6 - Growth in Childhood Flashcards
What is the average weight and length of a fetus at birth?
50cm long
3.3kg weight
What is used to check height and growth patterns are normal?
Centile charts are a way of looking at this range of height and checking that growth patterns are normal.
Every child has a handheld record which includes their growth charts- the “Red book”.
What does a centile chart tell you?
There are centile charts for a range of growth measurements- height, weight, head circumference and BMI are the commonest
They are based on surveys of large numbers of children- in the UK we use both UK population based charts and ones from the WHO which look at an international population.
To use a centile chart you plot the age (x axis) against height (y axis). 50% of children will be shorter than the 50th centile, 25% shorter than the 25th centile, and so on.
Centile charts are not a ”normal range”, they are just a way of looking at where height is compared to others
There are centile charts for girls and boys
What must be ensured when measuring the height and weight of children?
The equipment should be accurate and maintained properly
Position the child properly to get an accurate height (read the instructions on the growth chart)
Make sure you get rid of things which interfere with measuring- shoes off, hair out of the way, clothes off to weigh.
Calculate the age and plot correctly on the chart.
What type of height is read off of a centile chart?
Cumulative height is read from a centile chart
- how tall the child is now (total of all the growth they have done)
What is height velocity?
Height velocity is how fast a child is growing in cm per year, usually this is calculated over a whole year.
Most short children are growing at a completely normal speed.
Other than a child’s height compared to average, what is some usefel information when assessing growth?
Other useful information when assessing growth is the height of family members- parents and siblings.
Ideally measure them yourself because people can be very inaccurate in assessing their own height.
What can influence a child’s growth?
Events before birth- poor fetal growth, low birth weight, prematurity
Medical issues in childhood- malnutrition, chronic disease, endocrine problems including growth hormone deficiency
Genetic factors- the height of the family and any inherited disorders of growth.
Randomness. Not every child of the same parents will be the same adult height, and tall parents can occasionally have a short child. There are multiple genes which determine adult height, and these are randomly distributed at conception.
Describe the normal pattern of child growth
The fastest phase of growth after birth is in the first 2 years of life. Children can move up and down through the centiles at this phase of growth.
Most children will move to a centile position by 2 to 3 years of age and then continue on this centile position through childhood. Normal children grow fast enough to keep on the same centile and movement up or down is unusual.
There is a phase of fast growth at puberty- the pubertal growth spurt. The timing of this depends on the age at which the child enters puberty.
The skeleton matures as the child grows, the epiphyses fuse at the end of puberty, and growth stops.
How is children’s height and weight consistently monitored?
All children should have height and weight measured occasionally and plotted in their red book.
If there are concerns about growth the child should be measured accurately and plotted on a centile chart over a period of time (at least a year).
If a child is growing fast enough to continue to grow on the same centile they are not likely to have a problem even if they are at the bottom of the centile chart.
Timing of puberty can impact on height- children who are late in developing can fall behind in height.
Outline the hormonal control of growth and growth hormone secretion
Growth hormone (GH) is the most important hormonal factor in growth.
GH secretion is controlled by the hypothalamus, which secretes growth hormone releasing hormone (GHRH) which stimulates secretion and somatostatin which suppresses secretion. GH is released by the pituitary as pulses most of which occur overnight.
GH has some growth effect itself and also stimulates the release of IGF1 (insulin like growth factor !).
IGF 1 circulates bound to a number of binding proteins and stimulates growth in all the tissues of the body
What is the commonest concern about growth?
Short stature
The majority of short children have a normal growth pattern, and do not have anything wrong with them.
If a child grows slower than normal over a significant period of time they will fall in their centile position.
What should be looked for if a child is grower slower than normal?
Poor nutrition
Chronic disease
Endocrine causes- GH deficiency, thyroid hormone deficiency
Genetic disorders affecting bone growth (eg achondroplasia, Turner syndrome, Down syndrome).
Psychological distress and neglect
What can be causes of abnormal tall stature?
Syndromes of overgrowth including Marfan syndrome and Soto syndrome
GH excess from a pituitary tumour. This is very rare indeed, most of the “tallest men and women in the world” have had this diagnosis
In precocious puberty the pubertal growth spurt occurs very early and so children with this can present with tall stature. However growth stops early as well so they can then be short as adults.
What is given to children with confirmed GH deficiency?
Children with confirmed GH deficiency will get a significant improvement in their adult height with treatment, and there are a number of other disorders of growth where there is some benefit from treatment.
