¼±Åà - È­»ìǥŰ/¿£ÅÍŰ ´Ý±â - ESC

 

Part 02. Growth and Development

Part 2. 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¡ ÇѵΠ´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±âÀ̹ǷΠÀ̶§ 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 Æí¾ÈÇØÇÏ¸ç ´Ù½Ã ³îÀÌ·Î µ¹¾Æ°¨

¨è ambivalently attached children

    - ¾È½ÉÇϳª È­°¡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 Ã³À½ 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 factorÀ̹ǷΠassessment & 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¯ÁöÇϸ鼭 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 ÆòÇàÇϸ鼭 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