Abnormal Growth Flashcards
what are centile lines
cross sections of the normal growth curve - spaced 2/3 of a SD apart
what is the first growth phase dependent upon
nutrition
what is the second growth phase based on
growth hormone
what is the third growth phase based on
sex steroid
what makes a child’s growth normal
if their measurement is within normal rage for their age
if their rate of growth is within normal range for their age
what is a reassuring sign for paediatricians
child growing normally
what way have growth charts shifted in the last 30 years
to the right
graph has longer tail
due to increasing severe obesity and an upward trend in height
how should babies be measured
without any clothes or nappy
with a proper length board or mat
requires 2 measures
what measurements are taken for children
head circumference
weight
height
what does it mean if the child’s height is ‘on the centile x’
the point is on the x line or within 1/4 of a space of the x line
what is the average ages for girls and boys to enter puberty
girls - 11
boys - 6 months later on average
what is the normal reference ranges for entering puberty for girls and boys
anything older than 8 for girls and 9 for boys
what are the gonadotrophic hormones
FSH and LH
what is the first sign boys have entered puberty
testicular volume >4ml
how is female puberty staged
in terms of when breasts, body hair and periods develop
Thelarche - breast budding
Adrenarche - body hair and odour
Menarche -periods start
how long after thelarche does menarche tend to occur
2 years (range 1-5)
what is the average height difference between men and women
12.5-14cm
when do boys have their growth spurt
average age 14
when do girls have their growth spurt
average 12
what to ask in a history for growth problems
ICE- see if child/parents are worried about height
Birth history - could be due to a placental insufficiency but child will catch up
PMH
Pubertal symptoms
FH
-parental heights
-parental puberty
what are some examinations for growth problems
height, weight, height velocity
signs suggestive of pathology
Pubertal status
growth problem investigations
bloods
-gonadotrophins, GH, testosterone/oestrogen, thyroid, karyotype
bone age
dynamic function tests
MRI brain
USS uterus - see if theres endometrial thickening
Causes of short stature
Genetic short stature Constitutional growth delay (late maturation occurring around puberty) Dysmorphic syndromes Endocrine disorders Chronic disease Psychosocial deprivation
why does growth matter
it’s a marker of health
abnormal growth may be indicative or other pathology
