Part 02. Growth and Development
Part II Growth And Development
Chapter 8. Overview and Assessment of Variability
8.1 Biophysiosocial Models Of Development
Biologic Influences
¨ç genetics
¨è in utero exposure to
teratogens
¨é postpartum
illnesses
¨ê exposure to hazardous
substances
¨ë maturation
#
Temperament
; *¡ã important clinical influence
; Child's characteristic
style of responding
; *ºÎ¸ðÀÇ À°¾Æ
¹æ¹ý¿¡ ¿µÇâÀ»
¹ÞÁö ¾Ê°í, »ó´ç±â°£ µ¿Áú¼º
À¯Áö
;
*ÀÓ»óÀû
Áß¿äÁ¡
- ºÎ¸ð°¡ ¼Ò¾ÆÀÇ ±âÁú¿¡ ´ëÇÏ¿© Ã¥ÀÓ°¨, ÁËÃ¥°¨¾øÀÌ ¹ÞÀÌ µéÀÏ ¼ö ÀÖ°Ô ÇÑ´Ù.
- Çൿ, Á¤¼ Àå¾Ö ¹®Á¦´Â ¼Ò¾ÆÀÇ ±âÁú°ú ºÎ¸ð°¡ Ãæµ¹ÇÒ ¶§ ¹ß»ýÇÑ´Ù.
Table 8-1
Psychological Influences : Attachment And Contingency
#
Attachment
; biologically determined
tendency to parent in stressful state
; inadequate attachement
-
parent-child relationshipÀÇ dysfunction
-
*result in ÇൿÀå¾Ö, ÇнÀÀå¾Ö
#
Contingency
; contigent response of
caregivers
-->
progress
; contigent new challenge
-->
learning
Social Factors : Family Systems And The Ecological
Model
Unifying concepts : The transactional model, Risk and
Resilience
;
biologic factor¿Í social influence´Â ¼·Î ¿µÇâÀ» ¹Ìħ
Developmental Domains and Theories of Emotion and
Cognition
;
Freud, Erikson, PiagetÀÇ psychoanalytic theroies¿Í
SkinnerÀÇ behavioral theory
¡ÚTable
8-2
#
PiagetÀÇ ¾÷ÀûÀÌ ¼Ò¾Æ°ú Àǻ翡°Ô ¸Å¿ì Áß¿äÇÑ 3°¡Áö ÀÌÀ¯
¨çinfancyµ¿¾ÈÀÇ ¸¹Àº ÈçÇÑ Çൿ¿¡ ´ëÇÑ ÀÌÇØ¸¦ µµ¿ò
¨èPiaget¿Í °°Àº °üÂûÀº
office¿¡¼ »¡¸® º¹»ç°¡ °¡´ÉÇÏ°í Æ¯¼ö Àåºñ°¡ ÇÊ¿ä¾øÀ½
¨éopen-ended questioningÀ» ÅëÇØ Áúº´°ú ÀÔ¿ø¿¡ ´ëÇÑ ¾î¸°ÀÌÀÇ ÀÌÇØ¸¦ ¾Ë¼ö ÀÖÀ½
Chapter 9. Fetal Growth and Development
Somatic Development
Embryonic Period
¡ÚTable
9-1
6
day : blastocyst formation
2
wk : implantation ¿Ï¼º. uteroplacental circulation ½ÃÀÛ.
endoderm
& ectoderm & amnion»ý¼º
3
wk : primitive neurnal tube & blood vesselÀ» µû¶ó mesodermÀÌ ³ªÅ¸³²
4
- 8 wk : embryologic plateÀÇ lateral folding
ÀÌÈÄ cranial and caudal endsÀÇ ¼ºÀå
ÆÈ, ´Ù¸®°¡ »¸¾î¼ Àΰ£ÀÇ ÇüŸ¦ ¸¸µê
skeletal muscle and vertebraeÀÇ precursors°¡ ³ªÅ¸³²
brain ±Þ¼ÓÈ÷ ¼ºÀå
8
wk ¸» : all major organÀÇ
rudiments µéÀÌ ¹ß´Þ
Æò±Õ embryo weight : 9g, CR length :
5cm
Fetal Period
;
9 wk
- fetal somatic change
/
cell number¿Í size Áõ°¡several
organ systemÀÇ structural remodelling
10
wk : midgutÀÌ umbilical cord·ÎºÎÅÍ
abdomenÀ¸·Î µé¾î¿È
counterclockwise rotation
12
wk : external genitalia ±¸ºÐ °¡´É. lung development
;
*20 - 24 wk
- *primitive alveoli°¡ Çü¼º --> 22wks¶§ gas
exchange °¡´É
- *24wks¶§ surfactant »ý»ê
½ÃÀÛ
;
3rd trimester
- weight°¡
3¹è°¡ µÇ°í ±æÀÌ´Â µÎ¹è.
- protein, fat, iron, calcium
ÃàÀû Áõ°¡
Neurologic Development
3
wk : neural plate°¡ ectodermal surface¿¡¼ ÃâÇö
neural tube¿Í neural crest Çü¼º
5
wk : forebrain, midbrain, hindbrainÀÇ subdivisionÀÌ È®½ÇÇØÁü
myelinizationÀº midgestation¿¡ ½ÃÀ۵Ǿî ù
2³âµ¿¾È °è¼ÓµÊ
8
wk¸» : nervous systemÀÇ
gross structure¿Ï¼º
Behavioral Development
8
wk : muscle contractionÀÌ Ã³À½ ³ªÅ¸³ª°í ÀÌÈÄ lateral flexion
movement
;
*13 - 14 wk
- *breathing and swallowing motion
- tactile stimulation¿¡
graceful movement º¸ÀÓ
;
*17 wk
- *grasp reflex ³ªÅ¸³²
27
wk : grasp reflex Àß ¹ß´Þ
26
wk : eye opening
midgestation¶§
newbornÀÇ full range movement°¡ °üÂûµÊ
;
3rd trimester
- 3°¡Áö
fetal behavioral state °üÂû
+- ¨ç ´«¿îµ¿À̳ª ½É¹Úµ¿ º¯ÈÀÇ Á¤Áö
| ¨è ´«¿îµ¿À» °è¼ÓÇÏ¿©
somatic activity¸¦ Çϰí
| heart
rate acceleration
+-
¨é tachycardia¿Í ÇÔ²² °è¼ÓÀûÀÎ ´«¿îµ¿°ú ½Åü¿îµ¿
Psychological Changes In The Parents
ÀÓ½ÅÁß ¾ö¸¶ÀÇ psychological
development´Â 3°¡Áö stage°¡ ÀÖÀ½
stage 1 : ÀÓ½ÅÇÑ »ç½ÇÀ» óÀ½ ¾Ë¾ÒÀ» ¶§ºÎÅÍ ½ÃÀÛ
stage 2 : ¾Æ±âÀÇ ¿îµ¿À» ÀÚ°¢Çϱ⠽ÃÀÛÇßÀ» ¶§ºÎÅÍ ½ÃÀÛ
stage 3 : ÀӽŸ»±îÁö
Threats To Fetal Development
. prenatal period µ¿¾È
mortality¿Í morbidity°¡ °¡Àå ³ôÀ½
. spontaneous abortion, chromosomal or
other abnormalities, major congenital
malformation, teratogen
#
Teratogen
; gross physical malformation»Ó¸¸ ¾Æ´Ï¶ó
growthÀÇ °¨¼Ò¿Í later cognitive or
behavioral deficits¿¡ ¿µÇâÀ» ¹Ìħ
;
infectious agents ( toxoplasma, rubella, syphilis ), chemical agents ( mercury,
thalidomide, antiepileptic medication, ethanol ), high temperature, radiation
; hostÀÇ Æ¯¼º°ú
dose, exposureÀÇ timing¿¡ ÀÇÇØ
teratogenic effect°¡ °áÁ¤µÊ
Chapter 10. The Newborn
Determinants Of Parenting
Prenatal Factors
Peri- And Postpartum Influences
# *Doula(encouragement)
--> shorter labor, fewer obstetric complications, reduced postpartum hospital stays
The Infant's Contribution
Interactional Abilities
Modulation Of Arousal
Behavioral States
#
¡ÚSix states
; quiet sleep, active sleep,
drowsy, alert, fussy, crying
#
*In allert state
; *visually fixate on objects or faces and follow horizontally
Mutual Regulation
10.3 Clinical Implications : The Physician's Role
1) deliveryÀü,
deliveryµ¿¾È, delivery ÀÌÈÄÀÇ Àû´çÇÑ
medical practices¸¦ µµ¸ð
2) parent-infant interactionÀ» Æò°¡
3) ºÎ¸ðµé¿¡°Ô newbornÀÇ °³ÀÎÀûÀÎ ´É·Â°ú ¾àÇÑÁ¡À» °¡¸£Ä¡´Â °Í
Chapter 11.The first Year
;
physical growth, maturation, ´É·ÂÀÇ ½Àµæ, psychological
reorganizationÀº ù Àϳ⠵¿¾È ºü¸£°Ô ³ªÅ¸³²
Table 11-4
Age 0-2 Month
Physical Development
#
weight
; *1wk
-
*excess ECFÀÇ excretion°ú poor intakeÀÇ
°á°ú·Î birth weightÀÇ 10%±îÁö °¨¼Ò
°¡´É
-
2wksÈÄ Á¤»ó ȸº¹
; 1mo
-
30g/day·Î üÁßÁõ°¡
¨èmovement
; largely uncontrolled, eye
gaze exception,head turning,sucking
¨écrying
; *6wk peak. 3hr/day Á¤µµ
crying
; *ÀÌÈÄ 3mo±îÁö 1hr/day·Î ÁÙ¾îµë
#
Smilimg
; *¹è³ÁÁþ
-
involuntary
-
REM sleep, ÀáÀÌ µå´Â ½Ã±â
; *social smile
-
*3-5wks, ÁÖÀ§ÀÇ
Àڱؿ¡ µû¶ó
Cognitive Development
;
visual, tactile, olfactory, auditory stimuliµîÀÇ ÀÚ±ØÀº cognitionÀÇ ¹ß´Þ¿¡ Áß¿äÇÑ ¿ªÇÒÀ» ÇÔ
¡æ ¾î¶² Àڱؿ¡ Ä£¼÷ÇØ Áö¸é µ¿ÀÏÇÑ Àڱؿ¡ ÀÇÇÑ ¹ÝÀÀº¸´Ù´Â ÀÚ±ØÀÌ ¹Ù²ð¶§±×µéÀÇ °ü½ÉÀÌ ´õ Áõ°¡ÇÔ
Emotional Development
#
EriksonÀÇ 1st psychosocial stage
; basic trust´Â ¿µ¾Æ°¡ ±×µéÀÇ ±ÞÇÑ ¿å±¸°¡ »ý±â°í À̰ÍÀÌ ÇØ°áµÇ´Â °ÍÀ» ¹è¿ì¸é¼ »ý°Ü³ª°Ô µÈ´Ù
#
Emotional Significance
; *depends on individual temperament as well as parent¡¯s response
; *feeding ¡°on demand¡± consistently experience
#
°³ÀÎÀûÀÎ ¿å±¸°¡ ÇØ°áµÇÁö ¸øÇϸé irritability,
psychologic instability, later behavioral problemÀ» °¡Áö°Ô µÊ
Implication For Parents & Pediatritian
;
feeding°ú sleep cycleÈ®¸³ÀÇ ½ÇÆÐ¿Í ¼º°ø¿¡ µû¶ó ºÎ¸ðµéÀÇ ¼öÀ¯ÀÇ È¿À²¼ºÀÌ °áÁ¤µÊ
Age 2-6Mon
Physical Development
¨çgrowth rate
; 3-4Mon¶§
20g/day
#
*early reflexÅðÈ
; asymmetric tonic neck
reflex
-
*roll over & examine objects in
the midline and manipulate with both hands
-
*ÇÑ±ÛÆÇ) ¹°°ÇÀ»
ºÙÀâ´Â´Ù 5-6°³¿ù, ¾þÄ£´Ù 6-7°³¿ù
; early grasp reflex
-
*hold objects & let them go
#
increased control of truncal flexion & head
¨ésleep
a)Àüü¾ç:14-16½Ã°£/day(¹ã:9-10½Ã°£)
b)4-6mon:sleep electroencephalogram-¼ºÀÎÇü
c)REM°ú 4°¡Áö
stageÀÇ non-REM sleep
d)sleep cycle-short:50-60min
cf)¼ºÀÎ-90min
Cognitive Development
;
4mo infant
- *"hatching" socially
- ¾ö¸¶ÀÇ Ç°¼Ó¿¡¼ ¼¼»ó¿¡ °ü½ÉÀ» °¡Áü
;
ÀÚ½ÅÀÇ ½Åü¿¡ °ü½ÉÀ» °¡Áü
- ÀÚ½ÅÀÇ ¼ÕÀ» ¿½ÉÈ÷ ÃÄ´Ù º½,
¼Ò¸®¸¦ ³¿, bubbleÀ» ¸¸µë,
ÀÚ½ÅÀÇ ±Í,»´,¼º±âµîÀ» ¸¸Áü
;
*self sensationÀÇ
ÃâÇö
Emotional Development & Communication
;
*primary emotion(anger, joy,
interest, fear, disgust, surprise)À» ¾ó±¼·Î
Ç¥Çö
;
¿µ¾Æ´Â ±×µéÀÌ ½Å·ÚÇÏ´Â ¾î¸¥µéÀÇ °¨Á¤°ú ¹ß ¸ÂÃß¾î °¨Á¤À» Ç¥ÇöÇÔ
- contactÇÏ´Â ½Ã°£ÀÇ ¾à
30%
;
face-to-face behavior
- ¿µ¾Æ°¡ °¨Á¤»óŸ¦ ºÐ¸®ÇÒ ¼ö ÀÖ´Ù´Â °Í°ú ÀÇ»ç¼ÒÅëÀÇ Ã¹´Ü°è¸¦ ÀǹÌ
Implication For Parents & Pediatritians
;
3-6mon ³ªÀÌÀÇ ¿µ¾Æ´Â motor¿Í
sensory maturationÀ¸·Î ÀÎÇØ Èï¹Ì·Ó°í »óÈ£°ü°è°¡ °¡´ÉÇÑ partner°¡ µÊ
- ºÎ¸ðµéÀº ÀÌ ±â°£µ¿¾È ÇູÇÔÀ» ´À±â°Ô µÊ
11.3 Age 6-12Mon
Physical Development
;
growth
- slows more
;
7mo
- sit unspported
;
*8mo
- *crawl (±â´Ù) , pull (Àú¾î¼
³ª¾Æ°¡´Ù)
;
9-10mo
- pivot while sitting, *pincer grasp (around 9mo)
;
Motor acheivement
- myelinization Áõ°¡,
cerebellar growth
;
tooth eruption
- mandibular central
incisor
Cognitive development
;
¸ðµç°ÍÀ» ÀÔÀ¸·Î °¡Á®°¨
;
¹°°ÇÀ» ÇÑÂÊ¿¡¼ ´Ù¸¥ÂÊ ¼ÕÀ¸·Î À̵¿
;
À̽ñâÀÇ ÀÎÁö ¹ß´ÞÀÇ good index
¡æ ¿µ¾ÆµéÀÇ ³îÀÌÀÇ º¹À⼺ ¡¡
;
9mo
- "object
constancy"
- ¹°Ã¼°¡ Áö¼ÓÀûÀ¸·Î
Á¸ÀçÇϴ°ÍÀ» ÀÌÇØÇϰí, »ç¶óÁö¸é ãÀ¸·Á°íÇÔ.
Emotional development
;
»çȸÀû, ÀÇ»ç¼ÒÅëÀÇ ¹ß´Þ°úº¯È; ¾çÀûÀÎ ¼ºÀåÀÌ ÀÖÀ½
;
*separation anxiety, stranger anxiety
-
*6°³¿ù
;
*À½½ÄÀ» ½º½º·Î
¸ÔÀ¸·Á°íÇÔ- ÀÚÀ²¼º
ÃâÇö
;
*Tantrums (¿ªÁ¤)
- ºÎ¸ðÀÇ Á¶Àý¿¡ ´ëÇÑ ÀÚÀ²¼º°ú ±â´ÉÁ¶Àý¿¡
´ëÇÑ ¹Ý¹ß
Communication
;
*7mo
- *nonverbal communication
;
*9mo
- »ç¶÷µé »çÀÌ¿¡¼ °¨Á¤ÀÌ ºÐ¸® µÇ´Â°ÍÀ» ±ú´ÞÀ½
- *¡°ºüÀÌ ºüÀÌ¡±À» ÇÑ´Ù
;
8-10mo
- ´Ù¾çÇÑ À½ÀýÀ» °¡Áø »õ·Î¿î ¸»À» ½ÃÀÛ
- À̰ÍÀº º»·¡ ¸»(µéÀº¸»)À» Èä³»³»´Â °ÍÀ» ¸»ÇÔ
;
*12mo
- *¡®¾ö¸¶¡¯ ¡®¾Æºü¡¯À̿ܿ¡ ÇѵÎ
´Ü¾î¸¦ ´õ
»ç¿ëÇÔ.
Implication For Parents & Pediatricians
;
¾à 9°³¿ù°æ, ¿µ¾Æ´Â ÀÌÀü¿¡ ÇØ°áÇÑ ¹®Á¦µé
(feeding, sleeping, re-emerge)ÀÌ reorganizationµÇ´Â ½Ã±âÀ̹ǷÎ
À̶§ ºÎ¸ðµéÀº ¾ÆÀ̵éÀÌ ÀÌÀü¿¡ ÀßÇÏ´ø ÇൿÀÇ º¯È¿¡ ´ëÇØ, ÀÌ·± »óȲµéÀ» Å𺸶ó°í »ý°¢ÇÒ ¼ö Àֱ⠶§¹®¿¡ ¼Ò¾Æ°ú ÀÇ»ç´Â ÀÌ·±°úÁ¤ÀÌ ¹ß´Þ°úÁ¤ÀÇ ÇÑ °á°ú¶ó°í ÀÌÇØ½ÃÄѾßÇÑ´Ù.
Chapter 12. The second year
Age 12-18 Mo
Physical Development
;
2¼¼ °æ¿¡ ¼ºÀå ¼Óµµ´Â Á¡Á¡ ´À·ÁÁö¸ç ½Ä¿åµµ °¨¼ÒÇÑ´Ù
(ü´± 2.5Kg,½ÅÀå
12cm Áõ°¡)
;
¿îµ¿·®ÀÇ Áõ°¡·Î ÇÇÇÏ Áö¹æÀÌ °¨¼Ò, lumbar lordosis Áõ°¡·Î ÀÎÇØ
abdominal protrusion Ư¡
;
³ú¼ºÀåÀº °è¼ÓµÇ¾î myelinizationÀÌ
2¼¼°æ¿¡ ÀÌ·ç¾îÁü
;
´ëºÎºÐÀÇ ¼Ò¾ÆµéÀº µ» °æ¿ì È¥ÀÚ °È±â ½ÃÀÛÇÔ
;
*2¼¼ µ¿¾È 8°³ÀÇ À¯Ä¡°¡
³ª¿È
- *total 14-16°³ÀÇ À¯Ä¡°¡
Á¸ÀçÇÔ
Table 12-1
Cognitive Development
;
reaching, grasping, realeasingÀÌ °ÅÀÇ ¿ÏÀüÈ÷ ¼º¼÷ÇÏ°í °ÈÀ» ¼ö Àֱ⠶§¹®¿¡ »ç¹°À» Ž»çÇÏ´Â °ÍÀÌ °¡¼ÓÈ µÈ´Ù
;
Àç¹ÌÀÖ´Â È¿°ú¸¦ ¸¸µé¾î ³»±â À§ÇÏ¿© ¹°Ã¼¸¦ Á¶ÇÕÇÑ´Ù
-
block ½×±â, ºñµ¥¿À Ä«¼ÂÆ® ·¹ÄÚµå ±¸¸Û¿¡ ¹°°Ç Áý¾î³Ö±â
;
ÀǵµÇÏ´Â ¸ñÀûÀ» À§ÇÏ¿© ¹°°ÇÀ» ÀÌ¿ëÇÑ´Ù
- ºø
, ÄÅ
;
ºÎ¸ð¿Í older childrenÀ» ¸ð¹æÇÔ
;
learningÀÇ Áß¿äÇÑ ¹æ¹ý
- ºÎ¸ð ÁÖÀ§¸¦ µ¹¾Æ´Ù´Ñ´Ù(orbit)
;
attachment relationship
¨ç securely attached children
- ³¸¼± ³îÀ̹濡 ¾ÆÀ̸¦ µÎ°í °¬´Ù°¡ ´Ù½Ã µ¹¾Æ¿Â °æ¿ì ÀÌ ¾ÆÀ̵éÀº Æí¾ÈÇØÇϸç
´Ù½Ã ³îÀÌ·Î µ¹¾Æ°¨
¨è ambivalently attached children
- ¾È½ÉÇϳª Ȱ¡³ª¼ ºÎ¸ð¸¦ ¶§¸²
¨éavoidant child
- ºÎ¸ð°¡ °¡¹ö¸° µ¥ ´ëÇÏ¿© ÀúÇ×ÇÏÁö ¾ÊÀ¸¸ç µ¹¾Æ¿ÔÀ» ¶§ ºÎ¸ð·ÎºÎÅÍ
µµ¸ÁÇÔ
--> insecure response
patternÀº ºÎ¸ðµéÀÇ Ã³¹úÀ̳ª ¹«°ü½É¿¡ ´ëÇ×ÇÏ´Â infantÀÇ Àü·«À¸·Î½á
³ªÁß¿¡ ÀÎÁö¹ß´Þ°ú °¨Á¤ÀûÀÎ ¹®Á¦µéÀ» ¾ß±âÇÒ ¼ö ÀÖ´Ù
Linguistic Development
;
¼ö¿ëÇü ¾ð¾î°¡ Ç¥ÇöÇü ¾ð¾îº¸´Ù ¾Õ¼±´Ù
;
*15mo
- *4-6°³ÀÇ ´Ü¾î¸¦
»ç¿ëÇϸç, ½Åü
ºÎÀ§¸¦ °¡¸£Ä£´Ù
Implication For Parents & Pediatricians
;
ºÎ¸ðµéÀº °È´Â °ÍÀÌ µ¶¸³ÀûÀÎ ÇൿÀÇ »ó¡ÀûÀÎ ÀǹÌÀ̱⠶§¹®¿¡ ´ëºÎºÐ ±â¾ï °¡´É
;
¾ÆÀÌÀÇ È£±â½ÉÀÌ Áõ°¡ÇÏ´Â °ÍÀº °¨½ÃÇϱ⠾î·Á¿ì¸ç ´ÙÄ¥ À§ÇèÀÌ Å©´Ù
;
³¸¼± »óȲÀÇ ½Ã¼ú¿¡ µî±ÞÀ» ¸Å±ä °Íµé¿¡ ´ëÇÑ ºñ½ÁÇÑ ¹ÝÀÀ patternÀÌ ¼Ò¾Æ°ú
clinic¿¡¼ °üÂû °¡´É ÇÏ´Ù
;
´ëºÎºÐÀÇ ¾ÆÀ̵éÀº °Ë»ç½ÇÀ» ŽÇèÇÑ ÈÄ, ÆíÇØÇϳª °Ë»ç¿¡ ´ëÇÑ
stress°¡ ÀÖ´Â °æ¿ì ºÎ¸ð¿¡°Ô ¸Å´Þ¸°´Ù
;
±×µéÀÇ ºÎ¸ðÀÇ ÆÈ¾È¿¡¼ ´õ ºÒ¾ÈÇØÇϰųª ºÎ¸ð·ÎºÎÅÍ ´Þ¾Æ³ª´Â °ÍÀº insecurely attachedµÈ °ÍÀÌ´Ù
;
°ï¶õÇÒ ¶§ ºÎ¸ðº¸´Ù ³¸¼± »ç¶÷¿¡°Ô ´Ù°¡¼´Â °ÍÀº ƯÈ÷ °ÆÁ¤½º·¯¿î ÀÏÀÌ´Ù
Age 18-24Mo
Physical Development
;
balance¿Í ¹ÎøÇÔÀÌ Áõ°¡ÇÏ¿© ¿îµ¿ ¹ß´ÞÀÌ Áõ°¡ÇϹǷΠ´Þ¸®±â ½ÃÀÛÇÏ¸ç °è´ÜÀ» ±â¾î¿À¸¥´Ù
;
µÎÀ§¼ºÀåÀº ºñ±³Àû ´À¸®³ª Ű,¸ö¹«°Ô´Â ¾ÈÁ¤µÈ ¼Óµµ·Î ´É°¡ÇÔ
;
*ÇÑ±ÛÆÇ) 2¼¼°¡
µÇ¸é ¸öÀÇ
Áß¾ÓÁ¡ÀÌ ¹è²Åº¸´Ù
¾à°£ ¾Æ·¡ÂÊ¿¡
ÀÖ´Ù.
Cognitive Development
;
»ç¹°ÀÇ ¿µ¼Ó¼º°ú À©Àΰú È¿°ú¿¡ ´ëÇÏ¿© Á» ´õ Àß ÀÌÇØÇÏ°Ô µÊ
;
¹®Á¦¸¦ ÇØ°áÇÏ´Â µ¥ À¯¿¬¼ºÀ» ³ªÅ¸³¿
- ¸Ö¸® ÀÖ´Â Àå³°¨À» °¡Áö±â À§ÇØ ¸·´ë±â¸¦ »ç¿ë
; ³îÀ̽à »ó¡ÀûÀÎ º¯ÇüÀº ÀÚ½ÅÀÇ ½Åü¿¡ ¸Å¿©ÀÖÁö ¾Ê´Ù
- ÀÎÇüÀÌ ºó Á¢½Ã¿¡¼µµ
¸ÔÀ» ¼ö ÀÖ´Ù.
Emotional Development
;
ÀÌÀüÀÇ ºñ±³Àû µ¶¸³ÀûÀÎ ½Ã±â·ÎºÎÅÍ 18mo°æ¿¡°Ô´Â ¸Å´Þ¸®´Â °ÍÀÌ Áõ°¡ÇÑ´Ù
- ÈÇØÀÇ ½Ã±â(rapprochment)
-
separationÀ» ´õ Àß ÀÌÇØÇÏ´Â µ¥¿¡ ´ëÇÑ ¹ÝÀÀ
- *¡°transitional object¡±»ç¿ë :
special blanket, stuffed toy
;
*ÀÚ¾Æ ÀǽĿ¡
´ëÇÑ Àνİú
Æò°¡¿¡ ´ëÇÑ
³»ÀçÈµÈ ±Ô¹üÀÌ
óÀ½ ³ªÅ¸³²
- Àå³°¨ÀÌ ¸Á°¡Áú °æ¿ì ºÎ¸ð¿¡°Ô °íÄ¡µµ·Ï °Ç³×ÁÜ.
- *¹è´¢, ¹èº¯ÀÇ
Àǻ縦 Ç¥Çö(ÇÑ±ÛÆÇ:18-24°³¿ù)
Linguistic Development
; *¡ã Dramatic periods
;
*18mo
- 10-15´Ü¾î »ç¿ë
;
*2yr
- 100´Ü¾î
- *3´Ü¾î·Î µÈ
¹®ÀåÀ» ¸»ÇÒ
¼ö ÀÖ´Ù.
Implication For Parents & Pediatricians
;
¿òÁ÷ÀÓÀÌ ´Ã¹Ç·Î ¹°¸®ÀûÀ¸·Î ¾ÆÀÌÀÇ Å½ÇèÀ» Á¦ÇÑÇÏ´Â °ÍÀº ºñÈ¿°úÀûÀÌ¸ç ¸»ÀÌ ÇൿÁ¶Àý¿¡ Á» ´õ Áß¿äÇÏ´Ù
;
¸»ÀÌ Áö¿¬µÈ ¼Ò¾ÆµéÀº ´õ Å« behavior problemÀ» °¡Áø´Ù
;
ºÎ¸ð°¡ ¸íÈ®ÇÑ ¹®ÀåÀ» »ç¿ë
;
±×¸²Ã¥À» ±ÔÄ¢ÀûÀ¸·Î º¸±â
;
¼Ò¾Æ°ú ÀÇ»çµéÀº ºÎ¸ðµéÀÌ separation¹®Á¦ÀÇ ÃâÇö°ú ÁÁ¾ÆÇÏ´Â ´ã¿ä³ª Àå³°¨ °õÀÎÇü µî,
¹ß´Þ Çö»óÀÇ ÃâÇö¿¡ ´ëÇÏ¿© ÀÌÇØÇÒ ¼ö ÀÖµµ·Ï µµ¿ÍÁØ´Ù
Chapter 13.Preschool Years
;
2-5¼¼
;
»çȸÀûÀÎ ¿µ¿ªÀÇ È®´ë¿Í öÇÐÀûÀÎ ¾ð¾î°¡ Áõ°¡µÊ
;
*ÀÚÀ²°¨ÀÇ Áõ°¡¿Í
³»Àû, ¿ÜÀû
Á¦ÇÑ »çÀÌÀÇ
±äÀåÀÌ ÀÌ
½Ã±âÀÇ ÁÖ¿äÇÑ dynamics¸¦ °áÁ¤ÇÑ´Ù
Physical Development
;
ü¼ºÀå°ú ³ú¼ºÀåÀÌ ´À·ÁÁö¸ç ¿µ¾ç ¿ä±¸·®°ú ½Ä¿å °¨¼Ò
;
Æò±Õ üÁß Áõ°¡ : 2kg/yr, ½ÅÀå Áõ°¡
: 7cm/yr
;
lordosis, protuberant abdomen »ç¶óÁü(4yr°æ)
;
½Ã·Â
- 3yr 20/30
- 4yr 20/20
;
¢Þ3¼¼
- 20°³ÀÇ À¯Ä¡ ¸ðµÎ Á¸Àç
- ¿ÏÀüÇÑ °ÉÀ½À¸·Î °È°í,
¾ÈÁ¤µÇ°Ô ´Þ¸°´Ù, *ÇÑÂÊ ¹ß·Î
Àá±ñ ¼±´Ù
- °øÀ» ´øÁö¸ç ÀâÀ¸¸ç ¹ß·Î Âù´Ù
- ¼¼¹ß ÀÚÀü°Å¸¦ ź´Ù
- ¿îµ¿ÀåÀÇ ³îÀÌ ±â±¸¿¡ ±â¾î ¿Ã¶ó°£´Ù
- *handedness
;
*4¼¼
- *hops on one foot, throws ball overhand
- copies cross and square
- count 4 pennies, tells a
story
Implication For Parents & Pediatricians
;
Á¤»óÀûÀÎ ½Ä¿å °¨¼Ò´Â ¼ºÀåÀÌ Á¤»óÀ̶ó¸é ¼·Ãë°¡ Àû´çÇÑ °ÍÀ̹ǷΠºÎ¸ð¸¦ ¾È½É½ÃŲ´Ù. ¾Æµ¿ÀÇ
self-regulatory mechanism¹æÇØ ¡æ °ú½Ä or¼Ò½Ä
;
¾ÆÁÖ È°µ¿ÀûÀÎ ¾Æµ¿Àº ´ÙÄ¥ À§ÇèÀÌ Å©´Ù
;
hyperactivity¿¡ ´ëÇÏ¿© ºÎ¸ð°¡ °ÆÁ¤Çϸé psychotherapy &
medicationÀÌ µµ¿òÀÌ µÉ ¼ö ÀÖ´Ù
Language, Cognition And Play
Language
;
°¡Àå »¡¸® ¹ß´Þ, ¹®Àå ´É·Â ¹ß´Þ
;
*3¼¼
- *°£´ÜÇÑ ´ëÈ
°¡´É, ÀÚ½ÅÀÇ
¼ºº°°ú À̸§À»
´í´Ù, ¼Â±îÁö
¼¾´Ù
;
Mental retardation
- *2¼¼°æ±îÁö speech°¡ delayµÉ ¶§
¹ß°ß °¡´É
;
¾ð¾î°¡ Áö¿¬µÈ ¾Æµ¿Àº tantrum & ´Ù¸¥
externalizing behaviorsºóµµ°¡ ³ô´Ù
;
Çе¿Àü±â ¾ð¾î ¹ß´ÞÀº ³ªÁß¿¡ Çо÷ ¼ºÃëÀÇ ±âÃʰ¡ µÈ´Ù.
Cognition
;
Piaget'sÀÇ preoperational(prelogical) stage¿Í ÀÏÄ¡
- *magical thinking, egocentrism, ¼ö¿ëÇü »ç°í°¡
Ư¡ÀûÀÌ´Ù
/
confusion of coincidence for causality, animism, unrealistic beliefs about
power of wishes
- »ç¹°ÀÇ ´Ù°¢ÀûÀÎ ¸é°ú ´Ù¸¥ »ç¶÷ÀÇ °üÁ¡À» Àß ÀÌÇØÇÏÁö ¸øÇÔ
Play
#
º¹À⼺°ú »ó»ó·ÂÀÌ ÇöÀúÈ÷ Áõ°¡
; 2-3¼¼
: ¼îÇÎ, ¾Æ±â¸¦ ħ´ë¿¡ ´¯È÷±â
;
3-4¼¼ : µ¿¹°¿ø¿¡ °¡±â
;
4-5¼¼ : ´Þ³ª¶ó ºñÇàÀ» »ó»óÇÔ
#
»çȸ¼ºÀÌ Á¡Á¡ °³¹ßµÊ
; 1-2¼¼
: È¥ÀÚ Á¹°Å³ª º´ÇàÇÏ¿© ³î±â(solo or parallel play)
; 3-4¼¼
: block ÇÔ²² ½×±â
#
2¼¼ °æ °¨Á¤ÀÌÀÔÀÌ ³ªÅ¸³²
#
±×¸² ±×¸®±â µî âÀÛ È°µ¿ÀÌ ³îÀÌÀÇ Áß¿äÇÑ ÇüÅÂÀÌ´Ù
; 2¼¼
: ¼öÆò¼±À» ±×¸°´Ù
; 3¼¼
: *¿ø°ú
½ÊÀÚ°¡¸¦ º¸°í
±×¸°´Ù
; 4¼¼
: »ç°¢ÇüÀ» º¸°í ±×¸°´Ù, ¸öÀÇ ¼¼ºÎºÐÀ» ±×¸°´Ù
Implication For Parents & Pediatricians
;
¾ð¾î´Â ÀÎÁö¹ß´Þ°ú °¨Á¤ ¹ß´ÞÀÇ indicator À̸ç,
Çൿ Á¶Àý°ú ÀÌÈÄ¿¡ Çо÷ ¼ºÃëÀÇ key factorÀ̹ǷÎ
assessment & interventionÀÌ Áß¿ä
;
ºÎ¸ðµéµµ ¾ÆÀ̵éÀÌ °¨Á¤À» ÇൿÀ¸·Î ³ªÅ¸³»±â º¸´Ù´Â ´Ü¾î·Î Ç¥ÇöÇϵµ·Ï µµ¿ÍÁØ´Ù
;
reassurances
- *use their ¡°great power ¡°(e.g. monster spray, tape) to guarantee the
child¡¯s safety
Emotional Development
;
°ø°ÝÀû, ¼ºÀûÀÎ Ãæµ¿°ú ¾î¸¥µé°ú µ¿³â¹èµé »çÀÌÀÇ °ü°è¸¦ À¯ÁöÇÏ¸é¼ Á¦ÇÑÀ» ¹Þ¾ÆµéÀδÙ
;
*Temper Tantrum
- ¿ÜÀûÀÎ »óȲÀ» Á¶ÀýÇÒ ¼ö ¾øÀ» ¶§ ³»Àû
controlµµ »ó½ÇÇÔ
- °øÆ÷,
Áö³ªÄ¡°Ô ÇǰïÇÑ °Í°ú, ½ÅüÀûÀÎ ºÒÆíµµ
T.TÀ» À¯¹ßÇÒ ¼ö ÀÖ´Ù
- 1¼¼ ¸»¿¡ ³ªÅ¸³ª
2-4¼¼ peak
- 15ºÐ ÀÌ»ó Áö¼ÓÇϰųª
ÇÏ·ç 3¹ø ÀÌ»ó ±ÔÄ¢ÀûÀ¸·Î ¹ß»ýÇϸé underlying medical,
emotional, social problems¹Ý¿µ
- ºÎ¸ðµéÀÌ ±×µéÀÇ ¿ä±¸¿¡ Á¾Á¾ ÀÀ´äÇϸé Àڱ⸦ º¸È£Çϴ å·«ÀÌ µÉ ¼ö ÀÖ´Ù.
;
*4-5¼¼(oedipal stage)
- ºÎ¸ðÁß µ¿¼º¿¡°Ô °æÀï½É ´À³¢°í,
¹Ý´ë¼ºÀÇ ºÎ¸ð¿¡ °ü½ÉÀ» °¡Áü
- *curiosity about genitalia & adult sexual organs
- *masturbation
;
*ÇüÁ¦°£ÀÇ ¾Ë·Â¿¡¼
¿¬·ÉÂ÷À̳ª ¼ºº°Àº
º°·Î ¹®Á¦°¡
µÇÁö ¾Ê°í, ºÎ¸ðÀÇ Åµµ¿Í
°¡Á·³»ÀÇ ºÐÀ§±âÀÇ
¿µÇâÀ» ¹Þ´Â´Ù.
Implication For Parents & Pediatricians
ÀÇÁ¸¼º°ú ¹ÝÇ×ÀûÀÎ µ¶¸³¼ºÀÌ »¡¸® º¯ÈÇÏ´Â ½Ã±â·Î ºÎ¸ðµéÀÌ ÀÌÇØÇϱâ Èûµé´Ù
Chapter 14. Early School Years
;
6-12¼¼
;
*latency stage
- ¼ºÀû,
°ø°ÝÀûÀÎ ÇൿÀº ÈÞÁö±âÀÌ¸ç »çȸÀû ¹ß´Þ, µ¿·áÀνÄ,
±ÔÀ² ¹× Áú¼¸¦ ¹è¿ì´Â °üÁ¡¿¡¼´Â ¸Å¿ì Ȱ¹ßÇÑ ½Ã±âÀÌ´Ù
;
by Erikson
- ±Ù¸é¼º°ú ¿µî°¨ »çÀÌÀÇ
crisis½Ã±â
Physical Development
;
*7¼¼ °æ¿¡ myelinizationÀÌ ¿Ï¼º
;
*6¼¼ °æ
Á¦1¿µ±¸Ä¡ÀÎ 1st molar»ý±è. ±×
ÀÌÈÄ ¸Å³â 4°³ÀÇ ¿µ±¸Ä¡°¡
³ª¿È
;
ÀÓÆÄ Á¶Á÷ ¹ß´ÞÀÌ ÃÖ°í¿¡ ´ÞÇÔ
;
*È£Èí±â °¨¿°ÀÌ
ÈçÇÏ¸ç °¨¿°¿¡
´ëÇÑ ¹ÝÀÀÀº
¼ºÀΰú À¯»çÇÔ
- Çе¿±â°£ È£Èí±â °¨¿°Àº ¸Å¿ì ÈçÇÏ¸ç ³â°£
6-7ȸ ÀÌ»óµµ ÈçÇÏ´Ù
Implication For Parents & Pediatricians
;
½Åü Å©±â, ¿Ü¸ð, ´É·ÂÀÇ ´Ù¾ç¼º
¡æ ±àÁö¿Í ¼öÄ¡¸¦ ´À³¤´Ù
¡æ Á¤±âÀûÀÎ ½Åü °Ë»ç·Î °ü½É°ú µÎ·ÁÀ½À» Á¶ÀýÇÑ´Ù
Cognitive & Language Development
;
preoperational(by Piaget) ¡æ concrete logical operationÀ¸·Î ÀüȯµÊ
;
Çб³°¡ cognitive demand¸¦ Áõ°¡½ÃŲ´Ù.
- 1-2Çгâ
: Àбâ, ¾²±â, ±âÃÊ »ê¼ö
- 3-4Çгâ
: º¹ÀâÇÑ °Í
Implication For Parents & Pediatricians
;
stress¸¦ ¹ÞÀ¸¸é prelogical thinkingÀ¸·Î µ¹¾Æ°¥ ¼ö ÀÖ´Ù
#
academic & classroom behavior problem
; Áø´ÜÀ» ¿äÇÔ
¨ç specific learning
didabilities
¨è MR
¨é primary attention
deficit
¨ê secondary attention
deficit
: emotion, depression,
anxiety, chronic illness
; Ä¡·á´Â
underlying problem¿¡ ÀÇÁ¸
Social & Emotional Development
#
latency
- oedipal conflictÀÇ
resolutionÀ¸·Î µ¿¼ºÀÇ ºÎ¸ð¸¦ µ¿ÀÏÈ ÇÔ
- ºÎ¸ðÀÇ µµ´öÀûÀÎ ÆÇ´ÜÀÌ ÃÊÀÚ¾Æ(superego)·Î½á ³»ÀçÈ µÈ´Ù
#
°¡Á¤, Çб³, »çȸÀÇ ÀÛ¿ë °úÁ¤ÀÌ´Ù.
Implication For Parents & Pediatricians
;
°¡Á¤, Çб³, »çȸ°¡ ¼Ò¾ÆÀÇ ÀûÀÀ ´É·Â¿Í ¼ºÀåÀ» µµ¿ÍÁÖ´Â Áö °ü½ÉÀ» °¡Á®¾ß ÇÑ´Ù
;
HEADSS
- Home
-
Education & employment, peer
-
Activities
-
Drugs
-
Sexuality
- Suicide or depression
Table 14-1
Chapter 15. Adolescence
;
12-20yr
;
½Åü Å©±â, »ý¸®, Á¤½ÅÀû,
»çȸÀû ±â´ÉÀÌ À绡¸® º¯ÈÇÏ´Â ½Ã±â
;
social structures with hormone : adulthood ·ÎÀÇ developmental agenda
;
conceptual framework¿¡ µû¸¥ developmental line
¢ÞTable
15-1
# ¢¾Characteristics
1) ¸ðµç û¼Ò³â¿¡°Ô °°Àº º¯È
2) ½ÃÀÛ°ú ¿Ï·á½Ã±â, ¼Óµµ, Á¤µµÀÇ ¹üÀ§°¡ ³Ð´Ù
3) °³ÀÎÀÇ º¯È´Â Á¤ÇØÁø ¼ø¼´ë·Î º¯ÇÑ´Ù
4) 2Â÷¼ºÂ¡ÀÇ ÃâÇöÀº ¼º¼º¼÷ÀÇ ´Ü°è·Î ºÐ·ùÇÑ ¼º¼±ÀÇ È°µ¿À¸·Î Ç¥ÇöÇÒ ¼ö ÀÖ´Ù
Early Adolescence
Biologic Development
#
¢¾Three change on HPU
1) *pulstile releasing of GnRH
-->
pulstile releasing of LH
;
sleeping½Ã ¹ß»ý
;
*»çÃá±â(puberty)ÀÇ
½ÃÀÛ
2) decreased sensitivity of
hypothalamus & pituitary gland against estradiol, testosterone
-->
increased GnRH, LH, FSH
3) positive feedback of
estrogen in female
¢¾Table
15-2(SMR in female)
¢¾Table
15-3(SMR in male)
;
¿©¼º : SMR 1-5±îÁö´Â
total fat Áõ°¡ 8-25%
;
³²¼º : Áö¹æº¸´Ù´Â ¿ÀÈ÷·Á ±ÙÀ°ÇüÀ¸·Î º¯ÇÔ
Female
¨ç breast bud development
: 1st sg
¨è thickening of vaginal
mucosa & endometrium
¨é ¡è pigmentation
¨ê vascularization
¨ë ovary,uterus,clitoris
enlarge
¨ì vaginal glycogen ¡è ¡æ
yeast infection¡è
Male
¨ç testicular enlargement
: 1st sg
¨è penisÀÇ ¹ß´Þ
(testisº¸´Ù´Â ¹Ì¾à)
¨é seminiferous tubule,
epididymis,
seminal vesicle, prostate enlarge
¨ê breast hypertrophy :
40-65%
#
Dentition : menarche & 2nd permanent molar eruptionÀº ¼·Î ¿¬°üµÇ¾î ÀÖÀ½
Sexuality
Cognitive & Moral Development
;
concrete operational thinking ¡æformal logical operation by Piager
;
formal operation(³í¸®ÀûÀÎ »ç°í)ÀÇ Æ¯¼º
¨çÃß»óÀûÀÎ °³³äÀ» ´Ù·ë
¨è¾Ë·ÁÁø ¿ø¸®ÀÇ ÀÌÀ¯¸¦ ´ï
¨é¿©·¯ °üÁ¡¿¡¼ ´Ù¾çÇÑ criteria¸¦ º½
¨ê»ç°í °úÁ¤¿¡ °³ÇÑ »ç°í
¨ë°¡´É¼ºÀ» ½ÇÁ¦Àû »óȲÀ¸·Î ´Ù·ç´Â ´É·Â
;
µµ´öÀûÀÎ »ý°¢Àº ÀÎÁö ¹ß´Þ°ú ´ëÃæ ÆòÇàÇÏ°Ô ¹ß´Þ
*Fig. 15-3
*Fig. 15-4
Self-Concept
# »çÃá±âÀÇ ½Åü º¯Çü°ú ¹ÝÀÀÇÏ¿© Áõ°¡
# ¿ÜÀû Ư¼º¿¡ µû¶ó ÀÚ°¢ÇÏ°Ô µÊ
# À߸øµÈ body image ¡æ
anorexia nervosa
Relationships With Family Peers & Society
;
°¡Á·À¸·ÎºÎÅÍ µ¶¸³
;
onset of pubertal development signal : a wish for privacy
;
peer group : µ¿¼ºÀÇ Ä£±¸°£ÀÇ ¿ìÁ¤ÀÌ ¹ß´ÞµÇ¸ç ÀÚ½ÅÀÇ ¸ðÀÓÀÇ Áß½ÉÀÌ µÇ·ÁÇÔ
;
school : ¿©·¯ factor°¡ Çб³ »ýȰ¿¡ ÀÛ¿ëÇÏ´Â µ¥
synchrony of pubertal development°¡ ƯÈ÷ Áß¿äÇÏ´Ù
Implication For Parents & Pediatricians
#
SMR°ú ¿¬°üµÇ¾î ÀÖ´Â °Í
; physical growth, body
preoccupation, sexual interest
#
*chronologic age¿Í
¿¬°üµÇ¾î ÀÖ´Â
°Í
; *cognitive advancement, separtion, change in social behavior
Middle Adolescence
Biologie Development
; *Growth
Acceleration
- ¼ºÀÎ ½ÅÀåÀÇ
20-25% : ³²ÀÚ 26-28cm, ¿©ÀÚ
23-28cm
- ¿¬·É
: ³²ÀÚ 12.5-15¼¼(Æò±Õ
14¼¼), ¿©ÀÚ 10-13¼¼(Æò±Õ
12¼¼)
- ¼Óµµ
: ³²ÀÚ 7-12cm/yr(Æò±Õ
10cm/yr), ¿©ÀÚ 6-11cm/yr(Æò±Õ
9cm/yr)
;
¢¾Growth SpurtÀÇ ³²³àÀÇ
Â÷ÀÌ
1) ¿©ÀÚ´Â ³²ÀÚº¸´Ù
PHV°¡ 18-24°³¿ù Á¶±â¿¡ ¹ß»ý
2) ¿©ÀÚÀÇ
PHV´Â ³²ÀÚº¸´Ù 2cm/yr ÀÛ´Ù
3) ³²ÀÚÀÇ
PHV¿Í PWV´Â ÀÏÄ¡Çϳª ¿©ÀÚ´Â PWV°¡
PHVº¸´Ù 6-9°³¿ù ´Ê°Ô ½ÃÀÛ
4) ³²ÀÚ´Â
PHV°¡ SMR4¿¡¼ ¹ß»ý,
¿©ÀÚ´Â SMR3¿¡¼ ¹ß»ý
;
¼ºÀå ±ÞÁõÀº *GH, androgenÀÇ
ÀÛ¿ë¿¡ ÀÇÇØ ¹ß»ý
- ±×·¯³ª ½ÅüÀÇ ¸ðµç ºÎÀ§¿¡ *µ¿½Ã¿¡
¹ß»ýÇÏÁö´Â ¾Ê´Â´Ù.
±×¸² 1-15(p42)
±×¸² 1-16(p43)
#
Bone maturation : SMR°ú °ü°è(+)
androgen controlÇÏ¿¡ epiphyseal closure
Table 15-5
¡ÚÇ¥1-13(p44)
#
³²ÀÚÀÇ ¼ºÀû ¹ß´Þ
; *G2¿¡¼ ½ÃÀÛ
; *ù¹øÂ° º¯È´Â
°íȯÀÇ Áõ°¡
; *spermarche - SMR3
#
¿©ÀÚÀÇ ¼ºÀû ¹ß´Þ
; *B2 ¶Ç´Â PH2¿¡¼
½ÃÀÛ
; *ù¹øÂ° º¯È´Â
Á¥²ÀÁöÀÇ µ¹Ãâ
; menarche
-
*SMR3 : 30%, SMR4 : 90%
-
growth spurt 1³â ÈÄ
-
peak of wt.velocity¿Í ¹ÐÁ¢ÇÑ °ü°è (+)
¨ç
genetics
¨è
adiposity
¨é
chr.illness
¨ê
exercise
; pubic hair - SMR3
Sexuality
;
À̼º°úÀÇ ¸¸³²ÀÌ ÀÌ·ç¾îÁü
Cognitive & Moral Development
;
formal operative thinking
Self Concept
;
¹ß´Þ
Relationship With Family, Peers & Society
;
ºÎ¸ð ÇüÁ¦µé°ú ´õ¿í µ¶¸³ÀûÀ¸·Î µÇ¸ç °ü°è ÀçÁ¤¸³ÀÌ ÀϾ
Implication For Parents & Pediatricians
;
½ÅüÀû, »çȸÀû ¼ºÀå ¼Óµµ´Â ¾ÆÁÖ ´Ù¾çÇϸç ÀÚÀ²¼º°ú ÀÚÁ¸½ÉÀÇ °¥µî ÇØ°áÀÌ ´Ù¾çÇÏ´Ù
Late Adolescence
Biologic Development
;
young adult proportion°ú ºñ½Á
;
SMR 5 stage¿¡ ÇØ´çÇÔ
Psychosocial development
ºÎ¸ð¿Í ´Ù¸¥ »ç¶÷µé¿¡°Ô empathetic, intimate
relationship³ªÅ¸³»´Â ´É·ÂÀÌ ÇÔÇâµÊ
Implication For Parents & Pediatricians
identityÈ®¸³,
°¡Á·À¸·ÎºÎÅÍÀÇ ºÐ¸®. °æÁ¦Àû µ¶¸³À» °èȹÇÑ´Ù.
Chapter 16. Assessment Of Growth
#
growth assessmentÀÇ °¡Àå ÁÁÀº tool : growth chart
Growth Chart Derivation & Interpretation
¢Þ¡Ø97 Àå±âº° ¹ßÀ° ÇüÅÂ(by scammon)
±×¸²1-2(p19)
¢ÞÀ¯¾Æ¿¡¼ °¡Àå À¯¿ëÇÑ routine physical measurement
¨ç µÎÀ§ ¨è ½ÅÀå ¨é ¸ö¹«°Ô
#
old chidren¿¡¼ ½ÅÀå°ú ¸ö¹«°ÔÀÇ ÃøÁ¤Àº length of body
segments·Î ´ëü °¡´É
(»çÁö
,span,¾ÉÀº Ű¿¡ ÀÇÇØ º¸Ãæ)
#
û¼Ò³â±â ¼ºÀå»óÅ : ¸ö¹«°Ô,
½ÅÀå ¿Ü¿¡ sex maturating rate
height
velocity,body fat contentÀÇ ÃøÁ¤µµ À¯¿ë
#
¢¾4 Standard Charts
; weight for age
;
height for age
;
head circumference for age
;
weight for height
¢Þ¡Ø96,
97 linear growth°¡ °¨¼ÒµÈ 4classÀÇ ÀüÇüÀûÀÎ growth curve
Fig.16-1 & ±×¸²1-4(p21)
±×¸²1-5(p21)
Analysis Of Growth Patterns
#
Wt = Ht < CA : °ú°ÅÀÇ nutritional or growth
failure
Wt < Ht < CA : °ú°Å,
ÇöÀçÀÇ nutritional or growth failure
Wt < Ht = CA : acute nutritional or
growth problems
#
In congenital pathologic short stature
; Ư¡
- ÀÛ°Ô Å¾ infancyµ¿¾È ¼ºÀå ÁÙ¾îµê
; ¿øÀÎ
¨ç
chromosomal abnormality : Turner synd. trisomy 21
¨è
infection (TORCH)
¨é
teratogens : phenytoin, alcohol
¨êextreme
prematurity
#
In constitutional growth delay
; ¿µ¾Æ±â ¸»¿¡
Wt & Ht °¨¼ÒÇÏ¿© middle childhood±îÁö
normal°ú ÆòÇàÇÏ°Ô ÀÚ¶ó¼ adolescence¸» ÂÊÀ¸·Î °¡¼ °¡¼ÓÈ
; ¼ºÀÎ ¶§´Â Á¤»ó Å©±â·Î ÀÚ¶÷
#
In familial short stature
; growth´Â
normal curve¿Í ÆòÇàÇÏ¸é¼ ¹Ù·Î ¾Æ·¡¸¦ µû¶ó¼ ´Þ¸°´Ù.
#
Wt for Ht°¡ standard 120%¡è
: obesity
#
¡ÚBody mass index(BMI) = üÁß(Kg)/½ÅÀå2(m2)
¨ç 4-5¼¼ »çÀÌ ÃÖÀú
¨è 5.5¼¼Àü¿¡ ¿À¸£±â ½ÃÀÛÇϸé
adult obesity Áõ°¡
¨é high lean mass ¼Ò¾Æ
; adiposity°¡ °ú´ëÆò°¡µÊ
¡æ
reference standards : triceps & subscapular skinfold µÎ²²ÀÇ Á÷°æÀ» ÃøÁ¤ÇÏ¿©
adiposity¸¦ ÃøÁ¤
Weight
;
»ýÈÄ 3-4Àϵ¿¾È *¾à4 %ÀÇ
initial Wt loss
- 10%±îÁö °¨¼ÒµÉ ¼öµµ ÀÖ´Ù.
- »ýÈÄ
7-10Àϰ ȸº¹
#
üÁß Áõ°¡
; *20-30gm during 5-6mo
; *10-20gm during 6-12mo
¡ÚÇ¥1-1(p22)
Height
¡ÚÇ¥1-2(p22)
;
*7cm/yr in infancy, 5-6cm/yr in
children, 8-10cm/yr in adolescence
;
2¼¼ ¶§ÀÇ Å°´Â ºÎ¸ðÀÇ Æò±Õ Ű¿Í °ü°è ÀÖ´Ù
;
*¹Ì¼÷¾Æ¿¡¼
postnatal age·ÎºÎÅÍ prematurityÀÇ weeks¸¦ »À¸·Î½á growth failureÀÇ °úÁø´ÜÀ»
ÇÇÇÒ ¼ö
ÀÖ´Ù.
- Head circumference : 18°³¿ù±îÁö
- Weight : 24°³¿ù±îÁö
- Height : 40°³¿ù±îÁö
#
failure to thrive : child weightÀÇ 5%il ÀÌÇÏ
or two major percentile lineÀÌÇÏ·Î ¶³¾îÁü
#
Acute undernutrition
: Wt for age & Wt for Ht curve°¡ °¨¼Ò
#
chr.malnutrition
¨ç Ht for age ¡é,
Wt for Ht curve return to nl (standard but not wasted)
¨è in infancy : head
growth¡é
¡ÚTable
16-1
#
height age (Wt. age)
: standard(median) height°¡ ¼Ò¾ÆÀÇ ÇöÀçŰ(¸ö¹«°Ô)¿Í µ¿ÀÏÇÑ ¿¬·É
#
height °¨¼Ò½Ã ¿øÀÎÀû °¨º°
|
nutrition°¨¼Ò |
cong.
constitutional familial endocrine |
Wt Ht Wt
for Ht |
¡é ¡é ¡é |
¡é
-+ µ¿½Ã¿¡ °¨¼Ò ¡é
-+ Nl
or¡è |
Other Index Of Growth
Body Proportions(½Åü ºñÀ²)
¡Ø93
Midpoint
; at birth, 2cm above
umbilicus
; beneath umbilicus in 2yr
; symphysis pubis in 16yr
#
Ãâ»ý½Ã ¸Ó¸®,¸öÅëÀÌ Å©´Ù.
; *»çÁö°¡ µ¿Ã¼º¸´Ù
»¡¸® ÀÚ¶ó°í
»çÃá±â°¡ µÇ¸é
ºñ½ÁÇÑ ¼Óµµ·Î
ÀÚ¶ó°í, ±×ÀÌÈÄ¿¡´Â
µ¿Ã¼°¡ ´õ
»¡¸® ÀÚ¶õ´Ù.
; »çÁö°¡ ±æ¾îÁü
#
lower body seg. = S.P ¡æ floor
upper
body seg. = Height¡æSymphysis pubis
Ç¥1-3(p23)
#
increase of ratio
¨ç
short limb dwarfism
¨è bone disorder(rickets)
Head Circumference
; Ãâ»ý½Ã ¾à34cmÀ̸ç, óÀ½ 1³â°£ 12cm/yr·Î Áõ°¡
- 46cm at 1yr
- *50cm at 4yr(90% of adult)
Fontanel
; Ant. fontabel
-
*close at 14-18mo
-
*»ýÈÄ 2³â°æ¿¡ ´ÝÈ÷´Â
°æ¿ìµµ ÀÖ´Ù.
; Post. fontanel
- close at 6-8wks
; Suture
- close at 6-8mo
Skeletal Maturation
#
Bone age
; chronologic ageº¸´Ù
sex maturity¿Í ÀÏÄ¡
; Lt. hand, wrist
-
early infancy¿¡¼± knee
; Greulich-PyleÀÇ ¾ÆÆ²¶ó½º¸¦
´ëÁ¶ or Tanner-Water-House(TW2)¹æ¹ý
#
*¿©¾Æ°¡ ³²¾Æº¸´Ù 2³âÁ¤µµ ºü¸£´Ù
Dental Development
#
Deciduous teeth
;
¸ðµÎ 20°³
;
´ë°³ *»ýÈÄ2³â¹ÝÀÌ µÇ¸é ´Ù ³ª¿Â´Ù.
;
¿ù·É-6
#
Natal teeth
#
Delayed eruption
; *13°³¿ù±îÁö Ä¡¾Æ°¡
ÀüÇô ³ªÁö
¾Ê´Â °æ¿ì
¨ç hypothyroidism
¨è hypoparathyroidism
¨é familial
¨ê idiopathic - ¡ã
#
¡ÚCause of early exfoliation (Á¤»óÀº 6¼¼ - 12¼¼ »çÀÌ)
¨ç *histiocytosis X
¨è *cyclic neutropenia
¨é trauma
¨ê idiopathic
#
¡ÚDiscoloration or malformation of Enamel
¨ç nutritional and
metabolic disturbance
¨è prolonged illness
¨é certain medication -
tetracycline
#
line of pitting on enamal
; time-limited insult
#
¢¾Drooling
; teething, stomatitis, *DM, acrodynia, certain medication
Physiologic & Structural Growth
Heart & Lungs
;
apex beat
- neonate / left 4 ICS in
midclavicular line
- at 2yr / left 5 ICS in
midclavicular line
;
CT ratio
- *within 1yr
/
*0.55 normal
;
È£Èí¼ö, ½É¹Ú¼ö - ù
2³â°£ ±Þ°ÝÈ÷ °¨¼ÒÇÏ°í ±× ÀÌÈÄ Áõ°¡
;
Ç÷¾Ð - 6¼¼ °æ¿¡ ¾ÈÁ¤µÇ°Ô Áõ°¡
Chest Circumference
; Ãâ»ý½Ã 33cm
; *»ýÈÄ 1³âÀÌ µÇ¸é, µÎÀ§¿Í ÈäÀ§°¡
ºñ½Á
; 10-11¼¼°¡ µÇ¸é, Ãâ»ý½Ã 2¹è
Sinus & Mastoids
; ¡Úethmoid,
maxillary, sphenoid
-
*at birth
-
sphenoid is no problem till 3-5yr
; frontal sinus - 6¼¼
; *ethmoid´Â ¼Ò¾ÆÃʱâ (7-14¼¼)¿¡
ÃÖ´ë Å©±â
³ª¸ÓÁö´Â »çÃá±âÀÌÈÄ¿¡
¼ºÀÎ Å©±â¿¡
µµ´Þ
Thymus
#
¢¾¡ØX-ray
ÆÇµ¶»ó °í·ÁÁ¡
1) ¼ûÀ» ³»½¬¾úÀ»¶§
À½¿µÀÌ ´õ Ä¿Áø´Ù.
2) ´©¿ö¼ Âï¾úÀ»¶§ À½¿µÀÌ ´õ ³Ð¾îÁø´Ù.
3) Á¤¸é°ú Ãø¸é »çÁø ¸ðµÎ°¡ ÇÊ¿äÇÏ´Ù.
-
Ãø¸é »çÁø»ó ±â°üÀÌ ´¸®°Å³ª ÀüÀ§µÈ ¸ð¾çÀ» °¡Áú¶§ Àǹ̰¡ ÀÖ´Ù.
4) *ÀÚ±ØÀÌ Àְųª, °¨¿° ¶Ç´Â
Ä¡·á½Ã¿¡´Â ÀÛ¾ÆÁø´Ù.
Gastrointestinal system
;
liver
- *within 1yr / 1.6cm palable
- between 1.5~10.5yr / 1cm
palpable
- between 10.5~16.5yr /
0.85cm palpable
Genitourinary system
;
bladder capacity
- at birth / 75ml
- infant / 250ml
- (146+6.1xAge)
;
labia
- *labia minor°¡ ÇöÀú
Lymphiud Tissue
: 6¼¼ °æ¿¡ ¼ºÀÎ Å©±â¿¡ µµ´Þ ÈÄ ±× ÈÄ ¼Ò¾Æ±â µ¿¾È °è¼Ó ¹Ù´ëÇÑ µÚ early adolescene¶§ ¼ºÀÎ Å©±â·Î °¨¼ÒÇÔ
drug metabolism : ù
1°³¿ù°ú »çÃá±â¶§ hormoneÀÇ ¿µÇâÀ¸·Î ±Þ°ÝÈ÷ º¯È
nutritional needs, biochemical &
hematologic value
¡æ developmental change¾ß±â
eg) ALP : °ñ¼ºÀå ºü¸¥ ½Ã±âµ¿¾È Áõ°¡
Hb:2°³¿ù ÃÖÀú
Chapter 17. Developmental Assessment & Biologic variation
Sensory Development
Vision
;
»ýÈÄ *¼öÀÏ
À̳»
Smell, Taste, Touch
;
Á¥³¿»õ¸¦ ¸ÃÀ» ¼ö ÀÖ´Ù.
;
*¹Ì°¢Àº Ãâ»ý½Ã¿¡µµ
ÀÖÀ¸¸ç, 3°³¿ùºÎÅÍ
¼¶¼¼ÇÑ ¹ÝÀÀ
Hearing
;
»ýÈÄ *¼öÀÏ
À̳»
;
*4-6°³¿ùÀÌ
µÇ¸é ¹æÇâÀ»
¾È´Ù.
Motor Function
¡ÚÇ¥1-6(p28)
Speech
Sleep
;
*dream, nightmare - REM sleep
;
night terror, sleepwalking - NREM sleep
Sphicter Control
;
*bowel controlÀ»
¸ÕÀú, --> daytime
control --> nighttime control
;
bowel control
- *3yr late
# in neonatal period : neurologic
impairment ¹ß°ß
ºÎ¸ðµéÀÌ ¾ÆÀÌÀÇ Æ¯Â¡À» ¿¹¹ÎÇÏ°Ô ÇÒ ¼ö ÀÖ´Ù
# in infancy
: sensory, motor, cognitive
emotional problems Á¶±â¹ß°ß, Ä¡·á
ºÎ¸ð¸¦ ¾È½É½ÃÅ´
# in middle childhood : academic &
social problemsÇØ°á
Neonatal Assessment
#
NBAS (Neonatal Behavioral Assessment Scale)
; *¡ãwidely used examination
1) Æò°¡ ³»¿ë
¨ç
infant's neurologic intactness
¨è
adaptation to extraut. life
¨é
primitive reflexes
¨ê
state organization
¨ë
self-regulatory ability
¨ì
interactive capacity from birth to 1mo
2) 30-40min °É¸²
3) ÀÇÀÇ
¨ç
Brain plasticityÁ¤µµ
¨è ¹ß´Þ¿¡ ´ëÇÑ È¯°æÀÇ ¿µÇâ
¨é *later development¿Í´Â
Àß ÀÏÄ¡ÇÏÁö
¾Ê´Â´Ù
Assessment In Infancy
#
developmental, emotional problemsÀÇ early intervention
#
screaning test & developmental surveillance
Screening tests
¡ÚTable
17-1
Developmental Surveillance
;
¾î´À ÇÑ ½Ã±âÀÇ »óŰ¡ ³ªÁßÀÇ ¹ß´Þ »óÅ Áß ¿ÏÀüÈ÷ ¿¹ÃøÇÒ ¼ö ¾ø´Ù.
Combined Approaches
; *¡ãeffective
;
¢¾5 Principle of Early Identification Of Development &
Emotional Problem
¨ç
parent, as a rule, are accurate observers
¨è
no child is too young for formal audiologic testing
-
Hx & P/FÀÇ½É ½Ã Ix
¡ØTable 17-2
¨é
risk factor are additive
¨ê
discomfort, fatigue, shyness, & oppositionallity may affect child¡¯s
performance on developmental testing
¨ë
pediatricians and parents worry about the adverse effects of labelling a child
Table 17-2
Diagnostic Assessment
#
screen test»ó potential problem°¡Áö¸é
D.A½Ç½Ã
Medical Evaluation Of Developmental Delays
#
ÁÖ¿ä Áúº´ÀÇ À¯º´À²
Table 17-3
#
History, P/E, Lab test ½Ç½ÃÇÑ´Ù
Developmental Diagnosis For Preschool-Age Children
# ´ÙÀ½À» Æ÷ÇÔÇØ¾ß ÇÔ
¨ç formal developmental
testing
¨è playroom observation
¨é ºÎ¸ð, °¡Á· ¸é´ã
¨ê °¡Á¤³» °üÂû
¨ë team meetings
¡æ ºÎ¸ð, °¡Á·,
»çȸÀû ȯ°æ»Ó¸¸ ¾Æ´Ï¶ó ¹ß´ÞÀÇ °¢ ¿µ¿ªÀ» ¸ðµÎ Æ÷ÇÔÇØ¾ßÇÔ
Diagnostic Assessment For School-Age Children
academic & behavioral problemÁø´Ü
¡æ
+- #specific learning disability
+-
#attention deficit
¨ç medical evaluation
¨è visual & hearing
deficits
¨é educational testing
¨ê psychological
evaluation : depression, anxiety
¨ë neuropsychological
testing : learing problemÆò°¡
#
assessment Æò°¡¸¦ À§ÇÑ Áú¹®µé
¨ç ÃæºÐÇÑ ½Ã°£À» ¼Ò¿äÇÏ¿´´Â°¡?
¨è standard educational
test¿Ü¿¡ psychological interview &
projective testingÀÌ ÀÌ·ç¾îÁ³´Â°¡?
¨é IQ°Ë»ç´Â ÇÏ¿´´Â°¡?
¨ê testingÀÌ ¸ðµç ¿µ¿ªÀÇ ±â´ÉÀ» ¼³¸íÇϴ°¡?
¨ë report°á°ú¸¦ Á¶ÇÕÇÏ¿´´Â°¡?
Biologic Variation