Childhood growth Flashcards
What determines growth
-Growth promoting hormones and factors
-parents phenotype and genotype
-quality and duration of pregnancy
-Psycho-social environment
-enviorment, nutrition
Describe what happens in prenatal growth
-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
What influences childhood growth
hormones, and growth fctors
genetic factors
nutrition
chronic illness
emotions
What stimulates growth hormone
Exercise
Stress
Hypoglycaemia
Fasting
High protein meals
Perinatal development
Puberty
What suppresess growth hormone
Hypothyroidism
Hyperglycaemia
High carbohydrate meals
Glucocorticoid excess
Aging
Why do we stop growing
our growth plates fuse due to oestrogen
How is height assessed
measure them
-look at proportin of staurture, arm span, trunk
What is a normal growth standards
2nd -98th centile
growth depends on parental height
How do you measure a child under 2
use a length board
measure without nappy and socks and shoes
How to measure children over 2
use a stadiometre
them height things
remove of shoes
How would you work out height
Weight; BMI; height velocity; head circumference
How to work out mid parental height for girl
(father’s height [cm]
– 13cm +mother’s height [cm])/2
How to work out midparental height for boy
(mother’s height
[cm] + 13cm +father’s height [cm])/2
How to work out final adult height
Final adult height ≈ 8.5cm within mid-parental
height
What history would you need to ask family
-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)
What examinations would you do
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
What factors do you need to consider in cinetct
- 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)
if child is short when investigation should you do
basic screen and refer
+karotype if female
havent caught up and below target height (growth hormone) -> refer
short stature (refer)
What is meant by short stature
A length or height >2 SD below the mean for age and gender
in context of parents
What is idiopathic short stature
don’t know why
-delay of growth and puberty but have a normal height prediction
how can illness lead to short stature
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
What is consititunal delay of growth and puberty
-common cause
-diagnosis of exculsion
-evidence becomes evident when their peers are changing
-delay in parents
-typically make it to target heights
Remember
Nutritional deficit can have a severe impact on growth at
any age
What are the causes of growth hormone defiecency
-idiopathic
-congential
-acquired
How do we diagnose growth hormone defiency
-look at growth hormone
-look at stature, usually short for target height
To consider GHD, you need both biochemical and auxological data
How do we treat growth hormone defiency
-typically give at night to mimic growth hromone
-long acting growth hormone -> one week injections
What is the definition of tall statures
two standards deviations above target height ot above population standard
Would you conisder about tall stature
birthweight
-devleopment history
-thyroid status
-obesity
-cardiovascualr status
-head circumferance
-neonatal history
Physical Findings
* Obesity
* Disproportion (arm span)
* Head circumference
* Arachnodactyly
* Cryptorchidism
