121 - Faltering Growth Flashcards
What are the general causes of faltering growth?
Inadequate caloric intake Inadequate absorption Excessive calorie use Genetic syndromes Psycho-social reasons Inborn errors of metabolism
Why is measuring growth important?
Indicator of good health
Indicator of child’s future
summary of adverse influences on child
Summary of populations socioeconomic state
What is PDA?
Patent ductus arteriosus
- ductus remains open at birth, blood shunted form high pressure aorta into pulmonaty artery - excessive pressure in pulmonary system
What does PDA cause?
Hyperactive precordial pulse Breathlessness ( due to pul oedema) Bounding pulse Harsh murmur Tachycardia, cold sweaty peripheries Failure to thrive
What are the treatment options for PDA?
Diuretics (for oedema)
Increase nutrition
Close ductus - coil occlusion / metal clip via thoractomy
How does acute wasting impact on a child’s growth?
Normal height for age
Reduced weight/height ratio
How does chronic stunting growth impact on a child’s growth?
Reduced height for age
Normal weight for height ratio
What is marasmus malnutrition? What is the mortality?
Acute wasting due to starvation
Little old man
thin flaccid skin, reduced fat
Physiological processes ok.
Mortality - 10%
What is Kwashiorkor malnutrition?
Body’s physiological processes affected
Oedema. flaky paint dermatitis. dry depigmented hair. hepatomegaly. Apathy + misery
Mortality - 30-40%
What is normal growth in g/week of: 0-3 month old
200g/week
What is normal growth in g/week of: 4-6 month old?
150g/week
How much is normal growth in height per year in childhood?
5cm/year
Feeding: How much milk should a 2.5kg + baby have?
150-200 mls/kg/24hrs
How much milk should a 4-6 month old have?
140 mls/kg/24hrs
How much milk should a 1 year + old have?
600 mls milk/day + water
How many calories should a normal infant have a day?
100-120 Kcal/kg/day
How many calories should an underweight infant have a day?
130-140 Kcal/kg/day ( or 110-120% that of its weight’s allowance)
What does colostrum contain?
First 3 days.
High protein
Low fat
High growth factors and immunity
What does mature breast milk contain?
40% caesin protien, 60% Whey protein
more fat
lactose
Iron - lower than formula, but very bioavailable
What is Small for Gestational Age (SGA?)
below the 10th centile.
What does Growth Hormone do?
Promotes protein synthesis
Inhibits carb and fat formation
Essential in chondrocyte proliferation
What is typical if you have low GH?
often fat
short stature
What happens if fetus is starved in later stages of pregnancy?
Asymmetrical growth - head is normal size, body small. Cerebrum protected.
What happens if fetus is starved throughout pregnancy?
Symmetrical reduced growth - whole baby is small.
What can cause macrosomia?
Diabetic mum
- High blood glucose, insulin produced by baby. Islet cells hypertrophied - produces GF - IGF-1, stimulates growth.
What is Foetal alcohol syndrome?
Dysmorphic face - small narrow eyes, small head, flat brow/above lip
developmental issues
many issues - epilepsy, renal failure..
What is most important in dif stages of growth?
Phase 1 + 2 - nutrition
Phase 3 - Hormones (GH + thyroid)
Phase 4 - Hormones (Sex hormones)
What is Adrenarche?
- 8yrs old
- onset on pubic and axilla hair gowth
What is gonadarche?
Puberty
Increase nocturnal secretion of GnRH - increase sex hormones - growth spurt.
