Growth & Puberty Pediatrician/Endocrinologist

Joyce Mbogo MD FAAP

Outline

•Growth • Factors influencing growth • Determinants of growth in different stages

•Puberty: • Triggers of puberty • Tanner Staging

GROWTH

Growth:

• An increase in body size both weight and height over a period of time.

• A sensitive indicator of health and well-being.

Factors involved in Growth

4

Main Factors Involved in Phases of Normal Growth

Growth hormone

Thyroid hormone

Sex steroids

Growth hormone

Nutrition

Rapid

deceleration

Slow

deceleration

Rapid

acceleration

then

deceleration

Infancy Childhood Puberty Phase:

Pattern:

Major

factor(s):

Clark PA, et al. Endocrinol Metab Clin North Am. 1996;25:665. Karlberg J, et al. Acta Paediatr Scand. 987;76:478,337(suppl):12. Kuczmarski RJ, et al. Adv Data. 2000;314:1.

5

Female vs. Male Pubertal Growth Spurt

Girls Boys

Peak

11.5 yr

Peak

13.5 yr

• Female vs. male – starts, peaks, ends ~1.5 – 2 yr earlier

– peak velocity ~ 1–2 cm lower

Start

9.5 yr

End

14.5 yr

Start

11.0 yr

End

16.5 yr

PUBERTY

PUBERTY

Developmental stage characterized by: • Maturation of gametogenesis • Secretion of gonadal hormones • Development of secondary sexual characteristics and

reproductive organs

Average age of Puberty Onset

Average Age of Puberty Onset: Girls 8.0 - 13.0 years Boys 9.0 - 14.0 years

What triggers puberty?

Source: http://flipper.diff.org/app/pathways/info/3997

Males Testicular Enlargement

Females Breast development

Tanner staging: Breast Development

Engebretsen L et al. Br J Sports Med 2010;44:476-484 Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.

Tanner staging: Testicular Development

Engebretsen L et al. Br J Sports Med 2010;44:476-484 Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.

In Conclusion: Adolescents

•Growth • Pubertal spurt

•Puberty: • Normal puberty

• Females: 8-13 years

• Males: 9 -14 years