The pubertal growth spurt and dental, skeletal, and pubertal development have been investigated in a prospective longitudinal study of 212 randomly selected Swedish children by means of maturation level indicators suitable for use in clinical orthodontics. The sample was examined from birth to adulthood and included a representative proportion of early-, average-, and late-maturing subjects. The number of dropouts and missing examinations was low and was allowed for in the statistical analysis. The results may therefore be considered representative for Swedish children. There was a 2-year sex difference in age at the beginning, peak, and end of the pubertal growth spurt in standing height. The individual variation was about 6 years at each event in both sexes. Dental development in relation to the pubertal growth was more advanced in boys than in girls, but the individual variation was great in both sexes. Skeletal development at the beginning and peak was more advanced in girls than in boys, whereas at the end of the pubertal growth spurt the skeletal development was more advanced in boys. Dental development, determined by means of dental emergence stages (DES), was not useful as an indicator of the pubertal growth spurt. The peak and end--but not the beginning--of the pubertal growth spurt could be assessed by means of indicators taken from the skeletal development of the hand and wrist and the pubertal development (menarche and voice change).

Adolescent↗

PubMed1981

Dental emergence stages and the pubertal growth spurt.

Longitudinal data on emergence of permanent teeth and pubertal growth in body height were collected as part of a prospective study of the growth and development of 212 randomly selected Swedish urban children. The onset, peak and end of the pubertal growth spurt were defined on the unsmoothed incremental curve of height. The dental development was assessed by means of dental emergence stages representing gingival emergence of various groups of permanent teeth. There was a sex-specific pattern in the relationship between dental development and the pubertal growth spurt. At all pubertal growth events the dental development was more advanced in boys than in girls. A statistically significant association between dental development and pubertal growth was found only in girls, and was then only weak. Because of the low correlation between age at the occurrence of pubertal growth events and age at the attainment of dental emergence stages, these stages have little value as indicators of the pubertal growth spurt. The sex-specific pattern and the great individual variation in the relationship between dental development and somatic growth may have implications for orthodontic treatment.

Adolescent↗

PubMed1981

Intrauterine varicella: a report of two cases associated with hyper-A-immunoglobulinemia.

Varicella during pregnancy may occasionally harm the fetus. This report described one case of congenital varicella syndrome and another of infantile herpes zoster after maternal varicella in the 16th and 29th week of pregnancy, respectively. A remarkable finding was that both mothers and infants had raised levels of serum IgA. This suggests that varicella is prone to lead to congenital disease in infants of pregnant women with an immunologic, perhaps genetically determined abnormality.

Adult↗

PubMed1980

The timing and duration of adolescent growth.

The adolescent growth of 212 randomly selected Swedish urban children has been investigated by using a graphical analysis of unsmoothed increments of height. The adolescent growth period has been divided into the pubertal spurt and the postpubertal period. On average, the pubertal spurt began at 10.0 years in girls, and 12.1 years in boys and ended at 14.8 years and 17.1 years, respectively. In both sexes peak height velocity occurred two years after the onset of the spurt (12.0 years and 14.1 years). Growth terminated at 17.5 years in girls and 19.2 years in boys. The standard deviation of the age at the occurrence of the various growth events is about one year in both sexes. The duration of the spurt did not differ between the sexes but the postpubertal period was significantly longer in girls. To include the total range of adolescent growth variability, the age range 6 -- 20 years in girls and 9 -- 23 years in boys must be considered in a Swedish population.

Adolescent↗

PubMed1980

Menarche and voice change as indicators of the pubertal growth spurt.

Longitudinal data on adolescent growth in body height and on the occurrence of menarche in girls and voice change in boys have been colleced as part of a prospective study of the growth and development of 212 randomly selected Swedish urban children. The onset, peak and end of the pubertal growth spurt was defined on the unsmoothed incremental curve of height. The relationship in time between these events and menarche and voice changes was studied. Menarche occurred between 10.7 and 16.1 years (mean 13.1 years, S.D. = 1.09). No menstrual bleeding occurred before peak height velocity and all girls had the menarche before the end of the spurt. Clinically assessed voice change began between 11.5 and 16.5 years (mean 13.9 years, S.D. = 1.03). A voice with adult characteristics was observed between 12.5 and 17.5 years (mean 15.0 years, S.D. = 0.98). The duration of the voice change varied between less than one year and more than three years. When the voice change of a boy has begun, the growth spurt is in its most intensive phase. When the voice has acquired adult characteristics the growth rate has begun to decelerate.

Adolescent↗

PubMed1980

Skeletal stages of the hand and wrist as indicators of the pubertal growth spurt.

Longitudinal data on adolescent growth in height and skeletal development of the hand and wrist were collected as part of a prospective study of the growth and development of 212 randomly selected Swedish urban children. The onset, peak and end of the pubertal growth spurt were defined on the unsmoothed incremental curve of height. The skeletal development was evaluated by studying the attainment of specified stages of the ulnar sesamoid of the metacarpophalangeal joint of the first finger, the epiphyses of the middle and distal phalanges of the third finger and the distal epihysis of the radius. All growth events and skeletal stages occurred earlier in girls than in boys. At the peak of the pubertal growth spurt the skeletal development was more advanced in girls than in boys, but at the end of the spurt the girls had a less mature skeletal development than the boys. The analysis of the relationship in time between the growth events and the skeletal stages showed that these stages can be used to indicate which period of adolescent growth an individual has reached.

Adolescent↗

PubMed1976

I. physical growth from birth to 16 years and longitudinal outcome of the study during the same age period.

Physical growth of 212 randomly selected Swedish urban children has been investigated from birth to sixteen years as part of a prospective longitudinal study of growth and development. Twenty body measurements have been taken at specified ages. In all, about 66,000 values of measurement have been recorded. At sixteen years 179 (84.4%) ofthe original children were still regularly being followed. Thirty-three (15.6%) of the 212 children left the study at various ages. A comparison between the children who left the study and those remaining did not show any significant differences in physical growth. All recorded data have been scrutinized in order to detect errors of measurement or administrative errors. Such values have been corrected or excluded. The editorial procedures also included the adjustment of each measurement to exact target age, interpolation of missing examinations and exclusion of children with an aberrant growth pattern. When comparing the present study with older Swedish investigations a secular trend was established, while there was good agreement with other contemporary Swedish investigations. Growth charts of distance values of various body measurements are presented. In the charts standard deviation lines (+/- 1, 2, 3 SD) and mean values are plotted. A logarithmic time scale (logarithmic conceptional age) has been used for both practical and theoretical reasons. When evaluating individual values in comparison with reference values standard deviations should be used rather than centiles. With this approach even grossly deviating values can be evaluated. Longitudinal follow-up of individual children and comparison of children of different ages will also be facilitated by this approach.

Adolescent↗

PubMed1976

II. evaluation of biological maturation by means of maturity criteria.

Maturation may be conceived of as a series of gradual transformations through time going on in the human body from conception to death as part of the life cycle of the organism. Maturity should be used as the general concept of any specified stage - or level -during the process of maturation. The maturity level can be assessed by examining the attainment of various maturity criteria relating to dental development, skeletal development and pubertal development. In a group of children the attainment can be analyzed by probit analysis using a logarithmic time concept (logarithmic conceptional age). This is exemplified by the attainment of breast stages according to Tanner (10) in the girls of the present study. When examined a child will be rated as being within a certain stage of maturity. The least advanced and the most advanced maturity level consistent with the rating can be established using the probit lines. The relative maturity level is then expressed in SD-scores of the Gaussian fitted distributions of age at attainment of various maturity criteria in a reference group of children. This is a laborious approach when there are many series of maturity criteria, e.g. in the assessment of skeletal maturity. In such cases each stage is instead given a certain maturity score. The individual maturity level is calculated by averaging the maturity scores of the stages, which are then evaluated in SD-scores by comparing with the Gaussian fitted distribution of averaged maturity scores at that age. In both approaches discussed in this paper the evaluation of individual maturity is made with a relative scale of measurement. Accordingly, the rate of maturation can only be assessed indirectly.

Adolescent↗

PubMed1976

III. dental development from birth to 16 years.

Tooth eruption in 212 randomly selected Swedish urban children has been investigated from birth to 16 years as part of a prospective longitudinal study of growth and development. The ages and the order of eruption of the deciduous and permanent teeth were in agreement with those reported in other contemporary studies. The good agreement with another longitudinal study of the tooth eruption of Swedish children born during the same period is an indication that the present sample was representative of contemporary Swedish children. In the deciduous dentition a probable male advancement was found, while girls were consistently the advanced sex as regards the eruption of permanent teeth. Sex differences have also been found in the relation between dental development and other criteria of somatic growth and development. The correlations were low or moderate with, in general, higher values for girls than boys. A positive association with somatic growth was observed both for the deciduous and the permanent dentition but with intriguing sex differences for various body measurements.

Adolescent↗

PubMed1976

IV. skeletal development from birth to 7 years.

The skeletal development of 212 randomly selected Swedish urban children has been investigated as part of a prospective longitudinal study of growth and development. Radiograms of the hand and wrist were taken at specified ages. Up to the age of seven years 2.191 radiograms were assessed. When comparing the timing of the first ossification of the various bones in the present study and an older Swedish investigation a secular trend was found. In contrast to a North-American growth study, there was a striking similarity of the pattern of the first ossification in the two Swedish investigations for both sexes separately. However, the relative sex differences of the ossification were quite similar in the North-American growth study and the present investigation. In comparison with British children the skeletal development of Swedish children was advanced at all ages, the advancement being greater for epiphyseal bones than for carpal bones.

Age Determination by Skeleton↗

PubMed1976

V. a new method for the assessment of skeletal maturity- the mat- method (mean appearance time of bone stages).

By means of probit analysis of the age at the appearance of the various bone stages according to Tanner-Whitehouse and using a logarithmic time concept (logarithmic conceptional age), a new approach to the evaluation of skeletal maturity has been elaborated. The maturity score of each bone stage corresponds to th4 mean maturity level of the observation of being within each stage. The individual maturity level is calculated by averaging the maturity scores of the stages of the various bones and is then evaluated is standard deviation scores by comparing with teh Gaussian fitted distribution of averages maturity scores of the age of the child examined. Special conditions apply for the scoring of a first and a last bone stage in a sequence, which will introduce less bias in the estimation of individual skeletal maturity with the MAT-method than with the TW-method. Ossification during early infancy can be evaluated and sequence polymorphism be detected by using the bone stage chart of the MAT-method.

Age Determination by Skeleton↗

PubMed1976

VII. graphic analysis of biological maturation by means of maturograms.

The attainment of various maturity criteria has been analyzed by probit analysis using a logarithmic time concept (logarithmic conceptional age). The resulting probit lines have been plotted in charts-maturograms -using the x-axis as an age-scale and the y-axis as a marker of standard deviations scores. The slope of the probit lines is in such a direction that early occurrences are assigned positive SD-scores and late ones negative scores. The maturity criteria can be divided into two catergories- sequential (e.g. number of erupted teeth) or non-sequential (e.g. the menarche). When examined a child is observed to be within a certain stage of maturity. The observation can be evaluated with a cross-sectional or a longitudinal approach. The latter requires repeated examinations. The evaluation will result in a relative scoring (SD-scores) of the observations, i.e. a relative maturity level is calculated. The practical procedure has been exemplified for pubertal and dental development. Two sets of charts-pubertograms-have been constructed for the assessment of pubertal development in each sex. For dental development there are also two sets of sex-specific charts -dentograms- one for the deciduousdentition and one for the permanent dentition. Individual patterns of maturation can be analyzed by plotting the estimated SD-scores of the various maturograms. Individual variations in the trends of the estimated SD-scores may be an indication of different velocities of maturation.

Adolescent↗