Endocrine Disorders And Centile Charts And Assessment Of Child Growth Flashcards
Why is assessment of child growth difficult
Children don’t grow linearly
What should not be weighed with babies and children
Babies - clothes, nappy
Children - shoes, toys
What is use to measure weight
Class iii clinical electronic scales
What is used to measure head circumference and where should it be measured
Plastic or paper tape
Where head circumference widest
What is used to measure length
Length board or mat
What can be used to measure height
Rigid rule with t piece
Stadiometer
At what age do you stop measuring length and start measuring height
2 yrs
How long does it take 80% of infants to recover weight lost in first week
2wks old
What does recovery of birthweight by 2 wks suggest
Effective feeding
Baby healthy
What amount of weight loss needs careful assessment at any age
> 10%
When are babies weighed after neonatal period
8 wks
12 wks
16 wks
1 yr
What does a centile mean and how close does a child have to be to the line to be on a centile
Percentage expected to be below that line
Within 1/4 space of line
What can cause abnormal growth
Chronic disease
Emotional instability
Unsecure family environment
Malnutrition
Overnutrition
Abnormal hormone/growth factor actions
Unhealthy growth plates
What nutrition problem is indicated by weight deficit greater than length deficit
Malnutrition
How does weight track in 1st yr
Usually within 1 centile space - often not on 1 particular centile
How does head circumference track
Usually within 1 centile space
What age can BMI be measured using centile
2yrs
How is midparental height calculated
(Mothers height + fathers height/2) +7 cm for boy/ -7cm for girl
What 4 aspects are used to evaluate short stature
Height v weight centile
When it started
Body proportions
Presenting signs
Causes of disproportionate short stature
Achondroplasia
Hypochondroplasia
Leri Weill dyschonrosteosis
Rickets
What causes leri Weill dyschonrosteosis
Short stature home box gene
How does leri Weill dyschonrosteosis present
Mesomelic limb shortening
Reduced sub ischial length
Madelung deformity of forearm - bowing of radius, dorsal dislocation of ulna, premature epiphyseal function
When does leri Weill dyschonrosteosis usually become apparent
Puberty
Most important monogenic cause of short stature
SHOX haploinsufficiency
Evaluations of proportional short stature
Psychosocial assessment
Syndromes features karyotype
Test for systemic disorders
Test for endocrine disorders
Why are all girls with short stature given karyotype analysis
Check for turners syndrome
Turners syndrome presentation
Webbed neck
Shield chest
Widely spaced nipples
Cubical vagus
Lymphoedema of hand and ankles
Shortening of 4th/5th metacarpal
Knock knees
Gonadal dysgenesis
2nd line tests in proportionate short stature
IGF-1 IGFBP3
GH stimulation test
MRI
Treatments for short stature
Oxandrolone
rhGH
Familiar short stature
Child grows along their growth centile and final height is short but appropriate for family
Constitutional growth delay
Appropriate final height but delay in skeletal maturity and onset of puberty, often with late growth spurt and continued growth older than most people
Deficiency of which hormone can cause short stature
GH
Where is GH produced, what stimulates and inhibits it’s secretion
Anterior pituitary
Stim - GHRH
inhibit - somatostatin
What is the pattern of GH secretion
Pulsation in response to sleep, exercise, hypoglycaemia
Growth hormone deficiency
Decreased growth velocity and delayed skeletal maturation in the absence of other explanations
How is GH deficiency treated
GH replacement
How does GH deficiency effect birth weight and length
Normal birth weight
Slightly reduced birth length
Why is GH deficiency often not recognised until 7-8yrs old
Other hormones mask deficiency - eg IGF1+2
Oxandrolone
Androgen anabolic steroid
What starts puberty
GnRH produced and stimulates pituitary to produce LH and FSH
What stages are used to describe puberty
Tanner stages 1-5
Precocious puberty
Girls reaching tanner stage 2 before age 8
Boys reaching tanner stage 2 before age 9
Most common cause of precocious puberty
Premature GnRH production
How is precocious puberty treated
GnRH to overstimulate pituitary and stop gonadotropin production
At what tanner stage does precocious puberty become irreversible to treatment
Stage 3
Delayed puberty
Onset of puberty after 14 yrs
Conditions commonly occurring with delayed puberty
Chronic disease
Cryptorchidism
Anosmia
Anorexia
Radio/chemo
