Child growth (Part 1 of growth and development)

Question 1

What does the dorsal developing brain look like at 4 weeks?

Answer 1

Future forebrain TOP (prosencephalon)
Future midbrain (mesencephalon)
Future hindbrain (rhombencephalon)
Future spinal cord

Question 2

What does the developing brain look like at 5 weeks?

Answer 2

Telecephalon and diencephalon ( two small projections just below the rectangular telencephalon) make up forebrain
Mid (slimmer)
Hind ( another balloonish ting halfway blown) made up of pons and medulla

Question 3

What does the developing brain look like at 8 week?

Answer 3

Developing hemisphere
Lateral ventricles and 3rd ventricle in forebrain
Aqueduct in midbrain
Develpoing cerebellum and 4th ventricle in the hindbrain

Question 4

Describe shifting morbidities epidemiologicaly

Answer 4

20% of children have special educational needs

2% have severe disability

Question 5

For which growth measurements are centile charts available?

Answer 5

height, weight, head circumference and BMI are the commonest

Question 6

How do you plot centile charts?

Answer 6

There are curves on the graph which are percentiles, centile charts are not a way of finding normal ranges they just ways of comparing height to others.

Question 7

What precautions must be taken when taking measurements?

Answer 7

Accurate and maintained equipment
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.

Question 8

What is the difference between cumulative height and height velocity?

Answer 8

Cumulative height is all the height since conception, how tall they are now, this is used in centile charts.
Velocity height is how fast child growing, growth in a year - lot of short children grow at a normal pace.

Question 9

What can influence a child’s cumulative height?

Answer 9

events before birth - poor fetal growth, low birth weight, premature
medical issues in childhood - malnutrition, GH deficiency
genetic factors - height of parents, height conditions
Randomness - many genes determine adult height and are randomly distributed at conception.

Question 10

When is the fastest phase of growth?

Answer 10

In the first 2 years - children can move up and down centiles

Question 11

Summarise normal growth using centiles

Answer 11

Most children move to a centile position by 2/3 and continue down this centile growth.
Normal children grow fast enough to stay on same centile, growth up or down is unusual

Question 12

When is there a phase of fast growth?

Answer 12

the pubertal growth spurt. The timing of this depends on the age at which the child enters puberty.

Question 13

When do epiphysis(end of a long bone) fuse?

Answer 13

end of puberty, growth stops

Question 14

How can puberty affect height?

Answer 14

children who are late in developing can fall behind in height.

Question 15

Briefly summarise hormonal control of growth

Answer 15

GH stim by GHRH has growth effect itself and stimulates the release of IGF1
IGF1 circulates bound to a number of binding proteins and stimulates growth in a number of tissues.

Question 16

Which factors can influence hypothalamus secretion of GHRH?

Answer 16

nutrution, health, age, puberty, psychological factors

Negative feedback by IGF1

Question 17

What are some causes for reduced growth of a child i.e. they are short?

Answer 17

Poor nutrition
Chronic disease
Endocrine causes- GH deficiency, thyroid hormone deficiency
Genetic disorders affecting bone growth - anchondroplasia, Turners, Down syndrome
Psychological distress and neglect
Intrauterine growth restriction

Question 18

Summarise Turner’s

Answer 18

Turner’s syndrome - only affects females, 45X, failure of ovary develpoment, short stature and heart defects.

Question 19

Give some causes of IGUR

Answer 19

Advanced diabetes.
High blood pressure or heart disease.
Infections such as rubella, cytomegalovirus, toxoplasmosis, and syphilis.
Kidney disease or lung disease.
Malnutrition or anemia.
Sickle cell anemia.
Smoking, drinking alcohol, or abusing drugs.

Question 20

What is there to consider if your child is as tall as lebron?

Answer 20

overgrowth syndromes - marfan’s or soto’s
GH excess from pit tumour RARE
Precocious puberty

Question 21

Why isn’t GH given to normal short children?

Answer 21

the tiny improvement in height seen is not worth the time, effort and expense of treatment.

Question 22

What is the definition of obesity?

Answer 22

For adults BMI of over 25 kg/m2 is overweight and over 30 kg/m2 is obese.

Question 23

How is BMI assessed in children?

Answer 23

Children have lower BMI than adults and this changes with age so these figures do not apply, and obesity is assessed on the BMI centile position.

Question 24

Why is global obesity complicated?

Answer 24

We can’t be sure that this increase in obesity will persist
Some nations have higher rates than others - cultures where being overweight shows wealth and high status and others where its associated with affluence or poverty
Some ethnic groups have lower tolerance for obesity, more likely to get T2DM complications at lower BMIs

Question 25

What are the disorders associated with obesity?

Answer 25

type 2 diabetes, cardiovascular disease, some cancers, orthopaedic problems.

Question 26

Why does obesity happen?

Answer 26

balance of energy taken in as food versus energy expenditure
Very small number where single gene causes POMC deficiency or MC4R mutation for example
Some gene variants e.g FTO gene that affect eating habits and desire to eat.