ADOLESCENT

GROWTH AND
SMR STAGING
Presented by: Dr. Meghana
Moderator : Dr. Swarnalata Das
  Adolescence is stage of transition from
childhood to adulthood .

 The appearance of sexual characters is coupled

DEFINITION with changes in cognition and psychology. This
entire process refers to adolescence

 Puberty refers to physical aspect.

 Age group – 10 to 19years (WHO)

 Rapid physical, cognitive, social, emotional and
sexual development.

What is special  Hormonal changes and puberty

about  Emotional changes
adolescents?  Sexual awareness and gender identity
 Enhanced and evolving cognitive ability
 Widening gap between biological maturity and social
transition to adulthood
What is special
about  More years in education and training
adolescents?  later onset of employment.
 Balance between protection and autonomy
What is special
about  Emerging autonomy but limited access to resources.
adolescents?  Appropriate representation in decision making
 Increased vulnerability to some aspects of globalization
  Maturation of GnRH pulse
generation is among 1st
neuroendocrine changes
associated with onset of
puberty.
HPG AXIS
(Biochemical  Adrenal production of
androgen mainly
changes in dihydroepiandrosterone
adolescence) sulphate (DHEAS), may
occur as early as 6 years of
age, with development of
underarm odour and faint
genital hair (adrenarche).
 ADOLESCENCE

EARLY MIDDLE LATE

(10-13YEARS) (14-16 YEARS) (17-19YEARS)
 COGNITIVE IDENTITY
PHYSICAL
AND MORAL FORMATION
• Secondary sexual • Concrete operations • Pre-occupied with
characters begin and • Egocentricity changing body
start of growth spurt • Unable to perceive • Self conscious about
in females long-term outcomes appearance
• Testicular • Follow rules
EARLY enlargement and
start of genital
ADOLESCENCE growth in males.

(10-13YEARS)
FAMILY PEERS SEXUAL

• Increased need for • Same gender peer • Anxieties and

privacy affiliations questions about
• Exploring boundaries pubertal changes
of dependency vs • Increased interest in
independence sexual anatomy
 BOYS(10-14YRS) FEMALES MALES

non communicable
DIARRHOEAL DIARRHOEAL
diseases DISEASES DISEASES
17% communicable
diseases
10% 43% nutritional con-  IRON  IRON
ditions DEFICIENCY DEFICIENCY
DISEASE 30%
injuries
ANEMIA ANEMIA

BURDEN  IDIOPATHIC  CHILDHOOD

IN EARLY INTELLECTUAL
DISABILITY
BEHAVIOURAL
DISORDER

ADOLESC GIRLS(10-14YRS)
 MIGRAINE  IDIOPATHIC
ENCE 12% non communicable
INTELLECTUAL
DISABILITY
diseases
14%
44%
communicable
diseases
30% nutritional con-
 SKIN DISEASES  ROAD INJURY
ditions
injuries
 BOYS(10-14YRS)
FEMALES MALES

COMMUNICABLE
DIARRHOEAL DIARRHOEAL
33% NON COMMU-
DISEASES DISEASES
NICABLE
49%
INJURIES
LRTI  DROWNING
18%
DEATH IN
EARLY
ADOLESCE SELF HARM  ROAD INJURY

NCE GIRLS(10-14YRS) TB  TB

COMMUNICABLE
24% NON COMMU-
DROWNING LRTI
NICABLE
54% INJURIES

22%
 PHYSICAL COGNITIVE IDENTITY
AND MORAL FORMATION
• Females- peak • Abstract thought • Increasing
growth velocity, • Perceive future introspection
menarche implication • Concern with
• Males- growth spurt, • Understand other’s attractiveness
MIDDLE secondary sexual
characters, nocturnal
perspective
• Sense of
ADOLESCENCE emission, facial hair
and voice changes.
invulnerability

(14-16 YEARS)
FAMILY PEERS SEXUAL

• Conflict over • Intense peer group • Initiation of

independence involvement relationship
• Struggle for • Exploration of
autonomy sexual identity
 PHYSICAL COGNITIVE IDENTITY
AND MORAL FORMATION
• Physical maturation • Future oriented with • Stable body image
slows and increased perspective of • Consolidation of
lean muscle mass in idealism. identity
males • Improved impulse
control
LATE
ADOLESCENCE
(17-19 years)
FAMILY PEERS SEXUAL

• Increased autonomy • Peer group values • Consolidation of

• Re establishment of recede in importance sexual identity
adult relationship • Focus on formation of
with parents stable relationship
and commitment.
 FEMALES MALES
BOYS(15-19YRS)
NON COMMUNICABLE
5% DISEASES TB TB
23% COMMUNICABLE
44% DISEASES

DISEASE 28%
INJURIES

NUTRITIONAL CON-
IDA ROAD INJURY

BURDEN IN DITIONS

MIDDLE AND SELF HARM DIARRHOEAL

DISEASES
GIRLS(15-19YRS)
LATE
ADOLESCENCE 10%2%
NON COMMUNICABLE
DISEASES
DIARRHOEAL
DISEASES
SELF HARM
COMMUNICABLE
16% DISEASES
46%
INJURIES MIGRAINE IDIOPATHIC
NUTRITIONAL CON- INTELLECTUA
26% DITIONS
L DISABILITY
maternal complications
 BOYS(15-19YRS) FEMALES MALES

COMMUNICABLE
16% DISEASES TB TB
INJURIES
45% NON COMMUNI-
CABLE DISEASES

DEATH IN 40%  SELF

HARM
ROAD
INJURY
MIDDLE AND  DIARRHOE  DIARRHOE
LATE GIRLS(15-19YRS)
AL
DISEASES
AL
DISEASES
ADOLESCENCE COMMUNICABLE
DISEASES
MATERNAL  SELF
4% CONDITIONS HARM
21% INJURY
45%
NON COMMUNICABLE
DISEASES ROAD INTERPERS
30% INJURY ONAL
MATERNAL CON-
DITIONS VIOLENCE
COMMON
HEALTH
ISSUES
  Adolescence is nutrition sensitive phase of growth in which
benefits of good nutrition extend to physiological system and also
to health of next generation.

NUTRITION IN  Formative role in timing and pattern of puberty as well NCD in

adult life
ADOLESCENTS
 20% of adult height
50% of adult weight
upto 40% of increase in bone mass
  Consume less food due to lack of time
Special issues  Fast food culture
in adolescent  Little information on nutritive value of food
nutrition  Increased nutritional requirement
  Obesity is emerging as public health problem in india.

OBESITY IN  According to “prevalence and contributing factors for adolescent

ADOLESCENCE obesity in present era- cross sectional study”(by s.seema et
al,2021) – teens who watched more than 2 hrs of screen time were
more obese, more in males than in females.
  More vulnerable
Why?
1. Rapid urbanization
NUTRITION 2. Climate change
3. Food system
4. Socioeconomic inequality
 Energy (Kcal) Protein(g) Visible fat(g)

10-12 years boys 2190 39.9 35

girls 2010 40.4 35
13-15 years boys 2750 54.3 45
girls 2330 51.9 40
16-17 years boys 3020 61.5 50
NUTRITION girls 2440 55.5 35
(RDA for adolescent) zinc folate iron
10-12 years boys 9 140 21
girls 9 140 27
13-15 years boys 11 150 32
girls 11 150 27
16-17 years boys 12 200 28
girls 12 200 26
  VITAMIN A (ug) -600
 VITAMIN C (mg) -40
NUTRITION  VITAMIN B12 (ug) - 0.2 to 1.0
 CALCIUM (mg) - 800
  The period during which adolescents reach sexual maturity and
become capable of reproduction.
 Characterized by :

PUBERTY 1. Appearance of secondary sexual characters

2. Increase in height
3. Change in body composition
4. Development of reproductive capacity.
 Thelarche

Sequence of
pubertal Pubarche
development

Menarche
  HEIGHT-

 linear growth begins in early adolescence for both genders

 15-20% of adult height acquired during puberty.

1. Peak height velocity in females: 8-9cm/yr @ SMR 2-3

NORMAL
PHYSICAL 2. Peak height velocity in males: 9-10cm/yr @ SMR 3-4

GROWTH
PATTERN  Males undergo increase in lean body mass ( strength spurt), whereas females

develop a higher proportion of body fat

 50-60% of total body calcium is laid down during puberty.

 Bone growth precedes increase in bone mineralization and bone density, which

increase adolescent risk of fracture during rapid growth.

SEXUAL
DEVELOPMENT
AND SMR
STAGING
 • Progression of development of secondary sexual characters
is described using tanner staging/SMR staging.

• In males first visible sign and hallmark of SMR 2 is testicular

CLINICAL enlargement.

KEY • Sperm may be found in urine ,nocturnal emission occur in

POINTS SMR 3

• Peak growth in males is when testicular volume reaches 9-

10 cm3 which is during SMR-4

• In females first visible sign and hallmark of SMR 2 is

thelarche (breast bud appearance)

• Menarche usually occurs during SMR3-4.

  Onset of secondary sexual characters before age of
8 years – in girls
9 years- in boys

PRECOCIOUS
PUBERTY  Can be either
Central - gonadotropin dependent
Peripheral -gonadotropin independent
  CAUSES
PRECOCIOUS 1. .
PUBERTY 2. .
CAUSES 3. .
4. .
  Absence of any breast development at 13 years or absence of
DELAYED menarche by 15 years in females

PUBERTY  Absence of increase in testicular volume(less than 4 ml) at 14 years

in males
  CAUSES
DELAYED 1. .
PUBERTY 2. .

CAUSES 3. .
4. .
  Time for development and learning and provides opportunities for
life long impact.
 Health status of adolescent determines health status in
adulthood.
 Forming personal identity and sense of self is a hallmark of
TAKE AWAY adolescence
 There is increasing nutritional problems in adolescents ranging
from micronutrient deficiency to obesity.
 Understanding adolescent biology and its relation to nutrition
needs to be addressed.