ANATOMIC AND PHYSIOLOGICAL DIFFERENCE THE DIFFERENCE IN ILLNESS IN CHILDREN AND ADULTS: The childs body is building up to maximum

level of development rather than being a plateau of physical fitness or in a stage of decline. The exact age of the peak of the process of bodily repair is not known, but repair does seem to decrease after 18 to 21 years of age. The difference in illness in children and adults are based on anatomic, physiologic and psychologic difference between the immature child and the mature adult. ANATOMIC AND PHYSIOLOGIC DIFFERENCE: Anatomic differences between the newborn and adult are obvious. Size is the outstanding difference; it influences the method and equipment used in caring for the child. A more specific anatomic difference between them is the greater size and weight of the newborn babys head, when compared with body length and weight. This characteristic, coupled with immature motor development, makes handling the infant quite different from handling the older child or adult. The sutures of the skull in the newborn baby are not united: the brain is not protected by the skull in the areas of the open fontanel. The infants bones are neither as firm nor as brittle as those of the older child. Thus, when ICP develops in the infant, the head simply enlarges as the sutures separate. This is not possible in older child or adult, who exhibits other indications of increased ICP. The normal shape of the head and the chest of the infant can be altered by constant pressure from lying in one position. The parent or the nurse must move the infant frequently so that the child bones will not become deformed. The difference in the physiologic processes of the newborn infant and the older child or adult is less obvious than the anatomic differences. But the physiologic characteristics of an age group are more important in the adaptation of nursing intervention to needs that are anatomic ones, since they are subject to greater control by medical and nursing procedures. Physiologic development, in addition to changes in anatomic structure of the various parts of the body, influences the childs susceptibility to certain diseases, the symptoms of the disease, and the probability of lasting harm.

Certain changes in the body caused by anatomic and physiologic development from the newborn period through adolescent are discussed below.

INTEGUMENTARY SYSTEM: The functions of the skin include thermoregulation and protection of the body from the all environment. The skin is composed of collagen; elastic fibers; hair follicles; eccrine, apocrine, and sebaceous glands; and blood and lymphatic vessels and nerves. At birth the structures within the skin are present, but many of the functions of the integument are immature. The two layers of skin, the epidermis and the dermis, are loosely bound to each other and are very thin. Rete pegs, which later in life anchor the epidermis to the dermis, are not developed. Slight friction across the epidermis, such as from rapid removal of tape, can cause separation of these layers and blister formation and or loss of epidermis. In term infants the transitional zone between the cornified and the living layers of the epidermis is effective in preventing fluid from reaching the skin surface. The eccrine sweat glands are found over the entire body surface, being most dense on the palms and soles. They function irregularly during infancy and toddler period.. Eccrine sweating of the palms and soles is produced by high emotion. It is less marked in prepubescent children than in adolescents and adults. The apocrine sweat gland is found in axillae, areola, peri-umblical area, and perianal and genital areas. The activities of these glands result from adrenergic stimuli, generally due to emotional stress. These glands are small and nonfunctional from birth through the preschool years and begin to function at between 8 and 10 years of age, and their functioning increases during pubescence, adolescence, and adulthood. The lipid surface film of the skin aids in its protection. This film is produced by sebaceous glands and the keratinizing epidermis. An accumulation of this sebaceous material in the skin of the fetus and newborn is the vernix caseosa, a thick, cheesy, oily substance.

 The sebaceous glands are large in neonates; however they diminish in size after birth and remain small during childhood. They again become active at puberty. The hair of the neonate is fine and silky; however, it becomes coarser with physiological development. The newborn babys nail are soft and thin but become harder and thicker as child grows older. Adipose tissue beneath the skin and other parts of body accumulates during infancy and then declines and ceases to accumulate during the early childhood years. This is the reason the toddler and the preschooler child seem thinner than they were as infants. Because the amount of melanin is low at birth, newborns are lighter skinned than they will be as children. Consequently, infants are more susceptible to the harmful effects of the sun. RESPIRATORY SYSTEM: During the newborn period and infancy, the tissues of respiratory tract are delicate and do not produce mucus as they do during childhood. The dermal layers of the mucous membranes and epithelium do not provide protection from invasion of infectious organisms. In case of throat infection, the anatomic closeness of the throat, eustachian tube and middle ear increases the susceptibility of infants and young children to fluid being trapped in ear, as a result, the potential for otitis media. The tonsils and adenoids are relatively large during childhood and are involved in the production of immune bodies. The sneeze and cough reflex is essential for maintenance of life. It clears nasal passage and foreign matter respectively. HEART AND CIRCULATORY SYSTEM: The weight of the heart increases rapidly after 4th month of gestation. During newborn period, there is a little gain in the weight of the heart, but from 4 weeks to puberty, it increases steadily in size. Heart sounds are of higher pitch and not distinctive during growth years. With increasing vagal control, the heart rate slows down and functional murmurs may not be heard. The normal pulse rate of 140 beats per minute in the newborn slows over the years of growth to about half rate in the late adolescent period.

 Normal systolic and diastolic blood pressure readings of children increase with advancing age from newborn period to the end of adolescent period. Electrocardiograms done on normal children at the age group of 6 years are similar to those of older adolescents or young adults.

HEMATOLOGIC SYSTEM: At about 2 months of age, erythropoiesis gradually increases. This results in a greater proportion of reticulocytes in the blood and a rise in the concentration of hemoglobin. There is a decline in concentration of hemoglobin during the first few weeks of neonatal life. FLUIDS AND ELECTROLYTES: The total body water in infants is about 750 ml/ kg body weight; in adults it is 550 ml/kg body weight. In the newborn baby, approximately 75-80% of body weight is composed of body water whereas approximately 60 % of body weight is body water in the adult man. During infancy, the normal rapid weight gain in weight is due to an increase in adipose tissue. The percentage of body fluid, contained in the extracellular compartment is greater for children up to 2 years of age than it is for adults. GASTROINTESTINAL SYSTEM: Dentition: humans have 20 primary and 32 primary teeth. Teeth calcify at 4-7 months gestation. Calcification ends when the roots of the permanent third molars are complete. The first permanent teeth to erupt are the 6 year molars. Organs of digestion: the structures of mouth and esophagus functions in an immature manner allowing only movements related to sucking and swallowing in newborns. In neonates, the emptying time of the stomach is about 21/2-3 hrs; in older infant it is 3-6 hours. The tissues of the GI

tract are delicate, they lack the ability to secrete adequate amounts of enzymes and fluids, and the mucous linings do not have the immunologic characteristics during early infancy that they will have in childhood. The liver is approximately 4% of body weight in newborn infants and occupies a major portion of the abdominal cavity. Digestion of carbohydrates, proteins and fats: At birth, a small amount of ptyalin or salivary amylase converts starch into maltose and dextrose, which helps in digestion of starch in the absence of pancreatic amylase as it does not reach the adult level for several months after birth. Protein breakdown is incomplete during early life, whereas the neonates absorb 85-90% of human milk fat, it gets absorbed like that of adults with increasing age.

URINARY SYSTEM: Under stress the functional reserves of kidneys in infants are reduced as compared with the adults. The GFR increases with the advancing age. Young infants cannot concentrate their urine as well as older children and adults. Premature infants smaller than 34 weeks gestation have decreased reabsorption of glucose, sodium, bicarbonate and phosphate. ENDOCRINE SYSTEM: The endocrine system develops during infancy and childhood. Levels of serum growth hormone produced by anterior pituitary increases during fetal life, decreases near term, then increases during childhood and decreases again as full growth is achieved. The production of hormone ADH or vasopressin by the posterior pituitary gland is limited during the first 12 months of life and thus the infant cannot regulate fluid balance. Thyroid stimulating hormone is secreted in small amounts during fetal life. Increasing amounts are produced during infancy. The adrenal glands are small during infancy and have limited functions, but increase their functions during puberty. Since ACTH has minimal

function during infancy, therefore it cannot respond to the stress of fluid and electrolyte imbalance. When the mother is diabetic, the pancreas of the fetus produces a large amount of insulin than normal. The islets of langerhans produces insulin that regulates carbohydrate metabolism. REPRODUCTIVE SYSTEM: Ovaries: in a normal full term baby girl, the ovary is approximately 10 mm in length and 2-4 m in width. Throughout the years, the follicles mature and undergo atresia, the cellular residue contributes to the increase in the size of the ovaries. Increase in the ovarian mass and follicular size implies an increased production of estrogen. Gonadotropic stimulation from the pituitary gland is responsible for ovarian growth during childhood. Testes: after birth, the testes are 1.5-2 cm in length and 0.7-1 c in width. They weigh 0.5 gm each. The size increases slowly until school age, greater increase occur between 6-12 years. The progressive maturation of the testes occurs with the increase in the pituitary gonadotropins during puberty. Development is complete between 13-17 years. The fully developed testes is approximately 3.5-5.5 c in length and 2.1-3.2 cm width, and weighs around15-20 gms. LYMPHOID AND IMMUNE SYSTEM: The function of lymphoid system is same in children and in adults; however, the relative maturation varies with the childs age. The antigenically stimulated fetus can synthesize IgM by 10.5 weeks, IgG by 12 weeks and IgA by 30 week of gestation. Newborn infants can respond to variety of antigens, but the predominant antibody is initially is of the IgM class. Adult levels of IgM are reached at about 1 years of age, and of IgA at about 10 years of age. Lymphoid tissue is proportionately small but is well developed at birth. But increases rapidly in relative size until 10 to 12 years. By the child is 6 years of age, the lymphoid tissue in adult size, after which slow atrophy occurs. The rapid growth of lymphoid tissue early in life is due to antigenic stimulation. Swelling of the spleen may also occur with some infections. As in lymph nodes, this swelling is due to the filtration of microorganisms, infected cells and their debris, and the active hyperplasia of the immune-active cells. When

the spleen is enlarged, there is a risk of traumatic rupture with accompanying danger of hemorrhage. During the first trimester of fetal life, immunologic competence is probably lacking. After this period the fetal lymphoid system is gradually populated with immunologically competent cells. During the last 6 months of gestation, the fetus can develop delayed hypersensitivity and can form plasma cells that are capable of synthesizing specific immunoglobulins, usually of IgM and IgA classes. If the infants immunologic system is normal, there will be a progressive hyperplasia of the follicles and a gradual appearance of plasma cells in lymphoid tissue in the body. This results in enlargement of the tonsils and lymph nodes from their miniature size at birth. The passive immunity obtained from the maternally derived IgG antibodies is gradually lost. The duration of young infants immunity to a particular infection depends on the level of that particular antibody in the mother plasma during pregnancy and upon the amount of antibody required to protect the infant from that particular kind of infection. If there is a congenital absence of the thymus gland or stem cells, the precursor of B and T lymphocytes, the affected infant will be unable to live a long, normal life. Since the immune system cannot develop without B and T lymphocytes, the infant will acquire severe bacterial, viral, or fungal.

MUSCULOSKELETAL SYSTEM: Since muscular tissue is almost completely developed at birth, growth occurs due to increase in size of muscle fibers, due to genetic inheritance, stimulation primarily use and exercise. The growth hormone, insulin and thyroxin stimulate the growth of muscle tissue from birth till puberty, at puberty the male hormone androgen causes increased muscle size in boys. During fetal life, bony tissues begin to develop as closely packed connective tissue. New bony tissues are constantly produced during the period of growth. Postural changes are the result of development of neurologic control, growth and development of bones and muscles, and deposition of adipose tissue. NEUROLOGIC SYSTEM:

 The brain weight of a neonate is about 300-350 gms. At 1 year of age, the weight two-thirds of that of adults. The sulci of the lobes of the cortex deepen, increase in number and become more prominent with rapid growth with age. Reflex activity, normal during infancy begins to disappear as voluntary control is developed. The knee jerk and blinking reflex never fade altogether. Myelination, the formation of insulation and protection of nerves is mostly completed by 2 years of age, when the child can perform motor movements like an adult but with less speed and co-ordination. In neonates, the eyes are not anatomically mature, thus are not able to function like those of an adult. The newborn infant has adequate central vision for fixation and can co-ordinate eye movements. Depth perception begins to develop at 9 months of age. Lacrimal glands start to function during 2nd to 3rd months. The neonate can hear louder noises at birth but by second month after birth, the infant can hear softer, soothing sounds. With further myelination, it can localize sounds by turning the head in their direction.

CONCLUSION: In summary, the symptoms of disease in an infant are different from those in older child or adult, owing to the pathogenic state caused by the injurious agents on the tissues in different stages of anatomic and physiologic development. It is important for the pediatric nurse to learn the cause and effect relationship of any pathologic agent to the development stage of childs body, to provide preventive and curative nursing intervention.

BIBLIOGRAPHY: Dorothy R Marlow, Barbara A Redding, TEXTBOOK OF PAEDIATRIC NURSING, Saunders Elsevier, 6th edition.