149. Growth: Disease Impact on Children

Question 1

How does a child’s growth and height change as they age? How to correct for prematurity? How to calculate genetic potential of height?

Answer 1

Prematurity correction: if born <37 weeks: corrected age = chronological age - (40 - gestational age)

Weight:
First few days: lose 5-10% birth weight
Day 7-10: return to birth weight
Month 4-5: double birth weight
Year 1: triple birth weight

Height:
avg 20in long at birth
30 in long at 1 year
3ft tall at 3 year
double birth length at 4 year

Genetic Potential: Girls: 0.5([dad-5] + mom), Boys: 0.5(dad+[mom+5])

Question 2

What do you use to assess for chronic malnutrition? acute malnutrition?
BMI cutoffs for adults vs. peds

Answer 2

Weight for length: use instead of BMI when pt <2yo; assess for ACUTE malnutrition

Length/height for age: assess for CHRONIC malnutrition (aka: stunting)

Adults: Underweight <19.8, Normal 19.8-26, Overweight 26.1-29, Obese 29+

Peds (>2yo): Underweight <5th%, Normal 5-85th%, Overweight 85-95th%, Obese >95th%

Question 3

How to diagnose malnutrition: mild vs moderate vs severe

Answer 3

Z-scores!
Mild: -1 to -1.9
Moderate: -2 to -2.9
Severe: >-3

Or less than expected weight gain velocity, deceleration in weight-for-length/height z-score

Question 4

Failure to Thrive

• dx
• cause

Answer 4

Weight-for-age or Weight/Length <5th%
Weight crossing 2+ major percentiles
Decrease in more than 2SDs on growth chart over 3-6mo

Cause: less intake, vomiting/diarrhea/malabsorption, high caloric demand (heart/liver/pulm disease), inability to utilize calories (mito disease, chromosomal abnormality)

Assess by good Hx (diet recall, hydration, stool count, social/enviro hx, growth parameters/genetic potential)

Question 5

Cystic Fibrosis

• how to assess GI sx
• why growth is important (goals for growth)
• tx for nutrition

Answer 5

GI: 90% have exocrine pancreatic insufficiency (fat malabsorption) - seen by high fecal fat collection, low fecal elastase

Growth: nutritional status linked to survival (higher BMI pts have better FEV)
Goal: >50th% for weight/length and BMI (need 110-200% daily caloric intake due to malabsorption)

Tx: PERT - dosed based on amount breast milk consumed or weight/fat content of meals

Question 6

IBD

• how to assess nutritional sx
• why do they have these nutritional problems
• RF for nutritional problems
• tx

Answer 6

Growth Failure/Faltering: Height <5th%, height velocity <5th%, fall off child’s growth curve
Higher incidence in CD than UC

Cause: low caloric intake (gastritis, esophagitis, fear of worsening sx/pain on eating), malabsorption, higher EE due to chronic inflammation

RF: boys more at risk than girls, poor growth assoc with more risk of surgery

TX: hard to return to genetic potential
Remicade (anti-TNF ab), humira (humanized anti-TNF Ab), immunosuppressants

Question 7

Celiac’s Disease

• when does it occur in children
• Dx
• complication in children

Answer 7

Occurs after introduction to solid food
Dx: serum IgA Ab (tissue transglutaminase), GOLD STANDARD - biopsy showing villous blunting/inflammation

Celiac Crisis in Children: severe diarrhea, hypoproteinemia, electrolyte abnormalities
tx: CS (avoid long term use which affects growth)

Question 8

What are 4 non-organic causes of growth faltering?

Answer 8

1. Post-partum depression (less maternal interaction)
2. Economic reasons (improperly prepared formula)
3. Young mother without social support
4. Maternal-Child Bonding issues

May necessitate in-patient hospitalization to monitor weight gain