Failure to thrive Flashcards
describe patterns of height growth over newborn to adolescent period
gradual decline in height velocity after the age of 2 until 12 years for girls and 15 for boys when height increases rapidly again briefly and then slows to stop
why do girls stop growing sooner
oestrogen closes epiphysis
describe patterns of weight gain over newborn to adolescent period
rate of weight gain declines until age 6 then velocity increases. Peaks at 13y for girls and 15 for boys then decreases to a stop at 16 for girls and 18 for boys
what is the peak age for lymphoid tissue development?
12y
describe what is required for growth
adequate hormones
neural mechanisms
positive energy balance
hormones involved in growth
insulin
thyroid
GH
sex steroids
what things increase HGH release
peptide hormones hypoglycaemia sex steroids sleep fasting exercise
what things decrease HGH
IGF1
sleep deprivation
hyperglycaemia
glucocorticoids
effects of HGH
acts on chondrocytes to promote division
acts on hepatocytes to release IGF1 which acts on muscle growth, osteoblasts and chondrocytes
causes lipolysis, gluconeogenesis and protein synthesis
effect of thyroxine (6)
Increases metabolism
Promotes division, development and maturation of chondrocytes
Promotes secretion of extracellular proteins in cartilage
Synergistic with IGF and HGH
Increases HGH and GHRH secretion
Bone maturation
how do we measure bone age?
look at wrist- ossicles in wrist develop in a predictable way at ages
affect of poor nutrition on growth
Poor nutrition at first delays growth
Later causes permanent reduction in height
what is failure to thrive?
A description, not a diagnosis
Height or weight below 3th percentile
Low weight-for-height
Crossing 2 major percentiles in 6 months
frequency of failure to thrive?
5-10% in community
features of failure to thrive
Of underlying disease Pallor, listless Reduced fat and muscle Buttock and thigh wasting cheeks preserved ascites PICA (eating random things), other deficiencies Sparse or thin hair. No features
