Child health- Growth and puberty

Question 1

what is growth as a physiological process

Answer 1

chondrogenesis

Question 2

what are regulators of growth

Answer 2

endocrine signals
nutrition
inflammatory cytokines
extracellular fluid (o2 deficiencies, acidosis, toxins)

Question 3

what are the stages for assessing growth

Answer 3

1. initial measurement
2. recording
3. interpretation
4. action

Question 4

describe the first stage of assessing growth

Answer 4

initial measurement

routine screening OR due to concerns

measurements taken with appropriate technique eg. height measurements vs length for babies

Question 5

describe the fourth stage of assessing growth

Answer 5

if concerns, plan for follow ups to aid evaluation.

refer for fuller assessment

Question 6

Achondroplasia- how does it manifest?

Answer 6

short limbs = hypochondroplasia

short back and long legs = delayed puberty

Question 7

what else should be considered when measuring head circumference?

Answer 7

centile position

adherence or deviation from centile

relation to body size

features of sutures and fontanelles- evidence of abnormal intracranial pressure?

familial factors

Question 8

give reasons for unreliable measurements in child health

Answer 8

inaccuracy
-faulty technique, inexperienced
-faulty equipment, wrongly positioned or calibrated

uncooperative child

different observers

different times of the day

Question 9

what is a limitation of growth charts used in the UK?

Answer 9

based on white UK children only

babies in the sample were breast fed exclusively for at least 4 months.

babies who were weighed were from non smoking homes

Question 10

how is height prediction calculated

Answer 10

Parents heights predict child’s height

Boys: Father’s height + (mother’s ht +12.5cm)/
2

Girls: Mother’s height + (father’s ht - 12.5cm)/
2

95% CI = mid-parental ht +/- 8.5cm

Question 10

how is growth velocity measured

Answer 10

kg or cm per year

Question 10

describe the growth and height velocity trends

Answer 10

• Fastest growth rate in
  utero and infancy
• Gradually decreasing rate
  to puberty
• Pubertal growth spurt
• Growth ends with fusion of
  epiphyses (Oestrogen
  effect)
• Huge inter-individual
  variability

Question 10

what are the tanner stages

Answer 10

pattern of pubertal growth changes observed in boys

Question 11

describe stage one of the tanner stages

Answer 11

Prepubertal: No pubic hair
* Testicular length <2.5 cm
* Testicular volume <3.0 mL

Question 12

describe stage two of the tanner stages

Answer 12

Sparse growth of slightly curly pubic hair, mainly base of penis
* Testes > 3 mL (>2.5 cm in longest diameter)
* Scrotum thinning and reddening

Question 13

describe stage three of the tanner stages

Answer 13

• Thicker, curlier hair spread to mons pubis
• Growth of penis in width and length; further growth of testes

Question 14

describe stage four of the tanner stages

Answer 14

• Adult-type hair, not yet spread to medial surface of thighs
• Penis further enlarged; testes larger, darker scrotal skin colour

Question 15

describe stage five of the tanner stages

Answer 15

Adult-type hair spread to medial surface of thighs
* Genitalia adult size and shape

Question 16

what is the normal testicular volume of prepubertal boys

Answer 16

1-3ml

Question 17

what is the normal testicular volume of adult males

Answer 17

15-25ml

Question 18

describe klinefelter syndrome

Answer 18

affects approx 1 in 1,000 males

47 XXY

primary hypogonadism

Azoospermia, gynaecomastia

reduced secondary sexual hair

osteoporosis

tall stature

reduced IQ in 40%

20 fold increased risk of breast cancer

Question 19

describe the HPG axis

Answer 19

Hypothalumus- Pituitary- gonads

GnrH released in hypothalumus in response to a reduction of sex hormone

LH, FSH released from pituitary

Triggers Gonadal sex hormone release in testis, which acts on receptors

Question 20

describe primary hypogonadism

Answer 20

reduced production of sex hormone from the gonads

causes hypergonadotropic action in the hypothalumus and pituitary (increased GnRH, LH, FSH)

Question 21

describe secondary hypogonadism

Answer 21

reduced production of LH and FSH from the pituitary

Question 22

describe tertiary hypogonadism

Answer 22

reduced production of GnRH from the hypothalumus

Question 23

what are tertiary and secondary hypogonadisms referred to as

Answer 23

hypogonadotropic hypogonadism

Question 24

describe the tanner stage one for girls

Answer 24

* Prepubertal: No pubic hair * Elevation of papilla only

Question 25

describe tanner stage two for girls

Answer 25

Sparse growth of long, straight or slightly curly, minimally pigmented hair, mainly on labia * Breast bud noted/ palpable; enlargement of areola

Question 26

describe the tanner stage three for girls

Answer 26

*Darker, coarser hair spreading over mons pubis * Further enlargement of breast and areola, with no separation of contours

Question 27

describe tanner stage four for girls

Answer 27

Thick adult-type hair, not yet spread to medial surface of thighs * Projection of areola and papilla to form secondary mound above level of breast

Question 28

describe tanner stage five for girls

Answer 28

* Hair adult-type and distributed in classic inverse triangle * Adult contour breast with projection of papilla only

Question 29

describe turner syndrome

Answer 29

45,X0 GIRLS * At birth oedema of dorsa of hands, feet and loose skinfolds at the nape of the neck * Webbing of neck, low posterior hairline, small mandible, prominent ears, epicanthal folds high ached palate, broad cheast, cubitus valgus, hyperconvex fingernails * Hypergonadotrophic hypogonadism, streak gonads * Cardiovascular malformations * Renal malformations (horseshoe kidney) * Recurrent otitis media * Short stature

Question 30

describe normal puberty

Answer 30

Breast buds first sign in girls * Testicular enlargement first sign in boys * Delay in girls > 13 years * Delay in boys > 14 years * Early in girls < 8 years * Early in boys < 9 years

Question 31

which factors influence birth weight?

Answer 31

Maternal size & weight * Parity * Gestational diabetes * Smoking * Paternal size

Question 32

what are common causes of short stature?

Answer 32

* Constitutional, Slow maturation (genetic), delayed puberty * Idiopathic * Environmental – psycho-social * Nutrition – pre- or postnatal * Physical disease * Skeletal disease * Turner’s syndrome * Endocrine

Question 33

which chronic diseases can cause short stature?

Answer 33

* Gastro-intestinal – coeliac disease – inflammatory bowel disease (Crohn’s, colitis ulcerosa) * Cardiovascular – congenital heart disease * Renal disease * Haematologic – chronic severe anaemia * Pulmonary – cystic fibrosis – bronchopulmonary dysplasia * Chronic Inflammation and infection

Question 34

what does overgrowth in childhood with an impaired adult hight indicate?

Answer 34

* Precocious Puberty * Congenital adrenal hyperplasia * McAlbright syndrome * Hyperthyroidism

Question 35

which conditions cause overgrowth in childhood with increased final height?

Answer 35

* Androgen/ or oestrogen deficiency/ oestrogen resistance * GH excess * Klinefelter syndrome (XXY) * Marfan syndrome * Homocystinuria (rare, inherited metabolic disorder that prevents the body from breaking down certain amino acids)

Question 36

what are psychosocial factors which can cause short stature?

Answer 36

* Usually seen over age 3 years * Emotional rejection key factor * Physical/sexual abuse may be associated * 50% show reversible GH deficiency Poor response to GH treatment

Question 37

how is nutritional obesity indicated in height?

Answer 37

child will be tall and fat

Question 38

how are endocrine issues indicated in obesity

Answer 38

short and fat stature

Question 39

influence of obesity on menarche

Answer 39

excess fat tissue = high leptin, early activation of the reproductive system causing precocious puberty girls with high BMI are more likely to experience menstrual disorders eg. PCOS, dysmenorrhea