develop growth new 09

8/11/2019 Develop Growth New 09

1/92

Physiology Child Growth

and DevelopmentProf.Dr. H.Gusbakti, MSc,PKK,AIFM


2/92


3/92

FACTORS INFLUENCING G& D

Heredity

Life Experiences

Health Status

Cultural Expectations


4/92

The Healthy Child: Stages of G & D

INFANT (1 month to 1year)

A. Psychosocial

Development

Depends on the

quality ofrelationship b/w

caregiver and infant.

If needs are met

consistently, itresults in feelings of

physical comfort and

emotional security.

Infants to love andbe loved.


5/92

INFANT (1 month to 1year)

B. Physical Growth and Developmentthere israpid gain in physical size & maturation. Length grows 20 inches at birth; 30 inches at 1

year (50% increase by 1 year): grows 1 inch everymonth for 6 months, then inch every month duringthe last 6 months.

Weightgains 1 Ibs/month; doubles body weightby 5-6 months; triples body weight by 1 year.

Head Circum ferenceHC is greater than chestcircumference until age 2.

Vital SignsPR=80-150/min (ave=100/min); RR=20-50/min


6/92


7/92

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


8/92

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 postureExtrusion 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


9/92

Toileting Practiceslearning bowel & bladdercontrol is one of the major tasks of toddler hood.

Uses toileting activities to control self & others. 18 monthshas bowel control

2 to 3 yearshas day time bladder control

3 to 4 yearshas 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 Accidentsfalls, poisonous ingestion,burns

and drowning.


10/92


11/92

Stuttering Is fairly common among toddlers and pre-schooler.

Parents should ignore stuttering so that the child doesnot become anxious.

Sleep Requires 9 to 12 hours sleep each night.

Sleep problems are most common.

Child may awaken with nightmares and may havefears of the dark.

Play (cooperative) Purposehelp child to share and play in small

groups; learns simple games & rules, languageconcepts & 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.


12/92

SCHOOL AGE (6 TO 12 YEARS)A. Psychosocial Developmentdevelops a sense ofcompetency and esteem academically, physically &socially; assumes more responsibility. Gainscompetency in mastering new skills and tasks.>

More responsive to peers; has best friends; desire foraccomplishment so strong that young school child may tryto change rules of game to win.

School phobiasmay occur as a result of increasecompetition 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.


13/92

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?


14/92

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

PsychosocialDevelops self-sufficiency

Pursues vocation/occupation

Has intense interpersonal relationships (most

frequently marriage and children)


15/92

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 andexperiences

Continues interpersonal relationships despite

changes and loss.


16/92

Prof.Dr.H.Gusbakti, MSc, PKK,AIFM

Department Physiology

UISU


17/92

Physiology of Growth

Each organism starts as a single cell

Process of development and differentiation Results in mature individual with many trillion cells


18/92

The Phenomenon of Growth

Animal growth

Starts with single cell

By birthindividual has most of same physical

characteristics as an adult True growthincrease in amount of protein and mineral in

the body

Fat (adipose) and water accumulation not part of true

growth


19/92

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


20/92

Growth and Development of Humans

Early in gestation (period of pregnancy)

Embryo stage

At 2 months1.5 inches but similar form to adult Third monthcalled a fetus

Seventh month - ~ 15 inches long and 2 lb

Parturitiontime of birth6 to 8 lb, 19 to 21 in

growing very rapidly near birth

G f


21/92

Growth and Development of Humans

Childhoodrapid 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


22/92

The Cell is the Unit of Growth

Growth results from increase in:

Cell numberhyperplasia

Cell sizehypertrophy

Hyperplasiaresults in increase in DNA

Number of cells increases so amount of

chromosomal material increases

Hypertrophyresults in increase in protein

From increase in amount of cytoplasm


23/92


Three different types of cells are found

Permanent cellscease dividing at embryo stage

Stable cellscontinue to divide during growth but

cease division at adult stage

Labile cellscontinue to divide and differentiate

throughout life


24/92


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


25/92

Growth and Development of

Muscle, Fat and Bone

Muscle cellsform 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


26/92



Fatconsists of adipose cells and

connective tissue

Adipocytemature adipose cell

Adipocyteresults from maturation of

immature cell called adipoblast.

Fat tissue increases and decreases by

changing size of adipocytes


27/92



Two types of fat tissue

White fatmost fat in mature individuals

depot of stored energy

Brown fatfound in newborn animals or

hibernating animals very active and helpful in maintaining body temperature (very

important in newborns)

G th d D l t f


28/92



Bone - ~50% mineral: 50% organic material and

water

Bone formed by interaction of three cell types

Chondrocytescells that produce cartilage

Osteoblastsproduce bone collagen

Osteoclastsbreak down bone during resorption

Bones grow by ossification at the epiphysial plate

Bones stop growing when completely ossified


29/92

Periods of Growth

Growth generally divided into two periods:

Prenatalprior to birth

Post natalafter birth


30/92

Prenatal Growth

Between fertilization and birth

Fertilizationunion of sperm and egg

Single celldiploid 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


31/92

Prenatal Growth

Differentiation into various structures and

organs begins early in pregnancy

Morphogenesis (organogenesis)

Organization of cells into specialized organs


32/92

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


33/92

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


34/92

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


35/92


Growth hormone (GH) (somatotropin)

Acromegalycaused by excess growth

hormone head, hands and feet enlarged

GH promotes protein accretion

GH reduces amount of fat stored in body


36/92

Gigantism

Definition

Increased GH before

epiphyses closed

Etiology

Hyperplasia of anterior

pituitary

Increase in number of

cells

Can become a tumor


37/92


38/92

Gigantism

Medical treatment

Irradiation of

anterior pituitary

Removal of pit viasurgery


39/92

Gigantism

High Risk for:

Heart failure

Hypertension

Thickened bones Osteoporosis

Delayed sexual

development


40/92

Gigantism

Pharmacology

IF pituitary is

destroyed or

removed Replace pituitary

hormones


41/92

Gigantism

Nursing interventions

Listen

Growth chart

measurements Long beds


42/92

Hyperpituitarism

Growth hormone

Increased

production

Affects Depends on age

Epiphyses

Epiphyses closed(adult)

Acromegaly


43/92

Acromegaly

Definition

Increased GH after

epiphyses have

closed Etiology

30-50 yrs

Hyperplasia

Tumor


44/92

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


45/92

Acromegaly

S&S

Moist, weak,

doughy handshake

Heart, liver spleenenlarged

Diaphoresis

Oily, leathery skin

Laryngeal

hypertrophy


46/92


47/92

Acromegaly: Medical Tx

Diagnosis

Hx

S&S

X-ray CT scan

Lab

hGH


48/92


Prognosis

?? Cause

i Life span

DM ??? GH

h Glucose levels

hInsulin

Stress pancreas

DM type 2



49/92


options

Radiation

Medication

Surgery

Transsphenoid


50/92

Transsphenoid

hypophysectomy

Post-op care

Nasal packing

Check for drainage

S&S infection

Nuchal rigidity

Pain control

NO

Coughing

Straining

Voming

Sneezing

Transsphenoid


51/92

Transsphenoid

hypophysectomy

Post-op care

Incentive

spirometer

No brush teeth x2wks

No lifting x 3

months


52/92

Acromegaly: Rx

Bromocriptinemesylate (Parlodel)

Action

Inhibits GH (andprolactin)

Nrs considerations

Give c food

S/E Drowsiness

Stim. ovulation


53/92

Acromegaly: Nrs interventions

HX

S&S

Glucose

Gait changes

Vital sign changes

Jaw changes

disphagia


54/92

Small group questions

Its your turn!


55/92


Thyroid hormone

Mostly thyroxine, some triiodothyronine

Controlled by TSH (thyroid stimulatinghormone)

Deficiency disrupts metabolism, development

and growth

H l C t l f G th


56/92


Thyroid hormone

Hypothyroidismlow thyroid activity

Reduced intake

Low blood sugar

Lower liver glycogen storage

Lower nitrogen retention

Increased fat deposition


57/92


Thyroid hormone

Hyperthyroidismincreased thyroid activity

Increased metabolic rate

Muscle catabolism (breakdown)

H l C t l f G th


58/92


Androgens

Male hormones

Stimulate growth

Castration (removal of testes)

slows growth, accelerates fattening process

Anabolic steroids synthetic hormones with growth promoting effects


59/92


Androgens

Anabolic steroids

used in beef industry

implanted into ear

~90% of all feedlot cattle are implanted

regulated by FDAkept at safe levels

currently banned by European Union


60/92


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)


61/92


Insulin

Protein hormonesecreted by pancreas

Stimulates growthsynthesis of RNA and protein Glucocorticoids

Produced by adrenal glands

Inhibitors of growth

Cortisoldecreases synthesis of DNA and protein

Nutrition and Growth


62/92

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


63/92

Heredity Mechanisms in Growth

Growth influenced by:

Genetics

Environment

Generally 20 to 40% of variation in growth

due to genetics


64/92


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


65/92


Growth from birth to weaning

Affected by genetic makeup of offspring

Affected by maternal environment care of offspring

milk production

H dit M h i i G th


66/92


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


67/92

Genetic Control of Growth Mechanisms

Growth is heritable

Elements of growth also heritable

Nutrient requirements

Hormonal control

Metabolic rate

Association between


68/92

Association between

Growth and Other Traits

Metabolic rate not directly related to

weight

Brodydoubling body weight increases

metabolic rate ~ 73 %

Basal metabolism varies to .73 power (W.73)


69/92

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


70/92


71/92

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

S H th b t A i


72/92


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)


73/92


Biochemical hypotheses

Rare, irreparable non-genetic metabolic

accidents occur

products accumulate in cells to interfere with metabolism

S H th b t A i


74/92


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


75/92

from womb to tomb

It is not the strongest of the species


76/92

that survive, nor the most

intelligent, but the one most

responsive to change.

Charles Darwin

Why Learn about Human Growth


77/92

Why Learn about Human Growth

and Development


78/92

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.


79/92

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 inUS every year with birth defects

most being preventable defects.



80/92


(The Birthing Process)


81/92

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 thebonding process, greater the chances for

a strong, positive, trusting relationship in

the future.

Its applicable to both fatherand the

mother.

E l Childh d (0 )


82/92

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 predictthe 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.

Ad l


83/92

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.

I t lli


84/92

Intelligence

So what are you


85/92

So what are youthe Left or the Right

T H A d B d


86/92

To Here . And Beyond

P bl i G ti I t ti


87/92

Problems in Genetic Instruction

Genetic disorders result in major physical problems and/or mentalretardation Chromosome abnormalitiesuneven 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 Syndromeextra 21stchromosome

Klinefelter Syndromeboys only; XXY

Turner Syndromegirls only; X chromosome, missing second

Hungington Disease (HD)

Phenylketonuria (PKU)

Sickle Cell Disease

Cystic Fibrosis (CF)

Period of the Embryo (week 2 8)


88/92

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 beforehands 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)


89/92

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


90/92

Development

Examples of Risk Factors for


91/92

Healthy Neurological Development

THANKS FOR


92/92

THANKS FOR

L I S T EN I NG

develop growth new 09

Documents