Growth and Development

Growth
Process by which a living or any of its parts increases in size and mass, either by multiplication or by enlargement of component cells. Quantitative

Measurable
Physical Aspects

Areas of Growth
Length/Height Weight Growth Velocity

Factors Affecting Growth

Genetics Environment Prenatal

Development
a complex process occurring in a child that encompasses growth, increase in understanding, acquisition of new skills and more sophisticated responses and behavior. Increase in functional capacity Qualitative

Psychosocial, Emotional, Behavioural, Cognitive,

Transactional Model of Development

Behaviour

Family Functions
DEVELOPMENT

Environment

Socio-Emotional

Principles of Development
1. Development is a continuous process from conception to maturity. 2. The sequence is the same in all children, but the rate varies from child to child. 3. It is intimately related to the maturation of the CNS. 4. Generalized mass activity is replaced by specific individual responses. 5. It follows a cephalo-caudal direction. 6. Certain primitive responses have to be lost before the corresponding voluntary

movement is acquired.

Basic Laws of Development

1. Development goes through a defined stages and phases.

2. Development infers change.

3. Development is seen as an increase in function and ability.

4. Development involves maturation.

5. Development and maturity takes time.

Areas of Development
1. Motor skills a. Gross b. Fine motor 2. Language Skills a. Receptive b. Expressive 3. Personalsocial skills 4. Cognitive Skills

Factors Affecting Motor Development

1. Environmental influences and opportunities 2. Physical size 3. Health condition (chronically ill) 4. Nutritional state 5. Mental Status 6. Adult attitudes

Gross Motor Skills

posture and locomotion

cephalocaudal
Early stabilization of head facilitates survivalb and enables awareness

Weakest correlation with intelligence

Achievement of movement opens avenues for development

Fine Motor
Refers to upper extremity and hand

manipulation with eyehand coordination

Proximodistal

Writing is the end point

Fine Motor

Language
a system of vocal, graphic, and gestural symbols used to communicate

feelings, ideas, and orders to others.

best predictor of future intelligence Development of speech Capacity to imitate & intent to communicate Ability to store and recall

Language
1. Receptive language - comprehension and understanding 2. Expressive language - speech or gestures

Stages of Language Development

1. Reflex sounds and feeble gestures

2. Babbling
3. Gestures

4. Word usage

Language Development
1 month of age - eye contact 2 months - vowel from consonant 4 months - coos and laughs - prefer speech with varied rhythm and stress 5 months - speech sounds are not influenced by sounds heard - Babbling starts to imitate parents speech First words: average age = 11 months (8.18months); - usually accompanied by gestures e.g. bye

Language Development
Word combinations usually appear after 50 single words Telegraphic sentence Progression of rules in grammar (even before formal education) 5 years few grammatical errors,usually self corrected 6 years - No apparent difference from adult 8 years - fully formed adult grammar

Personal and Social Development

patterns of social interaction, feeding, dressing behavior It depends to a large extent on culture and environmental factors such as social expectations, level of parenting skills,education and training

Cognitive Development
- Jean Piaget Theory of Cognitive Development Infants grow by predetermined steps through various stages Each stage has its own characteristics and needs and must be negotiated successfully before going to the next.

Cognitive Development
Sensorymotor birth to two years Infants begin to learn through sensory observation, and they gain control of their motor functions through activity, exploration, and manipulation of the environment.

Critical achievements by the end of this period: 1. Object performance objects have an existence independent of childrens involvement in them
2. Symbolization expressed in mental symbols and words

Cognitive Development
Preoperational Thought - 2 to 7 years Children use symbols and language more extensively, but thinking and reasoning are intuitive. Characteristics: 1. Sense of imminent justice - punishment for bad deed is unavoidable. 2. Egocentrism

Cognitive Development
3.phenomenalistic causality events that occur together are thought to cause one another. 4. animistic thinkingphysical events and objects are endowed with feelings and intentions.

Cognitive Development
Concrete Operations 7-11 years Egocentric thought is replaced by operational thought, which involves attending to information outside; children are able to understand another point of view.

Critical Achievements: 1. Conservation 2. Reversability

Other Theories of Development

Psychosexual Theory Sigmund Freud Stages: Oral - birth to one year Anal - 1 to 3 years Phallic - 3 to 5 years Latency - 5/6 years to puberty Genital - puberty to adulthood

Other Theories of Development

Psychosocial theory Erik Erikson

Stage 1 Basic trust vs. Mistrust Stage 2 Autonomy vs. Shame & Doubt Stage 3 Initiative vs. Guilt Stage 4 Industry vs. Inferiority Stage 5 Ego Identity vs. Role Confusion/Diffusion Stage 6 Intimacy vs. Isolation Stage 7 Generativity vs. Stagnation Stage 8 Ego Integrity vs. Despair

Other Theories of Development

Moral development - Lawrence Kohlberg 1. Preconventional 2. Conventional children try to conform to gain approval & to maintain good relationships with others 3. Postcoventional - children comply with rules on the basis of concept of ethical principles.

Other Theories of Development

SeparationIndividuation Theory Margaret Mahler

Stages: Normal Autism Birth to 2 months Symbiosis 2 to 5 months SeparationIndividuation Proper: 1. Differentiation 5 to 10 months 2. Practicing 10 to 18 months 3. Rapprochement 18 to 24 months 4. Object constancy 2 to 5 years

Stages of Growth and Development

Prenatal Embryonic Fetal Postnatal Newborn - birth 1st month of life Infancy 1 month to 1 year Toddler 1 year to 2 years Preschool 2 years 5 years Middle Childhood 6 12 years Adolescence 12 20

Prenatal Period

Prenatal Period

Neonates

Neonates
Weight Average Weight = 3.4 kg 1st week of life - weight loss of 10-15% because of changes in body water compartments 2nd week of life - Weight gain generally begins 10-20 g/kg/day or 20-30 g/day (1-3% of body weight/day). Infants should be weighed daily.

Neonates
Length Average Length 50cm Average length gain preterm infants - 0.8-1.0 cm/week term infants average - 0.69-0.75 cm/week

Neonates
Average Head Circumference 35 cm Head circumference. Intrauterine growth is 0.5-0.8 cm/week. This is used as an indicator of brain growth. increase in head circumference >1.25 cm/week may be abnormal associated with hydrocephalus or intraventricular hemorrhage. 38 cm by 1 month Boys larger by 1 cm

Neonates
Vision and Hearing focal length of 8-12 in - distance from the breast to the mothers face Hearing is well developed and they turn toward a female voice

Neonates
Behavioral States Quiet sleep Active sleep Drowsy Alert Fussy Crying

Infants and Toddlers

Infants and Toddlers

Infancy - 112months Toddler - 1324 months

Growth Patterns
Weight BW = 3000 g 10 days regain birth weight 5 months double the birth weight 1 year tripled 2 years quadrupled

Growth Patterns
<6 months: W in g = age in months x 600 + BW 612 months W in g = age in months x 500 + BW

16 years: W in kg = age in years x 2 + 8 712 years: W in kg = age in years x 75 2

Growth Patterns
Length Birth length = 50 cm 1 year = increased by 50% 2 years = of mature height 4 years = doubled 13 years = tripled

Growth Patterns
Height in cm = age in yrs X 5 + 80 Average Gains per month: Birth3months - 9 cm 36 months - 8 cm 69 months - 5 cm 912 months - 3 cm

Growth Patterns
Average gains: First 4 months: inch/mon = 2 inches Next 8 months: inch/mon = 2 inches 2 years = 1 inch 35 years: inch/yr = 1.5 inches TOTAL = 6.5 inches

Neurodevelopmental Patterns - The First 3 Months

Gross Motor
Newborn Prone Arms and legs flexed, pelvis high Head held below body Arms and legs semi-flexed Complete head lag Legs extended

Ventral Supine Pull to sit Head upright

Neurodevelopmental Patterns - The First 3 Months

4 Weeks Prone Ventral Supine Pull to sit Head upright

Lifts head; pelvis lower Lifts head momentarily Arms and legs semi-flexed Lifts head momentarily Stepping/placing reflexes

Neurodevelopmental Patterns - The First 3 Months

Gross Motor
6 Weeks Prone Supine Pull to sit

Holds head in line with body for few seconds Holds head for few seconds Holds head for few seconds

Neurodevelopmental Patterns - The First 3 Months

Gross Motor
12 Weeks Prone Pull to sit Head upright
Lifts head and chest off surface No head lag Sags at knees; reflexes disappear

Neurodevelopmental Patterns - The First 3 Months Fine Motor

4 Weeks Grasp reflex Drops object immediately Hand remain fisted Sweeping movements towards objects 12 Weeks Little or no grasp reflex Opens and closes hands Watches objects for a few seconds Hand regard begins Holds bottle for few seconds

Neurodevelopmental Patterns - The First 3 Months

Personal and Social

4 Weeks Can imitate tongue protrusion Gazes at bight light, faces, and colored objects Recognizes mother 12 Weeks Laughs at playful activity Recognizes familiar situations Likes feeding, bathing Dislikes being left

Neurodevelopmental Patterns - The First 3 Months Language Development

Vocalization and speech 4 weeks Crying/whimpering Produces some vowel and few consonant sounds 12 weeks Different cries for pain, hunger, and discomfort Decreased crying time Some repetitive sounds (ga, ga), coos and sighs Vocal gurgle in response to soothing voice Some imitative response to speech

Response and Comprehension

Smiles, decreases activity Startles to loud sounds

Neurodevelopmental Patterns - The First 3 Months Cognitive Development

Stage 1 (birth to 1 month) - use of reflexes Stage 2 (1-4 months) - primary circular reactions

Neurodevelopmental Patterns - The First 3 Months Vision and Hearing

Vision Fixates and watches face intently Follows face with his eyes as it moves across the line of vision Head moves a few moments after tracking with the eyes Hearing Voice, bell or rattle as a stimulus Reactions; quieting, cry or stilling

Neurodevelopmental Patterns 3 6 Months

Gross Motor
Age 4 months Gross Motor Prone: Steady head hold Lifts head 90 degrees Supine: Rolls over from side to side May roll from prone to supine Kicks and extends legs Sitting: needs maximal support to sit but can be propped Head is steady and erect

Neurodevelopmental Patterns 3 6 Months

Gross Motor
5 months Prone: Lifts chest off surface and supports self on Wrist Supine: Rolls over from supine to prone Rolls and twist around Lifts and extends legs high Sitting: Sits unsupported for longer periods Sitting: Sits by self supported by own hands

6 months

Neurodevelopmental Patterns 3 6 Months

Fine Motor
Age 4 months Gross Motor Both hands are unfisted and remain open more than 75% of time. Manipulates fingers (i.e. plays with his/her hands by grasping and ungrasping other hand) Plays with objects put in hand

Neurodevelopmental Patterns 3 6 Months

Fine Motor
5 months Pulls objects towards himself with one or both hands Brings objects to mouth May start holding bottle Can lift objects/toys off a surface using thumb finger position Can lift a cup Holds bottle and can rotate wrists

6 months

Neurodevelopmental Patterns 3 6 Months

Personal and Social
Age 4 months

Decreased interest in feeding because of increasing social interest. Vocalizes moods, enjoyment, indecision and protest. Laughs while socializing; wails if play is disrupted Shows anticipation and excitement

Neurodevelopmental Patterns 3 6 Months

Personal and Social
5 months Shows fear, disgust, and anger Discriminates self and mother in mirror Smiles and vocalizes to mirror image Smiles to human faces and voices to make social contact Tries to get close to person near crib; clings when held

Neurodevelopmental Patterns 3 6 Months

Personal and Social
6 months Watches and imitates facial expressions Disturbed by strangers; distinguishes adults from children Reaches out to pat even strange children Calls parents attention for help Enjoys playing with people, especially peek-a-boo, come and get me, go and fetch

Neurodevelopmental Patterns 3 6 Months

Language
Age 4 months Receptive Skills Stops activity when talked to Listens well Observes mouth movements closely Can turn directly to the source of voice, especially if it is the mother calling out her babys name Expressive Skills Cooing becomes pitchmodulated Smiles, laughs, squeals in pleasure Tries to imitate tones

Neurodevelopmental Patterns 3 6 Months

Language
5 months Understands name and turns directly when name is called Razzes (blows through closed lips accompanied by a spray of saliva) Experiments with own sound after hearing others

Neurodevelopmental Patterns 3 6 Months

Language
6 months Reacts to differences in intonation and reflections Can understand no Babbling starts (consonantvowel-combination) Pleasure/displeasure is expressed through differing modulations of these vocalizations.

Neurodevelopmental Patterns 3 6 Months

Cognitive
Stage 3 better sense of external things able to find partly hidden objects

Neurodevelopmental Patterns 3 6 Months

Vision and Hearing
Vision visual acuity is 6/12 but is difficult to check discriminatory function visual world tends to be close, about 10 feet in an ordinary environment Hearing should be carefully tested at this age voice is used as stimulus usually turns to the side the sound is coming from

Neurodevelopmental Patterns 3 6 Months

RED FLAGS
seems very stiff or floppy cannot roll over cannot sit with help by six months reaches with one hand only does not turn/respond to sounds does not babble does not smile/show interest still has Moro reflex and tonic reflex at 4 months

Neurodevelopmental Patterns 7 12 Months Gross Motor

7 months sit unsupported 8 months creep pull to standing cruise 9-10 months able to pivot while sitting - crawl, takes steps with both hands held

Neurodevelopmental Patterns 7 12 Months Fine Motor

7 months transfer objects, rakes at pellet 9 months pokes with forefinger, neat pincer grasp 12 months able to extend and release objects on request

Neurodevelopmental Patterns 7 12 Months Personal and Social

6-8 months separation anxiety, finger feeds 9-10 months object constancy, play peek-a-boo, pat-a-cake, casting 12 months kisses on request, waves goodbye

Neurodevelopmental Patterns 7 12 Months

Language
Age in months 6 9 12 Receptive Turns to sound laterally Responds to no Responds to words e.g. where is daddy?; shows interest in picture book Expressive Repetitive vowel sound Repetitive consonant sounds 2 or 3 words with meaning

Neurodevelopmental Patterns 7 12 Months

Cognitive
Stage 4 (Coordination of Secondary Schemes) genuine sense of object permanence performance of two separate actions to obtain a single result

Neurodevelopmental Patterns 7 12 Months

RED FLAGS
Drags one side of the body while crawling Does not stand when supported Does not search for objects that are hidden Does not respond to name Does not have single word e.g. mama/papa Does not learn to use gestures like waving, shaking head for no Doesnt point to objects or pictures

Neurodevelopmental Patterns 15 24 Months Motor

Age in months

15
18

Gross Able to walk alone, crawl upstairs Runs stiffly, walks upstairs with 1 hand held

24

Fine Puts pellet in a bottle, tower of 2-3 cubes Dumps pellet from the bottle, tower of 4 cubes, imitates vertical strokes, spontaneous scribbling Runs well; jumps, walks up Tower of 6-8 cubes, and down the stairs, opens imitates horizontal lines door, climbs furniture and circular strokes

Neurodevelopmental Patterns 15 24 Months Personal and Social

15 months indicate some desires or needs by pointing 18-24 months indication of toileting needs -Solitary play, Parallel play - imitations of actions by mother and siblings - helps to undress

Neurodevelopmental Patterns 15 24 Months Language

Age in months

15

Receptive Follows simple commands Asks by pointing Follows simple commands without gesture Points to body parts Refers to self by name Understands 2-step commands

Expressive Immature jargoning Several intelligible words Mature jargoning Many intelligible words (~1015) Speaks in phrases 50% intelligible speech Echolalic

18

24

Neurodevelopmental Patterns 15 24 Months Cognitive

Stage 5-6 Experimentation (Little Scientists) Remembers situations and think about immediate future Shape perception

Neurodevelopmental Patterns 15 24 Months Vision and Hearing

Vision near adult levels at 18 months - matches shapes Hearing adult levels -no further development until 5 years

Neurodevelopmental Patterns 15 24 Months

RED FLAGS
Doesnt walk by 18 months Doesnt imitate actions or speech Doesnt establish eye contact No words or phrase Doesnt imitate Doesnt follow instructions Doesnt know the function of common objects No symbolic play Engage in rocking or head banging for extended periods of time

Preschool

Preschool Child
3-5 years Children change significantly during pre-school Look differently Act differently Think differently Preoperational cognition

Improved language

Preschool Child Physical Development

Height Weight
Increase of 6-8 cm/year

Weight
Increase of 2 kg/year

Head circumference
Increase of inch per year

Preschool Child Physical Development

Central Nervous System
Myelinization slows down by 3 years old and is completed by 7 years Brain attained 90% of its size by 5 years; weight is 1/3 of adult Hand-eye coordination is myelinated at age 4

Preschool Child Physical Development

Face 20 deciduous teeth by 2 to 3 years First to erupt are the central incisors Longer length of face Prominent lower jaw Wider upper jaw

Preschool Child Physical Development

General Body Habitus
Stronger and mature appearance Disappearance of exaggerated lordosis and protuberant abdomen Becomes slimmer

Preschool Child Motor Development

Gross motor skills and dexterity advance substantially thru neuromaturation and practice Wide range in motor activity (Run up and down stairs) Handedness is established by 3 years

Preschool Child Motor Development

Age
3

Gross Motor Pedal a tricycle Stands momentarily on one foot

Hops on one foot Downstairs on alternating feet

Fine Motor Imitate bridge Copy a circle

Copy a bridge Copy a cross and a square Can draw a man Copy gate Copy a triangle

Skips

Preschool Child Language Development

Phenomenal growth in language
Vocabulary increase to 1000-2000 words Sentence structure advance from telegraphic 2-word phrases to complete sentences Learn grammatical rules prior to school entry

Language regulates behavior of children

Preschool Child Language Development

Important steps in language activities:
Shared attention Active participation Immediate feedback Repetition Graduated difficulty

Preschoolers TALK to LEARN

Preschool Child Language Development

Clinical importance:
Regulation of behavior
More vocabulary = less tantrums They have tantrums because they cant express their feelings through words

Reflects emotional and cognitive development Critical foundation of literacy

Reading is language based

Preschool Child Language Development

Age

Receptive Uses pronouns Obeys prepositions Knows age and sex Gives full name, age, and sex Enjoys jokes

Expressive 3-4 word sentence 75% intelligent speech Counts 3 objects 4-5 word sentence 100% intelligible speech Tells stories Imitation of words Fluent speech Narrative has cause-effect sequence

Gives birthday and address Defines words Same or different

Preschool Child Personal and Social Devt

New friendships Simplified sense of morality
I will be good so teacher will like me.

Awareness of sexuality
Interest in genital organs is healthy and natural Nudity and sexual play in public is not acceptable NO other persons including friends and relatives may touch the private parts

Preschool Child Personal and Social Devt

Control of Aggressive Impulse
Aggression declines but certain amount of aggression is normal Healthy sign of self-assertion and occasion for social learning If usually aggressive, they may have emotional problems

Preschool Child Personal and Social Devt

AGE 3 4

Dry thru night; Undresses; spills little, pours some

Toilet trained; can dress and undress; takes turn and shares; helps set table Dresses alone; uses knife and fork; engages in cooperative play; helps cook

Preschool Child Cognitive Development

Preoperational stage Symbolic functions enables them to present people, places or events Thinking still lacks logic Perception dominates over reasoning Egocentrism Magical thinking

Preschool Child Cognitive Development

Age

Names color; recalls part of story; simple fantasy play

Concept of time; follows rules in simple games; interactive games Make believe and dressing up games; follow rules of games

Preschool Child Emotional Development

Play
Role in shaping the preschoolers mind and language Learn social skills and moral rules Key role in emotional development; transitional objects dramatic play

Fascination with heroes

Preschool Child Emotional Development

Challenges:
Accepting limits Reining aggressive and sexual impulses Interacting with adults and peers

Central issue is CONTROL Temper tantrums are NORMAL

But if tantrums are more than 15 minutes, regularly occurring more than three time a day = PROBLEM!!! May indicate language development delay

Preschool Child Emotional Development

Spanking is discouraged

Time out = 1min/year of age

Attention span = age in years x 3-5min Withdrawal of rewards

Preschool Child 3 Year Olds

RED FLAGS
Use little or no speech No optimal awareness of other children Doesnt follow simple directions Doesnt engage in imaginative play Avoids looking at pictures or pointing to familiar objects Has not begun to ask questions

Preschool Child 3 Year Olds

RED FLAGS
Engages in specific objects or activity for long periods Cannot throw a ball overhead Cannot ride in place Cannot ride a tricycle Persistence of toe-walking o Should not be observed by 2 years

Preschool Child 4 Year Olds

RED FLAGS
Does not have at least partially understandable speech with sentences Uses echolalic speech or frequent, bizarre, meaningless sounds Does not focus visually on pictures Does not seem interested in listening to a simple story about his/her experiences Does not draw some sort of representation of human beings Cannot tolerate changes and frustrations

Preschool Child 5 Year Olds

RED FLAGS
Has difficulty scribbling or copying a circle Ignores other children; no interest in interactive games Resists dressing, sleeping or using the toilet Doesnt use sentences of more than 3 words Doesnt use me or you appropriately Doesnt engage in fantasy play Runs from one thing to another every minute or so without getting fully involved in any activity

School Age

School Age Children

A.k.a middle childhood; early school age Age range is 6-12 years Relatively benign or latent period Basic goal is honing of motor, language and adaptive skills Central issue is SELF-ESTEEM Eriksons Industry vs. Inferiority

School Age Children Physical Development

Weight
Average weight gain: 3-3.5 kg (7lbs) per year

Length/Height
Average height increase: 6-7 cm (2.5 inches) per year

Head Circumference
Grows only about 2-3 cm throughout the entire period

Systemic Changes
CNS myelination slows down by 3 years old and is completed by 7 years

School Age Children Physical Development

General Body Habitus
Physical structure or habitus remain stable Head and Neck
Gradual growth of mid- and lower face Loss of deciduous teeth at 6 years old Replacement with adult teeth at a rate of four teeth per year Impressive tonsils and adenoids due to lymphoid tissue hypertrophy

School Age Children Physical Development

Musculoskeletal System
Progressive increase of strength, stamina and coordination Epidemiologic studies show a general decline in physical fitness due to prevalence of sedentary life

Genital System
Generally immature Some may experience initial pubertal changes Interest in gender differences and sexual behavior starting to become more active

School Age Children Physical Development

Developmental Skills
Gross motor
Honing previously learned skills Strength, speed and accuracy

5 years old tandem walk 6 years old skip on alternating foot 8 years old hop on 1 foot twice, then the other

School Age Children Fine Motor

Improved dexterity and eye-hand coordination Graphomotor skills emerge Irregularly arranged letters evolve into joined up writing at 9-10 years 6 years old tie shoe laces 7 years old print letters, letter reversal 8-10 years old rapid alternating movement of the hand; cursive writing; letters are smaller 10-12 years old manipulative abilities similar to adult

School Age Children Fine Motor

School Age Children Language

Increase ability to express thoughts using language directively Able to hypothesize and solve problems Reading is an acquired complex ability Receptive language
Ability to comprehend complex constructions, function words (e.g., if, when, only, except), nuances of speech, and extended blocks of language (e.g., paragraphs)Expressive language

Ability to recall acquired words effortlessly (word finding), to control meanings by varying positions and word endings, to construct meaningful paragraphs and stories

School Age Children Language

5 years old
Large vocabulary, mastering basic grammar and syntax

School age years

Adept uses of clauses, figures of speech

Growth: vocabulary, word finding skills, fluency Evidence of the ability to read
Response to written message Laughing at humor of written sentence

School Age Children Language

Three major phases which merge into each other:
Pre-reading (up to 6) Reading practice (6-9) Application/use of Reading (>10)

School Age Children Language

Concrete logical operation
Coordinate several characteristics that focus on a single property of an object Allow lucid understanding of time, space, amount, and number Apply rules based on observable phenomena Ability to consider two aspects of a problem simultaneously Thinking is mostly concrete or monolithic (black is black and white is white) (del Mundo, 2000)

School Age Children Language

7-8 years (Grade 1-2)
Fundamental skills (reading, writing, basic math skills)

9-10 (Grade 3-4)

More complex materials Understands strategy games and word play

School Age Children Social and Emotional

Affected by three contexts: home, school, and neighborhood Very active imaginations Group identification and team games Identification and reliance on peer groups

7 years; attachment to parents decrease and attachment to peers increase 9 years; tightly knit groups are formed

School Age Children

RED FLAGS
Exhibit extremely aggressive, fearful, or timid behavior Is unable to separate from parents/yaya Is easily distracted and unable to concentrate on any single activity for more than 15-20 minutes Refuses to respond to people in general Rarely uses fantasy/imitation in play

School Age Children

RED FLAGS
Cant give his full name Doesnt use plurals or past tense Seems unhappy or sad much of the time Avoids or seems aloof with other children or adult Has trouble eating, sleeping, dressing or using the toilet Cant differentiate between fantasy and reality Cant understand 2-part commands and prepositions Seems uncomfortable using the pencil or pen

Adolescence

Adolescence
9/10 years - 20 years Three periods:

Period of Puberty Hormones Period of Differentiation Transition from Child to Adult

Early Adolescence: 10-13 y.o. Middle Adolescence: 14-17 y.o. Late Adolescence: 18-20 y.o.

Adolescence
PUBERTY is the biologic process in which a child becomes an adult. - appearance of the secondary sexual characteristics - increase to adult size, - and development of reproductive capacity.

Puberty
LH and FSH rise throughout middle childhood without dramatic effect. Puberty - begin with increased sensitivity of the pituitary to GnRH; - pulsatile release of GnRH, LH, and FSH during sleep

- and corresponding increases in gonadal androgens and estrogens.

The triggers for these changes are incompletely understood may involve ongoing neuronal development throughout middle childhood and adolescence. Sexual Maturity

Sexual Maturity - Girls

Sexual Maturity - Girls

Sexual Maturity - Girls

Sexual Maturity - Boys

Sexual Maturity - Boys

BOYS

GIRLS

Early Adolescence Physical Changes, Girls

Breast buds -1st visible sign of puberty and the hallmark of SMR2 is the (8 and 12 yo) Menses typically begins 2-2 1/2 yrs after (9-16 yr;med=12y) later;SMR3-4 enlargement of the ovaries, uterus, labia,and clitoris, and thickening of the endometrium and vaginalmucosa.

Early Adolescence Physical Changes, Boys

Testicular enlargement - the 1st visible sign of puberty and the hallmark of SMR2 (9 1/2 yr) followed by penile growth during SMR3. Peak growth occurs when testis volumes reach approximately 9-10 cm3 during SMR4. the seminiferous tubules, epididymis, seminal vesicles, and prostate enlarge due to LH and testosterone left testis normally is lower than the right. Breast hypertrophy, typically bilateral in 40-65% of boys during SMR2-3 due to excess of estrogenic stimulation.

Early Adolescence Physical Changes, General

Growth acceleration begins in early adolescence for both sexes, but peak growth velocities are not reached until SMR3-4. Boys peak 2-3 yr later than girls, begin this growth at a later SMR stage and continue their linear growth for approximately 2-3 yr after girls have stopped.

Early Adolescence Physical Changes, General

The asymmetric growth spurt begins distally, with enlargement of the hands and feet, followed by the arms and legs, and finally, the trunk and chest. Rapid enlargement of the larynx, pharynx, and lungs leads to changes in vocal quality, typically preceded by vocal instability (voice cracking). Elongation of the optic globe often results in nearsightedness.

Dental changes include jaw growth, loss of the final deciduous teeth, and eruption of the permanent cuspids, premolars, and finally, molars

Early Adolescence Central Issues

Middle Adolescence
Growth acceleration 6-7 cm (3 in)/year Girls - growth spurt peaks at 11.5 yr at a top velocity of 8.3 cm (3.8 in)/year stop at 16 yr Boys - the growth spurt starts later, peaks at 13.5 yr at 9.5 cm (4.3 in)/year.Stop at 18 yr.

Middle Adolescence
Weight gain parallels linear growth, with a delay of several months Muscle mass also increases, 6 mo later by an increase in strength

boys greater muscle mass and strength

Middle Adolescence
Doubling in heart size and lung vital capacity. Blood pressure, blood volume, and haematocrit rise. Acne and body odor - Androgenic stimulation of sebaceous and apocrine glands Physiologic changes in sleep patterns and requirements may be mistaken for laziness; adolescents have difficulty falling asleep and waking up,

Middle Adolescence
Menarche - 30% SMR3 and by 90% SMR4 (95% have menarche at 10.5-14.5 yr of age). 1 yr after the growth spurt Anovulatory - during the 1st 2 yr after menarche (50%)

Before menarche, the uterus achieves a mature configuration, vaginal lubrication increases, and a clear vaginal discharge appears (physiologic leukorrhea). In boys, the phallus lengthens and widens during SMR3, and sperm are usually apparent in semen.

Late Adolescence
Final stages of breast, penile, and pubic hair development occur by 17-18 yr of age in 95% of males and females. Minor changes in hair distribution often continue for several years in males, including the growth of facial and chest hair and the onset of male pattern baldness in a few. Acne occurs in the majority of adolescents, particularly males.