[European collaborative study on congenital hypothyroidism. Results of mental development and current report on neonatal screening of hypothyroidism in Europe].
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Child Development↗
Biomedical subjects
R H Largo
Publications and source records attributed to R H Largo.
Pubertal development in girls. Variability and interrelationships.
Concerns about somatic disturbances of pubertal development are most frequently due to the large variability in normal growth and development patterns which occur during this age period. This article provides data on the normal variation of the following aspects of pubertal development: secondary sex characteristics, height growth, and menstrual cycles. In addition, clinically relevant interrelationships between the appearance of pubertal signs, height growth and bone age are discussed. The data presented are based on the First Zurich Longitudinal Study.
Adolescent↗
[Somatic puberty development in girls].
In 142 Swiss girls of the First Zurich Longitudinal Study. The somatic pubertal development between 9 and 18 years is described. The mean chronological age at the onset of the pubertal growth spurt was 9.6 years (standard deviation 1.2 years). The peak of the pubertal growth spurt (peak height velocity: PHV) was reached at a mean age of 12.2 years (SD 1.0). The development of pubic hair started at a mean age of 10.4 years (SD 1.2), breast development at 10.9 years (SD 1.2) and the development of axillary hair at 12.0 years (SD 1.1). Menarche occurred 2.7 years (SA 1.1) after the initiation of pubic hair development and 2.2 years (SD 1.1) after the breast development had started. Menarche was noted at a mean age of 13.4 years (SA 1.1). At menarche the mean height was 156.9 cm (SD 6.3), the mean weight 45.5 kg (SD 6.8) and the mean bone age (according to Greulich and Pyle) 12.6 years (SD 0.8). With the onset of menarche 95.3% (SD 1.7) of adult height were reached; the corresponding remaining height gain was 7.8 cm (SD 2.8). Acne was observed in 81% and striae in 41% of the girls by 18 years.
Adolescent↗
Visual acuity and stereopsis between the ages of 5 and 10 years. A cross-sectional study.
The development of visual acuity and stereopsis was studied in 321 boys and 340 girls aged between 5 and 10 years. Visual acuity was assessed by the E test and a modified version of the STYCAR test, stereo acuity by the Lang-Stereo test [17]. Both vision tests showed an increase in the median visual acuity between the ages of 5 and 10 years. The E test indicated an increase from 1.2 between 5 and 6 years to 1.5-1.7 between 7 and 10 years. The values obtained with the STYCAR test were 0.6-1.3 higher, depending on the test rating used. Visual acuity norms between 5 and 10 years are presented as empirical centile curves. No significant differences were observed in visual acuity between the left and right eyes, nor between the sexes. The right eye was found to be the leading eye in 54.8% of the boys and 54.5% of the girls (P less than 0.001). The Lang-Stereo test was passed by 87.9%-94.3% of all children, and there were no significant differences with respect to age and sex. Children who failed the test had a significantly lower visual acuity than those who passed it. In the former group a significant interocular difference in visual acuity was present (P less than 0.01).
Age Factors↗
Language development of term and preterm children during the first five years of life.
Language development during the first five years is reported for 114 high-risk preterm children (20 with varying degrees of cerebral palsy) and 97 healthy term children. Most stages of language development occurred at slightly later ages among the neurologically unimpaired preterm children than among those born at term. Preterm children with cerebral palsy were more delayed and had more articulation defects compared with neurologically unimpaired preterm children. Girls were more advanced in early language development and showed less articulation defects than boys. The perinatal optimality score was significantly correlated with the ages at which the stages of language development were reached, and with language performance at five years in preterm children, but much less in term children. Birthweight and gestational age were negatively correlated with language development at all ages. Socio-economic status and birth order had an age-related influences on language development, but no correlation was found with the number of minor congenital malformations.
Articulation Disorders↗
Sixty children with congenital hypothyroidism detected by neonatal thyroid: mental development at 1, 4, and 7 years: a longitudinal study.
A prospective study of mental development has been carried out in 60 unselected children with congenital hypothyroidism (C.H.) detected between 1976 and February 1985. Treatment with 1-thyroxin was initiated at the age of 10.4 +/- 2.5 days and supervised by T4 and TSH monitoring in 3-6 monthly intervals. Although clinical signs were mild or missing, skeletal maturation was prenatal in more than half. Developmental testing was carried out at 1, 4 and 7 years by the Brunet-Lezine (n = 60), the non-verbal Snijders-Oomen (n = 40), and the german version of the Wechsler intelligence test (n = 20), respectively. The global DQ/IQ in all but a few children at each age group are within the 3rd and 97th percentile of the DQ/IQ distribution in a control group tested during the same period of time. The mean values of all global and subscores, however, are lower than that one in the control group, differences being highly significant at 1 year. In 21 of our 60 children, associated findings and/or risk factors were present. The DQ/IQ in children without risk factors are identical to that of the control group. There are no significant DQ/IQ differences neither between athyroidism and ectopic thyroid glands, nor between prenatal bone age and normal skeletal maturation at diagnosis. We assume that the favourable results in our children with C.H. may be ascribed to the early onset of thyroid hormone replacement and the strictly controlled compliance.
Aging↗
[Prospective study of the work of the practising pediatrician].
In this supplementum a prospective study on the activity of the pediatrician in private practice is reported. The study was carried out with the collaboration of 39 pediatricians in the area of Zurich between 1980 and 1982.
Ambulatory Care↗
[Management of at-risk children: parent-child relations in the first half year. A descriptive study].
Early development of parental behavior was studied in 10 infants born at risk. The infants were firstborn, suffered from prematurity and perinatal complications and were separated from their mothers for at least three days after birth. Semistructured videotaped interviews with the parents and developmental and neurological testing of the infants were performed prior to the dismissal from the neonatal unit, and at three and six months after term. Premature birth, perinatal complications and separation of mother and child had a strong impact on the emotional development of the parents affecting mothers and fathers differently. A number of pre-, peri- and postnatal factors are reported influencing the mother-father-infant triad as well as the marital relationship. The findings of this study indicate that pediatric care of infants born at risk requires knowledge about the emotional changes during early parenthood, the risk factors of parenting after premature delivery and perinatal complications, and, in particular, about the emotional adaptation of the parents under these circumstances.
Adaptation, Psychological↗
Anterior fontanel: size and closure in term and preterm infants.
Size and closure of the anterior fontanel from birth to 24 months of age and their relationships to growth parameters, bone age, and gestational age are reported in 111 term and 128 preterm infants. Great variability of both fontanel size and age when fontanel closed was observed. There were no significant differences in size and age at closure of the anterior fontanel between term and preterm infants or between the sexes. At ages beyond term, fontanel size was negatively correlated with weight and length; however, only a few correlations reached statistical significance. No significant relationships were noted between anterior fontanel size and head circumference or bone age. Age at closure of the anterior fontanel was also not significantly related to any of the growth parameters or bone age.
Age Factors↗
[Early psychomotor development--normal and abnormal. References for the detection and evaluation of development disorders].
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Child↗
Developmental and behavioural disturbances in 13 boys with fragile X syndrome.
Developmental and behavioural aspects were studied in 13 boys aged 2.6-12.5 years from three families with the fragile X syndrome. The following observations were made. Moderate to severe retardation was present in all boys; non-verbal IQs ranged between 25 and 67 (mean 46 +/- 14); IQ and age were negatively correlated (P less than 0.01). Language development was grossly delayed in all boys; most had severe articulation problems. Imitative and symbolic play (e.g. doll play) were strikingly retarded as compared to abstract play (e.g. block design). Autistic features such as no use of eye contact, stereotyped movements and echolalia were found in 9/13 boys; the same number showed aggressive behaviour. General activity was reduced during the 1st year of life; most boys became very hyperactive during the second year; and short attention span and increased distractability were observed in all. Motor development was mildly delayed; all boys were clumsy and moderately hypotonic. The fragile X syndrome ought to be considered in retarded boys with a dissociated developmental pattern, in particular a striking delay in language and play development, and autistic features.
Child↗
Early development of locomotion: significance of prematurity, cerebral palsy and sex.
Data on the development of locomotion during the first two years of life were collected for 128 preterm infants (21 with varying degrees of cerebral palsy) and for 111 healthy term infants. Most stages of locomotion occurred at slightly later ages among the neurologically unimpaired preterm infants than among those born at term (age corrected for prematurity). There was no difference between preterm and term infants with regard to the number and types of pathways of locomotion, or to age at onset and type of first movements through space. By 9.5 months of age, 95 per cent of term infants and 92 per cent of preterm infants showed some ability to move through space. The infants with severe cerebral palsy had considerable delay in the development of locomotion, but this occurred to only a minor extent when the degree of cerebral palsy was mild or moderate. Most stages of locomotion occurred at slightly earlier ages for boys than for girls, but these differences were not significant at any age. The number and types of pathways of locomotion, and types of first movements, were comparable in both sexes.
Cerebral Palsy↗
The fragile X syndrome (Martin-Bell syndrome). Clinical and cytogenetic findings in 16 prepubertal boys and in 4 of their 5 families.
Clinical and cytogenetic findings from 16 prepubertal males with the fragile X syndrome (X-linked mental retardation with postpubertal macro-orchidism and fragile site at Xq27/8, or Martin-Bell syndrome) and from their families are reported. During the first postnatal years, protruding, large ears, full periorbital tissue, and thick septum and alae nasi were the most characteristic phenotypic findings, while after approximately 6 years of age a longish face with full lips and prominent maxilla and mandible became more distinct. It was estimated that a clinical suspicion of the fragile X syndrome could be made in most of the 16 boys from phenotypic findings in combination with the characteristic developmental profile described in our previous paper. The marker X chromosome was demonstrated in each of the 16 patients; the incidence of fra(X)-positive cells did not correlate with either age or the degree of mental retardation. 13 boys stemmed from 2 families, the other 3 were sporadic cases. In one family with 11 affected boys, the gene was transmitted by 4 brothers, grandfathers to the probands, who were intellectually normal; three of them did not show the clinical picture of the fragile X syndrome and did not express the marker. All mentally subnormal heterozygote females and one half of daughters of heterozygotes revealed the marker, but this was present only in a minority of non-retarded adult heterozygotes. In contrast to the overall incidence of about 1/4 to 1/3 mentally retarded heterozygotes, all 15 daughters of the four normal obligatory hemizygous brothers were of normal intelligence.
Child↗
A developmental approach to the management of children with sleep disturbances in the first three years of life.
A developmental approach to the management of sleep disturbances was successful in 85% (44/52) of the children (aged 2-36 months) within 2-6 weeks. No drugs were used. The approach was based on the following two principles: taking into account the characteristics of sleep behavior in infants and young children by setting up seven rules of normal sleep behavior, and dealing with the expectations and anxieties of the parents by means of a sleep chart.
Child Development↗
Timing of pubertal growth and maturation in the first Zurich longitudinal growth study.
Definitions and normal age values are given for start, peak and end of the pubertal growth spurt. In spite of a sex difference in chronological age and bone age, general maturity at the start and at the peak of the growth spurt was identical in both sexes, i.e. it occurred at the same stage of skeletal maturation and at the same relative distance from adult height. Normal values for the main steps of sexual maturation are also given. The overall pattern of the growth spurt, skeletal maturation and sexual maturation was strikingly similar in both sexes.
Adolescent↗
Pubertal development in Swiss boys.
Pubertal development between 8 and 18 years is reported in 142 Swiss males of the First Zurich Longitudinal Study (1954-1980). Genital and pubic hair development were rated according to TANNER [14]. Testicular growth was assessed by comparative palpation with the orchiometer of PRADER [10]. The age at which pubertal development was initiated varied between the eighth and the fifteenth year of life. Reaching a testicular volume of 3 ml was found to be the most reliable indicator for the onset of pubertal development. The various pubertal stages of genital and pubic hair development tended to occur at earlier ages in this study than previously reported. This was particularly true for PH6 which was observed in 73% of the boys by age 20. Standard deviations of 1.0 to 1.5 years for the ages at which the pubertal stages were reached reflected the large variations in the timing of pubertal development. The mean duration of genital development was 3.5 +/- 1.1 years, of pubertal penis growth 1.8 +/- 0.7 years, of pubertal testicular growth 3.5 +/- 1.0 years and of pubic hair development 2.7 +/- 1.0 years. Moderate correlations were found between the ages at which genital development, pubic hair development and pubertal testicular growth were initiated. The ages at completion of these pubertal characters and the age at which the peak of the adolescent growth spurt was reached were highly positively correlated with each other. For a given stage of a pubertal character at least 80% of the children were within two successive stages of any other pubertal character, e.g. 87% of the boys were either in G2 or G3 when they reached PH2. No significant relationship between the durations of genital development, pubic hair development and pubertal testicular growth could be established. Likewise no significant relationship could be found between the timing and duration of pubertal development.
Adolescent↗
Pubertal development in Swiss girls.
Pubertal development between 8 and 18 years is reported in 142 Swiss females of the First Zurich Longitudinal Study (1954-1980). Genital and pubic hair development were rated according to TANNER [9]. Pubertal development was initiated at the earliest between 8 and 9 years and at the latest between 14 and 15 years of age. The first secondary sex character in 53% of the girls was the onset of pubic hair development and in 18% the onset of breast development. In 29% both the initiation of breast and that of pubic hair development were observed as the first pubertal signs. Pubertal development was completed at the earliest between 12 and 13 years and at the latest between 17 and 18 years of age. Most pubertal stages of breast and pubic hair development tended to be reached at earlier ages than previously reported. Omissions of stages occurred only in a few percent of the girls. A notable exception was breast stage 4 which was absent in 33%. Reversions of stages, particularly of breast stage 5 to a lower breast stage, were occasionally observed. The mean duration of breast development was 3.2 +/- 1.4 years and pubic hair development 3.6 +/- 1.1 years. The mean age at menarche was 13.4 +/- 1.0 years. Menarche was reached on the average 2.2 years after the initiation of breast development and 2.7 years after the initiation of pubic hair development. In spite of large variations in timing and duration of pubertal stages some significant relationships were noted between the pubertal characters. Moderate correlations were found between the ages at initiation of breast and pubic hair development and menarche. The ages at completion of breast and pubic hair development, menarche and the age at which the peak of the adolescent growth spurt (PHV) was reached were highly correlated with each other. There was no significant relationship between the duration of breast development and that of pubic hair development. Furthermore, no clear relationship between the timing of pubertal development and its duration could be established. In contrast to previous reports the temporal relationship between pubertal development and the adolescent growth spurt was found to be similar in both sexes.
Adolescent↗
[Pubertal development in Swiss children].
Pubertal development between 8 and 18 years is reported in 142 Swiss boys and 142 Swiss girls of the First Zurich Longitudinal Study (1954-1980). Mean and standard deviations of onset and duration of the following secondary sex characteristics are given: genital development and testicular growth in boys, breast development and menarche in girls, pubic hair development and adolescent growth spurt in both sexes. The interrelationships between timing and duration of these secondary sex characteristics are discussed.
Adolescent↗