Growth Flashcards
Stages of development?
Embryonic - first 8 weeks
Fetal period - 9 weeks till birth
Neonatal period – birth – 28 days of life
Infancy – 1st year of life
Pre-adolescence - 9 - 12 years
Adolescence - 13-19 years
What are the rules of thumb for growth?
- weight loss in first few days: 5-10% of birthweight
- return to birthweight: 7-10 days of age
- double birth weight: 4-5 months
- triple birthweight: 1 year
What is the normal daily weight gain?
- 20 - 30g for first 3-4 months
- 15 - 20g for rest of the first year
What are the important growth monitoring parameters?
- weight
- height or length
- head circumference
What is the body mass index?
(BMI) defined as weight (kg)/height2(m)
- Age- and gender-specific BMI values available
- Used to classify overweight or underweight
What are the BMI category cutoof points?
- underweight <5th percentile
- normal - 5th percentile to 85th percentile
- at risk for overweight - 85th percentile to <95th percentile
- overweight >95th percentile
What is weight for age?
- Most often used measurement to determine physical growth
- Reflect immediate nutritional status
- Infants should be weighed monthly
What is linear growth?
Reflects musculoskeletalgrowth
- Governed by many non-nutritional factors
1. Endocrinologic
- growth hormone, thyroid hormone, steroids
2. Nonendocrine
- chronic illness, genetic disorders, undernutrition
What is mid-parental height?
- Is the target height estimate of a child’s genetic potential
- Also called mid-parental height (MPH)
- Midpoint between the Hts of parents
What is head circumference?
- This measurement reflects brain growth, which picks during the first year of life
- For practical purposes, brain growth is complete after the first three years
What are the causes of microcephaly?
- Familial – present from birth with normal development
- Autosomal recessive condition – with developmental delay
- Congenital infection e.g. CMV
- Acquired , e.g. perinatal hypoxia, hypoglycaemia or meningitis,
- often accompanied by cerebral palsy and seizures
What are the causes of macrocephaly?
- Hydrocephalus
- Macrosomia
- Familial macrocephaly
- Raised intracranial pressure
- Chronic subdural haematoma
- Cerebral tumour
- Neurofibromatosis
- Cerebral gigantism (Sotos syndrome)
- CNS storage disorders, e.g. mucopolysaccharidosis (Hurler syndrome).
What is neurofibromatosis?
an autosomal dominant genetic disorder of the nervous system
- It causes tumours to grow on nerves
What is Sotos syndrome?
also known as cerebral gigantism, isa rare genetic condition that causes children to grow faster than other children of their age
- Characteristics of Sotos syndrome include:
1. Tall stature
2. Large head with distinct facial features
What is mucopolysaccharidoses (MPS)?
a group of inherited lysosomal storage disorders
What is a growth spurt?
increase in growth velocity
e.g. adolescents
What is a growth lag?
decrease in the rate or velocity of normal expected growth
e.g. malnutrition
What is catchup growth?
increase in growth rate to return to normal size
e.g. preterm
What is catch down?
weight falls down a lower, genetically determinedgrowthcentile
e.g. infants of diabetic mothers
What is failure to thrive?
insufficient weight gain or absence of appropriate physical growth in children
Causes of failure to thrive?
- Inadequate intake: food insecurity; developmental delay; emesis (pyloric stenosis)
- Malabsorption or loss
e.g., food protein allergy - Increased metabolic demand
e.g., malignancy, chronic disease
How is inadequate intake as a cause failure to thrive?
Investigation?
- Neglect
- Failure of breast-feeding
- Cleft palate
- investigate through observation
Vomiting as a cause of FTT?
Investigation?
- Gastroesophageal reflux
- Pyloric stenosis
- investigated through Observation, upper gastrointestinal barium study, abdominal ultrasound
Malabsorption as a cause of FTT?
Investigation?
- Cystic fibrosis
- Coeliac disease
- Milk intolerance
Investigation of malabsorption as a cause of FTT?
- Sweat test
- Coeliac antibodies
- Upper small bowel biopsy
- Stool sugar chromatography
- Trial of alternative milk
Renal cause of FTT?
Investigation?
urinary tract infection
- urine culture
Cardiac causes of FTT?
Investigation?
congenital heart disease
- echocardiogram
Other causes of FTT?
- Chromosomal disorders
- Congenital syndromes
- Inborn errors of metabolism
- Perinatal infections
What is short stature?
Height < 2 to 2.5 standard deviations (SD) below the mean for age
Causes of short stature?
- Normal (constitutional or familial)
- medical problems
- Failure to thrive (FTT)
- Growth Failure
Medical problems that cause short stature?
- Chronic illness
- Emotional and psychological effects (psychosocial dwarfism)
- Low birth weight, small for gestational age
- Chromosomal abnormalities, syndromes, infections ,maternal alcohol
Investigations for short stature?
- Bone age radiography
- CBC, ESR, chemistry profile, and UA (Chronic illness)
- Free T4and TSH levels (Hypothyroidism)
- Karyotype (Turner Syndrome)
- Insulin-like growth factor (IGF)-1 - GH deficiency
