1. PERIODS OF DEVELOPMENT GROWTH AND DEVELOPMENT

2. Infant care = aims the normal, physiological, harmonious developement of the children by providing them optimal growth conditions and by preventing illness since pregnancy.

3. Infant care = profilactic side of child`s medicine Pediatrics = curative side (knowledge and treating child diseases).

4. Infant care aimed at different stages of life: Preconception infant care - measures to ensure the health of parents; Prenatal infant care - monitoring pregnant women and intrauterine development of foetus; Postnatal infant care - care measures, nutrition and supervision necessary for the growth and harmonious development of the infant and child.

5. PRENATAL INFANT CARE Monitoring pregnancy Intrauterine development of foetus Complete medical history: HCA, PFA, PPA Clinical examination: - monthly until the last trimester of pregnancy; - in the last trimester – 2 months - 2 times / month; - 1 month - weekly. Recommendations on Diet

6. PRENATAL INFANT CARE Pregnant women at risk - Sustained surveillance: - Advanced mother`s age - Spontaneous abortions in the PPA - Incompatibility Rh / ABO - poverty

7. PRENATAL INFANT CARE Laboratory: - CBC - Blood group, Rh antibodies - Glucose - Urinalysis ± urine culture - Syphilis serology, HIV, HBV, rubella, toxoplasmosis ±, CMV, listeria

8. PRENATAL INFANT CARE Ultrasound exam: → gestational age (GA) → position → fetal malformations → fetal malformations → placenta and amniotic fluid.

9. PRENATAL INFANT CARE 2. Intrauterine development of foetus Genetic factors ± Environmental factors (Teratogens) ↓ ↓ Product design Genetic factors ± Environmental factors (Teratogens) ↓ ↓ Product design 12 wk ↓ ↓ Embryopathy Foetus`malformation 12 wk ↓ ↓ Embryopathy Foetus`malformation

10. PRENATAL INFANT CARE Environmental factors: - Maternal hormonal and uteroplacental disorders; - Viral infection (rubella, influenza, epidemic hepatitis, polio, measles, herpes, cytomegalovirus, HIV); - Bacterial infections (syphilis, listeriosis, tuberculosis); - Parasitic infection (toxoplasmosis);

11. PRENATAL INFANT CARE - Endocrine factors (diabetes); - Immune factors (Rh and ABO isoimmunization, autoimmune diseases); - Mechanical factors (amniotic disease); - Iatrogenic factors (aminopterina, thalidomide, testosterone, progesterone, tetracyclines, iodine); - Chemical factors; - Actinic factors (X-rays, ultraviolet).

12. CHILHOOD PERIODS

13. First period: - birth → three years (ending temporary teeth eruption) - the most important for development, nutrition and child pathology. Periods: - Newborn; - Infant - Toddler - Infant - Toddler

14. New Born

15. Newborn period The first 28 days of life: - Rapid weight and height growth; - Characteristic phenomena: - physiological decrease in weight - physiological jaundice, - genital crisis, - thirst fever, - physiological albuminuria, - meconium;

16. Newborn period - underdeveloped cortex; - the importance of transplacental immunity; - deficiency functions of the skin and mucosal barrier; - infections tend to transform in septicemia; - dominate the pathology of congenital malformations and diseases related to the act of birth (trauma, infections).

17. Infancy

18. Infancy 28 days → 1 year: - weight and height growth continues; - the gradual development of relationship functions; - development of locomotor function; - creation of the first signaling system; - the appearance of teeth and digestive function development;

19. Infancy - develop its own active immunity; - Pathology dominated by diseases of the respiratory tract, middle ear; - The family plays an important role in furthering the development motor skills, language, affectivity.

20. Toddler period (Before Preschool)

21. 1 → 3 years: - the rythm of weight and height growth slows down; - Changing the proportions of the head, torso and limbs; - Completion of first toothing; - Varied diet similar to that of adult; - Completion of motor function; - Formation of conditioned reflexes: word = new signaling system;

22. Toddler period (Before Preschool) - Immunity has supported the progressive development through vaccination; - Pathology: infectious and contagious diseases, accidental poisoning, trauma; - Psycho-emotional family climate is very important.

23. Second period of Childhood (Preschool)

24. 3 → 7 years: - End appearance of temporary teeth and starts appearance of permanent teeth; - Development of the CNS and thus complex thinking, speech, locomotion → child increasing independence; - Slow growth rate;

25. Second period of Childhood (Preschool) - Food is similar to that of the adult; - Dominated by infectious disease pathology; - There are some new diseases like: Acute Infantile Rheumatism, Cardiac earned Diseases, Oseous Tuberculosis. Acute Infantile Rheumatism, Cardiac earned Diseases, Oseous Tuberculosis.

26. Third period of Childhood

27. 6-7 years → late puberty First school years period: - 6-7 years → puberty (10-11 years in girls; 12-13 years in boys); - Maturation of cortical areas of the brain; - Slowing growth rate in the first period, followed by an acceleration in prepuberty;

28. Third period of Childhood - Changes of the body segments growth: a process speeded up at the chest and upper limbs; - Temporary dentition is progressively replaced by permanent dentition; - Pathology: upper airways infections, skin diseases, viral hepatitis, tuberculosis, hematologic malignancies; - Contagious diseases are rare due to spontaneous immunization (disease) or induced (vaccinations).

29. Third period of Childhood High school period (puberty): - Corresponds to the occurrence of menarche in girls (11- 14 years) and development of sexual function in boys (13-16 years); - H growth rate slows, accelerates growth in W; - Change the size of segments – the appearance is similar to that of adult;

30. Third period of Childhood - Intellectual development is intense, but of great psychological and autonomic instability; - Immune defense: transient depression → resistance ↓ and ↑ sensitivity to current infections; - Pathology: disorders of the nutritional status (malnutrition / obesity), bone deformities (rapid growth, vicious positions), behavioral disorders, malignant diseases.

31. Tanner stages of sexual maturation assessment

32. Pubic hair growth in females is staged as follows: Stage I (Preadolescent) - Vellos hair develops over the pubes in a manner not greater than that over the anterior wall. There is no sexual hair. Stage I (Preadolescent) - Vellos hair develops over the pubes 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. This stage is difficult to quantitate on black and white photographs, particularly when pictures are of fair- haired subjects. Stage II - Sparse, long, pigmented, downy hair, which is straight or only slightly curled, appears. These hairs are seen mainly along the labia. This stage is difficult to quantitate on black and white photographs, particularly when pictures are of fair- haired subjects. Stage III - Considerably darker, coarser, and curlier sexual hair appears. The hair has now spread sparsely over the junction of the pubes. Stage III - Considerably darker, coarser, and curlier sexual hair appears. The hair has now spread sparsely over the junction of the pubes. 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 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. 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.

33. 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 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 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. 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. 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 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. 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.

34. In young women, the Tanner stages for breast development are as follows: Stage I (Preadolescent) - Only the papilla is elevated above the level of the chest wall. Stage I (Preadolescent) - Only the papilla is elevated above the 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 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 III - The breasts and areolae continue to enlarge, although they show no separation of contour. Stage IV - The areolae and papillae elevate above the level of the breasts and form secondary mounds with further development of the overall breast tissue. Stage IV - The areolae and papillae elevate above the level of the breasts and form secondary mounds with further development 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 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.

35. The stages for male genitalia development are as follows: Stage I (Preadolescent)- The testes, scrotal sac, and penis have a size and proportion similar to those seen in early childhood. Stage I (Preadolescent)- The testes, scrotal sac, and penis have a size and proportion similar to those seen in early childhood. 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 obvious when viewed on a black and white photograph. 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 obvious when viewed on a black and white photograph. 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. 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. 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. 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. Stage V - The genitalia are adult with regard to size and shape. Stage V - The genitalia are adult with regard to size and shape.

37. GROWTH AND DEVELOPMENT Growth = increase in quantity of cells, tissues and organs. Development (of organs and apparatus) = change to adapt to living conditions. The two processes are carried out simultaneously in their own rhythm.

38. GROWTH AND DEVELOPMENT 1. Mechanism of growth and development: a. Increasing the quantity: - Hyperplasia (cell division: mitosis / meiosis) → cell proliferation; - Hypertrophy (protein synthesis) → increase the volume of the cell.

39. b. Increased quality = cell differentiation. → Genetic suppression of a variable number of genes depending on the type of specialized cell. → Biochemical differentiation is the accumulation of a specific substance (eg accumulation of hemoglobin in erythrocytes, of myosin and actin in muscle cells). Result = emergence of cellular differentiation - specific functions of each cell type formed.

40. 2. Growth laws a) the law of alternation: the growth and development can not be made simultaneously in the same proportions throughout the body, body segments do not grow all at once, but the alternative (eg upper limbs do not grow at the same time as lower limbs); b) the law of proportions: each has a specific period of childhood growth (faster in the first two years of life, then decreases, and decreases prepubertary is increasing again when sexual maturity is completed); a) the law of alternation: the growth and development can not be made simultaneously in the same proportions throughout the body, body segments do not grow all at once, but the alternative (eg upper limbs do not grow at the same time as lower limbs); b) the law of proportions: each has a specific period of childhood growth (faster in the first two years of life, then decreases, and decreases prepubertary is increasing again when sexual maturity is completed);

41. 2. Growth laws c) the law of uneven growth: growth and development are not the same scale, each body segment has its own growth rate; d) the law of antagonism morphology and weight: accumulative growth during differentiation is low and vice versa. c) the law of uneven growth: growth and development are not the same scale, each body segment has its own growth rate; d) the law of antagonism morphology and weight: accumulative growth during differentiation is low and vice versa.

42. 3. Factors affecting growth

43. I. Exogenous factors II. Endogenous factors III. Pathological factors I. Exogenous factors a) Food: -affect growth even in the womb; -poor nutrition of the pregnant woman → small for gestational age new born (SGA); -severity and duration of intrauterine growth restriction (IUGR) → postnatal growth reduction; I. Exogenous factors a) Food: -affect growth even in the womb; -poor nutrition of the pregnant woman → small for gestational age new born (SGA); -severity and duration of intrauterine growth restriction (IUGR) → postnatal growth reduction;

44. 3. Factors affecting growth a) Food: - human milk contains growth modulators (epidermal factor, nervous growth factor, stimulation of B lymphocytes, taurine) → accelerates height and weight growth in the first 6 months of life; - food deficiency primarily affects weight gain. - food deficiency primarily affects weight gain.

46. 3. Factors affecting growth a) Food: - protein deficiency → reduced protein synthesis and cell volume, but does not affect cell multiplication in the case of adequate energy intake; - mineral deficiency → mineral repercussions on the skeleton and the cellular enzymes; - mineral deficiency → mineral repercussions on the skeleton and the cellular enzymes; - deficiency of vitamins (fat soluble) → affect proliferation and differentiation of cells; - early over nutrition → adipocytes hypertrophy ± hyperplasia → obesity.

47. 3. Factors affecting growth b) geographical environment: - microclimate conditions (air, sun light, temperature, humidity, atmospheric pressure, UV light) have greater effects in the first five years; - temperate climate has the most favorable action on growth;

48. b) geographical environment: - excessively climate is associated with low H; altitude > 1500 m → lower growth in utero and postnatall (chronic hypoxia); - H increase is higher in spring and W increase in autumn; - UV and X rays in small doses stimulates growth (large doses one stop). - UV and X rays in small doses stimulates growth (large doses one stop).

49. 3. Factors affecting growth c) Socio-economic: - sanitation; - infectious and parasitic morbidity; - housing; - parents' profession, the financial situation; - social dynamics (mean H and W values are increased in urban environment) - mental stress → "psychosocial dwarfism".

50. 3. Factors affecting growth d) emotional-educational factors: - influence psycho-intellectual development of children especially in the first three years; - family has a major role to model and highlight the physical and mental qualities of the child;

52. d) emotional-educational factors: - calm family environment favoring the development; - family educational concern → faster intellectual development of children; - conflicting states → delayed growth rate, social adjustment difficulties.

53. 3. Factors affecting growth e) Exercise: - infant massage and gymnastics favors somatic and motor development; - playing a sport adapted to child opportunities → toning muscles, strengthening joints, improve tissue oxygenation → positive role of stimulating growth and development.

55. 3. Factors affecting growth f) chemical pollutants, radiation, trauma → may adversely affect growth and development. g) Cultural factors → limiting effect on development.

56. 3. Factors affecting growth II. Endogenous factors: a) Genetic factors → constitutional characters, individual and dynamic growth to maturity, as the family morphological type. - evident influence of puberty (earlier in girls due to the greater sensitivity of cartilage growth to estrogen). - evident influence of puberty (earlier in girls due to the greater sensitivity of cartilage growth to estrogen). - autosomal chromosome numerical changes shall be accompanied by a decline in stature and intellectual deficit.

57. 3. Factors affecting growth b) hormonal factors: -occur in utero and postnatal -endocrine functions of the embryo and fetus are less developed (hormones have minor role in fetal cell multiplication); -maternal hormones: GH, glucocorticoids and mineralocorticoids crosses the placenta in sufficient quantity, while insulin and thyroid hormones to a small extent -maternal hormones: GH, glucocorticoids and mineralocorticoids crosses the placenta in sufficient quantity, while insulin and thyroid hormones to a small extent

58. 3. Factors affecting growth Hypothalamus: coordinate with pituitary releasing factor Somatostatyn inhibits pituitary growth hormone Pituitary: Hypothalamus: coordinate with pituitary releasing factor Somatostatyn inhibits pituitary growth hormone Pituitary: - STH produces proliferation of chondrocytes in cartilage series and long bone growth - STH have direct and independent action on chondrocytes at different stages of differentiation or maturation

59. 3. Factors affecting growth Thyroid → thyroxin and triiodothyronyn : - Stimulates protein synthesis; - Stimulates tissue oxidative processes; - Increase the activity of respiratory enzymes; - Regulating glycogenolysis; - Produce lipolysis.

60. 3. Factors affecting growth Thyroid → thyroxin and triiodothyronyn : - Increase basal metabolism, - Involved in brain development, the growth of teeth and thermogenesis, - Produces hypertrophy of chondrocytes in cartilage and bone growth and mineralization of the skeleton, - Enhances the action of STH's (myxedema = congenital dwarfism and mental retardation).

61. 3. Factors affecting growth Adrenal glands: Glucocorticoid hormones: - Inhibits growth - Activated protein catabolism - Enhance the elimination of calcium and potassium - Inhibits GH action in liver.

62. 3. Factors affecting growth Adrenal glands: Mineralocorticoid hormones: - Stimulates the synthesis of DNA, - Stimulates tubular reabsorption of sodium and water. Thymus: - Synergistic with STH's, - Role of T cell maturation.

63. 3. Factors affecting growth Endocrine pancreas: Insulin = anabolic hormone - Promotes the penetration of amino acids in the cells involved in RNA synthesis and cell hypertrophy. Glucagon = hormone catabolism Insulin = anabolic hormone - Promotes the penetration of amino acids in the cells involved in RNA synthesis and cell hypertrophy. Glucagon = hormone catabolism - Inhibits growth - Increases glycolysis and inhibits gluconeogenesis.

64. 3. Factors affecting growth Parathyroid glands → parathyroid hormone → acts on intestinal cells, bone and renal calcium homeostasis → intervenes and calcification of the skeleton. Sexual glands: Androgens → anabolic effect: - Stimulates cartilage cell proliferation, - Participating in sexual differentiation and maturation. Androgens → anabolic effect: - Stimulates cartilage cell proliferation, - Participating in sexual differentiation and maturation.

65. 3. Factors affecting growth Sexual glands: Estrogens: - Stimulates less growth - Significant effect on calcification of cartilage growth. At puberty: determining a characteristic physical appearance: - Girls → widening the pool of girls, - Boys → shoulder development. calcification of cartilage → upswing stature.

66. 3. Factors affecting growth III. Pathological factors: - Infant endocrinopathies: myxedema, pituitary dwarfism; factors acting on the pregnant woman: - Acute or chronic infections (syphilis, malaria); - Chronic poisoning (alcoholism, smoking, lead poisoning); - Disorders of nutrition (malnutrition);

67. 3. Factors affecting growth III. Pathological factors factors acting on the child: - Nutrition and chronic digestive disorders → "intestinal dwarfism; - CNS disorders; - Congenital heart disease → "heart dwarfism; - Congenital renal → "renal dwarfism; - Chromosomal abnormalities; - Visceral disease with prolonged evolution (cystic fibrosis).