Screening Healthy Children

Law Of Attraction For Kids

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Key Points

Male

Female

Stage

genitalia

Pubic hair

breasts

1

Preadolescent:

None; may be

Preadolescent:

testes, scrotum,

vellus hair, as

elevation of papilla

and penis are

over abdomen.

only.

childlike in size.

2

Slight

Sparse growth

Breast bud stage;

enlargement of

of long, slightly

breast and papilla

scrotum with

pigmented,

form a small

reddening of

downy hair,

mound; areolar

skin; little or no

straight or

diameter enlarges.

enlargement of

slightly curled,

penis.

primarily at

base of penis or

along labia.

3

Further

Hair

Further

enlargement of

considerably

enlargement of

scrotum; penis

darker, coarser,

breast and areola

enlarges, mainly

and more

with no separation

in length.

curled; spreads

of their contours.

sparsely over

junction of

pubes.

4

Further

Adult-type hair

Areola and papilla

enlargement

that does not

project to form a

and darkening

extend onto

secondary mound

of scrotum;

thighs, covering

above the contour

penis enlarges,

a smaller area

of the breast; stage

especially in

than in adult.

4 development of

breadth; glans

the areolar mound

develops.

does not occur in

10% of girls and is

slight in 20%; when

present, it may

persist well into

adulthood.

5

Adult in size and

Adult in quantity

Mature female;

shape.

and type with

papilla projects and

extension onto

areola recesses to

thighs but not

general contour of

up linea alba.

breast.

6

Spreads up

linea alba (80%

of men, 10% of

women).

Modified from Tanner JM. Normal growth and techniques of growth assessment.

Clin Endocrinol Metab 1986;15:436.

earlier NCHS data and constructed height and weight velocity curves for American boys and girls that account for those groups who mature earlier and later. These charts also allow for notation of the various stages of puberty described by Tanner (1986) (Table 23-2).

The onset of puberty generally occurs at age 9 in American girls, with the peak height velocity occurring at age 11.5 years (range, 9.7 to 13.5 years for early to late maturers). American boys have onset of puberty at age 11 and peak height velocity at 13.5 years (range, 11.7 to 15.3 years) (Tanner and Davies,

• All newborns should have a hearing screen within the first month of life.

• Examine eyes at all well care visits; screen vision beginning at age 3 years.

• Provide anticipatory guidance regarding discipline starting at 15 months of age.

Preventive care services for children often include screening for health conditions in which early detection and early treatment can prevent or ameliorate more serious disease in the future. Screening tests should detect most persons with the condition (sensitivity) while excluding most persons who do not have the condition (specificity) in a cost-effective manner. In an inner-city Medicaid population, high continuity of care in infancy was associated with improved screening for anemia, lead, and tuberculosis (Flores et al., 2008).

Age (years)

Age (years)

Age (years)

Figure 23-1 Sequence of pubertal events in average American boys.

(Modified from Brookman RR, Rauh JL, Morrison JA, et al: The Princeton Maturation Study; 1976, unpublished data for adolescents in Cincinnati, Ohio. in Copeland KC, Brookman RR, Rauh JL [eds]: Assessment of Pubertal Development. Columbus, Ohio, Ross Products Division, Abbott Laboratories, 1986, p 4.)

Age (years)

Figure 23-1 Sequence of pubertal events in average American boys.

(Modified from Brookman RR, Rauh JL, Morrison JA, et al: The Princeton Maturation Study; 1976, unpublished data for adolescents in Cincinnati, Ohio. in Copeland KC, Brookman RR, Rauh JL [eds]: Assessment of Pubertal Development. Columbus, Ohio, Ross Products Division, Abbott Laboratories, 1986, p 4.)

Age (years)

Age (years)

Age (years)

Figure 23-2 Sequence of pubertal events in average American girls. (Modified from Brookman RR, Rauh JL, Morrison JA, et al: The Princeton Maturation Study, 1976 unpublished data for adolescents in Cincinnati, Ohio. in Copeland KC, Brookman RR, Rauh JL [eds]: Assessment of Pubertal Development. Columbus, Ohio, Ross Products Division, Abbott Laboratories, 1986, p 4.)

Age (years)

Figure 23-2 Sequence of pubertal events in average American girls. (Modified from Brookman RR, Rauh JL, Morrison JA, et al: The Princeton Maturation Study, 1976 unpublished data for adolescents in Cincinnati, Ohio. in Copeland KC, Brookman RR, Rauh JL [eds]: Assessment of Pubertal Development. Columbus, Ohio, Ross Products Division, Abbott Laboratories, 1986, p 4.)

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