Evaluation of Worrisome Growth Flashcards
3 height definitions worrisome growth
- short stature: below -2SD for age and gender or height more than 2SD below mid parental height target
- dwarfism: below -3SD for age
- Midget: dwarf with normal body proportions
worrisome growth velocity
abnormally slow linear growth velocity or dropping across two major gentile lines on the growth chart
genetic potential formula
Boys:
.5[mother’s height + 13cm(5in) + father’s height]
Girls:
.5[father’s height - 13cm(5in) + mother’s height]
The degree of skeletal maturation is directly correlated with what?
time of epiphyseal closure
body proportions at birth vs 10yearsold
upper to lower body ratio
birth: 1.7
10years: 1.0
Arm span boys vs girls
boys: shorter than height before 10-11 years; average adult male arm span 5.2cm>ht
girls: shorter than height before 10-14 years; average adult female arm span 1.2cm>ht
constitutional growth delay definition
growth deceleration during first 2 years of life followed by normal growth and paralleling lower percentile curve throughout prepubertal years
constitutional growth delay characteristics
- delayed skeletal maturation
- catch up growth during late puberty and delayed fusion of growth plates
- end result: lower end of normal height for families
- polygenic trait; positive family in about 60-80% of patients
treatment of growth delay characteristics
normal growth pattern
boys >11 with testosterone to avoid compromising final height
girls with estrogen
familial short stature
children have normal growth velocity and height wnl for parent’s height
initially will have decrease in growth rate between 6 and 18 mnths of age
some families may have tubular bone alterations: brachydactyl syndromes, SHOX haploinsufficiencies
failure to thrive
infants or young children with
1. deceleration of weight gain to a point
nutritional growth retardation
linear growth stunting from poor weight gain in children under 2years of age
may be secondary to systemic illnesses like celiac, iBD
stimulant medications
sometimes hard to distinguish from constitutional growth delay and constitutional thinness
small for gestational age (SGA)
less than -2SD for birth weight or length
etiologies:
- maternal: infection, nutritional deficiencies, uterine abnormalities, smoking, ETOH, drugs
- Placental: previa, abruption, infarcts, structural, multiple gestation
- fetal: chromosomal abnormalities, metabolic, infections, malformations
Catch up growth and final height in SGA
most healthy infants achieve catch up height by age 2 years; most of which is achieved within 6 months of birth
10-15% of children born SGA will remain short as adults
final height can also be compromised by early puberty
GH treatment in SGA children
SGA children who have catch up growth by 2 years
GH should not be given without appropriate nutritional intake
may increase final height by an average of 3 inches: -1.1–> -0.9 SD from -2.3 SDS
