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Changes from birth to adulthood. Physiology: Cognitive Milestones Month 3-5: Attends to and reaches for objects Month 4-8: Pulls string to secure a ring Month 8-15: Imitates patting doll Month 14-20: Finds Hidden Object Month 18-28: Completes simple puzzles.

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slide2

Physiology: Cognitive Milestones

    • Month 3-5: Attends to and reaches for objects
    • Month 4-8: Pulls string to secure a ring
    • Month 8-15: Imitates patting doll
    • Month 14-20: Finds Hidden Object
    • Month 18-28: Completes simple puzzles
slide4

Physiology: Language Milestones

    • Month 1.5-3: Squeals
    • Month 3.5-8: Turns to locate a voice
    • Month 9-13: Says Mama or Dada
    • Month 14-24: Combines two different words
    • Month 21-36: Uses plurals
slide5

Physiology: Fine Motor Milestones

    • Month 2.5-4: Grasps rattle
    • Month 4.5-7: Transfers cube hand to hand
    • Month 8-12: Has neat pincer grasp
    • Month 15-20: Builds tower of four cubes
    • Month 18-24: Imitates vertical line
    • Month 28-36: Copies circle
    • By age 5 years: Draws a square
    • By age 5.5 years: Tripod pencil grasp
    • By age 7 years: Draws diagonal line
    • By age 9: Draws cross with same dimensions
    • By age 12: Draws three dimensional cube
slide6

Physiology: Self Help Milestones

    • Month 4.5-8: Feeds self crackers
    • Month 10-14: Drinks from cup
    • Month 13-19: Removes clothes
    • Month 18-28: Washes and dries hands
    • Month 30-42: Dresses without supervision
    • Attained on average by age 4.5 years
      • Rides a Bicycle with training wheels
      • Cuts paper with scissors
      • Colors inside lines
    • Attained on average by age 5.5 years
      • Ties shoelaces
      • Prints first and last names
    • Attained on average by age 6 years
      • Rides a Bicycle without training wheels
slide7

Physiology: Cognitive Milestones

    • Month 3-5: Attends to and Reaches for objects
    • Month 4-8: Pulls string to secure a ring
    • Month 8-15: Imitates patting doll
    • Month 14-20: Finds Hidden Object
    • Month 18-28: Completes simple puzzles
  • Physiology: Language Milestones
    • Month 1.5-3: Squeals
    • Month 3.5-8: Turns to locate a voice
    • Month 9-13: Says Mama or Dada
    • Month 14-24: Combines two different words
    • Month 21-36: Uses plurals
  • Physiology: Gross Motor Milestones
    • Month 2-4.5: Rolls Over
    • Month 5-8: Sits without support
    • Month 10-14: Stands Alone
    • Month 14-20: Walks up steps
    • Month 21-28: Pedals tricycle
    • Month 30-44: Balances on one foot
    • By age 6: Rhythmic skipping
    • By age 8.5: Alternates foot-hop in place
    • By age 10: Holds tandem stance for 10 sec (eyes closed)
slide8

Physiology: Social and Emotional Milestones

    • Month 1.5-4: Smiles at others
    • Month 4-9: Seeks primary caregiver
    • Month 8-15: Stranger anxiety
    • Month 10-15: Displays 2 or more recognizable emotions
    • Month: 11-20: Exploratory play by self
    • Month 21-36: Cooperative play in small groups
growth in body weight
Growth in Body Weight

http://www.healthforallchildren.co.uk/?SHOP=HFAC4&DO=USERPAGE&PAGE=PLOTCHART

slide15

The characteristic pubertal growth spurt results mainly from the synergetic effect of:

gonadal sex steroids, growth hormone, and IGF-I production, with all showing a significant increase at the time of pubertal growth acceleration.

slide16

Insulin is also important for normal growth. Plasma insulin levels increase throughout childhood, but the rise is particularly pronounced during puberty with a strong positive correlation with IGF-I.

slide17

•Growth hormone-releasing factor (GRF) levels and GH secretion increase considerably during puberty, mainly at night

•The amplitude of GH peaks increases early in puberty IGF-I is an important modulator of growth during childhood and adolescence

•Adrenal androgens seem to have no physiological role in normal growth

slide18

•Puberty of patients with isolated GH deficiency is frequently delayed, Leydig cell function is diminished, and the response to chorionic gonadotropins is decreased

•GH administration can restore testicular responsiveness to LH and Leydig cell steroidogenesis

slide20

Sex steroids promote secondary sex characteristics in peripheral tissues, regulate GnRH neurons via a neuroendocrine feedback loop and facilitate social behaviors by acting on central neural circuits. The pubertal increase in GnRH neuronal activity and episodic gonadotropin secretion is grossly timed by a developmental clock and fine-tuned by the neural integration of multiple permissive internal and external signals. At the onset of puberty, steroid feedback and steroid-independent neural mechanisms are engaged to disinhibit and excite GnRH neurons.

Sisk et al. Nature Neuroscience 2004

slide21

Permissive signals (related to energy balance):

Body fat

Leptin

Insulin

Melatonine

•Peptide hormone

•Regulates food intake and energy expenditure at the hypothalamic level (satiety factor)

•Expressed predominantly in adipocytes

•Regulated by body weight and nutrition

•Involved in the regulation of GnRH secretion

•Permissive factor for puberty (48kg)

•Interacts with insulin, IGF1, GH and glucocorticoids

slide22

After birth the gonadsrespond to stimuli such as:

•LH-in boys up to the age of 6 months

•FSH-in girls up to the age of 12-24 months

slide23

•In prepubertalchildren, no significant luteinizinghormone (LH) or follicle-stimulating hormone (FSH) response to intravenous or subcutaneous administration of GnRH is observed.

•During adolescence, the LH response to GnRH increases progressively in both sexes.

•The increase of FSH is much less marked than that of LH.

•The primary triggering mechanism that initiates the activation of the hypothalamic-pituitary-gonadalaxis at puberty is still hypothetical.

slide24

activation of the hypothalamic-pituitary-gonadalaxis:

•induces and enhances the progressive ovarian and testicular sex hormone secretion

•responsible for the profound biological, morphological, and psychological changes to which the adolescent is subjected

sex steroid production:

•appearance and maintenance of sexual characteristics

•capacity for reproduction

slide25

•In girls, circulating FSH levels increase progressively from 10 to 11 years of age, approximately 1 year prior to those of LH

•Thereafter, gonadotropins continue to increase throughout puberty, but important fluctuations are observed in relation to the menstrual cycle.

slide26

•In boys, a significant increase in both plasma FSH and LH is also found from the onset of puberty, closely linked to the rapid increase in testicular size characteristic of this pubertal stage.

•A further significant increase in circulating gonadotropins is also observed at late puberty

puberty statistics
Puberty statistics

GIRLS BOYS

Beginning of puberty 10.9 years (8.5-13.3) 11.2 years (9.2-14.2)

Growth spurt 12.2 years 13.9 years

Years of puberty 2-3 years 3-5 years

Menarche/

Voice deepening 12.9 years (10-15) 14.6 years (12-17)

physiological changes in puberty

Physiological changes in puberty

http://www.youtube.com/watch?v=2zncsnYFGGQ&feature=channel

slide29

Describe the hormonal changes involved in the growth spurt which is one of the main characteristics of puberty in both girls and boys. (Schematic drawing of a sequence of events is encouraged).