OLFU MED

2012

Pediatrics I
Dra. M. San Pedro
08.13/09.08.09

Temperament: A childs characteristic behavioral

response to internal and external stimuli
Basic Principles of Development 1. Easy, highly adaptable child
Factors of Growth & Development 2. Difficult child
Pre-Natal development
- 1-9 months of development
3. Slow-to-warm-up
Intrauterine Nutrition Psychological: Child-rearing environment, family functioning,
contents

6 Mechanisms of Transplacental transfer attachment and contingency

Adaptive Mechanism of oxygenation Attachment: Tendency of a young child to want to
Uterine Accomodation be near the parent during times of stress
Organ development
- Sensory development
Contingent responsiveness: Reinforcement
- Nervous system depending on the behavior of the other
- Circulatory system Social: Socio-economic status, family system, extended family,
- Respiratory system subculture, culture and society
- Blood
- Immunity
- Lymphatic system
- Digestive system
- Urinary system
- Skeletal system
- Muscular system
- Cutaneous structure

Specific Objectives
To define & differentiate growth & development
To discuss the principles of development and its effects on the
child
To discuss the factors affecting growth and development
To discuss prenatal and organ development
PRENATAL DEVELOPMENT
0-280 days
Growth
An increase in size & mass
Quantitative

Development
An increase in function/skills
Qualitative
More complex & broader
May or may not be interchangeable but actually inseparable
from growth

Basic Principles of Development

1. Development proceeds in an orderly and predictable sequence
-- cephalocaudal direction and proximodistal
2. Development proceeds from general to specific, from the basic
to the more specialized
3. Development depends on maturation and learning, on the
combination of both genetics (nature) and environment
(nurture)
4. Early development is more critical than later development
5. There are developmental domains, within which are
developmental lines leading up to developmental tasks for the
individual
6. Development is progressive and dynamic
7. The rate of development is unique to each individual
8. Development is interactional

Factors of Growth & Development

Biological: Genetics, prenatal factors, postnatal illnesses,
nutrition, environment, physical & neurological maturation

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Intrauterine Nutrition

Trophoblasts, outer layer of blastocyst, precursor cells of

placenta first appear 4 days after fertilization
Placental supply starts 3 weeks after fertilization or 1 A 7.5-day human blastocyst, partially embedded in the endometrial
week after implantation stroma. The trophoblast consists of an inner layer of mononuclear
Primitive umbilical ring end of 5th week after fertilization cytotrophoblast and an outer layer without distinct cell boundaries,
Placental permeability increases - latter part of pregnancy the multinucleated syncytiotrophoblast. The embryoblast is formed
by the ectoderm and endoderm. The amniotic cavity appears as a
small cleft.
Six Mechanisms of Transplacental Transfer
1. Osmosis: Electrolytes transfer by simple diffusion
2. Facilitated Diffusion: Substances transfer through carrier By the 2nd week
system or complexes The embryoblast contains both the ectodermal and the
3. Active Enzymatic Transfer: Molecules transferred against endodermal germ layers with amnion forming
electro-chemical gradient Ectodermal derivatives -- CNS, peripheral NS, epithelium of
4. Destruction: Compounds altered sufficiently destroying their the sensory organs, epidermis including the hair, nails,
physiological activity subcutaneous glands, hypophysis, enamel of the teeth & the
5. Pinocytosis: Whole molecules are engulfed by macrophages epithelial lining of other organs
6. Membrane Leakage: Intact cells like red cells transfer from Endodermal derivatives -- epithelial lining of the RT,
fetus to mother and vice-versa tymphanic membrane, Eustachian tube, part of the bladder &
urethra, parenchyma of the thyroids, tonsils & parathyroids,
Adaptive Mechanisms for Oxygenation thymus, liver, pancreas & the GIT
1. Many times increase in the cardiac output
2. Favorable oxygen dissociation in the fetus
3. Increased oxygen capacity
By the 3rd week
4. High red blood cell count The mesoderm has appeared with primitive neural tube and
5. Capacity to reset to anaerobic metabolism blood vessels, paired heart tubes begin to pump
Mesodermal derivatives -- skeletal system, muscle cells,
dermis & subcutaneous tissues, urinary system, mesothelial
Uterine Accommodation portions of the serous membranes of the peritoneal, pleural &
pericardial cavities, CVS, lymphatic system including the
spleen, gonads & the corresponding ducts & the cortical
portion of the suprarenals

One Month

Phase of Preparation: Proliferation of uterine tissues

*Human Chorionic Gonadotropin (hCG)
*Progesterone Length 0.5 cm & weight 0.02 gm
*Human Chorionic Somatomammotropin (hCS; hPL) Somite formation begins (eventual vertebrae and muscles)
Period of Uterine Enlargement: Hypertrophy of uterine Eyes and ears begin to form
tissues Trachea and lungs begin to form
*Estrogens Intestinal tract, liver & pancreas begin to form
Uterine Stretching: Marked decrease in rate of uterine Yolk sac, site of initial blood cell formation is completely
growth during rapid enlargement of the product of formed
conception There is allantois, the primitive excretory duct, as
component of the developing umbilical cord
Limbs begin to form

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 Three Months
One month
Fetal Stage

Fetal length 7.8 cm & weight 26 gm

Epidermal layers begin; hair matrix, sebaceous & apocrine
glands can be identified
Muscles develop & cartilage changing to bone
Two Months All major organs completed & beginning to function
Fetus swallows amniotic fluid, digests & urinates it
Sex organs develop & can be detected by ultrasound
Fetus can move almost every part of its body - kicking legs,
sucking thumbs etc.

Four Months

Length 2.8 cm& weight 2.7 gm

Has all basic organs (except sex organs) & features of
human being
Brain develops very rapidly
Basic heart structure complete
Mouth and nose form Length 13.3 cm & weight 150 gm (largest increase of body)
Main digestive system becomes differentiated Dermis differentiates into connective tissue containing
Liver and spleen take over production of blood cells collagenous & elastic fibers
Calcification begins Fetus becomes covered with fine downy hair (lanugo)
Fingers and toes apparent slightly webbed Facial and palatal organization complete
Sense of touch begins & embryo starts to move - photo Heartbeat can be heard clearly
shows thumbsucking Articulations (joints) begin
Fetus very active & movement called quickening or first
kick may be felt by mother

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 Seven Months
Five Months

Fetal length 18.5 cm & weight 460 gm

Myelination of spinal cord begins Length 27 cm & weight 1492 gm
Skull bones most important bones being developed at this Cerebral hemispheres cover almost entire brain
time but will not complete development until birth Pituitary gland completely formed
Keratin & nail production begins Eyelids open & retina sensitive to light
Eccrine sweat glands appear Intestinal plicae complete
Vernix caseosa, a waxy, protective coating of skin begins to Testes begin to descend
form Fingernails cover fingertips
Nostrils completely formed & open Fetus can make a variety of reflex movements: startle,
Tonsils completely formed grasp & swim
Vocal cords work fetus can cry
Intestinal subdivisions complete
Sense of balance develops & fetus starts noticing changes in
mothers posture Eight Months

Six Months

Length 31 cm & weight 2274 gm

Layers of fat piling on, fetus gaining about 200-300 gm per
week
Taste receptors complete & functional
Fetal length 23 cm & weight 823 gm Pulmonary branching & alveolar formation complete
Age of viability Nephron formation complete
Brain becoming functional regulating basic body functions Testes descent completed by now or at the time of birth
& states (breathing, sleep patterns etc), a critical element Epiphyseal plate formation begins
for attaining viability The fetus probably will settle into the head-down position
Eyebrows & eyelids visible but is capable of changing positions
Lungs filled with amniotic fluid & fetus has breathing
motions
Pulmonary surfactant production begins
Fingerprints are formed
Light & sound can be sensed

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 ORGAN DEVELOPMENT
Nine Months Early Postnatal Development
Alveoli inflate at birth (breathing begins)
The cardiovascular system changes at birth
The immune system becomes operative
Myelinization, layering, and CNS tract formation continue
Formation and growth of epiphyseal plates continue
Muscle mass and control increase
Hair changes in consistency and distribution

Organ Growth Curve

Length 34.6 cm & weight 2912 gm

All body systems complete now, only growth takes place
The organs increase their activity
Lanugo is shed & vernix covers entire body
Eyes are normally blue at birth because pigmentation not
normally formed until after a few weeks of exposure to
light
The fetus acquires antibodies from the mother for
temporary immunity against some diseases
The fetus alternates between periods of activity & periods
of quiet
Birth usually occurs approximately 280 days after the first
day of the mothers last menstrual period

General Type
Growth spurt till 6 years, leveling off by late childhood
followed by another growth spurt towards adolescence
Neural Type
Rapid growth in 1 st 3 years then gradual slowing by mid-
childhood to 10 years followed by a small terminal increase at
adolescence then plateaus
Lymphoid Type
Lymphoid organs grow very rapidly, peaking at 12 years
then undergoing relative reduction after
Genital Type
An early plateau during childhood then growth peaks at
adolescence to adult life

Sensory Development
Periods Vision Hearing Others

Newborn At birth, not well At birth, auditory Pain sensation not

developed; system functional developed,
At 1 mo, can generalized
regard 9-12 in movement & crying
front object Taste not well
developed
Sense of smell
observed

Infancy At 4 mo, clear By 6 mo, sound can At 7-9 mo, can

vision; be localized & localize pain &
By 6 mo, visual familiar voices withdraw from it;
acuity 6/12 & recognized; At 12-16 mo, shoves
visual world 10 By 2 yr, adult levels pain & brings hand
ft attained with some to site;
fine tuning At 3 mo, acute taste
discrimination
achieved

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Preschool By 6 yr, Over 5 yr old, child 4 years of age Neutrophils = lymphocytes
Child macula complete can immediately 8 years Leukocyte count similar to
development locate a sound made adults
directly over his
head
Immunity
School By 7 yr of age, Newborn almost entirely IgG
Child visual acuity Maternal antibodies 1 st 6-9 months
20/20
Immunity of prematures < terms
Antibodies
IgM 1st to develop, 1 yr adult levels
IgG 4 years
Nervous System IgA Adolescence
6-12 months Myelinization completed
(some nerves 2 yr old)
Relative size of brain to total body weight
At birth 10% Lymphatic System
5 years 5% Lymphoid tissue
Adult 2% 6-7 years Peak growth (hypertrophy of
10 years Pineal body calcifies tonsils & adenoids) coincides w/
greatest susceptibility to ARI & GIT
infections
After puberty Relative reduction
Circulatory System Spleen
Normal FHB 140-160/min somewhat > in females At birth Largest lymphoid organ relating to
Heart horizontal, apex beat at 4 th ICS versus adults at 5 th ICS body
Complete Anatomical Closure At adult life Increases in weight to 12x,
Ductus venosus & foramen ovale 8 months or more does not atrophy like the nodes
Ductus arteriosus 1-3
months
Normal Cardiac Rate Digestive System
At 1-7 years 100-110/min Stomach Capacity
From 7 years <100/min Birth 30-90 ml
Blood pressure changes daily, increases w/ age 1 month 90-150 ml
1 year 210-360 ml
2 years 500 ml
Later childhood 750a-900 ml
Thereafter depends on feeding habits
Small Intestines
Birth 300-350 cm
1 year 1.5x increase in length
Puberty 700 cm
Large Intestines at birth
Ascending colon Short & increases w/ age
Sigmoid High in abdomen w/ meconium
Rectum Relatively longer

Urinary System
Kidney size
6 months old 2x birth size
1 year old 3x birth size
5 years old 5x birth size
Puberty 10x birth size
Glomerular function
12-24 hrs Normally may not void
5-6 years Mature function

Skeletal System
Respiratory System Ossification centers
Sinuses At 8-9 weeks AOG Primary
Newborn Small maxillary, ethmoidal Last 2 fetal mo Secondary at distal epiphyses of femur;
& sphenoidal absence at birth evidence of prematurity
3-7 years Frontal sinus appears Other secondary 400 at birth, 400 after
7-14 years Ethmoidal maximum size Skeletal age
After puberty Others maximum size 0-5 years Presence of ossification centers
Larynx 5-14 years Calcification of the cartilaginous areas
At birth 1/8 adult size but size relative to 14-25 years Epiphyseal fusion
body same as adult Stature measures Reflect only linear growth of bone
3 years Longer & wider in boys Shoulders, ribs & neck
Trachea Newborns 4 cm long, of adults Birth Shoulders elevated, neck hardly seen
Bifurcation of trachea 3-10 years Ribs slope down,
At birth T3-T4 neck appears longer
4 years T5 Vertebral Spine
12 years T5-T6 Birth Two concavities
3 months Cervical convexity appears
Walking Lumbar curvature shows
Blood 3 years Lumbar curvature fully developed
Hemoglobin
At term 80% fetal hemoglobin Muscular System
5 months of age 5% fetal hemoglobin
Muscles
WBC Birth 1/5 to of total body size
At birth Neutrophil predominant Early adolescence 1/3 of total body size
After 1 week of life Lymphocytes predominant Early adulthood 2/5 of total body size

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 12-16 years Strength doubles ==>> asus.;-)
Growth in muscle mass
after maximal height Sometimes, in our relentless efforts to find the person we love we fail to recognize and
appreciate the people who love us. We miss out on so many beautiful things and simply
because we allow ourselves to be enslaved by our own selfish concerns. Go for the man
Cutaneous Structures of deeds and not for the man of words for you will find rewarding happiness not with the
man you love but the man who loves you more.
Skin & Hair
Newborn With vernix caseosa, also lanugo The best lovers are those who are capable of loving from a distance, far enough to allow
At 1 mo Sweat glands temperature function the other person to grow, but never too far to feel the love deep within your being. To let
By 2 years Scalp hair replaced by coarser hair go of someone doesn't mean you have to stop loving, it only means that you allow that
Subcutaneous Fat person to find his own happiness without expecting him to come back. Letting go is not
just setting the other person free, but it is also setting yourself free from all bitterness,
About 9 months Greatest hatred, and anger that is kept in your heart.
During 1st year Increases then diminishes
Adolescence Increases again girls > boys Do not let the bitterness lure away your strength and weaken your faith, and never allow
Second decade Body fat continually increases pain to dishearten you, but rather let yourself grow with wisdom in bearing it. You may
find peace in just loving someone from a distance not expecting anything in return. But
in girls while boys tend to
be careful, for this can sustain life but can never give enough room for us to grow. We
decrease after age 14 can all survive with just beautiful memories of the past but real peace and happiness
comes only with open acceptance of what reality is today.

There comes a time in our lives when we chance upon someone so nice and beautiful and
we just find ourselves getting so intensely attracted to that person. This feeling soon
becomes a part of our everyday lives and eventually consumes our thoughts and actions.

The sad part of it is when we begin to realize that this person feels nothing more for us
than just friendship. We start our desperate attempt to get noticed and be closer but in the
end our efforts are still unrewarded and we end up being sorry for ourselves.

----------------------------- end of lecture--------------------------------
You don't have to forget someone you love. What you need to learn is how to accept the
verdict of reality without being bitter or sorry for yourself. Believe me, you would be
better off giving that dedication and love to someone more deserving. Don't let your heart
run your life, be sensible and let your mind speak for itself. Listen not only to your
feelings but to reason as well.

Always remember that if you lose someone today, it means that someone better is coming
tomorrow: If you lose love that doesn't mean that you failed in love. Cry, if you have to,
but make sure that the tears wash away the hurt and the bitterness that the past as left you.
Let go of yesterday and love will find its way back to you. And when it does, pray that it
may be the love that will stay and last a lifetime........

--------------------------------------------

Congrats sa basketball team secB( #12-piolo!!, 6-nur, 19-brian, 66-

kashiem, 21-vida, 8 jason, 15- elias) !! Kay # 12- galling mo naman..
sinong mag-aakala star player ka pala!! Belated happy bday sa u!!! Kay #
34 sana maglaro ka na sa susunod! Keep it up!!! Ang liksi mo
maglaro..in fairness.. galling naman natalo nyo mga third yr!!!! good luck
sa mga susunod nyo pang laro..hehehe..

Next game daw sec a vs sec b a mjust see game daw.. goodluck sa
team ni piolo as well as sa team ni jethro!! Go go go;-)

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