Physiology Child Growth

and Development
Prof.Dr. H.Gusbakti, MSc,PKK,AIFM
DEFINITION OF TERMS
GROWTH
Refers to the increasing size of the physical structure of the
body.
It denotes quantitative change.
It is measured by inches, centimeters, kilograms or pounds.
DEVELOPMENT
Refers to the improvement in skill or ability to function.
It denotes qualitative change.
CHRONOLOGICAL AGE
Defined as age in years.
DEVELOPMENTAL AGE
Refers to age based on functional behavior and ability to adapt
to the behavior.
INTEGRATION OF SKILLS
Ability to combine simple movement or skills to achieve
complex tasks.
FACTORS INFLUENCING G& D
Heredity
Life Experiences
Health Status
Cultural Expectations

The Healthy Child: Stages of G & D
INFANT (1 month to 1year)
A. Psychosocial
Development
Depends on the
quality of
relationship b/w
caregiver and infant.
If needs are met
consistently, it
results in feelings of
physical comfort and
emotional security.
Infants to love and
be loved.
INFANT (1 month to 1year)
B. Physical Growth and Development there is
rapid gain in physical size & maturation.
Length grows 20 inches at birth; 30 inches at 1
year (50% increase by 1 year): grows 1 inch every
month for 6 months, then inch every month during
the last 6 months.
Weight gains 1 Ibs/month; doubles body weight
by 5-6 months; triples body weight by 1 year.
Head Circumference HC is greater than chest
circumference until age 2.
Vital Signs PR=80-150/min (ave=100/min); RR=20-
50/min

Fontanels
Anterior diamond shaped; closes at 12-18 months
Posterior triangle shaped; closes at 2 months
Teeth
4-8 months: central mandibular incisors
By 1 year has 8 teeth
Sleep
0-6 months sleeps thru the night
8-9 months sleeps 10-12 hours at night
Play
Solitary purpose is to stimulate sensorimotor
development.
Toys: safe, simple, stimulating, easily handled,
washable
Types: mobiles, musical, rattles, squeeze & sponge
toys
9-12 months: activity box, balls, blocks, pots & pans
Games: peek-a-boo



MAJOR NEONATAL REFLEXES
REFLEX DESCRIPTION
Rooting Turning the mouth and nose in the direction of any facial
touch
Sucking Using the tongue and mouth to take in liquid or food
Swallowing Movement of throat muscles to push food from mouth to
esophagus
Grasp Firm contraction of hand muscles around an object
Babinski When foot stroked, toes fan upward and outward
Moro When startled, arms and legs swing quickly out, then
immediately back and neonate curls up into a ball
REFLEX DESCRIPTION
Smiling Turning lips upward; neonate looks happy
Blinking Rapid closing and opening of eyelids
Sneezing A violent, spasmodic, sudden expiration of breath
Coughing Explosively expelling air from the lungs
Crying Making a loud, wailing sound
Tonic neck When head is turned to side, arm and leg on same side are
extended in a fencing posture
Extrusion Tongue pushes outward when touched by an object at the
tip
Head turning Moving face to one side or the other when airway is
blocked by a surface such as a bed or pillow
Toileting Practices learning bowel & bladder
control is one of the major tasks of toddler hood.
Uses toileting activities to control self & others.
18 months has bowel control
2 to 3 years has day time bladder control
3 to 4 years has night time bladder control

Limit Setting & Discipline
Help child to learn self-control and socially
appropriate behavior
Discipline should occur immediately after wrongdoing;
be firm and consistent when enforcing limits;
disapprove of the behavior not the child.
Positive approach is best
Common Accidents falls, poisonous ingestion,
burns
and drowning.
PRE-SCHOOLER (3-6 YEARS)
a. Psychosocial development
A period of curiosity, discovery, imaginary fears
and fantasies.
Child learns to do things, derives satisfaction
from activities.
Imitates role models; has active imagination; may
have imaginary friends; has exaggerated fears
b. Physical G & D
Gains 4-5 Ibs/year
Thinner, taller, more erect

Stuttering
Is fairly common among toddlers and pre-schooler.
Parents should ignore stuttering so that the child does
not become anxious.
Sleep
Requires 9 to 12 hours sleep each night.
Sleep problems are most common.
Child may awaken with nightmares and may have
fears of the dark.
Play (cooperative)
Purpose help child to share and play in small
groups; learns simple games & rules, language
concepts & social roles. Play maybe creative,
imitative and dramatic
Types: dolls, dress-up clothes, housekeeping toys,
wagons, tricycle, picture books, jigsaw puzzles,
materials for cutting, pasting and painting.
SCHOOL AGE (6 TO 12 YEARS)
A. Psychosocial Development develops a sense of
competency and esteem academically, physically &
socially; assumes more responsibility. Gains
competency in mastering new skills and tasks.>
More responsive to peers; has best friends; desire for
accomplishment so strong that young school child may try
to change rules of game to win.
School phobias may occur as a result of increase
competition and desire to succeed.
B. Physical G & D
Height: growth is slow & regular (1-2 inch gain in height per
year); Females usually taller than males.
Weight: 3 to 6 Ibs weight gain per year.

ADOLESCENT (12-20 YEARS OLD)
Begins at puberty and ends when
physical maturity is achieved.
It is an essential period in sexual
development and formation of
personality.
Asks, Who am I? What do I want to
do with life?


YOUNG AND MIDDLE ADULTHOOD
Developmental state and function characterized by
self-sufficiency in pursuit or occupation/vocation and
defined interpersonal relationships.
Physical/cognitive
Stabilized growth rate (weight is variable) and
functioning
Refines formal operational abilities
Undergoes menopause
Begins physical degeneration
Psychosocial
Develops self-sufficiency
Pursues vocation/occupation
Has intense interpersonal relationships (most
frequently marriage and children)



LATE ADULTHOOD
Physical / cognitive
Has general slowing of physical and cognitive
functioning
Psychosocial
Needs to establish highest degree of
independence (self-sufficiency) physically
possible by adopting environment to ability.
Reflects on life accomplishments, events and
experiences
Continues interpersonal relationships despite
changes and loss.


Prof.Dr.H.Gusbakti, MSc, PKK,AIFM
Department Physiology
UISU
Physiology of Growth
Each organism starts as a single cell
Process of development and differentiation
Results in mature individual with many trillion cells
The Phenomenon of Growth
Animal growth
Starts with single cell
By birth individual has most of same physical
characteristics as an adult
True growth increase in amount of protein and mineral in
the body
Fat (adipose) and water accumulation not part of true
growth
The Phenomenon of Growth
Wide variation within species
e.g. Clydesdale and Shetland pony are very
different in size
Different parts of body grow at different rates after
birth
Growth and Development of Humans
Early in gestation (period of pregnancy)
Embryo stage
At 2 months 1.5 inches but similar form to adult
Third month called a fetus
Seventh month - ~ 15 inches long and 2 lb
Parturition time of birth 6 to 8 lb, 19 to 21 in
growing very rapidly near birth
Growth and Development of Humans
Childhood rapid growth continues to ~ 2 yr
Starts to level off until growth spurt in adolescence
Growth generally stops by age 18-20
Maximum height generally at ~ age 26
Gradual decrease in height afterward
Due to decrease in cartilage pad thickness

The Cell is the Unit of Growth
Growth results from increase in:
Cell number hyperplasia
Cell size hypertrophy
Hyperplasia results in increase in DNA
Number of cells increases so amount of
chromosomal material increases
Hypertrophy results in increase in protein
From increase in amount of cytoplasm
The Cell is the Unit of Growth
Three different types of cells are found
Permanent cells cease dividing at embryo stage
Stable cells continue to divide during growth but
cease division at adult stage
Labile cells continue to divide and differentiate
throughout life
The Cell is the Unit of Growth
Cell division at maturity
Cell number remains relatively constant
each cell division results in one viable daughter cell and one
daughter cell which is lost
Cancer Cells
Restraints on cell division are largely
removed so uncontrolled growth
Growth and Development of
Muscle, Fat and Bone
Muscle cells form through unique series
of events
Cells which will become muscle cells
(myogenic cells) divide many times until
becoming a myoblast
Myoblasts fuse to form myotubes
Further growth of muscle due to hypertrophy
Growth and Development of
Muscle, Fat and Bone
Fat consists of adipose cells and
connective tissue
Adipocyte mature adipose cell
Adipocyte results from maturation of
immature cell called adipoblast.
Fat tissue increases and decreases by
changing size of adipocytes
Growth and Development of
Muscle, Fat and Bone
Two types of fat tissue
White fat most fat in mature individuals
depot of stored energy
Brown fat found in newborn animals or
hibernating animals
very active and helpful in maintaining body temperature (very
important in newborns)
Growth and Development of
Muscle, Fat and Bone
Bone - ~50% mineral: 50% organic material and
water
Bone formed by interaction of three cell types
Chondrocytes cells that produce cartilage
Osteoblasts produce bone collagen
Osteoclasts break down bone during resorption
Bones grow by ossification at the epiphysial plate
Bones stop growing when completely ossified
Periods of Growth
Growth generally divided into two periods:
Prenatal prior to birth
Post natal after birth
Prenatal Growth
Between fertilization and birth
Fertilization union of sperm and egg
Single cell diploid number of chromosomes
Two complete sets of chromosomes
One set of chromosomes from each parent
Fertilized egg begins to divide
Rate varies widely among species
Prenatal Growth
Differentiation into various structures and
organs begins early in pregnancy
Morphogenesis (organogenesis)
Organization of cells into specialized organs

Prenatal Growth
Size of off spring at birth
Controlled by genes supplied by both parents
Also controlled heavily by uterine
environment
small mothers will have small offspring even if genes from sire
would promote large birth weight
Postnatal Growth
Growth follows a sigmoid (S-shaped) curve in
virtually every animal and plant species
Growth very rapid to about 1/3 to 1/2 of mature
weight
Starts to level off until mature size is reached

Hormonal Control of Growth
Many hormones involved in growth
regulation
Growth hormone (GH) (somatotropin)
Secreted by anterior pituitary
Protein hormone
Removal of pituitary causes growth to stop
injection of pituitary extracts will cause growth to resume
Hormonal Control of Growth
Growth hormone (GH) (somatotropin)
Acromegaly caused by excess growth
hormone
head, hands and feet enlarged
GH promotes protein accretion
GH reduces amount of fat stored in body

Gigantism
Definition
Increased GH before
epiphyses closed
Etiology
Hyperplasia of anterior
pituitary
Increase in number of
cells
Can become a tumor

Gigantism
Clinical
manifestations
Onset
Infants / children
> 8 feet
Proportional
overall growth
Do not have
strength that size
implies

Gigantism
Medical treatment
Irradiation of
anterior pituitary
Removal of pit via
surgery
Gigantism
High Risk for:
Heart failure
Hypertension
Thickened bones
Osteoporosis
Delayed sexual
development
Gigantism
Pharmacology
IF pituitary is
destroyed or
removed
Replace pituitary
hormones
Gigantism
Nursing interventions
Listen
Growth chart
measurements
Long beds
Hyperpituitarism
Growth hormone
Increased
production
Affects
Depends on age
Epiphyses
Epiphyses closed
(adult)
Acromegaly
Acromegaly
Definition
Increased GH after
epiphyses have
closed
Etiology
30-50 yrs
Hyperplasia
Tumor
Acromegaly
Clinical S&S
Hypertrophy
Increase in volume of
tissue d/t enlargement
of existing cells
hulking
Enlarge jaw
Thick tongue
Tufted
Thick fingers with tips
like arrowheads



Acromegaly
S&S
Moist, weak,
doughy handshake
Heart, liver spleen
enlarged
Diaphoresis
Oily, leathery skin
Laryngeal
hypertrophy
Acromegaly
S&S
Heat intolerance
Weight gain
Joint pain
Hirsutism
Excessive hairiness
Decreased libido
Impotence
Oligomenorrhea
Infertility
Acromegaly: Medical Tx
Diagnosis
Hx
S&S
X-ray
CT scan
Lab
h GH
Acromegaly: Medical Tx
Prognosis
?? Cause
i Life span
DM ???
GH
h Glucose levels
h Insulin
Stress pancreas
DM type 2


Acromegaly: Medical Tx
options
Radiation
Medication
Surgery
Transsphenoid
hypophysectomy
Post-op care
Nasal packing
Check for drainage
S&S infection
Nuchal rigidity
Pain control
NO
Coughing
Straining
Voming
Sneezing
Transsphenoid
hypophysectomy
Post-op care
Incentive
spirometer
No brush teeth x
2wks
No lifting x 3
months
Acromegaly: Rx
Bromocriptine
mesylate (Parlodel)
Action
Inhibits GH (and
prolactin)
Nrs considerations
Give c food
S/E
Drowsiness
Stim. ovulation

Acromegaly: Nrs interventions
HX
S&S
Glucose
Gait changes
Vital sign changes
Jaw changes
disphagia
Small group questions
Its your turn!
Hormonal Control of Growth
Thyroid hormone
Mostly thyroxine, some triiodothyronine
Controlled by TSH (thyroid stimulating
hormone)
Deficiency disrupts metabolism, development
and growth

Hormonal Control of Growth
Thyroid hormone
Hypothyroidism low thyroid activity
Reduced intake
Low blood sugar
Lower liver glycogen storage
Lower nitrogen retention
Increased fat deposition

Hormonal Control of Growth
Thyroid hormone
Hyperthyroidism increased thyroid activity
Increased metabolic rate
Muscle catabolism (breakdown)


Hormonal Control of Growth
Androgens
Male hormones
Stimulate growth
Castration (removal of testes)
slows growth, accelerates fattening process
Anabolic steroids
synthetic hormones with growth promoting effects
Hormonal Control of Growth
Androgens
Anabolic steroids
used in beef industry
implanted into ear
~90% of all feedlot cattle are implanted
regulated by FDA kept at safe levels
currently banned by European Union
Hormonal Control of Growth
Estrogens
Produced by ovary
Increased with onset of puberty
Aid in regression and closure of plate of long
bones (explains why girls generally stop
growing after puberty)
Hormonal Control of Growth
Insulin
Protein hormone secreted by pancreas
Stimulates growth synthesis of RNA and protein
Glucocorticoids
Produced by adrenal glands
Inhibitors of growth
Cortisol decreases synthesis of DNA and protein
Nutrition and Growth
Nutrients must by obtained by
consumption
Effect of underfeeding
Depends on:
age at which underfeeding occurs
length of underfeeding period
type of deficiency (energy, vitamin etc)
Recovery from underfeeding
Rapid (compensatory) growth
Heredity Mechanisms in Growth
Growth influenced by:
Genetics
Environment
Generally 20 to 40% of variation in growth
due to genetics

Heredity Mechanisms in Growth
Prenatal Growth
If a genetic potential for large birth weight
may be inhibited by several factors
e.g. piglets from large litters may have diminished birth weight

Heredity Mechanisms in Growth
Growth from birth to weaning
Affected by genetic makeup of offspring
Affected by maternal environment
care of offspring
milk production


Heredity Mechanisms in Growth
Postweaning growth
Maternal influence lessens
Selection projects have demonstrated genetic
influence on postweaning growth
Late maturing animals generally leaner at
market weight
Early maturing animals generally fatter at
market weight
Genetic Control of Growth Mechanisms
Growth is heritable
Elements of growth also heritable
Nutrient requirements
Hormonal control
Metabolic rate
Association between
Growth and Other Traits
Metabolic rate not directly related to
weight
Brody doubling body weight increases
metabolic rate ~ 73 %
Basal metabolism varies to .73 power (W
.73
)

Senescence (Aging)
Less important in farm animals than
humans
Farm animals generally culled for
production reasons prior to old age
Performance usually peaks at some
middle age
Senescence (Aging)
Some thought that life span related to total
calorie expense per kilogram adult body
size during life
Value is similar among many species (but not
humans)
Rate of decline in velocity of growth with
increasing age is generally inversely
proportional to the length of life
Some Hypotheses about Aging
Genetic hypotheses
Accumulation of mutations causes organ
degeneration
Telomeres (ends of chromosomes) become
shorter at each cell division
Shorter telomeres ultimately stop cell
division
Some Hypotheses about Aging
Immunological hypothesis
Gradual loss of ability to form antibodies
Increases susceptibility to some infectious diseases

Developmental hypothesis
Aging results from over-differentiation (extreme
cellular specialization)
Some Hypotheses about Aging
Biochemical hypotheses
Rare, irreparable non-genetic metabolic
accidents occur
products accumulate in cells to interfere with metabolism
Some Hypotheses about Aging
Biochemical hypotheses
Free radical theory
lipids in cell membrane exposed to free radicals, leading to
unstable cells
Glycosylation theory
results in a deterioration of organ function
Human Growth & Development
from womb to tomb


It is not the strongest of the species
that survive, nor the most

intelligent, but the one most
responsive to change.
Charles Darwin
Why Learn about Human Growth
and Development
Principles of Human Growth and Development
Growth in an Organism is that
structural change which increases its
level of functioning in specific ways,
although the potential for some
different but related function may be
concomitantly decreased.

As child learns language, use of baby
talk declines.

Areas of Development
The most observable of the
developmental processes is that of
physical development. Beginning in
utero on conception and is
influenced by the environment
provided by the mother.
Approx 2,50,000 babies are born in
US every year with birth defects
most being preventable defects.
Areas of Development
(The Birthing Process)
Bonding
The forming of the attachment with
another person, can begin immediately
after birth, forming the bases of a lifetime
relationship. Skin contact, cuddling,
touching, stroking, eye contact, and
talking are all functions of the bonding
practice.
Greater the length of time involved in the
bonding process, greater the chances for
a strong, positive, trusting relationship in
the future.
Its applicable to both father and the
mother.
Early Childhood (0 to 5 years)
The foundation for all of the childs future growth &
learning becomes well established at this time.
Will attain half of their future height by age 2+.
By age 4, childs IQ will be stable enough to predict
the IQ at age 17.
By age 5, the child has 75% of their ultimate brain
weight and 90% of it by age 6.
At 5 the child is energetic, active and uses the
large muscles fairly well.
Age 6 to 12, physical growth slows down
considerably, bodily proportions continue to
change, large muscle development continues and
greater small muscle refinement.
Adolescence
Adolescence, from a purely physical
sense, begins with the prepubertal growth
spurt and ends with the attainment of full
physical maturity.
Skeletal growth is complete, total height
being attained, and upper limits of
genetic potential for endocrine
development have been reached.
Adolescents have both the pleasure and
the pain of being the direct observers of
the entire process.
Intelligence
So what are you
the Left or the Right
To Here . And Beyond
Problems in Genetic Instruction
Genetic disorders result in major physical problems and/or mental
retardation
Chromosome abnormalities uneven division of chromosomes during
meiosis
1 in 150 births may result in:
An extra chromosome
A missing chromosome
A wrongly formed chromosome
Single-gene defects - inherited from one or both parents

Common chromosomal and genetic disorders include :
Down Syndrome extra 21
st
chromosome
Klinefelter Syndrome boys only; XXY
Turner Syndrome girls only; X chromosome, missing second
Hungington Disease (HD)
Phenylketonuria (PKU)
Sickle Cell Disease
Cystic Fibrosis (CF)

Period of the Embryo (week 2 - 8)
Major body structures and life support are formed
Placenta grows - forms umbilical cord
Provides food, liquid, oxygen
Removes waste
Secretes hormones to sustain embryonic growth
Embryo develops
Head and heart
From top to bottom (head first, feet last)
From inside to outside (torso before limbs, arms and legs before
hands and feet)
Neural tube (eventual brain and spinal cord) forms
Internal organs appear
Buds and limbs develop
Fingers and toes are recognizable at 8 weeks

Period of the Fetus (week 9 to birth)
Grows in size and weight, sensory abilities, brain
structures and organs needed for survival

Third month
Head is large, slows growth
Eyes move into place; increasingly human-looking
Genitalia form
Reflex and muscular movement (although not felt)
Four month
Rapid growth in length (height)
Slow weight increase
Hair growth on head and eyebrows
Fifth month
Rapid growth in length (height) continues
Fine hair growth covers body
Movement is felt by mother
Sixth month (avg. weight 1 lb. 13 oz.)
Skin is red and wrinkled; body is lean; fingernails are evident
Development of respiratory and central nervous system continues
Seventh month (avg. weight 2 lb. 14 oz.)
Eyes open; eyelashes and toenails form
Body fills out
Eighth month (avg. weight 4 lb. 10 oz.)
Skin becomes pink and smooth; fat growths beneath skin
Testes descend (in males)
Sensitive Periods in Prenatal
Development
Examples of Risk Factors for
Healthy Neurological Development
T HANKS F OR
L I ST ENI NG