4. Growth in childhood Flashcards
How is a baby’s height measured?
Lay down on measuring plate with hard board at both ends
What do centile charts measure?
Express variation within the population • Head circumference • Weight • Height • Leg length • BMI • Growth velocity
What are fontanels?
Soft membranous gaps between the cranial bones - allow the expansion of the head as the brain grows
Why do we measure head circumference?
- To check if the brain is growing well
* To check for increased fluid in the head
What units is the height-velocity chart expressed in?
cm/year
What happens to height velocity at puberty?
Sudden fast growth then stop - pubertal growth spurt
How often do we calculate height for height-velocity calculations?
6 months or a year apart (any less will introduce error)
Which axis is the regulator of human linear growth?
GH - IGF-1 axis
How is GH secreted?
- By somatotroph cells of anterior pituitary
- Pulsatile secretion
- Influenced by nutrition, sleep, exercise and stress
Where is 70% of IGF-1 made?
Liver
Where are IGF-1 receptors located?
Growth plates of bones
What types of hormonal effects does IGF-1 have?
Autocrine and paracrine
What bone cells does IGF-1 stimulate?
Osteoblasts
Which hormone negatively controls the growth hormone?
Somatostatin from the hypothalamus
When is the most rapid phase of growth?
Antenatal
Does IGF-2 control growth?
Yes (paternally imprinted)
What mainly controls growth in the baby’s first year?
Nutrition
How are sex steroid involve in growth?
- Work with GH to make you grow fast
* They then fuse the growth plates
When do girls and boys have their growth spurt?
- Girls - beginning of puberty (13yrs)
* Boys - slightly after (15yrs)
Is there an average height difference between boys and girls?
Boys are 13-14cm taller than girls
What are the final epiphyses to fuse?
In the pelvis
Are centiles a “normal range”?
No, they are a population distribution
What are the causes of short stature?
- Genetic
- Pubertal and growth delay
- IUGR/SGA
- Dysmorphic syndromes
- Endocrine disorders
- Chronic paediatric disease e.g. asthma, CF, IBD
- Psychosocial deprivation
What can the mid-parental centile be used for?
Estimate maximum potential height of child, by correcting the growth chart, adjusted for the parents’ height
How can you calculate leg length?
Standing height - sitting height
shorter legs cause abnormal standing height, but normal sitting height
What endocrine disorders can cause short stature?
- Hypothyroidism
- GH deficiency
- Steroid excess
What can cause tall stature?
- Genetic
- Early puberty
- Marfan’s syndrome
- GH excess
What proportion of adults are overweight/obese?
2/3
How is obesity changing in the world?
Increasing
What are complications of obesity?
- T2DM
- Orthopaedic problems
- Polycystic ovarian disease
- Cardiovascular risk
- Psychological problems
- Cancer
- Respiratory difficulties
Is the BMI for children the same for adults?
No
Which synromes are associated with obesity?
- Cushing’s
- Prader-Willi
- Lawrence Moon-Biedl
When should a human have primitive reflexes?
- Only as babies
- Most disappear in the first few weeks of life
- If they don’t disappear in childhood, this is problematic
When can a baby stand and walk?
- Stand - 12 months
* Walk - 15 months
When can a baby imitate speech (dada, mama, gaga)?
6 months
dada, mama specifically at 9 months
When can a child put on shoes?
2 years
When does cerebral palsy appear?
Early childhood
abnormal development or damage to the parts of the brain that control movement, balance and posture
What are commonly used assessment tools for childhood development?
- Standardised tests
- Schedule of Growing Skills
- Griffiths developmental scale
- Bailey developmental scale
- Denver developmental screening tests
