
Neural, Cerebral, or Cranial Growth Pattern
0014 The growth of the central nervous system is extremely
quick during the prenatal period and in the first years
of life, reaching 90% of adult weight at the age of 5.
Lymphoid Growth Pattern
0015 The growth processes of some lymphoid structures,
such as thymus, lymphatic nodes, and adenoid glands
or tonsils, undergo great development in early life.
Thus, at the age of 5, they will have already reached
100% of their adult size, following their enlargement
up to 180%, which is achieved at 12–13 years of age.
From that time onwards, size nearly halves so that,
roughly at 20, it reverts to the 5-year-old size.
Growth Pattern of the Reproductive System
0016 Gonad and external genital growth takes place in two
stages: embryonic–fetal stage, permitting sexual dif-
ference, followed by a long period when growth is
very slow, without significant changes from birth to
the end of prepuberty. At the beginning of puberty,
and within a 3-year period, the second stage of
growth, takes place when gonad and external sexual
character growth is completed and reproductive
capacity is achieved.
Growth Pattern of Adipose Tissue
0017 This is characterized by rapid growth during the first
year of life. Then it decreases, and from 10 years
onwards there is a new increase, which is more evi-
dent in women’s case, which continues in puberty. In
contrast, in men it decreases, so that at the end of the
growth process women’s rate of body fat is almost
twice that of men.
Growth and Variation of Body Proportions
0018 After 2 months of fetal life, craniofacial section rep-
resents 50% of total body length. This decreases to
25% in the newborn, whilst in adulthood it is only
one-eighth of total size. Leg proportion undergoes an
opposite evolution to that of the cranium. Trunk
proportional changes are much more limited. They
affect the superior/inferior body segment ratio, which
ranges from 1.7 at birth to 1.0 at 10 years.
Critical or Sensitive Periods of Cell
Growth
0019 Teratogens, infections, and nutrient deficiency have
different effects on the growth and function of
organs, depending on growth speed. That is, during
the growth process there are critical or sensitive
periods which are characterized by an increase of
vulnerability to a specific stimulus. This phenomenon
occurs along periods of maximum cell proliferation
(cell hyperplasia), mainly in the fetal period and the
first year of life, and in puberty, to a lesser extent.
0020In line with this is the ‘programming phenomenon.’
Poor nutrition and other adverse biological and envir-
onmental influences in the critical periods of fetal
development and the first year of life may cause per-
manent changes in gene expression, cell replication,
organic function and structure, hormone action and
secretion, and growth factors. These factors, apart
from affecting growth and body composition, will
also favor the development of degenerative diseases
such as cardiovascular disorders, high blood pressure,
diabetes or hyperlipidemia (X-syndrome) during
adulthood, and these diseases are nowadays the
main cause of morbid mortality. Fetal growth is a
significant predicting factor for postnatal growth
and adult size (Figure 2).
Human Growth Pattern: The Infancy–
Childhood–Puberty Model
0021Currently, the most accurate model for the relation-
ship between growth and the biological factors re-
sponsible for growth at different stages of life is
Kalberg’s ICP (infancy–childhood–puberty) model.
Based on experimental data, this model shows a
general growth curve representing the additive and
partially overlapping effect of its biological basis,
from the fetal period to the end of puberty (Figure 3).
Normal
growth
Catch-up
growth
No catch-up
growth
Gestation Birth
Insult
Insult
Fewer cells
Cell proliferation
Cell growth
Smaller
cells
Fetal weight
fig0002Figure 2 This diagram illustrates how fetal growth is predom-
inantly by cell proliferation in early pregnancy and later by cell
growth. For this reason, an early insult may result in a permanent
reduction in cell number, whereas one later in pregnancy may
reduce cell size and be reversible after birth. Reproduced with
permission from Holmes R and Soothill PW (1998) Normal fetal
growth. In: Kelmer ChJH, Savage MO, Stirling HF and Saenger P
(eds) Growth disorders, pp. 143–157. Cambridge: Chapman & Hall.
2976 GROWTH AND DEVELOPMENT