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TAS Growth And Puberty ✅ > Clinical Assessment of Growth Failure ✅ > Flashcards

Clinical Assessment of Growth Failure ✅ Flashcards

1
Q

What can growth failure arise from?

A
  • Genetic abnormalities
  • Nutritional problems
  • Endocrine problems
  • Defects in almost any organ system
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2
Q

What should be included when taking a history in a child with growth failure?

A
  • Family history
  • Antenatal history
  • Feeding history
  • Development of signs of puberty
  • Other symptoms
  • Social history
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3
Q

What should be included in the family history for a child with growth failure?

A
  • Parental heights

- Parental timing of puberty

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4
Q

Why is family history important in growth failure?

A

Genetics has an important influence

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5
Q

What should be included in the antenatal history for a child with growth failure?

A
  • Pregnancy
  • Mode of delivery
  • Birth weight
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6
Q

Why is antenatal history important in growth failure?

A

May impact on infant phase of growth

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7
Q

Why is it important to ask about other symptoms in a child with growth failure?

A
  • Look for symptoms suggestive of pituitary dysfunction or intracranial disease
  • Look for systemic symptoms that might suggest co-existent medical disorders
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8
Q

What symptoms might suggest pituitary dysfunction or intracranial disease?

A
  • Headache

- Visual disturbance

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9
Q

What is it important to include when taking a social history in a child with growth failure?

A

Details of how the short stature is affecting the child

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10
Q

What should be specifically enquired about in the history of a child with tall stature?

A
  • Symptoms suggestive of precocious puberty

- Symptoms of thyrotoxicosis, Marfan’s syndrome, or other overgrowth syndromes

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11
Q

What needs to be done when taking serial growth measurements?

A
  • Undertaken at approximately the same time of day

- Preferably by the same measurer

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12
Q

Why should serial growth measurements be taken at the same time of day?

A

Because of the effect of time of day on height - human height shortens as the day progresses

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13
Q

Why should serial growth measurements ideally be taken by the same person?

A

To avoid inter-observer variation on measurement

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14
Q

What should be used to measure height in children over 2 years?

A

A radiometer (preferably wall mounted)

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15
Q

What position should the child be in when measuring using a stadiometer?

A
  • Heels, buttocks, and shoulders against the backplate

- Head in the Frankfurt plane

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16
Q

What is the Frankfurt plane?

A

Imaginary line connecting lower border of the eye socket with external auditory meatus

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17
Q

How should height be measured under the age of two years?

A

Supine table measurements or a neonatometer

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18
Q

What is required to ensure accuracy when measuring length in a child under 2?

A

Two observers

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19
Q

What position should a child be in when using a supine table measurement or neonatometer?

A
  • Frankfurt plate vertical
  • Child’s head in firm contact with the headboard
  • Foot dorsiflexed against movable baseplate
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20
Q

Why should the sitting height also be measured?

A

Skeletal dysplasia may impair the growth of different parts of the skeleton differentially

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21
Q

What is the measurement of sitting height a proxy for?

A

Vertebral body growth

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22
Q

How should sitting height be measured?

A

Using a table-mounted stadiometer

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23
Q

What does subtracting the sitting height from standing height produce?

A

Sub-ischial leg length

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24
Q

What is sub-ischial leg length a measure of?

A

Long bone growth in the leg

25
Q

When should head circumference be measured as a growth parameter?

A

In children under 2 years

26
Q

What should height measurements be compared with?

A

Weight

27
Q

How should height measurements be compared with weight?

A

By plotting measurements on a growth chart

28
Q

What growth charts are used in the UK?

A

UK-WHO growth charts

29
Q

What are the UK-WHO growth charts derived from?

A

UK90 charts and WHO growth standards

30
Q

What were the UK90 charts derived from?

A

Cross-sectional growth data

31
Q

What do the WHO growth standards describe?

A

Growth of healthy breastfed children from six countries

32
Q

Why does weight data need to be adjusted for height?

A

Because of the association of weight with height (taller children tend to be heavier)

33
Q

How is weight data adjusted for height?

A

By calculation of the BMI

34
Q

How is the BMI calculated?

A

Weight (kg) / (height (m))^2

35
Q

How can the growth pattern be interpreted?

A

Height measurements should be compared with all measurements taken in the past and plotted on a growth chart

36
Q

What indicates an abnormal height velocity on a growth chart?

A

Crossing of centiles

37
Q

How is the appropriateness of a child’s height for their genetic background assessed?

A

By calculating the target height range

38
Q

How is the target height range calculated?

A

Mid-parental centime (mid-point between the parents centimes) +/- 8.5cm

39
Q

What additional features should be assessed on physical examination of a child with abnormal growth?

A
  • General appearance and nutritional state
  • Dysmorphic features
  • Pubertal staging
  • Detailed systems review
40
Q

What dysmorphic features in particular should be looked for in the examination of a child with abnormal growth?

A

Abnormalities of the craniofacial skeleton or suggestive of skeletal disproportion or an underlying syndrome

41
Q

Why is pubertal staging important in assessing a child with abnormal growth?

A

It is important in evaluating the chronology of physical development, which has major influences on growth

42
Q

What should be included in the detailed systems review of a child with abnormal growth?

A
  • Blood pressure

- Visual fields and fundoscopy

43
Q

What should be done before considering any investigations for abnormal growth?

A

Integrate the history and examination into a differential diagnosis

44
Q

What should be done if features on history and examination are suggestive of a defect in a clinical system?

A

Appropriate further tests of the relevant system to confirm the diagnosis

45
Q

What investigations should be done in a short or slowly-growing child with no obvious pathology?

A
  • XR left wrist

- Bloods

46
Q

Why is an XR of the left wrist bone in a short/slowly-growing child with no obvious pathology?

A

To calculate bone age

47
Q

Why is it important to calculate bone age in a short/slowly-growing child?

A

To assess the degree of delay in physical development

48
Q

What should be checked for in the bloods of a child who is short/slowly growing with no obvious pathology?

A
  • FBC
  • Blood film
  • ESR or CRP
  • U&E
  • Calcium and phosphate
  • TFTs
  • IgA and anti-tTG antibodies
  • Karyotype (in girls)
  • IGF-1
49
Q

Why is karyotyping done in a short/slowly growing girl?

A

To exclude Turner’s syndrome

50
Q

What is the limitation of measuring IGF-1?

A
  • Limited sensitivity for screening for GH deficiency

- May be affected by nutritional state

51
Q

What further investigation can be done if initial investigations into a short/slowly-growing child with no obvious pathology are normal?

A

Formal stimulation tests of GH secretion

52
Q

What investigations may be done in a tall or rapidly-growing child?

A
  • Bone age
  • Karotyping (in boys)
  • TFTs
  • IGF-1
  • Cardiac USS
  • FMR1 gene analysis
  • DNA for specific genetic syndromes
53
Q

Why is karyotyping done in boys who are tall/rapidly-growing?

A

Exclude Klinefelters syndrome

54
Q

Why are TFTs done in a child who is tall/rapidly growing?

A

To look for hyperthyroidism

55
Q

Why is IGF-1 measured in children who are tall/rapidly-growing?

A

To exclude GH over secretion

56
Q

When might cardiac ultrasound be done in a child who is tall/rapidly-growing?

A

If Marfan’s syndrome is suspected

57
Q

Which children who are tall/rapidliy-growing might FMR1 gene testing be indicated in?

A

Boys with learning difficulties

58
Q

What is FMR1 gene analysis looking for?

A

Fragile X syndrome

59
Q

Give 3 specific genetic syndromes that may be looked for in a tall/rapidly-growing child?

A
  • Marfans
  • Beckwith-Wiedemann
  • Sotos syndrome

TAS Growth And Puberty ✅ (12 decks)

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