Child growth and development Flashcards
Why do we measure child growth?
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.
What is a centile chart?
Centile charts are a way of expressing variation within the population:
- head circumference
- weight
- height/length
- leg length
- BMI
- growth velocity
- specialist charts
How is height velocity calculated?
(height now - height last visit)/(age now - age last visit).
Expressed in cm/yr.
Interval approximately 6 months.
How is growth controlled endocrinologically?
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.
What is the most rapid phase of growth?
Antenatal. Maternal health and the placenta are important factors.
Describe growth in infancy.
Rapid initial growth ~23-25cm in first year.
Continuation of foetal growth.
Nutritionally dependant.
9-12 months influence of GH.
Describe growth in childhood.
Post-infancy to adolescence.
Growth rates in boys and girls similar.
GH/IGF-1 axis drives growth.
Nutrition less impact.
Describe growth in puberty.
Sex steroids and GH stimulate the pubertal growth spurt.
Fuse growth plates.
Y chromosome adds 13-14cm to height.
What happens to halt growth?
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.
What questions should be asked when assessing child growth?
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?
List causes of short stature.
Genetic Pubertal and growth delay IUGR/SGA Dysmorphic syndromes Endocrine disorders Chronic paediatric disease Psychosocial deprivation Normal growth pattern
What is more important, pattern of growth or position on a centile?
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.
How can someone with a normal growth pattern be of short stature?
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.
What information is necessary to determine whether a child’s short stature is normal or not?
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
What are some endocrine problems that lead to abnormal growth pattern, short stature, and/or reduced growth velocity?
Hypothyroidism
Growth hormone deficiency
Steroid excess
What can cause abnormal growth despite normal hormones?
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.
List some chronic paediatric diseases.
Asthma Sickle cell Juvenile chronic arthritis Inflammatory bowel disease- Crohn’s disease, coeliac disease Cystic fibrosis Renal failure Congenital heart disease
What are some causes of tall stature?
Tall parents
Early puberty
Syndromes, e.g. Marfans
Growth hormone excess
Give some complications of obesity and associated features.
Type 2 diabetes Orthopaedic problems Polycystic ovarian disease Cardiovascular risk Psychological problems Cancer Respiratory difficulties
Why is obesity an issue?
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.
How does obesity harm children and young people?
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.
What are the genetics of weight?
Polygenic inheritance. Weight highly heritable trait (40-70%). Monogenic obesity syndromes- rare: -leptin deficiency -leptin receptor deficiency -POMC deficiency -PC-1 deficiency -MC4R deficiency
