Introduction to the Anatomy and Physiology of Children A
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ROUTLEDGE
Introduction to
the Anatomy and
Physiology of
Children
Janet MacGregor
LONDON AND NEW YORK
First published 2000
by Routledge British Library Cataloguing in Publication Data
11 New Fetter Lane, London EC4P 4EE A catalogue record for this book is available
from the British Library
Simultaneously published in the USA and
Canada Library of Congress Cataloging-in-Publication
by Routledge Data
29 West 35th Street, New York, NY 10001 MacGregor, Janet
Introduction to the anatomy and physiology
Routledge is an imprint of the Taylor & Francis
of children/Janet MacGregor.
Group
p cm.
This edition published in the Taylor & Francis Includes bibliographical references and index.
e-Library, 2001. 1. Children–Physiology. 2. Human anatomy.
3. Child development. I. Title. [DNLM: 1.
© 2000 Janet MacGregor Child Development. 2. Anatomy–Child.
All rights reserved. No part of this book may 3. Anatomy–Infant. 4. Physiology–Child.
be reprinted or reproduced or utilised in any 5. Physiology–Infant. WS 103 M146i 2000]
form or by any electronic, mechanical, or RJ125.M23 2000
other means, now known or hereafter 612'.0083–dc21 99–34182
invented, including photocopying and DNLM/DLC CIP
recording, or in any information storage or
retrieval system, without permission in writing ISBN 0–415–21508–0 (hbk)
from the publishers. ISBN 0–415–21509–9 (pbk)
ISBN 0-203-18331-2 Master e-book ISBN
ISBN 0-203-18406-8 (Glassbook Format)
This book is dedicated to my students and the
children we care for.
I am particularly grateful to four ‘little people’,
whom I have studied closely in compiling this
book:
Morgan
George
Annabel
Hamish
May these reflections on your individual
development help those who are interested in
other children’s physical development to
understand all children’s needs and thus provide
the optimum environment for them to achieve
their unique genetic potential.
Thank you.
Contents
Contents
List of illustrations xiii
Preface xv
1 Child physical needs 1
Child development theories 2
The nature–nurture debate 3
Genetic inheritance 4
A healthy environment 5
The need for protective care 6
Protection from visible risks 6
Accidental injury 6
Non-accidental injury 7
Protection from invisible (biological) risk 9
Immunisation 9
The need for food 9
The need for temperature control 12
The need for activity and rest 13
Physiology knowledge in practice 14
Scenario 14
Extend your own knowledge 16
2 The skeletal system 17
Embryology 18
The changing skeleton 18
Growth in height 20
Genetic inheritance 21
Hormones of growth 23
CONTENTS
Diet calcium for bone growth 26
Exercise 26
Nature–nurture 26
Changes in bone due to exercise 27
Strength 27
Physical activity play 28
Body shape changes 29
Physiology knowledge in practice 32
Scenario 32
Extend your own knowledge 32
3 The nervous system 35
Brain growth embryology 36
Nerve growth 37
The eye 40
The ear 41
Birth onwards 42
The brain 42
The nerves 43
Reflexes 44
Psychological maturation 46
Neuromuscular control 46
General functional areas 47
Body location 48
Sleep 48
Temperature control 51
Physiology knowledge in practice 53
Scenario 53
Extend your own knowledge 54
4 The cardiovascular system 55
Heart embryology 56
Foetal heart circulation 56
Circulation changes in the heart at birth 59
Changes in the cardiovascular system in childhood 60
Exercise and cardiovascular function 62
Blood pressure and exercise 62
Children’s blood 64
Common blood tests 65
Guthrie Test 65
Routine diet supplement 66
Vitamin K 66
Physiology knowledge in practice 66
VIII
CONTENTS
Scenario 66
Extend your own knowledge 67
5 The respiratory system 69
Embryology 70
Surfactant 71
The lungs at birth 72
The first few weeks 72
Baby breathing 73
Apnoea 74
Respiratory resuscitation 75
Assessment 75
Action 77
The small child’s breathing 78
Changes at puberty 78
Respiration during exercise 79
Sleep and breathing 82
Development of the ear 82
Physiology knowledge in practice 85
Scenario 85
Extend your own knowledge 85
6 The renal system 87
Embryology 88
The kidney and urine production at birth 89
Fluid requirements in the first week 91
Continence 92
Bed wetting – enuresis 94
Water balance 95
Urine 96
Collecting urine 96
Observing urine 97
Testing urine 98
Dehydration 99
Oral rehydration 100
Over-hydration 100
Replacement of body electrolytes by diet 100
Physiology knowledge in practice 101
Scenario 101
Extend your own knowledge 102
IX
CONTENTS
7 The digestive system 103
Embryology 104
The mouth 104
Physical assessment of the mouth 106
Reflexes of the mouth and throat 107
The stomach 107
The gut 110
Weaning 111
Failure to thrive 112
Too little in 112
Failure to utilise nutrients 112
Too much out 112
Calorie needs as basic metabolic rate
(BMR) changes 113
Teeth 114
Liver maturation 115
Physiological jaundice 115
Bowels 116
Babies’ stools 118
Physiology knowledge in practice 119
Scenario 119
Extend your own knowledge 120
8 The reproductive system 121
Embryology 122
Changes at birth 124
Body composition and sex differences 125
Body fat and sex differences 125
Brown fat 126
Changes in the reproductive system at puberty 127
Secondary sexual characteristics in male and female 127
Ovary cycle 128
Menstrual cycle 130
Exercise and secondary amenorrhea 132
Physiology knowledge in practice 133
Scenario 133
Extend your own knowledge 134
9 The immune system 135
Protection from micro-organisms 136
Acquisition of immunity 137
Lymphocyte development 137
X
CONTENTS
B cells 137
Embryology of the thymus gland and
T lymphocyte development 140
Lymph vessel development 141
Lymphocytes in the foetus and new born 141
Stress 142
Chronic stress hormones 144
Immunisation 146
Points of interest when vaccinating children 148
The future 148
Physiology knowledge in practice 149
Scenario 149
Extend your own knowledge 150
10 Coordinating the systems 151
Thyroid gland effect in growth 152
Screening 152
Foetal growth 153
The school-aged child 154
The five year old 154
The seven to eight year old 154
The eleven to twelve year old 155
The fourteen year old 155
Vision 155
Hearing 156
Weight 157
Height 158
The role of the thyroid in all tissue development 159
Thyroid hormones 159
The importance of the hypothalamus in linking
the physical with the psychological person 162
The happiness factor 163
Physiology knowledge in practice 166
Scenario 166
Extend your own knowledge 167
Glossary 169
Bibliography 173
Index 183
XI
Illustrations
Figures
2.1 Primary and secondary ossification centres 19
2.2 Development of the four vertebral curves 19
2.3 Bone structure in the infant and adolescent skull 20
2.4 The growth plate 22
2.5 How body proportions change with age 30
3.1 Brain growth, 30–100 days 37
3.2 Axon myelination 38
3.3 The most active parts of the brain at birth 43
3.4 General functional areas in the cerebral cortex 47
3.5 The ‘sleep centres’ in the brain 49
4.1 Foramen ovale and ductus arteriosis 57
4.2 Foetal circulation 58
4.3 Circulation after birth 60
5.1 Lung buds at week four and bronchi at week five 70
5.2 The Eustachian tube’s position 84
5.3 The Eustachian tube opening in the nasopharynx 84
6.1 Kidney bud position 89
6.2 Bladder sphincters 93
6.3 The reflex arc for bladder emptying 93
7.1 Sucking from the breast 105
7.2 Sucking from the bottle 105
7.3 The oesophagus sphincter 109
7.4 Internal and external anal sphincters 117
8.1 The Müllerian and Wolffian systems 123
8.2 Uterine lining, ova changes and circulating hormones 132
I L L U S T R AT I O N S
9.1 Sequence of T and B lymphocytes’ action on antigen 138
9.2 Thymus development 140
9.3 The ‘acute’ stress response 143
9.4 The ‘chronic’ stress response 144
10.1 Migration of thyroid gland 159
10.2 Hypothalamus development at foetal week ten 162
Tables
4.1 Apgar score sheet 59
4.2 Normal paediatric cardiac output:stroke volume 61
4.3 Heart rates in childhood 62
4.4 Blood pressure changes over childhood 63
4.5 Normal haematology in childhood 65
4.6 Body mass index, 50th percentile range 67
5.1 Resuscitation 76
5.2 Respiratory rates in children 79
6.1 A rough guide for electrolyte requirements 91
6.2 Fluid requirements in the first week after birth 91
6.3 Daily fluid requirements for children 95
6.4 Urine output by age 98
7.1 Stomach capacities by age 108
7.2 Estimated average requirements for dietary energy 113
7.3 Expected weight gains for children in the UK 114
9.1 Recommended immunisation schedule for the UK 147
10.1 Body mass index expressed as percentile 158
10.2 Normal serum levels of triiodothyronine, total T3-RIA
in childhood 160
10.3 The interrelationship of hypothalamic functions 164
XIV
Preface
This book is not a comprehensive guide to children’s physical development, but
an introduction to some selected topics commonly discussed with students
working in child health contexts, and for parents who wish to provide the
optimum environment for their offspring to flourish.
There is a wide range of ‘normal’ at any age, no more so than in the period
before adult attributes are attained. However, there are physical milestones that
all children reach in a definite sequence, and these milestones are universal.
Most parents note the age their baby rolls and sits; most teachers know
which skills their pupils should be able to perform; most health professionals
know the parameters of their small charges’ vital signs.
The content of this book, which is for parents, teachers and health profes-
sionals, will first set the scene for physical development to take place. Two
development theories have been chosen which present the nature–nurture
effect on physical change. Some selected topics are then addressed, such as
healthy environments and health promotion issues, which should facilitate chil-
dren’s optimal growth. The succeeding chapters then investigate the body
systems in more detail, where it is hoped the reader will be stimulated to take
their own interest further and research some of the topics more fully. The final
chapter takes the reader back from the physical to the psychological, and thus
completes the circle, where a healthy body is intricately entwined with a happy
child.
Chapter 1
Chapter 1
Child physical needs
• Child development theories
• The nature–nurture debate
• Genetic inheritance
• A healthy environment
• The need for protective care
• Immunisation
• Healthy diet
• Keeping warm
• Exercise
