11. Growth and Endocrine Conditions Flashcards
What factors influence height?
Age Sex Race Nutrition Parental heights Puberty General health Growth disorders Emotional well being Social-economic status
What are the three phases of child growth?
Infantile-10/15cm per year
Childhood - 5/7cm per year
Pubertal- girls 11-15, boys 14-18
How d you measure a babies height up to 2 years of age?
Put them in between a plate. Measure length, I.e. baby is lying down
What other measurements do we do in under 2’s
Head circumference
How do you measure a child 2 years and shoves height?
Height stand- shoes and socks off stand up straight
Sitting height- May indicate body disproportions
What special growth charts can be used?
Condition specific growth charts for those with disabilities
What simple tools can be used to assess if growth is on track?
Chart parental height and work out child’s estimated height
Bone age- radiograph interpretated by radiographer
What would you like to assess on history and examination?
Birth weight and gestation PMH FH/SH/ schooling Systematic enquiry Dysmorphic features Systemic examination including pubertal assessment
In summary what are the assessment tools you use
Height/length/head circumference Growth charts and plotting MPH and target centiles Growth velocity Bone age Pubertal assessment
What are some indications for referral to the growth clinic?
Extremely short or tall stature Height be,low tartget height Abnormal height velocity History of chronic disease Obvious dysmorphic syndromes Early/late puberty
What are the common categories of short statures?
Familial- runs in the family, completely normal
Constitutional- short fro now but will catch up later on
SGA/IUGR- interested at these ones- if they don’t catch up, further investigate
What are the pathological causes of short stature?
Undernitrition Chronic illness (JCA, IBD, coeliac) Iatrogenic (steroids) Psychological and social Hormonal (GHD, hypothyroidism) Syndromes (turner, P-W)
Why would you do a FBC and ferritin Test in a child with small stature!
General health
Coeliacs
LFT’s, U&E’s
Renal and liver disease
Calcium metabolism problem?
Coeliac serology
Coeliac
IGF-1
Hormonal disorders
Karyotyoe
Turner’s syndrome
What is an IGF-1 Test?
A growth hormone stimulation test aimed to see if arginine and insulin affect growth
What is. Typical presentation of thyroid deficiency in children?
Gained weight and lost height
What are the presentations of turners syndrome?
Webber neck, wide carrying angle,
Do a karotype test to confirm
What is pari vili syndrome
Picked up at birth
What is noonans syndrome ?
Genetic disorder of childhood, come dine with me
What is achondroplasia
Diagnosed antenatal your just after birth
Short legs, long limbs
No treatments apart from leg lengthening when older
How do assess puberty?
Use tanners method: B breasts 1-5 G genitalia 1-5 PH pubic hair 1-5 AH axillary hair 1-3 T testicles 2-20ml (oligometer) SO- e.g. stat,ent as B3 PH3 or G2 PH2 6/6
What are the various stages of tanners?
1 2- important one 3 4 5- fully grown
What are the relationships between growth and changes in puberty in males
Testicular growth
Penile growth
Advanced changes of puberty (testicular 10-12ml)
Facial hair and shaving (comes at the end of puberty)
What happens to girls between growth and puberty
Breast budding
Early breast development
Menarche
What is constituational delay of growth and puberty?
Boys mainly
FH in dad or brothers
Bone age delay
Need to exclude organic diseases
What is normal pubertal age range?
8-13- girls
9-14- boys
How does hypothyroidism present in children?
Congenital presents in 2 week blood spot
Lack of height gain
Pubertal delay
Poor school performance
When you have a fat child what do you consider?
Height- obese and tall is relatively okay but obese and small is not good
What are the presenting symptoms of diabetes in children?
Weight loss
Tiredness
Increased thirst
Polyuria
What are the immediate things you do for kids with diabetes?
Test! If blood glucose is over 11mmol/l admit
How do children under 5 present with diabetes?
Heavier than usual nappies Blurred vision Candidiasis Constipation Recurring skin infection Irritability behaviour change
What are the symptoms of DKA?
Nausea and vomiting
Abdominal pain
Ketotic breath
Drowsiness
Rapid deep sighing respiration
