Maternal and child healthcare Flashcards
1
Q
Who are the targets of MCH?
A
- Women in their reproductive age (15–49 years old)
- Children
- School-aged population
- Adolescents
2
Q
Define
Maternal and child healthcare
A
The health services provided to mothers (women in their reproductive age) and children
3
Q
Define
MCH programs
A
Programs focusing on health issues concerning women, children, and families, such as:
- recommended prenatal and well-child care visits,
- infant and maternal mortality prevention,
- maternal and child mental health,
- newborn screening,
- child immunizations,
- child nutrition, and
- services for children with special healthcare needs
4
Q
What are the objectives and targets of MCH services?
A
- To reduce morbidity and mortality among mothers and children through health promotion activities rather than curative interventions
- To improve the health of women and children through expanded use of fertility regulation methods, adequate antenatal coverage, and care during and after delivery
- To reduce unplanned or unwanted pregnancies through sex education and the wider use of effective contraceptives
- To reduce perinatal and neonatal morbidity and mortality
- Promotion of reproductive health and the physical and psychosocial development of the child and adolescent within the family
- To reduce the risk of sexually transmitted diseases, HIV infection, and cervical cancer
- To reduce domestic and sexual violence and ensure proper management of victims
5
Q
What percentage of the population consists of children under the age of 15?
A
34.3%
6
Q
What percentage of the population consists of women in their reproductive age?
A
20%
7
Q
What is the age range for women designated as the reproductive age?
A
15–49 years old
8
Q
What percentage of pregnancies in developing countries develop obstetric complications?
A
40%
9
Q
What are examples of complications of pregnancy?
A
- Miscarriage
- Induced abortion
10
Q
What percentage of maternal deaths in developing countries are due to direct obstetric causes?
A
80%
11
Q
What are the effects of poorly timed, unwanted pregnancies?
A
- High risks of morbidity and mortality
- Social and economic costs
12
Q
What are the causes of perinatal mortality?
A
- Premature delivery (oftentimes leading to low birthweight)
- Uncontrolled hypertension (resulting in preeclampsia and low birthweight)
- Poor management techniques during labor and delivery (mainly asphhyxia)
- Maternal health and nutritional status before pregnancy
- Antepartum hemorrhage
- Uncontrolled diabetes
- Fetal growth restriction (oftentimes resulting in low birthweight)
- Fetal anomalies (e.g. anencephaly)
- Polyhydramnios
- Post-date delivery
13
Q
What are the justifications for providing MCH?
A
- Mothers and children constitute over half of the population
- Maternal mortality is an adverse outcome of many pregnancies
- 40% of pregnancies in developing countries develop obstetric complications
- 80% of maternal deaths in developing countries are due to direct obstetric causes
- Most pregnant women in the developing world receive insufficient or no prenatal care and give birth without appropriately trained healthcare providers
- Poorly timed, unwanted pregnancies lead to negative personal, health, economic, and social effects
- Poor maternal health affects women’s productivity, family welfare, and socioeconomic development
- Women with poor nutrition are more likely to deliver a low-birthweight infant
- Most perinatal deaths are associated with preventable causes
- Most pregnancies that result in maternal death also result in fetal or perinatal death
- The physiological changes that the mother and her child undergo
14
Q
Define
Risk factor (in pregnancy)
A
Any condition, past or present, that is known to be associated with increased maternal and/or fetal morbidity
15
Q
What are the types of risk factors in pregnancy?
A
- Epidemiological risk factors/social circumstances
- Obstetric history
- Medical conditions
- Complications arising in pregnancy
16
Q
What are the medical-condition risk factors in pregnancy?
A
- Diabetes mellitus
- Anemia
- Hypertension
- Urinary tract infection
- Heart disease
- Epilepsy
- Problems related to drug usage
17
Q
What are the risk factors in pregnancy related to past obstetric history?
A
- History of operative delivery
- History of stillbirth or neonatal death
- Previous antepartum hemorrhages
- Previous postpartum hemorrhages
- History of low-birthweight infant
18
Q
What are the epidemiological risk factors in pregnancy?
A
- Maternal age
- Social circumstances
19
Q
What are indicators of the health status of populations of women?
A
- Maternal mortality rate per 100,000
- Malnutrition among women in the reproductive age group
- Teenage pregnancy
- Low-birthweight deliveries
- Weight gain during pregnancy
- Percentage of women who visit antenatal care clinics
- Percentage of labors attended by medical staff
- Percentage of women who receive family planning services
20
Q
Which indicator of the health status of women is the most sensitive for maternal health?
A
Maternal mortality rate per 100,000
21
Q
What is the definition of low birthweight?
A
<2500 g
22
Q
What are the different maternal health services?
A
- Premarital
- Preconceptional
- Conceptional: care during pregnancies (antenatal care) and labor (risky pregnancy)
- Delivery care (centers, staff, and equipment)
- Postnatal and family planning services
23
Q
Who are the targets of premarital services?
A
- Couples about to marry
- Newlyweds
- Any individual seeking advice
24
Q
What are the main functions of premarital services?
A
- Family health education
- Sexuality and puberty
- Marriage and parenthood
- Avoiding hazards (smoking, alcohol, drugs)
- Nutrition and weight monitoring
- Immunization
- Gynecologic/obstetric history
- Medical history (STDs, past menstrual history, etc.)
- Physical examination
- Genetic counseling
- Fertility investigation (hormonal tests for females; semen analysis for males)
25
How are nutrition and weight monitored before and during pregnancy?
* BMI is the preferred indicator of nutritional status
* Preconceptional intake of folate
* Anemia during pregnancy is commonly associated with poor pregnancy outcome and can cause potentially fatal complications for the mother and fetus
26
What are the complications of severe maternal anemia during pregnancy?
* Prematurity
* Spontaneous abortion
* Low birthweight
* Fetal death
27
# Define
Premature (preterm) birth?
Birth occurring before the 36th week
28
How long does a normal pregnancy last?
40 weeks
29
What are the conditions associated with premature infants?
* Brain hemorrhage
* Pulmonary hemorrhage
* Hypoglycemia
* Neonatal sepsis
* Patent ductus arteriosus (an unclosed hole in the main blood vessel of the heart)
* Anemia
* Neonatal respiratory distress syndrome
30
Infection with which virus is particularly dangerous in pregnant women?
Rubella (German measles)
31
Why is infection with rubella dangerous in pregnant women?
Primary rubella infection, especially in the first trimester, can cause:
* miscarriage,
* intrauterine fetal demise, or
* congenital rubella syndrome (CRS; fetal malformations)
32
Why should pregnant women **not** be given the MMR vaccine ?
It contains live attenuated rubella, which can cause the same dangerous effects as natural infection
33
What are the implications of the danger of rubella in pregnancy on vaccination programs?
Adolescent girls and adult women should be vaccinated; women of childbearing age should ensure they are vaccinated before becoming pregnant
34
How long must women wait after receiving the MMR vaccine to get pregnant?
At least 4 weeks
35
Who is given premarital screening and genetic counseling (PMSGC)?
At-risk couples for children with genetic illnesses
36
Why is premarital screening and genetic counseling (PMSGC) offered?
To educate at-risk couples on the reproductive risks and available options if they conceive, e.g. identifying β-thalassemia carriers
37
What are the aims of PMSGC?
* Prevention of at-risk marriages by discouragement during counseling
* Where legal, termination of affected fetuses through prenatal diagnosis and therapeutic abortion
38
In which demographic group are premarital exams more common in Jordan?
Those with higher education
39
What percentage of ever-married women and their husbands have had a premarital exam?
50%
40
# Define
Preconception health
A woman's health before she becomes pregnant
41
What is included under preconception health?
* Past medical history
* Social history
* Controlling risk factors
* Psychological and social counseling
42
# Define
Antenatal care (ANC)
The services offered to a mother and her unborn child during pregnancy. It is an essential part of basic PHC during pregnancy, and offers a mosaic of services than can prevent, detect, and treat risk factors early in the pregnancy
43
What are the objectives of ANC?
* Promote and maintain the physical, mental, and social health of mother and baby by providing education on nutrition, personal hygiene, and the birthing process
* Detect and manage complications during pregnancy
* Assess the risk of complications in later pregnancy, labor, or delivery and arrange for a suitable level of care
* Develop birth preparedness and complication readiness plans
* Help prepare the mother to breastfeed successfully, experience normal puerperium, and take good care of the child
44
What are the checks and tests offered in ANC?
* Weight and height checks
* Urine tests: urinalysis, checking for proteinuria
* Blood pressure checks
* Blood tests (CBC, TSH, blood glucose)
* Ultrasound scans
45
What is the purpose of ultrasound scans in ANC?
* Checking the baby's size and growth
* Screening for congenital abnormalities
* Showing the position of the baby and the placenta (e.g. when the placenta is low down in late pregnancy, a C-section may be advised)
46
What is the focused ANC (FANC) model?
Healthy women with no underlying pregnancy complications should be scheduled a minimum of 4 ANC visits, and more than four in case of danger signs or pregnancy-related illnesses
47
How is effective is the FANC model?
FANC is associated with more perinatal deaths than ANC models that comprise at least 8 visits
48
What are the 2016 WHO ANC recommendations?
At least 8 contacts:
* One in the first trimester
* Two in the second trimester
* Five in the third trimester
49
What are the risk factors that are considered in ANC?
* Age under 18 or above 35
* Height below 150 cm
* BMI under 18 or above 25
* Education and income
* Past medical history
* Past obstetric history
* Previous postpartum or antepartum hemorrhage
* Social history: smoking and alcohol use
50
Why is teenage pregnancy of special interest?
* Children born to very young mothers are at increased risk of sickness and death
* Teenage mothers are more likely to experience adverse pregnancy outcomes
* Teenage mothers are more constrained in their ability to pursue education
51
Which governorate of Jordan has the highest rate of women aged 15–19 who have begun childbearing?
Mafraq (13%)
52
Which governorate of Jordan has the lowest rate of women aged 15–19 who have begun childbearing?
Karak and Tafiela (both 2%)
53
What topics are covered in antenatal classes?
* Health in pregnancy, including a healthy diet and exercise
* What happens during labor and birth
* Coping with labor and information about different types of pain relief
* Relaxation techniques during labor and birth
* Caring for the baby, including feeding
* Health after birth
* Refresher classes for those who have already had a baby
54
What are the elements that affect access to ANC services?
* Distance from a facility
* The physical availability of services
* Cultural and social factors that may impede access
* Economic and other costs associated with use of services
* The quality of the services offered
55
# Define
Maternal morbidity
Any departure from a state of physiological or psychological maternal well-being during pregnancy, childbirth, and the pospartum period (up to 42 days of delivery)
56
What are the causes of maternal morbidity?
* Comorbidities (hypertension, diabetes, anemia, depression, postpartum sepsis)
* Stillbirth and abortion
* Hemorrhage
* Premature delivery
* Ectopic pregnancy
* Perineal tears
* Uterine rupture
* Obstructed labor
57
# Define
Chronic hypertension
BP exceeding 140/90 mmHg before pregnancy or before 20 weeks of gestation
58
# Define
Preeclampsia
A multisystem, pregnancy-specific disorder characterized by the development of hypertension and proteinuria after 20 weeks of gestation
59
How is preeclampsia diagnosed?
New-onset hypertension in a previously normotensive woman, with BP exceeding 140/90 mmHg on 2 separate occasions that are at least 6 hours apart **AND** proteinuria, developing **after** 20 weeks of gestation
60
# Define
Eclampsia
New onset of epileptic seizures due to angiospasms in the brain and brain edema
61
What are the risk factors for preeclampsia?
**Maternal risk factors**
* First pregnancy
* Age <18 or >35
* History of preeclampsia
* Family history of preeclampsia in a first-degree relative
* Black race
**Medical risk factors**
* Chronic hypertension
* Type 1 or type 2 diabetes
* Renal disease
* SLE
* Obesity
62
# Define
Intimate partner violence (IPV)
Physical, sexual, and emotional abuse and controlling behaviours by an intimate partner
63
Why don't women leave violent partners?
* Fear of retaliation
* Lack of alternative means of economic support
* Concern for their children
* Lack of support from family and friends
* Stigma or fear of losing custody of children associated with divorce
* Love and the hope that the partner will change
64
What are the types of factors associated with IPV?
* Individual factors
* Relationship factors
* Community and societal factors
65
What are the individual factors associated with a man participating in IPV?
* Young age
* Low level of education
* Witnessing or experiencing violence as a child
* Harmful use of alcohol and drugs
* Personality disorders
* Acceptance of violence (e.g. feeling it is acceptable for a man to beat his partner)
* Past history of abusing partners
66
What are the individual factors associated with a woman experiencing IPV?
* Low level of education
* Exposure to violence between parents
* Sexual abuse during childhood
* Acceptance of violence
* Exposure to other forms of prior abuse
67
What are the relationship factors associated with IPV?
* Conflict or dissatisfaction in the relationship
* Male dominance in the family
* Economic stress
* Man having multiple partners
* Disparity in educational attainment, i.e. where a woman has a higher level of education than her male partner,
68
What are the community and societal factors associated with IPV?
* Gender-inequitable social norms (especially those that link notions of manhood to dominance and aggression)
* Poverty
* Low social and economic status of women
* Weak legal sanctions against IPV within marriage
* Lack of women’s civil rights, including restrictive or inequitable divorce and marriage laws
* Weak community sanctions against IPV
* Broad social acceptance of violence as a way to resolve conflict
* Armed conflict and high levels of general violence in society
69
What are the effects of IPV on children?
* Anxiety
* Depression
* Poor school performance
* Negative health outcomes: less vaccination, increased diarrheal disease, greater risk of dying before age 5
* Risk of future exposure to IPV
70
What are steps related to reforming legal frameworks to deal with IPV?
* Strengthening and expanding laws defining rape and sexual assault within marriage
* Sensitizing and training police and judges about partner violence
* Improving the application of existing laws
71
What are common symptoms of postpartum blues?
* Mood swings
* Mild elation
* Irritability
* Tearfulness
* Fatigue
* Confusion
72
What is the definition of postpartum depression
A major depressive disorder (MDD) with a specifier of pospartum onset within 1 month after childbirth
73
Why is it challenging to diagnose PPD?
Changes in sleep patterns and appetite as well as fatigue are routine for women after delivery
74
What is the optimal time to screen for PPD?
Between 2 weeks and 6 months after delivery
75
What are the infant and child outcomes associated with PPD?
* Higher incidence of excessive infant crying or colic
* Sleep problems
* Temperamental difficulties
76
What does interpersonal psychotherapy (IPT) involve?
Addresses interpersonal issues such as:
* role change,
* the marital relationship,
* social support, and
* life stressors
77
# Define
Anemia
A reduction in one or more of the major RBC measurements (hemoglobin concentration, hematocrit, RBC count)
78
Why are pregnant women at higher risk for developing anemia?
The excess amount of blood the body produces to help provide nutrients for the baby
79
What is the prevalence of anemia in reproductive-age women?
30%
80
What are the diagnostic criteria for anemia in pregnant and postpartum women?
* First trimester: <11.0 g dL–1
* Second trimester: <10.5 g dL–1
* Third trimester: <11.0 g dL–1
* Postpartum: <10.0 g dL–1
81
What are the causes of anemia in pregnant women?
* Physiological (dilutional)
* Iron deficiency
* Folate deficiency
82
What is physiological (dilutional) anemia?
The volume of the plasma increases more than the increase in total RBC volume, so the hematocrit/hemoglobin level decreases
83
How is folate deficiency associated with anemia in pregnancy?
Folate deficiency causes megaloblastic anemia (as well as neural tube defects in the fetus)
84
What are the common risk factors for anemia in pregnancy?
* Twin or multiple pregnancy
* Poor nutrition, especially multiple vitamin deficiencies
* Smoking
* Excess alcohol consumption
85
Why are urinary tract infections more prevalent in pregnant women?
* The short urethra in females and its close location to the vagina
* Pregnancy is a relatively immunocompromised state
86
When is screening for urinary tract infections and bacteriuria performed?
12–16 weeks gestation
87
What are the complications of untreated bacteriuria?
* Prematurity
* Low birthweight
* Perinatal mortality
88
# Define
Gestational diabetes mellitus (GDM)
Hyperglycemia that develops during the second or third trimester of pregnancy
89
Why does GDM occur?
Increased insulin resistance during gestation
90
What is the course of GDM after pregnancy?
* Usually resolves after pregnancy
* Women who experience GDM have a higher risk of developing type 2 diabetes in the future
91
What are the risk factors for GDM?
* GDM in a previous pregnancy (40% recurrence)
* Family history of diabetes, especially first-degree relatives
* Obesity before pregnancy
* Medical conditions/illnesses associated with development of diabetes (e.g. polycystic ovarian syndrome, PCOS)
* Older maternal age (≥35 years of age)
* Previous birth of an infant ≥4000 g
92
What are the maternal complications of GDM?
* Cesarean section
* Polyhydramnios: excessive accumulation of amniotic fluid
* Preeclampsia
* Type 2 diabetes
93
What are the fetal complications of GDM?
* Increased risk of macrosomia (birthweight ≤4000 g)
* Shoulder dystocia (difficult birth due to impaction of the anterior fetal shoulder against the maternal pubic one)
* Obesity
* Type 2 diabetes
* Autism spectrum disorders
* Cardiomyopathy
* Neonatal respiratory problems and metabolic complications
* Stillbirth
* Medically-indicated preterm birth
94
# Define
Maternal mortality
Death during pregnancy or within 42 days of termination of pregnancy, regardless of the duration and site of pregnancy, due to causes related to or aggravated by the pregnancy or its management, but **not** from accidental or incidental causes
95
What is the leading cause of death among women of reproductive age in most of the developing world?
Maternal mortality
96
What are the major causes of maternal mortality?
* Severe bleeding
* Infections
* High blood pressure during pregnancy
* Complications of delivery
* Unsafe abortion
97
How is the WHO responding to the issue of maternal mortality in the developing world?
* Addressing inequalities in access to and quality of MCH services
* Ensuring universal health coverage for comprehensive MCH services
* Addressing all causes of maternal mortality and morbidity
* Strengthening health systems to collect high quality data to respond to the needs and priorities of women
* Ensuring accountability to improve quality of care and equity
98
What are the services provided under postnatal care?
* Observing physical status of the mother
* Advice and support on breastfeeding
* Emotional and psychological support
* Health education on weaning and food preparation
* Advice on food planning
99
What do the letters in the RESPECT framework stand for?
* R: strenghtening healthy **R**elationship skills
* E: **E**mpowerment of women
* S: **S**ervices insured (for victims of violence)
* P: **P**overty reduction
* E: **E**nvironments made safe
* C: **C**hild and adolescent abuse prevented
* T: **T**ransforming attitudes, beliefs, and norms
100
What is needed for optimal brain development in children?
* A stimulating environment
* Adequate nutrients
* Attentive caregivers
* Social interactions
101
How soon after birth is the first well-baby exam recommended?
7–10 days
102
What are the services provided by well-baby clinics?
* Physical examination
* Growth and development assessment
* Vaccination
* Nutrition assessment
* Health education (breastfeeding education, maternal hygiene, smoking cessation, etc.)
103
# Define
Neonatal mortality
Death of a child under 28 days of age
104
# Define
Post-neonatal mortality
Death of a child between 28 days and 1 year of age
105
# Define
Infant mortality
Death of a child between 0 and 12 months of age. Divided into neonatal and post-neonatal mortality
106
# Define
Under-five mortality
Death of a child under the age of 5 years
107
# Define
Perinatal mortality
The number of late fetal deaths (stillbirths) and early neonatal deaths (before day 7), per 1000 births
108
What are the factors that affect neonatal mortality?
* Events during pregnancy
* Delivery
* Care given to the mother and baby in the neonatal period
109
What are the factors that affect post-neonatal mortality?
Parental circumstances, including socioeconomic position and the care provided for the infant
110
What are the causes of asphyxia during normal delivery?
* Cord prolapse
* Ruptured uterus
* Placental abruption
* Sepsis
111
What are the causes of low birthweight?
**Mainly**
* Prematurity
* Fetal growth restriction
**Also**
* Low pregnancy weight
* Anemia
112
By what factor are low-birthweight babies more predisposed to perinatal death?
100 times
113
What are the main causes of fetal growth restriction?
* Hypertension
* Syphilis
114
What are the potential lifetime illnesses/conditions arising from low birthweight?
* Neurological problems and slow development
* Hearing and visual defects
115
What are the factors during delivery/labor that help ensure a healthy start in life for the baby?
* Skilled attendance
* Familial support and care
* Infection control
* Management of complications
116
What are the nutritional interventions given in ANC?
* Folate supplementation to avoid neural tube defects
* Calcium supplementation to reduce risk of hypertensive disorders
* Zinc supplementation to reduce risk of premature birth
* Balanced energy and protein supplementation, aiming for proteins to contribute 25% of total caloric intake
117
What are the infections of particular interest in ANC?
* Neonatal tetanus infection, resulting from umbilical cord contamination during unsanitary delivery; treated by vaccinating pregnant women
* Syphilis, which may lead to premature birth and fetal growth restriction; treated with penicillin in infected pregnant women
* HIV, which is passed to the fetus; treated with short antiretroviral therapy courses before labor
118
# Define
Adolescence
The phase of life between childhood and adulthood, from ages 10 to 19 years
119
What do adolescents need to grow and develop in good health?
* Age-appropriate comprehensive sex educaation
* Opportunities to develop life skills
* Health services that are acceptable, equitable, appropriate, and effective
* Safe and supportive environments
* Opportunities to participate in the design and delivery of interventions to improve and maintain their health
120
What are the phases of adolescence?
* Early adolescene: 10–13 years
* Middle adolescence: 14–16 years
* Late adolescence: 17–19 years
121
What are the features of early adolescence?
* Rate of growth increases
* They start initiating independence from the family and the desire for privacy
* There may be a clash between their wish for autonomy and parental authority
122
What are the features of middle adolescence?
* The peak of the height velocity curve is seen
* Auxiliary hair and sweat glands develop
* Timing of this phase is influenced by genetic factors and nutritional status
* Any chronic illness can delay puberty
123
What are the features of late adolescence?
* The body approximates a young adult's and development of secondary sexual characteristics is completed
* Career decisions are finally traced
* The child gradually returns to the family
124
What are the groups that exert influence over adolescents?
* Parents
* Teachers
* Friends (peer pressure)
125
Why are adolescents particularly susceptible to peer pressure?
* Adolescents look to their peers to understand social norms. They align their behavior with that of the group they wish to belong to—peer socialization
* Adolescents find it rewarding to gain social status by aligning with peers
* Adolescents are hypersensitive to the negative effects of social exclusion
126
What is the public health rationale for focusing on adolescent health?
* There is large disparity in the proportion of adolescent living in high-income countries and in low- and middle-income countries
* In 11 countries, a quarter of adolescent girls are underweight
* In 21 countries, a third of adolescent girls are anemic
* Globally, about 1.7 million adolescents live with HIV
* 40–70% of ever-married girls aged 15–19 report that they experienced emotional, physical, or sexual violence by their current or most recent husband/partner
* Adolescents are at risk of participating in risky behavior
127
What are the negative health and social consequences of tobacco, alcohol, or illicit drug use in adolescents?
* Accidents and dangerous driving
* Violence
* Unsafe sex
* Premature death
* Neurocognitive alterations, leading to behavioral, emotional, social, and academic problems in later life
128
How can use of tobacco in adolescents be controlled?
* Prohibiting sale of tobacco products to minors
* Increasing the price of tobacco products through higher taxes
* Banning tobacco advertising
* Ensuring smoke-free environments
129
What are the nutritional challenges that face adolescents?
* Malnutrition by deficit or excess
* Micronutrient deficiencies (e.g. iron, vitamin A, iodine)
130
What is the leading nutritional deficiency associated with adolescent morbidity?
Iron deficiency anemia
131
What is the percentage of overweight adolescents?
17% (1/6)
132
What are the factors impacting on the mental health of adolescents?
* Exposure to violence
* Poverty
* Stigmatization
* Exclusion
* Living in fragile humanitarian settings
133
What is the global prevalence of mental disorders in adolescents?
* 13.5% for 10–14-year olds
* 14.7% for 15–19-year olds
134
What are the components of the nurturing care framework?
* Good health
* Adequate nutrition
* Safety and security
* Opportunities for early learning
* Responsive caregiving
135
The "good health" component of the nurturing care framework refers to the health and well-being of children **and** their caregivers. Why is this?
Physical and mental health of caregivers can affect their ability to care for the child
136
Why does the "good nutrition" component of the nurturing care framework address both maternal and child nutrition?
* The nutritional status of the mother during pregnancy affects her health and well-being and that of her unborn child.
* After birth, the mother’s nutritional status affects her ability provide adequate care to her young child
137
What is the foundational component of the nurturing care framework?
Responsive caregiving, as responsive caregivers are better able to support the other four components
138
When does the brain undergo rapid phases of change?
* Age 0–3 years
* Age 9–14 years
139
How does puberty affect the brain?
* Hormonal changes
* Structural remodeling and neural re-configuration of key brain systems
* Improved cognitive skills and emotional control
* Greater sensitivity to social evaluation
* Increased sensation seeking (e.g. the urge to speed while driving)
* Exploration of identity
* Sensitivity to social relations
