Growth and Puberty

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GROWTH

DR OMAR ALI NAFI MRCP

Mutah university



Defnition… It’s an increase in the size of the body and it can

be easily measured. While development is anincrease in the function of processes related tobody and mind.

Growth is the best general index of the health ofan individual child. It permits early detection ofmalnutrition



Growth rates…

Height.

Neural growth.

ymphoid tissue. Genital growth

!at.



Heiht…

"he rate of growth in height is notconstant throughout childhood.

it is at its greatest when the child isborn

#$%&years growth in height iscomparatively slow and steady

"he adolescent growth spurtcommences 'ust before puberty ( thisrapid rate continues during puberty(followed by sharp deceleration falling

to zero when adult status is reached.



Nuera! rowth…

It represent particularly the brain. "he human brain growth spurt begins in mid$pregnancy

and is largely complete by the third year. In fact thereare two spurts)

Neural cell multiplication occurring between %*+ ,& wee-sgestation.

Glial cell multiplication starting at ,* wee-s and extendinginto the second year with myelination continuing into thethird or forth years.



Ly"#hoi$ tissue…

It grows progressively throughoutchildhood but ceases at the age of %&$%,years( before the puberty growth spurt. (

these changes can be watched in thetonsils which are barely visible at birth(becomes very obvious by the age of $*years and get smaller in the early teens



Genita! rowth…

Growth is minimal during infancy andchildhood but becomes very rapid with the

onset of puberty.



Fat…

It increases rapidly during the first %, monthsof life( being followed by a small steady loss untilthe age of / years0 thereafter the amount of fatremains constant until it’s pre$pubertal spurtwhich occurs before that of bone and muscle."he increase in the amount of fat during thechild’s first year is of vital importance as towhether or not the individual becomes obese.





Nutrition an$ rowth…

It’s difficult to assess theinfluence of nutrition ongrowth since it is seldomthe only factor involved

1etardation of growth

occurs only if malnutritionis severe



2uring a period of illness or starvation therate of growth is slowed ( but after theincident is over and ade3uate diet is

maintained ( the child grows more rapidlythan usual so that he catches up to hisoriginal growth curve .

When caloric inta-e is inade3uate( the weight

percentile falls first( then the height and lastthe head circumference.



Hor"ones an$ rowth…

Hormonal control during childhood is broughtabout by thyroxine and growth hormonewor-ing synergistically thyroxinepredominantly re3uired for s-eletal

maturation. 4nd growth hormone for lineargrowth. "he adolescent growth spurt is largely brought

about in boys by the rise in adrenal andtesticular androgens.



"he adolescent growth spurt in girls is broughtby the rise in ovarian oestrogens togetherwith adrenal androgens and oestrogens.

4nabolic steroids( androgens and oestrogensaccelerate bone age more than height(thereby causing the ultimate height to be less

than expected.



Ru!es o% thu"& %or rowth…'

Weight)%$ weight loss in first few days) *5$%&5 of birth weight.,$ return to birth weight) /$%&days of age double birth weight) $* months triple birth weight) % year

3uadruple birth weight), years#$ average weights ) #.*-g at birth %&-g at %year ,&-g at * years #&-g at %& years$ daily weight gain) ,&$#&g for first #$ months

%*$,&g for rest of the first year



%$ average length) *& cm at birth(

,$ /*cm at % year.

#$ at age years( the average child is %&&

cm tall6 double birth length7

$ average annual height increase ) *$8cm between age years and puberty.

Height)



Head circumference 6H97)

%$ average H9) #*cm atbirth.

,$ H9 increases)%cm:month for first year

6 ,cm:month for first #months( then slower70%&cm for rest of life.



Growth "onitorin…

"he 44; recommends routine office visits in the ) %. %st wee- of life 6 depending on

nursery discharge7 ,. 4t , wee-s #. 4t ,((8(%,(%*(and %< months.

. 4t , years and then annually up tothe age of 8

*. =very , years between age 8 andadolescence

4n accurate measurement of the height( weight and headcircumference should be obtained at every health supervision

visit. "hen they are compared with the statistical norms in astandard fashion on growth charts.



When plotting growth( serialmeasurements are much more usefulthan single measurement because they

can detect deviations from a particularchild’s growth pattern even if the valueremains within the statistically definednormal limits 6i.e between the #rd and

the >/th percentile7



How to asses())

Growth 9harts)$?sing these charts( health careproviders can compare growth ininfants( children( and adolescents witha nationally representative referencebased on children of all ages and racialor ethnic groups.



$ 4vailable growth charts) 6929( ,&&&7

$ for &$#8 months) %. weight for age

,. length for age

#. head circumference for age . weight for length



$ !or ages ,$,& years)

%. weight for age

,. height for age

#. @AI for age

$ for premature infants)

%. length$for B gestation$ ad'usted age

,. weight Bfor$gestation$ad'usted age

















Pre"ature Gir!s *Lenth to ae



Pre"ature Gir!s *weiht to ae



Pre"ature +oys*Lenth to ae



Pre"ature +oys*weiht to ae



Inter#retation… What the percentiles meanC

How useful is each chartC 4nd what arethe significant valuesC



What the Percentiles Mean?!

When you loo- at the standard growth charts(you will see seven curves that follow the samepattern. =ach curve represents a differentpercentile) *th( %&th( ,*th( *&th( /*th( >&th(

and >*th. "he *&th percentile line representsthe average for a particular age group. "hechildDs measurements will be plotted on thecharts( so that yo can see how your childDsmeasurements compare to the average for his

or her age group.



1. If the measurement for an infant's head circumferenceis in the 90th percentile, that means that the child'shead measurement is greater than about 90% ofchildren that age in the country. Only 10% of infantsthat age have head measurements that exceed those ofthat infant.

. If a !"year"old's #eight at a chec$up is at the0th percentile, that means about 0% ofchildren that age #eigh more than that child, and0% of $ids in the country #eigh less than thatchild.

&xamples



@AI for age )

$ It’s an index for classifying adiposity

$ If the @AI is between the <*th and >*th percentiles the child is at ris- for beingoverweight

$ I! the @AI is E >*th percentile the child isoverweight.



Fa,tors a-e,tin rowth

#attern Gestational age @irth weight ;arental stature) is considered before

assuming there is a health or nutritionconcern. ;resence of a chronic illness Fpecial health care need



puberty



Defnition

;uberty from atin Dpubes meaning hair.

1efers to the process of physical changes bywhich a childDs body becomes an adult body

capable of reproduction. "ransitional stage from childhood to adulthood

manifested by physiological changes +development of FF9.

The normal age of puberty :

1- in male : about 14 years

2- in female : about 12 years



The cause of this GnRH rise is complex. Puberty begins ataroun 4! "g for girls an ## "g for boys.

This epenence on boy$eight ma"es leptin a goocaniate for causing GnRH rise.

The le%els of leptin change in line $ith the onset of puberty&an then ecline to ault le%els.



' simple escription of hormonal puberty is :

The brain(s hypothalamus begins to release pulses of GnRH.

)ells in the anterior pituitary respon by secreting *H an +,H

into the circulation.

The o%aries or testes respon to the rising amounts of *H an

+,H by gro$ing an beginning to prouce estraiol an

testosterone

http://en.wikipedia.org/wiki/Hypothalamus

http://en.wikipedia.org/wiki/GnRH

http://en.wikipedia.org/wiki/Pituitary

http://en.wikipedia.org/wiki/Pituitary

http://en.wikipedia.org/wiki/GnRH

http://en.wikipedia.org/wiki/Hypothalamus



Rising le%els of estraiol an testosterone prouce the

boy changes of female an male puberty.

The onset of this neurohormonal process may precee

the first %isible boy changes by 1-2 years.



Physical changes inPhysical changes inmalesmales

1-Testicular sie function



1-Testicular sie& function&

an fertility

n boys& testicular enlargement is the first physicalmanifestation of puberty

Testes in prepubertal boys change little in sie fromabout 1 year of age to the onset of puberty&a%eraging about 2/0 cc in %olume an about 1.#-2 cm in length. Testicular sie continue toincrease throughout puberty& reaching maximal

ault sie about years later.hile 13-2 cc is ana%erage ault sie& there is $ie %ariation in thenormal population



The testes ha%e t$o primary functions:

1- to prouce hormones

2- to prouce sperm.

The *eyig cells prouce testosterone & $hichin turn prouces most of the changes of male

sexual maturation an maintains libio .

Ho$e%er& most of the increasing bul" of

testicular tissue is spermatogenic tissue



,perm can be etecte in the morning urine of most

boys after the first year of pubertal changes

Potential fertility is reache at about 10 years ol in

boys& but full fertility $ill not be gaine until 14-1

years of age.



2-Pubic hair

Pubic hair often appears on a boy shortly after the

genitalia begin to gro$..

the hair gro$ing continue till it sprea the thighs an

up$ar to$ars the umbibilicus as part of the

e%eloping abominal hair.



0-5oy an facial hair

6ther areas of s"in $hich respon to anrogens

e%elop hea%ier hair 7anrogenic hair8 in

roughly the follo$ing se9uence: axillary hair&

perianal hair& upper lip hair& preauricular hair&an the rest of the boy area.

There is a large range in amount of boy hair

among ault men& an significant ifferences

in timing an 9uantity of hair gro$th amongifferent ethnic groups



4-oice change

;ner the influence of anrogens& causes

hypertrophy of the laryngeal mucosaan enlargement of larynx

oice may start crac"ing for a perio of timebut graually change into the typical

ault %oice



#-muscle e%elopment an

boy shape

-5oy oor s"in changes



5oy oor& s"in changes&

acne

Rising le%els of anrogens can change the fatty aci

composition of perspiration& resulting in a more<ault< boy oor.

,"in becomes more oily & an more thic"ness

5oy $ill s$eat more.'cne may e%elop



Physical changes inPhysical changes in

femalesfemales



1-5reast e%elopment

The first physical sign of puberty in females is usually a firm&tener lump uner the center of the areola of one or bothbreasts& occurring on a%erage at about 1 years of age.

ithin six to 12 months& the s$elling has clearly begun inboth sies& softene& an can be felt an seen exteninguner the eges of the areola .

5y another 12 months & the breasts are becomes maturesie an shape .there is so much %ariation in sies anshapes of ault breasts



2-Hair:

increased activity of the suprarenal cortex at puberty with

increased production of adrenal androgens which lead

to appearance of pubic and axillary hair

Hair gro$th begins shortly after breast e%elopment .



0- agina& uterus& o%aries

The mucosal surface of the %agina also changes in

response to increasing le%els of estrogen&

becoming thic"er an a more pin" in color

hitish secretions are a normal effect of estrogen as

$ell.

The uterus an o%aries increase in sie& an folliclesin the o%aries reach larger sies.



4- =enstruation an fertility

The first =enses is referre to as menarche.

=enses are not al$ays regular an occures monthly an last

from 0 to ! ays .

6%ulation is necessary for fertility& but may or may not present

in The first =enses.

4- 5oy shape fat istribution an boy



4- 5oy shape& fat istribution& an boy

composition

>uring this perio& also in response to rising le%els of

estrogen& the lo$er part of the pel%is an hips $ien.

+at tissue increases to a greater percentage of the boy

composition than in males& especially in the typicalfemale istribution of breasts& hips& buttoc"s& thighs&

upper arms& an pubis.



#- 5oy oor& s"in changes& an acne

Rising le%els of estrogen can change the fatty aci

composition of perspiration& resulting in a more <ault<

boy oor.

,"in becomes more oily.

5oy $ill s$eat more.

'cne may e%elop



?motional )hanges: n both

sexes,tart to care more about $hat others thin".

ant to be accepte an li"e.

6ften begin to separate from parents anientify more $ith friens.

=ay become self conscious about these gro$th

changes 7too tall& too short& too fat& too thin8.

i b t



precocious puberty

appearance of any of the secondary sexualcharacters before the age of

years in females and9 years in males



in females

this is usu idiopathic or familial and follows thenormal se3uence of puberty (

the organic causes are rare and are ass w )

dissonance when the se3uence of pubertal changes isabnl ( eg) isolated pubic hair with virilisation of thegenitalia ( suggesting excess androgen

rapid onset neurological symptoms and signs ( eg )

neurofibromatosis



f i b



causes of precocious puberty:

%( gonadotrophin dependant ) *central , true ( *inc +, - (

familial :idiopathic

9NF abnormalitiescongenital anomalies ( eg) hydrocephalusac3uired ( eg) post irradiation ( infxhypothyroidism

( gonadotropin independent ) *peripheral , false ( *dec +, -( adrenal disorders $ tumors( congenital adrenal hyperplasia

ovarian tumorstesticular tumors

d l d b t



delayed puberty

$ the absence of pubertal development by % yearsof age in females and %* years in males

in contrast to precocious puberty ( the problem iscommon in males ( in whom it is mostly due tocontitutional delay

% $ ! $ & t



,auses o% $e!aye$ #u&erty *

%7 constitutional delay of growth and puberty

,7 high gonadotrophin secretion

$ chromosomal abnormalities 6 -linefelters syndrome.turners syndrome7

$ steroid hormone enzyme deficiencies$ ac3uired gonadal damage #7 lo# gonadotrophin secretion $ Fystemic disease) cystic fibrosis ( severe asthma ( crohns disease ( anorexia

nervosa

$ Hypothalamopituitary disorders) panhypopituitarism ( intracranial tumors($ -allmanns syndrome 6H1H dificiency and inability to smell 7



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Growth and Puberty