Child growth and development

Question 1

Why do we measure child growth?

Answer 1

Poor growth in infancy is associated with high childhood morbidity and mortality.
Growth is best indicator of health.
Demonstration of normality of growth by age and stage of puberty.
Identify disorders of growth.
Assess obesity.

Question 2

What is a centile chart?

Answer 2

Centile charts are a way of expressing variation within the population:

• head circumference
• weight
• height/length
• leg length
• BMI
• growth velocity
• specialist charts

Question 3

How is height velocity calculated?

Answer 3

(height now - height last visit)/(age now - age last visit).
Expressed in cm/yr.
Interval approximately 6 months.

Question 4

How is growth controlled endocrinologically?

Answer 4

GH-IGF-1 axis regulator of human linear growth.
GH single chain polypeptide.
Somatotroph cells of anterior pituitary.
Pulsatile secretion- influenced by nutrition, sleep, exercise, stress.

Question 5

What is the most rapid phase of growth?

Answer 5

Antenatal. Maternal health and the placenta are important factors.

Question 6

Describe growth in infancy.

Answer 6

Rapid initial growth ~23-25cm in first year.
Continuation of foetal growth.
Nutritionally dependant.
9-12 months influence of GH.

Question 7

Describe growth in childhood.

Answer 7

Post-infancy to adolescence.
Growth rates in boys and girls similar.
GH/IGF-1 axis drives growth.
Nutrition less impact.

Question 8

Describe growth in puberty.

Answer 8

Sex steroids and GH stimulate the pubertal growth spurt.
Fuse growth plates.
Y chromosome adds 13-14cm to height.

Question 9

What happens to halt growth?

Answer 9

The bones mature and epiphyses fuse at the end of puberty.

The final part of growth occurs in the spine and the final epiphyses to fuse are in the pelvis.

Question 10

What questions should be asked when assessing child growth?

Answer 10

Is a child too short or tall for their age- could there be a problem?
Has puberty started and is it progressing normally?
Is growth normal for stage of puberty?
Is this child overweight or obese?

Question 11

List causes of short stature.

Answer 11

Genetic
Pubertal and growth delay
IUGR/SGA
Dysmorphic syndromes
Endocrine disorders
Chronic paediatric disease
Psychosocial deprivation
Normal growth pattern

Question 12

What is more important, pattern of growth or position on a centile?

Answer 12

Pattern of growth.
Most very tall or very short people are healthy and grow in a normal pattern.
A child who falls significantly in centile position is not growing normally, whatever their height.

Question 13

How can someone with a normal growth pattern be of short stature?

Answer 13

Most short children have a normal growth pattern and do not have any medical problem.
They are usually the children of short parents.
Not all children with intrauterine growth restriction catch up completely.
Growth will be normal in childhood but they have ‘lost’ some height in the antenatal period.

Question 14

What information is necessary to determine whether a child’s short stature is normal or not?

Answer 14

Birth history and weight
Parental heights- mid-parental centile
Medical history
Previous measurements
Full blood count
CRP
Serum iron
Liver and kidney function
Thyroid function
Coeliac screen
IGF-1
Bone age
MRI pituitary
Pituitary function testing

Question 15

What are some endocrine problems that lead to abnormal growth pattern, short stature, and/or reduced growth velocity?

Answer 15

Hypothyroidism
Growth hormone deficiency
Steroid excess

Question 16

What can cause abnormal growth despite normal hormones?

Answer 16

Syndromes:

• Turner syndrome, X0
• Down syndrome, T21
• Skeletal dysplasias

Significant illnesses can interfere with growth because of inflammation, poor nutrition and the effects of drugs such as steroids.

Question 17

List some chronic paediatric diseases.

Answer 17

Asthma
Sickle cell
Juvenile chronic arthritis
Inflammatory bowel disease- Crohn’s disease, coeliac disease
Cystic fibrosis
Renal failure
Congenital heart disease

Question 18

What are some causes of tall stature?

Answer 18

Tall parents
Early puberty
Syndromes, e.g. Marfans
Growth hormone excess

Question 19

Give some complications of obesity and associated features.

Answer 19

Type 2 diabetes
Orthopaedic problems
Polycystic ovarian disease
Cardiovascular risk
Psychological problems
Cancer
Respiratory difficulties

Question 20

Why is obesity an issue?

Answer 20

It’s widespread: 2/3 of adults, 1/4 of 2-10 year olds, and 1/3 of 11-15 year olds are overweight or obese.

Prevalence remains high- overweight and obesity in adults is predicted to reach 70% by 2034. More adults and children are now severely obese.

Consequences are costly- a high BMI is costly to health and social care, and has wider economic and societal impacts.

Question 21

How does obesity harm children and young people?

Answer 21

Emotional and behavioural- stigmatisation, bullying, low self esteem.
School absence.
High cholesterol.
High blood pressure.
Pre-diabetes.
Bone and joint problems.
Breathing difficulties.
Increased risk of becoming overweight adults.
Risk of ill health and premature mortality in adult life.

Question 22

What are the genetics of weight?

Answer 22

Polygenic inheritance.
Weight highly heritable trait (40-70%).
Monogenic obesity syndromes- rare:
-leptin deficiency
-leptin receptor deficiency
-POMC deficiency
-PC-1 deficiency
-MC4R deficiency