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Normal growth and sexual development 

Normal growth and sexual development
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date: 12 December 2017

The growth of a human being from a single cell to a fully mature individual is a remarkable process and something that is subject to a large number of influences across the whole growth period. Growth before birth is actually the most rapid and probably the least understood phase, but a detailed description of antenatal events is beyond this chapter. Size at birth, however, is dependent on a number of factors, primarily maternal, in particular the wellbeing of the fetoplacental unit and its level of functioning. This unit is markedly affected in maternal undernutrition, which translates into significant deleterious effects on fetal growth. Probably as important as placental function is maternal size. Small maternal size will constrain growth even when the fetus is potentially of a genetically large size. Lastly, fetal factors are important themselves. Genetic or endocrine disturbances may constrain fetal growth, but these are secondary to maternal effects.

In paediatric practice we are concerned about postnatal growth. It is useful to think of growth in three separate phases: infancy, childhood, and puberty (1). The infancy phase is largely nutrition dependent and lasts for 1–2 years. After this, the childhood phase, which is predominantly growth hormone-driven takes over, and continues until the pubertal or adolescent phase. This final phase is under the influence of the sex steroids and the speed of this phase determines the timing and rate of acceleration of the pubertal growth spurt, and the cessation of growth. It is very helpful to consider the different influences on each phase when presented with the diagnostic challenge of a child with abnormal growth (2).

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