The main manifestation of adolescence is the emergence of the second rapid growth period (sudden increase period). Boys: 10- 12cm/ year (peak rate); Female students: 7-9cm/ year. The secondary sexual characteristics begin to develop, with obvious gender differences and reproductive functions.
There are two periods of rapid growth in a person's life: infancy, 0-3 years old, and the rapid growth of children is mainly affected by the growth of the fetus in the womb during pregnancy. The growth rate is the fastest in the first year after birth, which can increase by 25 cm, and the growth rate in the second year is 10 cm. From the age of 3 to adolescence, the growth rate will slow down. The second peak is adolescence, which is a period of accelerated growth. Due to the regulation of growth hormone and sex hormone, the growth of boys and girls accelerates again after puberty. Among them, growth hormone plays a leading role in human growth: sex hormones not only promote growth, but also promote sexual maturity and skeletal maturity, leading to the cessation of height growth. The height of boys can be increased by 25-28 cm throughout adolescence, and that of girls can be increased by about 25 cm.
The process of puberty development is generally divided into three periods. Early stage: the sudden increase in height begins, which is the peak of the sudden increase. The second sexual characteristics begin to develop, such as the development of girls' breasts and boys' testicles, which lasts for about 2 years; The middle stage is marked by menarche and nocturnal emission, with the gradual development of sexual organs and characteristics, and the growth rate of height gradually decreases, which generally lasts for 2-3 years; Late stage: the body grows very slowly (1-3cm/ year) until the epiphysis is completely healed, and the development of sexual characteristics and sexual organs reaches the adult level, about 2 years. The boundaries of these three periods are not clear, but the process is the same.
The puberty development age is 12- 15 for boys and 13 for girls. Different races, different regions, different times and different living conditions will produce differences. There are both individual differences and family genetic factors. In the outpatient clinic, we often ask parents when menarche occurred and when the height suddenly increased.
The whole process of puberty development is relatively long, and the breast development of girls is 9- 1 1 year; 10- 1 1 year old breast development, pubic hair began to grow; 1 1- 12 years old, developed internal and external genitalia, changed vaginal smear, further developed breasts and increased pubic hair. 12- 13 years old nipple pigmentation, menarche; 13- 14 years old ovulation will have fertility function; 14- 15 years old with acne and voice tone change; Bone development stopped at 16- 17 years old. This is a general rule. With the difference of time and region, there will be some advance.
10- 1 1 year-old boys' testicles begin to develop (volume > 4 ml), so we should pay attention to the development of boys' testicles from an early age, and when it is larger than 4 ml, it is a sign of puberty; 1 1- 12 years old scrotum development and pigmentation, penis development; 12- 13 years old prostate activity and pubic hair development; 13- 14 years old, with rapid development of testicles and penis and developed breast tissue; 14- 15 years old armpit hair, acne, tone sandhi, first nocturnal emission; 15- 16 years old sperm maturation; Bone development stopped at 17- 18 years old.
The changing trend of adolescent age is constantly advancing. The average age of menarche in women: 1962 14. 16 years old, in 2000 12. 14 years old, two years earlier. According to the survey in Beijing, in 2004, the female students in Beijing were 12. 1 year-old, in the urban area1.9 years old and in the suburbs 12.5 years old. Breast development: 9.5 years old, 9.4 years old in urban areas and 9.6 years old in suburbs. Appearance of pubic hair: 1 1. 1 year old, urban 1.8 years old, suburban 1 1.4 years old.
In the 20 years from 1962 to 1982, it was 8.4 months ahead of schedule, while in the recent 10 year, it was 5.2 months ahead of schedule. As can be seen from this data, everything is ahead of schedule. This is related to many factors, such as nutrition, education and publicity.
The average age of male first spermatorrhea is 1995 14.56 years old, urban 14.44 years old and rural 14.87 years old. In 2004, Beijing 14.4 years old, urban14./kloc-0 years old, and suburban 14.8 years old. The median age of testis reaching 4ml is 10.7 years old, urban area is 10.8 years old and suburban area is 10.7 years old. The median age of pubic hair is 12.2 years old, and it is 12.0 years old in urban areas and 12.4 years old in suburbs. Many of boys' nocturnal emission is retrospective and will not be remembered as clearly as girls' menarche. The puberty development of boys is not particularly obvious.
Generally speaking, growth refers to the growth of long bones. The female is about 15- 16 years old and the male is about 17- 18 years old. Generally, children should be told to exercise well at this time, and there is still room for growth. After that, the growth of vertebral body and epiphysis, about 20 years old, is 1-3 cm per year, mainly the growth of flat bone.
The data shows that the height of women at menarche is equivalent to 95% of their final height. The final height = the height at menarche ÷ (0.9585 0.0 178), which can generally increase by 3.6-9.5 cm, with an average of 6.5 cm.
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Sexual development process and average age of girls
Age (year) development
9- 10 breasts begin to develop.
10- 1 1 breast development, pubic hair began to grow.
1 1- 12 development of internal and external genitalia, change of vaginal smear, further development of breast and increase of pubic hair.
12- 13 nipple pigmentation, menarche
13- 14 ovulation
14- 15 acne, tone sandhi
Skeletal development arrest
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Sexual development process and the average age of boys
Age (year) development
10- 1 1 Testis begins to develop (volume > 4 ml).
1 1- 12 scrotum development and pigmentation, penis development
Prostate activity and pubic hair development
13- 14 rapid development of testis and penis and development of breast tissue.
14- 15 armpit hair, acne, tone sandhi, first nocturnal emission
15- 16 sperm maturation
Skeletal development arrest
Both precocious puberty and stunting are abnormal puberty.
Adolescent developmental abnormalities include precocious puberty and developmental retardation.
Precocious puberty: the second sexual characteristic of boys before 10 years old and girls before 8 years old may be precocious puberty. There are also great differences between different ethnic groups. For example, in the west, the secondary sexual characteristics of boys before the age of 9 are called precocious puberty. Investigate its etiology: some are gonadotropin-dependent true precocious puberty, that is, central precocious puberty, which is more common in girls; There are also true precocious puberty caused by brain organic lesions, such as precocious puberty caused by pituitary adenoma; Some are gonadotropin-independent pseudoprecocious puberty: women are stimulated by ovarian and adrenal tumors and exogenous estrogen (such as drugs), and men suffer from congenital adrenal cortical hyperplasia, testicular and adrenal tumors; In addition, there are incomplete (partial) precocious puberty, such as simple breast development and early pubic hair.
The most important influence of early puberty is the final height, as well as psychological influence. There will be some psychological changes from adolescence to adulthood. Once there is an abnormality in adolescence, you should seek medical attention in time after finding it. You need to check bone age, sex hormone level and head MRI. Many athletes look special, largely because of tumors. B-ultrasound of adrenal gland, uterus and ovary is also needed. There are more idiopathic precocious puberty in women and more rational precocious puberty in men. There is an increasing trend now. Many children have the characteristics of precocious puberty at the age of 8, sometimes it is not called precocious puberty, but called early development.
Treatment of precocious puberty: some children need temporary observation, and some children have not really started puberty. They will recover after a period of time after the emergence of secondary sexual characteristics. It must be reviewed regularly to observe the changes after reducing possible external stimuli. Some need treatment, and the effective drug is gonadotropin-releasing hormone inhibitor, which can inhibit the process of sexual development and slow down the excessive growth of bone age. For those with low height and slow growth, growth hormone should be added. Eat less foods containing hormones, as well as legumes and nutrients. A child ate some kind of children's oral liquid and menstruated at the age of 2. Therefore, for nutrition, we recommend careful use, and we will advise parents not to use some food. Some female cosmetics contain estrogen, which will have a stimulating effect. Don't let children always touch female cosmetics. In addition, some bad websites and all kinds of publicity in the society will make children come into contact with sexual content prematurely, which will also stimulate the children's center and affect them.
Developmental retardation: females are older than 13 years old and males are older than 14 years old, indicating developmental retardation. But either stunting or all diseases need to be diagnosed by examination.
The bone age is younger than the actual age, the growth rate is normal, and there is a family genetic history. Finally, the normal development is the delay of physical development. Some children develop late and grow taller. The growth spurt is late, and the final height is generally higher. For example, there is a girl who developed late in adolescence, but just caught up with the SARS period. There is no class at school. She gets enough sleep every day and exercises more to play badminton. Her growth suddenly improved significantly and her life became higher. Generally speaking, physical retardation does not need treatment, and individual psychological problems and promoting development can be treated temporarily, such as taking a small amount of sex hormones. As for whether it is late development, it depends on bone age and sexual development.
There are also some abnormalities in adolescence that are affected by other reasons. Some children have normal bone age and no sexual characteristics, so they need to consider special diseases, such as chromosomal abnormalities and familial diseases. They need to come to the hospital for examination as soon as possible, find diseases and treat them in time.
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Developmental delay of adolescent dysplasia
No secondary sexual characteristics were found in female > 13 years old.
Male > 14 years old has no secondary sexual characteristics.
Physical retardation
The bone age is younger than the actual age.
Normal growth rate
Have a family history
Eventually develop normally.
When children are in adolescence, parents should intervene in nutrition, exercise and sleep.
In the process of children's growth and development, parents should pay attention to the order, process and speed of their sexual characteristics. In particular, boys' development needs special attention, because girls' menarche is more likely to be discovered by their parents, while boys' first nocturnal emission is generally not noticed by their parents, unless a particularly careful mother washes her son's underwear by hand, the probability of discovery will be greater, and few parents can answer accurately when asked in the clinic. There are also some special examples among girls. I once went to the suburbs of Beijing to investigate and found a girl of 10 years old who was menstruating, but she didn't know it at all. I didn't know until I asked. The child went to school late, and it was only the second grade. The students are still little girls. Her parents are not around. She talked to her grandmother, who never told her. Parents must assume the responsibility of educating their children on adolescent health.
As mentioned above, children should have different development processes at different ages. If the development process is consistent with the growth rate, it is basically normal. However, parents should carefully observe the growth rate of their children. For example, the development of boys' breasts depends on whether there is induration. Obese children often have this situation, so that they are afraid of being laughed at by their classmates at school in summer. Such children need to adjust their diet, especially diet and irrelevant stimuli, and need surgery if necessary.
Parents should grasp the sudden increase of children's height. Living with children every day may not change the height of children obviously. In adolescence, the sudden increase of children's height is generally one year 10- 12 cm. If there is no peak rate, the growth is not ideal and you need to see a doctor in time. Many times it is due to insufficient secretion of adolescent growth hormone.
Nutrition, exercise, sleep, etc. Can't be ignored. When children's food intake increases, they may begin to accelerate their growth. Parents should ensure their children's nutrition, pay attention to the absorption of calcium and protein, but need a balanced diet, not partial eclipse, to prevent obesity and blood sugar metabolism. Parents should pay attention to the whole process of children's growth and development. At this stage, children are also very nervous about learning. Both the senior high school entrance examination and the senior high school entrance examination are fatal, but you must ensure your exercise and sleep time. Let children go to bed early, and don't stay up late, because the peak of growth hormone secretion is at night, which is about 1 1- 12 o'clock in the evening, so as to ensure quiet sleep and good blood supply, which is helpful for growth hormone secretion.
Attention should be paid to properly supplementing calcium and vitamin D in adolescence, but they need to be eaten together to help children grow taller.
When the bone age is commensurate with the age, the development of bone age is normal, so it is necessary to carry out regular bone age detection.
In health, psychology, behavior and other aspects, adolescent should pay special attention to precocious children, and parents should also play a certain role in physiological education. Because the education in some schools is relatively backward, although there are health education classes in schools, many problems have not been discussed or thoroughly explained. I sometimes ask the children who come to see a doctor if this question has been discussed by the school teacher, and the children either say no or can't say clearly. Correct sex education should be available. Precocious children are somewhat different from their peers and need some psychological education to avoid psychological abnormalities.
Another important issue that needs attention is that precocious puberty is easy to cause sexual risks, and it is necessary to give children some knowledge to make them aware of prevention and know how to protect themselves.
Let's take a look at these questions that are often mentioned by patients:
15-year-old boy's height 155cm is normal?
Judging from the normal age law, the boy is short. If sexual characteristics do not appear, there is still room for growth. If sexual characteristics have appeared, there is little room for children to grow up.
Children are still relatively tall among their peers from small to large. Why are you shorter than others now?
This happens in early maturity and early development. It is necessary to know the child's puberty development, see his growth potential, and also need to look at the bone age. Every child has a growth curve. Adolescent children will have a sudden increase in adolescent height, and all the factors in adolescence are well controlled. Generally, the height of children is ideal.
They all say jump at 23, why don't my children jump?
Regularly speaking, this situation is not obvious, because the growth of flat bone is not obvious. If your child's growth and development are not obvious, you must seek medical advice as soon as possible. Never wait until he is 23, it will be too late.
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What adolescent parents should pay attention to.
The sequence, process and speed of sexual characteristics.
If you suddenly increase your height, you should seek medical advice in time.
Nutrition, exercise, sleep, etc.
Supplement of calcium and vitamin d
Bone age monitoring
Other health, psychological behavior, etc.
■ Live Express
Since its opening, Beiqing Health Tour Lecture Hall has been welcomed by readers. The sixth lecture, about children's adolescence and height, attracted a large number of readers. Yesterday morning, before the class started, the audience had already filled the conference hall on the second floor of the outpatient department of the Capital Children's Hospital. Late readers could only stand and listen. During the lecture, most readers not only listen carefully, but also take notes from time to time. In the interactive session that followed, readers raised many specific questions and experts answered them in detail. Many readers are very concerned about when the lecture content will be released and when the next lecture will be held. After each lecture, we will sort out and publish the lecture contents on the "Health Observation" page as soon as possible. We will also announce the opening hours of the next lecture hall in the newspaper, so please pay attention.
Question and answer interaction
Reader 1: My relative has a 7-year-old boy who is now 1.05 meters tall. Is it short?
Sun Shuying: It's a little short. We should look at the growth rate of children and how much they grow each year. Many parents ignore this. At the clinic, they asked their parents how much their children's height grows every year. Many of them can't answer, they can only say a rough idea, so we must remember how much their children grow every year, which is not within the normal range. The child should take a bone age film and have it tested. In addition, his nutritional status and growth hormone level need to be considered.
Reader 2: Male, 15 years old, 1.72 meters, always thinks he is short, clamoring for higher medicine, is it necessary?
Sun Shuying: His height should be within the normal range. He needs to pay attention to his mentality and rest, and strengthen the correct understanding of psychology. Usually you can do more stretching exercises, which is good for your growth, such as touching the high jump, playing basketball, swimming and so on.
Reader 3: My little grandson is 8 years old and now 1.32 meters. He felt that he was growing up slowly. Should he take calcium supplements? Can eating too many calcium tablets increase epiphyseal closure?
Sun Shuying: If it is normal growth, we recommend that children drink milk. Generally, add 250 ml of milk every day, and other foods are enough for basic growth. If there is too much protein and too much fat, it will affect the absorption of calcium. Therefore, we do not advocate drinking milk on an empty stomach, and eating some staple foods will absorb calcium well. If your little grandson doesn't have bone pain, you don't need to take calcium supplements, but you should take calcium supplements when you reach puberty. Not all children can grow up quickly by supplementing calcium. There are also many problems in supplementing calcium, such as increasing the burden on the kidneys, and calcified stones may appear, leading to organ calcification. Eating well is the most important thing, a bag of fresh milk and a bag of yogurt a day, getting more sunshine and doing more exercise. There is no evidence that calcium can accelerate epiphyseal closure.
Reader 4: Is it true that there are increased drugs on the Internet?
Sun Shuying: I can't say these things, but if the child is short, it depends on the specific situation, whether it is a nutritional problem or other physical diseases. Be sure to go to the hospital, don't blindly take medicine, and prescribe the right medicine.
Reader 5: Girl, birthday at the end of 1998, breast development at the beginning of this year, and now she is about 1.5 meters tall. Isn't it a little early for her to be like this, and she's afraid to give it to her, for fear that the nutrition is too good and her menstruation will come and she won't grow.
Sun Shuying: The child's situation is normal now. The sooner you eat, the better. You can't eat too much meat. You need to strengthen your exercise. However, the nutrition of adolescence must be guaranteed, and the growth rate and diet are normal.
Reader 6: Girl, in the second grade, had her period two years ago, but it didn't affect her height. Now 1.7 meters, but the menstruation is abnormal. Is it normal to come once every six months or once every few months?
Sun Shuying: Because of individual differences, the growth of bone age is uneven. Some girls grow fast after menstruation 1-2 years, while others don't grow long after menstruation. Menstruation once every six months or several months may be because the estrogen level in the body has not reached the level of adolescence, so you can go to the pediatric gynecological examination.