Child Growth and Development Flashcards
Why do we measure 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. We measure:
- head circumference: the head can enlarge if there is excess fluid, or not grow if there is death
- weight
- height/length
- leg length
- BMI
- growth velocity
- specialist charts
Centiles are not a “normal range”
- you can be taller or shorter than the centile lines and still be completely normal and healthy. E.g is you have very tall parents, you would have genes for tall height.
Most children set out on a centile by about 2 years and grow on the same centile during childhood - see diagram of the centile graph
Pattern of growth is more important than position on the centiles.
- Most very tall or very short people are healthy and grow in a normal pattern.
A child who falls significantly in their centile position is not growing normally, whatever their height.
Describe the height in terms of a centile chart
It is cumulative slide 6
Lines plateau because you stop growing at the end of puberty
What do height centiles show?
They express how many people in the population are at a particular height at any age
See diagram
Describe height velocity
Expressed in cm/year
[Height velocity calculation:
height now - height last visit]/[age now - age last visit]
Interval approximately 6 months
See diagram - Massive growth in utero. Puberty causes massive growth acceleration (caused by GH) Then your sex steroid comes and your growth plates fuse
What is the endocrine control of growth?
- GH-IGF-1 axis regulator of human linear growth
- GH single chain polypeptide; meaning must be given i.v
- Somatotroph cells of anterior pituitary
- Pulsatile secretion
1) Influenced by nutrition, sleep, exercise, stress.
See slide 13 for a diagram. GH is stimulated to be released from the anterior pituitary by GHRH. Somatostatin inhibits the secretion of GH. GH then acts on GH receptors which stimulates the production of IGF-1.
Both GH and IGF-1 have their own actions. IGF-1 binds to IGF-1 receptors on growth plates causing you to grow.
Describe the antenatal phase of growth
Antenatal - the most rapid phase of growth.
Maternal health and the placenta are important factors.
Define infancy
- Rapid initial growth ~23-25 cm in first year
- Continuation of fetal growth
- Nutritionally dependant
- 9-12 months influence of GH starts to take over. You need GH from 9-12 months onwards to grow normally
Define childhood
- Post infancy to adolescence
- Growth rates in boys and girls similar
- GH/IGF-1 axis drives growth
- Nutrition less impact
Switch between infancy and childhood
What affects the speed of growth in height?
Look at height velocity chart for girls and boys. Girls get puberty before boys. Girls also get their growth spurt before boys while boys get their growth spurt towards the end of puberty.
- Puberty, sex steroids and GH stimulate the pubertal growth spurt. The sex steroids accelerate growth and cause the fusion of the growth plates.
Describe the growth of bone in children?
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 are the causes of short stature?
- Genetic
- Pubertal and growth delay
- IUGR(interuterine growth retardation - when you’re born tiny and never really grow and catch up to the normal)/SGA
- Dysmorphic syndromes (Downs)
- Endocrine disorders (hypothyroidism)
- Chronic paediatric disease (If you have lots of inflammatory cytokines this triggers a pathway that blocks the effect of GH)
- Psychosocial depravation (neglect = causes changes in GH pulsitility)
What is the cause of most short children?
Normal growth pattern
Most short children have a normal growth pattern and do not have any medical problem.
They are usually the children of short parents
Describe children with intrauterine growth restriction?
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.
How do you examine a short child? What questions do you ask?
Birth history and weight
Parental heights
Medical history
Previous measurements
full blood count, CRP, serum iron - checking if they are anaemic.
Liver and kidney function - to see if they are ill
thyroid function
coeliac screen
IGF 1
bone age
MRI pituitary
Pituitary function testing
What endocrine problems can cause abnormal growth pattern, short stature and reduced growth velocity?
Hypothyroidism
Growth hormone deficiency
Steroid excess
What can cause abnormal growth despite normal hormones?
Syndromes
- Turner syndrome XO
- Down syndrome T21
- skeletal dysplasias
Skeletal dysplasia
- Achondroplasia
Significant illnesses can interfere with growth, because of inflammation, poor nutrition and the effects of drugs such as steroids.
List some chronic paediatric diseases which can affect growth?
Asthma Sickle cell Juvenile chronic arthritis Inflammatory bowel disease Crohns disease Coeliac disease Cystic fibrosis Renal failure Congenital heart disease
What are the causes of tall stature?
tall parents
early puberty
syndromes eg Marfans
growth hormone excess - gigantism
Why is getting fat bad?
With increasing weight there is increasing risk of death
See slides 40
What are the complications of obesity and associated features?
Type 2 diabetes Orthopaedic problems - knee joints go Polycystic ovarian disease Cardiovascular risk - hypertensive psychological problems Cancer Respiratory difficulties
Describe the BMI in children?
measured in terms of centiles
List some syndromes associated with obesity?
Cushings
Prader willi
Lawrene-Moon-Beidal
Describe the genetics of weight
Polygenic inheritance
Weight highly heritable trait (40-70%)
Mongenic obesity syndromes –rare
- Leptin deficiency
- Leptin receptor deficiency
- POMC deficiency = low ACTCH = Low cortisol
- PC-1 deficiency
- MC4R deficiency
Define development
Complex interplay between somatic and neurologic transformations psychosocial and environmental influences.
When does most of the development happen in a person
Most of the changes happen antenatally:
Organogenesis - most vulnerable = first 3 months of life
Potential insult can last for life.
Fetal programming
What are the four main domains of development?
- cognitive
- gross motor skills: walking, sitting , running
- fine motor skills: use of hands
- social skills (speech and language): understanding
There are developmental mild stones based off these domains. e.g a Child can sit by 6 months, by 9 months they can start crawling, around a year the child can walk, at 2 months they realise their hands are theirs.
Language first start to say things at 9-12 months old. At two years old they can start to make phrases.
So if a parent comes in a says their children can’t walk at 2 years old you should be worried. Object permanence exists at 9 months - babies like to play peek-a-boo. 9 months old they start having separation anxiety. 3 months the child can start knocking things together.
What are the commonly used assessment tools?
Standardised tests
Schedule of growing skills
a bunch of developmental scales
What are patterns of abnormal development?
Regression - is a sever sign suggests autism
Slow, steady, plateau or regression of development.
How do you evaluate the child with abnormal development?
History
- parental anxiety (antenatal history)
- birth history
- family history
PMHX
- Developmental history
- Current skills
Examination
- Developmental assessment + general and neurological examination
- Investigations - as appropriate
What are the different types of developmental delays?
Developmental delay
- Global (all 4 domains)
- Specific (individual domains)
Causes:
Perinatal
Prenatal
Postnatal
What are some postnatal factors causing developmental delay?
?
What are some causes of global delay?
Chromosomal abnormalities Metabolic Antenatal and perniatal factors Environmental-social issues Chronic illness
What are causes of languages delay?
…
What are the principles of management?
- Maximise mobility
- Minimise discomfort
- Promote speech and language
- Promote social and emotional health
Other people need to help - physio, speech therapist, psychologist, occupational therapists = MULTIDISCIPLINARY TEAM required
Describe autism
Impairment of these 3 domains:
- Social interactions
- Communications
- Behaviour, interests, activities
They like to spin things - repetitive movements
Lining up of objects
Describe ADHD
- Inattention, increased distractability
- Poor impulse control
- Motor overactivity and motor restlessness
Anger, day dreaming, concentration and lashing out.
