Growth and Development

pattern of Adolescence

Mei Neni Sitaresmi

Social PediatricGrowth and Development Sub Department
Pediatric Department
Faculty of Medicine- Gadjah Mada University
Yogyakarta
introduction
Adolescent (WHO) : 10 -19 years
Transitional: no longer children but not yet
adults
20 % worlds population (1,2 billion), 80% of them
in developing countries.
Most challenging period in human
development:
Simultaneus but asynchronous development within
several development strems
A critical time of rapid physical, cognitive,
psychological, behavioral, spiritual development.
Why pay attention to the health of
adolescent
Healthy : they have survived the diseases of
early childhood, and the health problems
associated with ageing are still many years
away.
Are exposed to health and development risk
Every year: 1.7 million die: mostly through
accidents, suicide, violence, pregnancy-related
complications and other illnesses
The underlying causes are closely related
(behavioral risk )
Preventable or treatable.
Cont.

To reduce death and disease, now

and during their future lives
Deliver on the rights of adolescent
to health care
Ensure that this generation of the
adolescents will safeguard the
health of their own children
What is unique about growth &
development during
adolescence ?
Growth & development (GD) during
adolescence, composed of physical,
cognitive and psychosocial aspects,
occurs more rapidly and in more ways
than at any other time in extra uterine life
The components of GD include pubertal
changes and physical growth, cognitive
and psychosocial developments
growth
 fetal growth
10 cm/month (end of second semester)
Influences by:
maternal factors, e.g. health, nutrition, placental
function
Hormones:
Thyroxin
Growth factors (IGF/ IGF-2, hepatic and epidermal GF, etc.)
Insulin
infantile growth
Extension of fetal growth phase, before
hormone dependent
Associated strongly with nutrition, but also
with normal thyroid function and bone
metabolism
The HPA (hypothalamo-pituitary axis) activated:
child with GH deficiency looks shorter in the first
year
catch up and catch down
catch up: 0 to 6-18 mo
catch down: 3-6 mo to 9-20 mo
childhood growth
Growth velocity decreased until just before puberty
The role of GH-IGF axis on epiphyseal growth plate
lengthening of extremities
Thyroxine, Vitamin D and calcium
Nutrition: 10% of total energy intake
Little difference in height between boys and girls
Girls mature earlier, 2 years advance in the onset
of puberty boys gaining 8-10 cm extra during
this period
Adolescence growth:
puberty
Rapid growth in height and weight
(growth spurt)
Primary and secondary sex
development
Continued brain development
Physiologic mechanism of
puberty
the activity the hypothalamic-pitutary-
gonadal axis pulsatile GnRH
secretion of FSH and LH production of
sex steroids: estrogen and testosteron:
Development of secondary sexual
characteristic, accelerates somatic
growth, permits the emergence of
fertility and other physiologic effects.
Factors influences puberty

Onset, timing, and magnitude varies,

are influenced by:
genetic (mother and daughter, twins)
general health, Nutritional; fat
composition (obese>>)
environmental and socioeconomic
factors
declined (seculer trend)
 Height growth during puberty
Growth rate accelerates from about 5-6 cm/years
during childhood to 8-15 cm in just a few months in
adolescence
period of peak height velocity (the pubertal growth
spurt)
up to 45% of skeletal growth takes place and 15 to
25% of adult height is achieved during adolescence
The only time after birth when velocity of growth
increases
Different age for different individual
not chronological age but SMR
Feeling uncomfortable
girls:
linear growth accerelates shorty after
the telarche and decelerates after
menarche (+ 7 cm after menarche).
girls who menarche early grow more after
menarche (eg 10 cm for girls who
menarche at 10 year; 5 cm for girls who
menarche at 15 y)
Estrogen matures the epiphyses and
induced bone fusion growth stopped
Height velocity curve
Boys higher that girls

Boys mature later (2 years) than girls giving

them 2 years additional prepubertal growth
Peak height velocity is greater grow faster
during their growth spurt
Height velocity curve is broader duration is
longer
Mean parental height

boys= father height+ mother height +13

2
girls= father height+ mother height -13
2
cont
Asymmetric growing: It begin distally:
early enlargement of hands, feet
followed by the arms and legs
finally by the trunk and chest
Changes of body composition:
pre pubertal girls=boys;
girls more fat (22-26 % vs 15-18%),
boys: more lean tissue
 Cont-
Weight gain:
Parallels linear growth
delay of several months first seem
to stretch and then fill out.
Muscle mass increase , follow by
an increase in strength (boys show greater gain )
Bone mineral density: 50% complete during 1st
month of life to puberty onset; 30% in puberty,
20% late adolescence Calsium
Bone maturation correlates closely with SMR
epiphysis closure is under estrogen
Increased of heart size, lung vital capacity, blood
pressure, blood volume, and hematocrit
 Stimulation of subaceous and apocrine
glands acne and body odor.
Vocal quality laryngeal and thoracic
growth
Dental changes: jaw growth, loss of
the deciduous teeth, eruption of
permanent teeth.
Sexual maturity
the reproductive capacity is established
Secretion of sex hormones affect body,
changes in sexual and emotional behavior
size and shape of body change, difference
between boy and girl:
Shoulder (boys) and hip/ pelvic (girls)
Lean body mass (boys); fat (girls)
Process of puberty can take as little as 3-4 years
or as much as 4-7 years. Reproductive capacity can
be achieved within 2-3 years after the onset of
puberty.
Tanner stage 2-5
 Cont.
Girls:
can begin as early as 6 or 7 years, late as
13 years
Menarche: usually occur when she has
reached Tanner stage 3-4 breast
development.
Primary amenorrhea: a girl has not had her
first period by 4 years after her breasts
begin develop

Boys:
Start as early as 8 years, as
late as 14 years of age
Puberty precocious, delayed
puberty
Staging of pubertal development in boys
(Tanner)
(Tanner)

G1-5, Pu 1-5, A 1-5, testicular volum > 4 ml first sign of male

puberty
Staging of pubertal development in girls
(Tanner)
(Tanner)

B 1-5, Pu 1-5, A 1-5. (B2 first sign of female puberty)

Continued brain
development
Not completely developed until late
adolescence (prefrontal cortex)
Emotional, physical and mental
abilities incmplete
May explain why some adolescence
seem inconsisten in controling
emotions, impluses and judgements.
Understanding adolescence
brain
a period of synaptic reorganization,
synaptic pruning
Adolescence are uniquely vunurable
to risk taking:
Novelty and sensation seeking increase
dramaticaly at puberty
Development of self regulation lags
behind
PSYCHSOCIAL
DEVELOPMENT
Development of the ability to understand
the self; its relation to others, and its place
in the overall scheme of things
Can be viewed as the achieving of
competency in four tasks :
Developing independence
Developing mature sexuality
Developing a realistic vocational goal
Developing mature and positive self-image
Period of adolescent
1. Early adolescent ( 10-13 years)
SMR 1-2
Beginning rapid growth
Sexual interest usually exceeds sexual activity
Cognitive & moral : concrete logical,
conventional morality
Family: ambivalence increase independence
Peers : same sex groups
Relationship: middle-school adjustment
2. middle adolescent ( 14-16 years)
SMR 3-4
Height growth peak, body shape and composition
change, acne, odor
Menarche, spermache
Sexual experimentation: questions of sexual
orientation
Cognitive & moral : abstract , self centered,
questions moral
Family: continue struggle for acceptance of
greater autonomy
Peers: dating, peers groups less important
Relationship to society : skill & opportunities
3. Late adolescent ( 17-20 years)

SMR 5
Slower growth
Sexual: consolidation of sexual activity
Cognitive & moral: idealism
Family : practical independence
Peers: possible commitment
Relationship to society: carrier decisions
 Health problems in adolescent
Problem originating in childhood
affecting adolescent health:
Malnutrition : stunted, Vit A def.
Infection, trauma, asphyxia result in
permanent disability: impact performance,
self-esteem, personality development
Sexual abuse, neglect may effect the
physical, mental, social well-being
Problem originating in adolescent
with lifelong health consequences:
Malnutrition
Undernourished delay puberty, anemia,
maternal mortality, low birth weigh,
premature
Obesity: risk factors of cardiovascular
disease, Type II DM
Death on road:
Emotional and social immaturity
Alcohol and other drugs:
Failure to use safety equipments
Sexual and reproductive behaviour
Unsafe sex is a major threat to the health
and survival of millions of adolescents.
STD including HIV : 1/ 20 adolescents
HIV:
Every day, over 7,000 young people (10 to 24
years old), that is, five every minute. Now >
2,5 million young people
> 50% new HIV cases
Sexual and reproductive
behaviour (cont.)
Unsafe pregnancies /early motherhood, :
Dangerous for both mother and child.
Mother: < 18 years old are two to five times
more likely to die in childbirth as women in
their twenties
Baby: low birth weight, prematurely, die of
infections and malnutrition before their first
birthday.
Unsafe abortions:
Each year, > 4.4 million
Substance and tobacco use

Substance use is a major contributing

factor to:
accidents, suicides, violence, unwanted
pregnanciesunwanted child
STDs (including HIV/AIDS)
used with tobacco.
TOBACCO USE :

One of the most damaging behaviours for the

long-term health of young people is the use
of tobacco.
Most adults smokers began during
dolescence.
300 million are smokers and 150 million will
die of smoking-related causes later in life.