4. Growth in childhood

Question 1

How is a baby’s height measured?

Answer 1

Lay down on measuring plate with hard board at both ends

Question 2

What do centile charts measure?

Answer 2

Express variation within the population
• Head circumference
• Weight
• Height
• Leg length
• BMI
• Growth velocity

Question 3

What are fontanels?

Answer 3

Soft membranous gaps between the cranial bones - allow the expansion of the head as the brain grows

Question 4

Why do we measure head circumference?

Answer 4

• To check if the brain is growing well

* To check for increased fluid in the head

Question 5

What units is the height-velocity chart expressed in?

Answer 5

cm/year

Question 6

What happens to height velocity at puberty?

Answer 6

Sudden fast growth then stop - pubertal growth spurt

Question 7

How often do we calculate height for height-velocity calculations?

Answer 7

6 months or a year apart (any less will introduce error)

Question 8

Which axis is the regulator of human linear growth?

Answer 8

GH - IGF-1 axis

Question 9

How is GH secreted?

Answer 9

• By somatotroph cells of anterior pituitary
• Pulsatile secretion
• Influenced by nutrition, sleep, exercise and stress

Question 10

Where is 70% of IGF-1 made?

Answer 10

Liver

Question 11

Where are IGF-1 receptors located?

Answer 11

Growth plates of bones

Question 12

What types of hormonal effects does IGF-1 have?

Answer 12

Autocrine and paracrine

Question 13

What bone cells does IGF-1 stimulate?

Answer 13

Osteoblasts

Question 14

Which hormone negatively controls the growth hormone?

Answer 14

Somatostatin from the hypothalamus

Question 15

When is the most rapid phase of growth?

Answer 15

Antenatal

Question 16

Does IGF-2 control growth?

Answer 16

Yes (paternally imprinted)

Question 17

What mainly controls growth in the baby’s first year?

Answer 17

Nutrition

Question 18

How are sex steroid involve in growth?

Answer 18

• Work with GH to make you grow fast

* They then fuse the growth plates

Question 19

When do girls and boys have their growth spurt?

Answer 19

• Girls - beginning of puberty (13yrs)

* Boys - slightly after (15yrs)

Question 20

Is there an average height difference between boys and girls?

Answer 20

Boys are 13-14cm taller than girls

Question 21

What are the final epiphyses to fuse?

Answer 21

In the pelvis

Question 22

Are centiles a “normal range”?

Answer 22

No, they are a population distribution

Question 23

What are the causes of short stature?

Answer 23

• Genetic
• Pubertal and growth delay
• IUGR/SGA
• Dysmorphic syndromes
• Endocrine disorders
• Chronic paediatric disease e.g. asthma, CF, IBD
• Psychosocial deprivation

Question 24

What can the mid-parental centile be used for?

Answer 24

Estimate maximum potential height of child, by correcting the growth chart, adjusted for the parents’ height

Question 25

How can you calculate leg length?

Answer 25

Standing height - sitting height | shorter legs cause abnormal standing height, but normal sitting height

Question 26

What endocrine disorders can cause short stature?

Answer 26

* Hypothyroidism * GH deficiency * Steroid excess

Question 27

What can cause tall stature?

Answer 27

* Genetic * Early puberty * Marfan's syndrome * GH excess

Question 28

What proportion of adults are overweight/obese?

Answer 28

2/3

Question 29

How is obesity changing in the world?

Answer 29

Increasing

Question 30

What are complications of obesity?

Answer 30

* T2DM * Orthopaedic problems * Polycystic ovarian disease * Cardiovascular risk * Psychological problems * Cancer * Respiratory difficulties

Question 31

Is the BMI for children the same for adults?

Answer 31

No

Question 32

Which synromes are associated with obesity?

Answer 32

* Cushing's * Prader-Willi * Lawrence Moon-Biedl

Question 33

When should a human have primitive reflexes?

Answer 33

* Only as babies * Most disappear in the first few weeks of life * If they don't disappear in childhood, this is problematic

Question 34

When can a baby stand and walk?

Answer 34

* Stand - 12 months | * Walk - 15 months

Question 35

When can a baby imitate speech (dada, mama, gaga)?

Answer 35

6 months | dada, mama specifically at 9 months

Question 36

When can a child put on shoes?

Answer 36

2 years

Question 37

When does cerebral palsy appear?

Answer 37

Early childhood | abnormal development or damage to the parts of the brain that control movement, balance and posture

Question 38

What are commonly used assessment tools for childhood development?

Answer 38

* Standardised tests * Schedule of Growing Skills * Griffiths developmental scale * Bailey developmental scale * Denver developmental screening tests