Childhood growth

Question 1

What determines growth

Answer 1

-Growth promoting hormones and factors
-parents phenotype and genotype
-quality and duration of pregnancy
-Psycho-social environment
-enviorment, nutrition

Question 2

Describe what happens in prenatal growth

Answer 2

-fetus grows 2cm per week in fetal period

what affects growth of fetys
-maternal size
-placnetak function and nutrition

key hormones involved
-Insulin, IGF-2 involved

Question 3

What influences childhood growth

Answer 3

hormones, and growth fctors
genetic factors
nutrition
chronic illness
emotions

Question 4

What stimulates growth hormone

Answer 4

Exercise
Stress
Hypoglycaemia
Fasting
High protein meals
Perinatal development
Puberty

Question 5

What suppresess growth hormone

Answer 5

Hypothyroidism
Hyperglycaemia
High carbohydrate meals
Glucocorticoid excess
Aging

Question 6

Why do we stop growing

Answer 6

our growth plates fuse due to oestrogen

Question 7

How is height assessed

Answer 7

measure them
-look at proportin of staurture, arm span, trunk

Question 8

What is a normal growth standards

Answer 8

2nd -98th centile

growth depends on parental height

Question 9

How do you measure a child under 2

Answer 9

use a length board

measure without nappy and socks and shoes

Question 10

How to measure children over 2

Answer 10

use a stadiometre

them height things

remove of shoes

Question 11

How would you work out height

Answer 11

Weight; BMI; height velocity; head circumference

Question 12

How to work out mid parental height for girl

Answer 12

(father’s height [cm]
– 13cm +mother’s height [cm])/2

Question 13

How to work out midparental height for boy

Answer 13

(mother’s height
[cm] + 13cm +father’s height [cm])/2

Question 14

How to work out final adult height

Answer 14

Final adult height ≈ 8.5cm within mid-parental
height

Question 15

What history would you need to ask family

Answer 15

-about birth history (what was pregancy like, scans, alcohol, gestation, mode of delivery)
-neonatal history (feeding, hypoglycemia)
infancy (weaning, feeding, reflux)
-development and behaviour
-past medical history (hospital admission, chronic illness, reccurent ear infection, thyroid symptoms, CNS symptoms)
social history (type of school, household etc)
-drug history (steroids)
family of history (ethnicty, consangunity, sibling growth)
-when did parents start worrying (red book good source of info)

Question 16

What examinations would you do

Answer 16

Dysmorphology- take time and look properly (do they look like mum and dad, and look at mum and dad)
* Neurocutaneous features
* Midline defects (cleft, central incisor_
* Goitre (Hashimoto’s thyroiditis); features of hypothyroidism
* apprioate pubertal assessment (chaperone!)
* Visual fields
* Spine; Skeletal deformities; Rickets
* Signs of neglect or abuse

Question 17

What factors do you need to consider in cinetct

Answer 17

• Birth weight - SGA?
• Height centile/HV
• Is the child crossing centiles (for some it takes > 2years to settle in a centile)
• Drugs
• Other illnesses (or Symptoms)
• Additional features: dysmorphic features, proportions?
• Short stature and female (always think about turners)

Question 18

if child is short when investigation should you do

Answer 18

basic screen and refer

+karotype if female

havent caught up and below target height (growth hormone) -> refer

short stature (refer)

Question 19

What is meant by short stature

Answer 19

A length or height >2 SD below the mean for age and gender

in context of parents

Question 20

What is idiopathic short stature

Answer 20

don’t know why
-delay of growth and puberty but have a normal height prediction

Question 21

how can illness lead to short stature

Answer 21

Any chronic disease can lead to short
stature

Gastro-intestinal
* coeliac disease
* inflammatory bowel disease (Crohn’s, UC

Cardiovascular
* congenital heart disease

• Renal disease

Haematologic
* chronic severe anaemia

Pulmonary
* cystic fibrosis
* bronchopulmonary dysplasia

Chronic Inflammation and infection

Drugs
* Steroids for asthma
* ADHD medication
* Radiotherapy for cancer

radiotherpay: spinal cause short stauture irresponsive of grwoth hormone

renal -> transplant

Question 22

What is consititunal delay of growth and puberty

Answer 22

-common cause
-diagnosis of exculsion
-evidence becomes evident when their peers are changing
-delay in parents
-typically make it to target heights

Question 23

Remember

Answer 23

Nutritional deficit can have a severe impact on growth at
any age

Question 24

What are the causes of growth hormone defiecency

Answer 24

-idiopathic
-congential
-acquired

Question 25

How do we diagnose growth hormone defiency

Answer 25

-look at growth hormone
-look at stature, usually short for target height

To consider GHD, you need both biochemical and auxological data

Question 26

How do we treat growth hormone defiency

Answer 26

-typically give at night to mimic growth hromone
-long acting growth hormone -> one week injections

Question 27

What is the definition of tall statures

Answer 27

two standards deviations above target height ot above population standard

Question 28

Would you conisder about tall stature

Answer 28

birthweight
-devleopment history
-thyroid status
-obesity
-cardiovascualr status
-head circumferance
-neonatal history

Physical Findings
* Obesity
* Disproportion (arm span)
* Head circumference
* Arachnodactyly
* Cryptorchidism