GROWTH AND DEVELOPMENT Part 2

1. GROWTH AND DEVELOPMENT Part 2

2. Millenium Development Goals

3. http://nursethechild.weebly.com/

4. Specific Objectives: By the end of this lecture, the student will be able to: • Identify the importance of growth and development. • Define growth and development. • Mention the principles of growth and development. • List factors affecting growth and development. • Mention types of growth and development. • Identify the stages of development.

5. 10 to 19 Year Old

6. Adolescent age • Physical growth • Physiological growth • Secondary sex characteristics • Cognitive development • Emotional development • Social development

7. Definition of adolescent: Adolescence is a transition period from childhood to adulthood. Its is based on childhood experiences and accomplishments. It begins with the appearance of secondary sex characteristics and ends when somatic growth is completed and the individual is psychological mature.

8. Physical growth: Weight: • Growth spurt begins earlier in girls (10–14 years, while it is 12–16 in boys). • Males gains 7 to 30kg, while female gains 7 to 25kg. Height: • By the age of 13, the adolescent triples his birth length. • Males gains 10 to 30cm in height. • Females gains less height than males as they gain 5 to 20cm. • Growth in height ceases at 16 or 17 years in females and 18 to 20in males

9. Physiological growth: Pulse: Reaches adult value 60–80 beats/min. Respiration: 16–20C/minute. NB: The sebaceous glands of face, neck and chest become more active. When their secretion accumulates under the skin in face, acne will appear.

10. Appearance of secondary sex characteristics 1- Secondary sex characteristics in girls: • Increase in transverse diameter of the pelvis. • Development of the breasts. • Change in the vaginal secretions. • Growth of pubic and axillary hair. • Menstruation (first menstruation is called menarche, which occurs between 12 to 13 years).

11. Body image

12. 2- Secondary sex characteristics in boys: • Increase in size of genitalia. • Swelling of the breast. • Growth of pubic, axillary, facial and chest hair. • Change in voice. • Rapid growth of shoulder breadth. • Production of spermatozoa (which is sign of puberty).

13. Adolescent • As teenagers gain independence they begin to challenge values • Critical of adult authority • Relies on peer relationship • Mood swings especially in early adolescents

14. Cognitive development: Through formal operational thinking, adolescent can deal with a problem. Emotional development: This period is accompanied usually by changes in emotional control. Adolescent exhibits alternating and recurrent episodes of disturbed behavior with periods of quite one. He may become hostile or ready to fight, complain or resist every thing. Social development: He needs to know "who he is" in relation to family and society, i.e., he develops a sense of identity. If the adolescent is unable to formulate a satisfactory identity from the multi-identifications, sense of self-confusion will be developed according to Erikson:- Adolescent shows interest in other sex. He looks for close friendships.

15. Adolescent behavioral problems • Anorexia • Attention deficit • Anger issues • Suicide

16. Adolescent Teaching • Relationships • Sexuality – STD’s / AIDS • Substance use and abuse • Gang activity • Driving • Access to weapons

17. "Adolescence"

18. Adolescence • is derived from the Latin word adolescere, which brings the meaning of “to grow in maturity” or “to grow into adulthood” • period of self-examination and emerging identity that spans the second decade, during which individual changes from being “childlike to adultlike” • The physiologic period between the beginning of puberty & cessation of bodily growth • the life stage that bridges childhood and adulthood

19. What makes adolescence different from childhood and being an adult? • Phase of rapid physical, psychological, emotional development • A time of new opportunities, new capacities, new experiences and new challenges • Changing roles, responsibilities, influences and expectations: moving towards family formation, economic security, citizenship

20. Classification • Adolescence : 10 – 19 years • Early Adolescence : 10 – 13 years • Middle adolescence : 14 – 16 years • Late adolescence : 17 – 19 years • Youth : 15 – 24 years • Young people :10 - 24 years

21. Characteristics of Early Adolescence • Preoccupation with body changes in search for identity • Minor parental conflicts and rebellion common • Peers are usually same sex and age, peer acceptance paramount • Concrete cognition • Beginning to seek independence • Limited dating

22. Characteristics of Early Adolescence • Limited ability to imagine the consequences of risky behavior • Limited ability to link cause and effect in regard to health behavior (eg, smoking, reckless driving, overeating) • Attachment to non-parental adults is common

23. Early Adolescence • Very moody • Very sensitive to their changing body and often measure their physical appearance and skills against idealized images. • Curiosity about sexual matters begins. • Young teens would much rather be with their friends than their family, especially their parents. • Realizes parents are not perfect and often points out their faults.

24. Early Adolescence • Searches for new adults to confide in instead of parents. • They often need a “hero” or an adult to look up today. • Young adolescents may be quick to disagree with parents and take the opposite view on an issue to test parental values. • Quick to demonstrate feel through behavior (acting-out). They become frustrated and anxious because of lack of experience and inability to cope with certain events and problems

25. Characteristics of Middle Adolescence • 14-18 years of age • Peer group remains very important for social and behavioral norms • Dating a major activity • Conflicts with parents, emancipation issues become dominant themes • Beginning of abstract cognition • Feelings of omnipotence and invincibility

26. Characteristics of Middle Adolescence • Pubescence almost complete • Risk-taking behaviors, rebellion, and impulsiveness are necessary as part of achieving independence • Rejection of authority and risk-taking tendencies may include rejection of medical advice and treatment previously accepted

27. Middle Adolescence • The majority of changes associated with puberty have taken place • Tenderness is shown toward the opposite sex with frequently changing relationships. • they often write down their inner thoughts and feelings in a diary. • Complains that parents interfere with their independence. • Teens during this stage experience the most conflict with their parents.

28. Middle Adolescence • Most teens this age still feel invincible and that nothing bad could possibly happen to them. This will cause them to engage in high risk behaviors. Experimentation with alcohol, cigarettes, marijuana, and sexual intercourse increases sharply during this stage.

29. Characteristics of Late Adolescence • 17-23 years of age (or older) • Emancipation complete, parent-child relationship is adult to adult • Peer group superseded by strong individual relationships • Intimacy with commitment rather than exploration • Planning for the future • Self-identity established

30. Characteristics of Late Adolescence • Understands consequences of actions and risk-taking behavior • Age does not equate to stage

31. Late Adolescence • Physiological development is generally complete. • Greater emotional stability. • Develops clear sexual identity. • Is very concerned about serious relationships and develops the capacity for tender and sensual love. • Young adult will start to listen to parents advice again. They may even seek out their parents opinion as parents accept adolescent as a young adult.

32. Late Adolescence • Teens this age begin to realize their mortality and begin to worry about the future. • Has greater ability to express ideas rather than acting out. Their value system is also changing. Often idealistic. Causes are embraced with conviction. Peer-group relationships are replaced by individual friendships.

33. aSSessMent

34. Adolescent Growth and Development Physiology of Pubescence (Puberty) • The term puberty refers to the physical changes that occur in a growing girl or boy during the transition from childhood to adulthood • Puberty is the period in which an individual first becomes capable of reproduction - Pubescence is a dynamic process that can take 2.5 to 5 years to complete

35. - GnRH stimulates production of LH and FSH, which stimulates the ovaries and testes to make estrogen and testosterone - Bone age (skeletal maturity) may be disparate by as much as two years from chronological age and still be normal - Individuals who begin growth spurt early are initially taller than peers,but they will ultimately be relatively shorter than those who begin their growth spurt later

36. Five chief physical manifestations of Puberty 1. Rapid acceleration in growth - w/c results in dramatic increase in height and weight 2. Development of Primary sexual characteristics - includes further development of gonads or sex glands - gonads: testes- in males ovaries – in females 3. Development in secondary sex characteristics - involves changes in the genitals & breasts, the growth of pubic, facial & body hair & further development of the sex organs 4. Changes in body composition -refers specifically to the quantity & distribution of fat & muscles 5. Changes in circulatory & respiratory systems -w/c leads to an increase in strength & tolerance to exercise

37. I. Physical Growth & Development • - The first sign of pubescence in males in usually testicular enlargement (normal age of onset is 11.5 years with a range of 9-14 years) • - The first sign of pubescence in females is usually breast bud formation (normal age of onset has a range of 8-14 years) • Most girls are 1 to 2 inches taller than boys coming into adolescence and generally stop growing three years post menarche • Boys grow about 4 to 12 inches on height and gain 15 to 65 lbs during adolescence • Girls grow 2 to 8 inches in height and gain 15 to 55 lbs.

38. Growth stops with closure of the epiphyseal lines of long bones- this occurs at about 16 or 17 years in females and about 18 to 20 years of age in males • Increase in body size does not occur in all organ at the same rate • Because the heart and lungs increase in size more slowly than the rest if the body, blood flow and oxygen availability are reduced. Thus adolescents may have insufficient energy and become more fatigued trying to do various activities that interest them

39. Androgen stimulates sebaceous glands to extreme activity, sometimes resulting in acne, a common adolescent skin problem • Apocrine sweat glands form shortly after puberty which produces a strong odor in response to emotional stimulation. Therefore, adolescents begin to notice they must shower or bathe more frequently than they once did in order to be free from body odor.

40. Secondary Sexual Characteristics • Males - testicular growth, pubarche, penile growth, peak height velocity • Females - breast budding, pubarche, peak height velocity, menarche • Menarche usually occurs around 2 years after thelarche • The height of girls will rarely increase more than two inches after menarche

41. Tanner Staging of Breasts Stage I (Preadolescent) – Only the papilla is elevated abovethe level of the chest wall. • Stage II - (Breast Budding) – Elevation of the breasts and papillae may occur as small mounds along with some increased diameter of the areolae. • Stage III - The breasts and areolae continue to enlarge, although they show no separation of contour. Stage I Preadolescent Stage II Breast Budding Stage III Continued Enlargement

42. Stage IV – The areolae and papillae elevate above the level of the breasts and form secondary mounds with furtherdevelopment of the overall breast tissue. • Stage V – Mature female breasts have developed. The papillae may extend slightly above the contour of the breasts as the result of the recession of the aerolae. Stage IV Areola and papilla form secondary mound Stage v. Mature female breasts

43. Gynecomastia • Breast enlargement in males • Gynecomastia occurs very commonly in pubertal males. • Pubertal gynecomastia can be asymmetric and not indicate pathology. • Gynecomastia can cause a change in dressing habits and physical activity. • Usually resolves in 1 to 2 years, and it rarely needs plastic surgery for correction.

44. Stages of Pubic Hair Development Pubic hair growth in females is staged as follows: Stage I (Preadolescent) - Vellos hair develops over the pubis in a manner not greater than that over the anterior wall. There is no sexual hair. Stage II - Sparse, long, pigmented, downy hair, which is straight or only slightly curled, appears. These hairs are seen mainly along the labia. I Preadolescent no sexual hair II Sparse, pigmented, long, straight, mainly along labia

45. Stage III • Considerably darker, coarser, and curlier sexual hair appears. The hair has now spread sparsely over the junction of the pubis. • Stage IV • - The hair distribution is adult in type but decreased in total quantity. There is no spread to the medial surface of the thighs. • Stage V • - Hair is adult in quantity and type and appears to have an inverse triangle of the classically feminine type. There is spread to the medial surface of the thighs but not above the base of the • inverse triangle. III Darker, coarser, curlier IV Adult, but decreased distribution V Adult in quantity and type with spread to medial thighs

46. The stages in male pubic hair development are as follows : • Stage I (Preadolescent) - Vellos hair appears over the pubes with a degree of development similar to that over the abdominal wall. There is no androgen-sensitive pubic hair. • Stage II - There is sparse development of long pigmented downy hair, which is only slightly curled or straight. The hair is seen chiefly at the base of penis. This stage may be difficult to evaluate on a photograph, especially if the subject has fair hair. • Stage III - The pubic hair is considerably darker, coarser, and curlier. The distribution is now spread over the junction of the pubes, and at this point that hair may be recognized easily on black and white photographs. I Preadolescent no sexual hair II Sparse, pigmented, long, straight, mainly along base of penis III Darker, coarser, curlier

47. Stage IV - The hair distribution is now adult in type but still is considerably less that seen in adults. There is no spread to the medial surface of the thighs. • Stage V - Hair distribution is adult in quantity and type and is described in the inverse triangle. There can be spread to the medial surface of the thighs. IV Adult, but decreased distribution V Adult in quantity and type with spread to medial thighs

48. Stages of Testicular Development Stage I (Preadolescent - The testes, scrotal sac, and penis have a size and proportion similar to those seen in early childhood, < 4 mL volume Stage II • There is enlargement of the scrotum and testes and a change in the texture of the scrotal skin. The scrotal skin may also be reddened, a finding not too obvious when viewed on a black and white photograph. 4 to 6 mL Volume I Preadolescent II Enlargement, change in texture

49. Stage III • Further growth of the penis has occurred, initially in length, although with some increase in circumference. There also is increased growth of the testes and scrotum. 8 to 10 mL volume • • Stage IV • - The penis is significantly enlarged in length and circumference, with further development of the glans penis. The testes and scrotum • continue to enlarge, and there is distinct darkening of the scrotal skin. This is difficult to evaluate on a black-and-white photograph. 10 to 15 mL volume • • Stage V • - The genitalia are adult with regard to size and shape. 15 to 25 mL volume III Growth in length and circumference IV Further development of glans penis, darkening of scrotal skin V Adult genitalia

50. II. DEVELOPMENT OF SEXUAL MATURITY • The onset of sexual maturation (puberty) typically is accompanied by an interest in sexual anatomy, which may be a source of anxiety. • As adolescents mature emotionally and sexually, they may begin to engage in sexual behaviors. • Masturbationis common among girls and nearly universal among boys. • Sexual experimentation • - often begins as touching or petting and may progress to oral, vaginal, or anal sex. • - By late adolescence, sexuality shifts from experimentation to being an expression of intimacy and sharing.