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Martha Phase 3a > Child health- Growth and puberty > Flashcards

Child health- Growth and puberty Flashcards

1
Q

what is growth as a physiological process

A

chondrogenesis

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2
Q

what are regulators of growth

A

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

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3
Q

what are the stages for assessing growth

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

describe the first stage of assessing growth

A

initial measurement

routine screening OR due to concerns

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

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5
Q

describe the fourth stage of assessing growth

A

if concerns, plan for follow ups to aid evaluation.

refer for fuller assessment

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6
Q

Achondroplasia- how does it manifest?

A

short limbs = hypochondroplasia

short back and long legs = delayed puberty

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7
Q

what else should be considered when measuring head circumference?

A

centile position

adherence or deviation from centile

relation to body size

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

familial factors

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8
Q

give reasons for unreliable measurements in child health

A

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

uncooperative child

different observers

different times of the day

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9
Q

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

A

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

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10
Q

how is height prediction calculated

A

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

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10
Q

how is growth velocity measured

A

kg or cm per year

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10
Q

describe the growth and height velocity trends

A
  • 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
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10
Q

what are the tanner stages

A

pattern of pubertal growth changes observed in boys

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11
Q

describe stage one of the tanner stages

A

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

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12
Q

describe stage two of the tanner stages

A

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

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13
Q

describe stage three of the tanner stages

A
  • Thicker, curlier hair spread to mons pubis
  • Growth of penis in width and length; further growth of testes
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14
Q

describe stage four of the tanner stages

A
  • Adult-type hair, not yet spread to medial surface of thighs
  • Penis further enlarged; testes larger, darker scrotal skin colour
15
Q

describe stage five of the tanner stages

A

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

16
Q

what is the normal testicular volume of prepubertal boys

A

1-3ml

17
Q

what is the normal testicular volume of adult males

A

15-25ml

18
Q

describe klinefelter syndrome

A

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

19
Q

describe the HPG axis

A

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

20
Q

describe primary hypogonadism

A

reduced production of sex hormone from the gonads

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

21
Q

describe secondary hypogonadism

A

reduced production of LH and FSH from the pituitary

22
Q

describe tertiary hypogonadism

A

reduced production of GnRH from the hypothalumus

23
Q

what are tertiary and secondary hypogonadisms referred to as

A

hypogonadotropic hypogonadism

24
Q

describe the tanner stage one for girls

A
  • Prepubertal: No pubic hair
  • Elevation of papilla only
25
Q

describe tanner stage two for girls

A

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

26
Q

describe the tanner stage three for girls

A

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

27
Q

describe tanner stage four for girls

A

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

28
Q

describe tanner stage five for girls

A
  • Hair adult-type and distributed in classic inverse triangle
  • Adult contour breast with projection of papilla only
29
Q

describe turner syndrome

A

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

30
Q

describe normal puberty

A

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

31
Q

which factors influence birth weight?

A

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

32
Q

what are common causes of short stature?

A
  • Constitutional, Slow maturation (genetic),
    delayed puberty
  • Idiopathic
  • Environmental – psycho-social
  • Nutrition – pre- or postnatal
  • Physical disease
  • Skeletal disease
  • Turner’s syndrome
  • Endocrine
33
Q

which chronic diseases can cause short stature?

A
  • 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
34
Q

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

A
  • Precocious Puberty
  • Congenital adrenal
    hyperplasia
  • McAlbright syndrome
  • Hyperthyroidism
35
Q

which conditions cause overgrowth in childhood with increased final height?

A
  • 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)
36
Q

what are psychosocial factors which can cause short stature?

A
  • 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
37
Q

how is nutritional obesity indicated in height?

A

child will be tall and fat

38
Q

how are endocrine issues indicated in obesity

A

short and fat stature

39
Q

influence of obesity on menarche

A

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

Martha Phase 3a (27 decks)

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