Growth & puberty

7/30/2019 Growth & puberty

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GROWTH ANDPUBERTY

Aditiawati

Pediatricendocrinolo

gy



Learning objective

• Explain the importance of monitoring growth in a child

• Know the sequence and timingof changes in normal puberty

( tanner stages)



GROWTH

* HYPERPLASIA AND HYPERTROPHYPROCESS

* SIZE/LENGTH/ORGAN HEIGHT ANDWEIGHT/BODY

* NORMAL GROWTH LINIER : PARALELWITH NORMAL GROWTH CHART



• One of the aspects that makes the field Pediatrics

different from adult medicine is that children are

constantly changing.

• They grow at a tremendous rate, especially during

the first few years of life.

• During this period, they also go through the

stages of physical and mental development.

• An important role of the pediatric check-up is to

make sure that children are growing and

developing normally.



• When a child is assessed, three importantmeasurements are taken:

height, weight and head circumference

• Whether a child is growing normally or not depends

on the rate of growth over time as comparedwith the average or normal rates for a child's age.

•

Boy is different than girls• Every child is different!



Optimal growth



It is important to understandthat each child is unique.Parents should not compare

one child to another. This isnot the purpose of growthcharts who's role is to help

make sure that a child isgrowing at a normal rate.



Factor of growth

Growth is a sensitive indicator of a child's

state of health and nutrition

GENETIC

NUTRITION

PSYCHOSOSIAL

HEALTH

HORMONE



GENETIC



GENETICALLY HEIGHT POTENTIAL

Boy’s predicted stature :

• ( father’s height +13) + mother’s height ± 8,5 cm2

Girl’s predicted stature :

• (father’s height -13) + mother’s height ± 8,5 cm2

Mid parental height(GENETIC POTENTIAL)



NUTRITION

NESTLE-HERMINA 2005

Defisiensi Nutrisi kronis

Penyakit Kronis

Tinggi Badan

Berat Badan

Usia (tahun)



HEALTH

SPORT -

EXERCISE



HORMONAL( GH,thyroid,cortisol,sex hormon,insulin, leptin)

NESTLE-HERMINA 2005

PENDEK



Endocrinology of growth in childhood



LOVE(PSYCHOSOCIAL)

NESTLE-HERMINA 2005



Monitoring of growth

Pemantauan optimal perlu

1. Pengukuran yang benar

2. Pencatatan yang benar

3. Referensi yang benar



REFERENSI

Usia Kecepatan Tinggi

0-6 bulan 32 cm/tahun 6-12 bulan 16 cm/tahun 1-2 tahun 10 cm/tahun 3-4 tahun 7-8 cm/tahun

5-10 tahun 5-7 cm/tahun



Growth in Children

• Growing is an essential part ofchildhood.

• Children's most dramatic growth phases

occur during fetal development, thefirst few years of life, and at the onsetof puberty.

• The rate at which a child grows is anindividual process, based partly onheredity, gender, and environmental

factors such as nutrition.









GROWTH

• GROWTH is sensitive indicator of child health

• PRIMARY IMPORTANCE IN CHILDREN

• GROWTH is one of the key features of childhood, andchanges in the normal pattern of child’s growth may bean early manifestation of an underlying pathologicprocess

• GROWTH is a COMPLEX PROCESS and INVOLVE THEINTERCTION OF MULTIPLE FACTORS

FREQUENT AND ACCURATE ASSESMENT OF GROWTHAS PART OF ROUTINE HEALTH MAITENANCE



• Understanding the normal pattern of growth

prerequisite to the diagnosis of growth

disorder

• Deviation from the normal pattern of growth

is frequently the first manifestation of a

wide variety of disorder



Phases of Normal Growth

• 1. Prenatal growth

• 2. Postnatal growth

a. Growth during Infancy ( 0 to 2 years)

b. Growth during Childhood (prepuberty)

c. Growth during Puberty

Adult period : no discussion

The infancy- childhood- puberty

(ICP) MODEL by Karlberg



Average growth velocity at different phases

• 1. Prenatal growth 1.2 to 1.5 cm/wk

• 2. Postnatal growth

a. Growth during Infancy 23 to 28 cm/yrb. Growth during Childhood 5 to 6.5 cm/yr

c. Growth during Puberty :

8.3 cm/yr (girls)9.5 cm/yr (boys)



Prenatal growth

• The most rapid phase of human growth

• Body weight increase 17x106 gram• Body length increase 5x103 cm• Fastest growth on second semester• Influenced by mother ( uterus, placenta,

nutrition) and baby (chromosomal

disorder, syndromes)• Factors : Insulin and IGF II



Growth during Infancy

• Growth deceleration

• 1 years body length : 1,5 x birth body length or 25cm growth velocity in the first year.

• 0-12 month ( mostly the first 6 month) growth

influenced by maternal and nutrition factors• Hormonal factor (Growth Hormone) influenced the

second 6 month of life, thyroid hormone

• Second years growth velocity 50% from first year

growth velocity : 12,5 cm ( 7.5 to 13 cm/yr)• 2 y old body height 50% of final height

• catch-up and catch down Phenomena : analyzegenetically height potential canalization



Growth during Childhood (prepuberty)

• Growth velocity 5-7,5 cm/y respectively

• Body height 2x birth body length on 4 y old,

•

Body height 3x birth body length on 13 y old,• Growth deceleration phase before puberty (

girl 11,5 y old, boy, 10 y old)

•

Final body height about 86% final height• Growth hormone !!!

• Thyroid hormone , sex hormone



Growth during Puberty

•

Growth acceleration or growth spurt andgrowth deceleration

• Growth hormone and sex steroid

• Mid pubertal phase growth velocity ( girl12 y, boy 14 y)

• Maximal growth velocity :Female: menarcheMale : testis volume 12-14 ml



Growth during Puberty

• Body height achievement on puberty :Female 18-23 cm, Male 25-30 cm

• Maximal growth velocity :

Female 8,3 +/- 1,2 cm/y,Male 9,5 +/- 1,3 cm/y• Secondary sex appearance• Male & female difference

Pre pubertyMaximal growth velocity



When does growth stop?

• As a general rule, growth in heightstops shortly after puberty when the

influence of hormones fuse the endsof the bones. However, bonescontinue to mature and increase indensity (bone thickness) for 5- 8

years after puberty. Bone densityespecially in the post pubertal yearsis very important for long term bone

health.



However, growth can be affected and,sometimes, stopped by many disorders and

diseases, including the following:

• hormone deficiencies

• nutritional deficiencies

• intestinal disorders

• kidney, lung, and heart diseases• bone disorders

• diabetes or other blood sugar disorders

• any severe form of a disease• severe stress or emotional trauma



NESTLE-HERMINA 2005



Age (years)

0 2 4 6 8 10 12 14 16 18

Males,Heightvelo

city(cm/yr)

0

2

4

6

8

10

12

14

0

2

4

6

8

10

12

14

50

75

97

25

3

E a r l y

m a t u r e r s

L a t e m

a t u r e r s

MALES HEIGHT VELOCITY



Age (years)

0 2 4 6 8 10 12 14 16 18

Fem

ales,Heightve

locity(cm/yr)

0

2

4

6

8

10

12

14

0

2

4

6

8

10

12

14

50

75

97

25

3

L a t e m

a t u r e r s E

a r l y

m a t u r e r s

FEMALES HEIGHT VELOCITY

Predominant influences on growth



Predominant influences on growthPre-natal

Maternal factors

Placental factorsGenetic factors

Post-natalHeredo-constitusional, Genetic factors

Race, congenital anomaly, syndromeEnvironmental factors

Nutrition, emotional environment, exercise,disease, socio economicEndocrine function

(GH,Cortisol,Thyroid,insulin,sex

hormon/ puberty)



puberty



Puberty

• Puberty is the stage of life when thereproductive system matures together withcompletion of somatic growth and sexualmaturity

• Puberty is defined as when physical changesbegin, reflecting underlying hormonalstimulation

• The onset of puberty ( normal age of puberty)a. Girl : 8-13 years

b. Boy : 9-14 years



Puberty• Puberty is complex process, which involve the activation

of hypothalamic function and maturation of the pituitary-gonadal axis

1. Resetting of the gonadostat

2. Neuroendocrine manifestation of puberty, is the resultof an increase in LHRH ( the central nervous system)

acetylcholine, catecholamine, aminobutiric acid ,

opioid peptides, prostaglandins, serotonin

3. Peripheral factors that influence GnRH activity :

steroid, peptide hormone, body mass, nutritional

factors, natural/synthetic environmental substances



Puberty

Onset of puberty --> Factor :

• Race

•

Social• Psychosocial

• Nutritional

• chronic disease

• Exercise



Aksis H-H-A

LHRH/GnRH

LH/FSH

gonadTESTOTERON/ESTROGEN



Puberty

• Three kinds of physical changes occur duringthis period of life:

•

1) the adolescent growth spurt,• 2) the development of primary sex

characteristics (The changes that mark thebeginning of puberty for girls and boys),

• 3) the appearance of secondary sexcharacteristics (Other external changes thatmake adolescents look like mature men and

women ). .



Physical changes of puberty

• The change of puberty may be very gradual

• Described by method developed by Tanner to

describe the maturation of secondary sexual

characteristics ( stage 1 is prepubertal, stage 5 isadult)

• The marker of puberty ( the first sign )

for girl : breast development(Development of breast bud)

for boys : genital growth

(Enlarge of the testes)



Stadium Pubertas

Tanner

















Puberty

Height and height velocity need to be interpreted in thecontext of pubertal status

Stage of puberty correlates better with bone age thanchronological age

Girls: Breast development mean age 11.0 years3rd to 97th percentiles 8.8 to 13.0 yrs

Males: Testicular enlargement mean age 11.5 years

Volume 4mls or moreLength 2.5 cm or more3rd to 97th percentiles 9.5 to 13.5 yrs



Pubertal approach to the age of puberty

•Hormone changes of puberty

• Physical change characteristic of puberty

• Pubertal growth 3 phase

1. A period minimal growth velocity

2. The time of most rapid growth ( earlier in girl)

3. A final phase growth with progressive

deceleration)

•

Skeletal Age ( bone age)• Shift an body composition

• Bone density

• Psychological factors and sexual behavior

Documents

Growth & puberty