki, notekis nafas, ko'pincha Cheyn-Stoks turida; apnoe xurujlari, sianoz, atelektazga moyillik.
GI tractOvqat hazm qilish
Weak sucking reflex; in high-grade prematurity even the hunger response/swallowing may be absent.So'rish refleksi kuchsiz; yuqori darajali chalalikda och qolish hissi va yutish ham bo'lmasligi mumkin.
Sclerema & hemorrhagic tendencySklerema va qon ketishga moyillik
Sclerema: skin/fat hardening (± edema) starting in the legs, precipitated by cold. Hemorrhagic tendency: mainly intracranial, from immature vascular elastic tissue.Sklerema: oyoqlardan boshlanadigan teri/yog' qattiqlashuvi (± shish), sovuqdan kelib chiqadi. Qon ketishga moyillik: asosan kalla ichi, tomirlarning elastik to'qimasi yetilmaganidan.
Borderline (Transitional) States of the NewbornChaqaloqning chegara (o'tish) holatlari
These reflect adaptation to extrauterine life (rise in catecholamines/glucocorticoids/TSH/ACTH/thyroxine, closure of fetal shunts, onset of enteral feeding, establishment of renal function) and are physiological, not pathological. Bular ona qornidan tashqi hayotga moslashishni aks ettiradi (katexolamin/glyukokortikoid/TTG/AKTG/tiroksin ko'tarilishi, fetal shuntlar yopilishi, enteral ovqatlanish boshlanishi, buyrak funksiyasi shakllanishi) va patologik emas, fiziologik hodisalardir.
Also part of the adaptation process: transient oliguria; transient hypoglycemia, metabolic acidosis, hypoproteinemia, hypocalcemia/hypomagnesemia. Moslashish jarayoniga yana kiradi: tranzitor oliguriya; tranzitor gipoglikemiya, metabolik atsidoz, gipoproteinemiya, gipokalsiemiya/gipomagniemiya.
Examination Methods: Inspection, Palpation, Percussion, AuscultationTekshirish usullari: ko'rik, palpatsiya, perkussiya, auskultatsiya
The four classic methods apply to children exactly as in adult medicine, with child-specific conditions: warm (20–22 °C), well-lit room; child fully undressed; never wake a sleeping child to begin — use sleep to count heart/respiratory rate and palpate the abdomen first; preschoolers examined out of fixed order, following their mood; throat and any painful area always examined last. To'rtta klassik usul bolalarda ham kattalardagi kabi qo'llaniladi, faqat shartlar o'ziga xos: issiq (20-22°C), yaxshi yoritilgan xona; bola to'liq yechintiriladi; uxlayotgan bolani hech qachon uyg'otmang — uyqu holatidan yurak/nafas sonini sanash va qorinni paypaslashda foydalaning; maktabgacha yoshdagilar qat'iy tartibsiz, kayfiyatiga qarab tekshiriladi; tomoq va og'riqli joy har doim oxirida ko'riladi.
Palpation (palpatio — touch)Palpatsiya (palpatio — silash)
Manual examination of location, consistency, elasticity, mobility, local temperature, tenderness, masses. Superficial before deep. Rules: warm room, warm short-nailed hands, examiner at patient's right, light gradual touch, always the healthy side first, then compare with the affected side.Organning joylashuvi, konsistensiyasi, elastikligi, harakati, mahalliy harorati, og'riqli joyi, o'smalarni qo'l bilan tekshirish. Yuzaki, so'ng chuqur. Qoidalar: xona issiq, shifokor qo'llari issiq va tirnoqlari kalta, bemordan o'ngda joylashadi, bosim yengil va asta-sekin, avval sog'lom tomon, so'ng kasal tomon bilan solishtiriladi.
Percussion (percussio — tapping)Perkussiya (percussio — tukullatish)
Tapping to interpret the resulting sound. Dense tissue (muscle, bone, fluid) → dull, short sound; air-containing lung → low-pitched sound; large air cavities (stomach, pneumothorax) → tympanic sound. Children are percussed more gently than adults.Tukullatib olingan tovushni talqin qilish. Zich to'qima (mushak, suyak, suyuqlik) → xira, qisqa tovush; havodor o'pka → past ovoz; katta havo bo'shliqlari (oshqozon, pnevmotoraks) → nog'ora tovushi. Bolalarda kattalarga nisbatan tinchroq perkussiya qilinadi.
Auscultation (auscultare — to listen): interpreting internal sounds, either direct (ear to body) or indirect (via stethoscope). Pathology alters the normal sound of an organ — wheezes/crackles in lung disease, murmurs in valvular heart disease — and recognizing these deviations is the basis of auscultatory diagnosis. Auskultatsiya (auscultare — eshitish): to'g'ridan-to'g'ri (quloq tanaga) yoki bilvosita (stetoskop orqali) ichki tovushlarni talqin qilish. Patologiya a'zoning normal tovushini o'zgartiradi — o'pka kasalligida xirillash, qopqoq kasalligida shovqin — va bu o'zgarishlarni bilish auskultativ tashxisning asosidir.
Apgar ScoreApgar shkalasi
Assessed by the birth attendant at 1 minute and 5 minutes after delivery (repeated every 5 minutes up to 20 minutes if the score stays low), scoring five signs from 0–2 each: Tug'ruqni qabul qiluvchi shifokor tomonidan tug'ilgandan 1 daqiqa va 5 daqiqa o'tgach baholanadi (ball past bo'lib qolsa, 20 daqiqagacha har 5 daqiqada takrorlanadi), besh belgi 0-2 balldan baholanadi:
| SignBelgi | 0 | 1 | 2 |
|---|---|---|---|
| Appearance (skin color)Ko'rinishi (teri rangi) | Pale/blue all overButun tanasi oqargan/ko'kargan | Body pink, extremities blueTanasi pushti, oyoq-qo'llari ko'k | Pink all overButunlay pushti |
| Pulse (heart rate)Puls (yurak urishi) | AbsentYo'q | <100 bpm | ≥100 bpm |
| Grimace (reflex irritability)Grimasa (refleks qo'zg'aluvchanlik) | No response to stimulationQo'zg'atishga javob yo'q | Grimace onlyFaqat yuz burishtiradi | Cries/coughs/sneezes vigorouslyKuchli yig'laydi/yo'taladi/aksiradi |
| Activity (muscle tone)Aktivlik (mushak tonusi) | Limp, floppyBo'shashgan, susaygan | Some flexionBiroz bukilish | Active motionAktiv harakat |
| RespirationNafas olish | AbsentYo'q | Slow, irregular, weak crySekin, notekis, zaif yig'i | Strong cry, regular breathingKuchli yig'i, muntazam nafas |
Silverman-Andersen ScoreSilverman-Andersen shkalasi
Used to grade the severity of respiratory distress, most often in preterm infants. Five signs, each scored 0–2 — note the scale runs opposite to Apgar: 0 is normal, higher is worse. Nafas qiyinligi og'irligini baholash uchun ishlatiladi, ko'pincha chala tug'ilgan chaqaloqlarda. Besh belgi, har biri 0-2 balldan — e'tibor bering, shkala Apgarga teskari: 0 — norma, ball qancha yuqori bo'lsa, holat shuncha og'ir.
| SignBelgi | 0 | 1 | 2 |
|---|---|---|---|
| Upper chest vs. abdomen movementKo'krak va qorin harakati | SynchronizedSinxron | Lag on inspirationNafas olishda ortda qolish | See-saw (paradoxical) motionQarama-qarshi (paradoksal) harakat |
| Intercostal retractionQovurg'a orasi tortilishi | NoneYo'q | Just visibleZo'rg'a bilinadi | MarkedYaqqol |
| Xiphoid retractionXanjarsimon o'simta tortilishi | NoneYo'q | Just visibleZo'rg'a bilinadi | MarkedYaqqol |
| Nasal flaringBurun qanotlari kerilishi | NoneYo'q | MinimalMinimal | MarkedYaqqol |
| Expiratory gruntNafas chiqarishda ingrash | NoneYo'q | Audible with stethoscopeFaqat stetoskopda eshitiladi | Audible to naked earYalang quloqqa eshitiladi |