Growth Flashcards
Vital Sign Tips
Respiratory rate and heart rate should be counted for a full minute with child calm and at rest
Each degree of Fahrenheit increases the HR 8-10 beats/ minute
Blood pressure When you have difficulty getting a blood pressure from a patient (i.e., it is too “quiet” to hear it), have the patient raise up their arm to help make it louder Sex, age, weight
Pubertal Growth Spurt
Girls = 8-12cm (3-5in) Boys = 10-14 cm (4-6in)
Why are measurements so important?
Clinical decisions and clinical interventions are based on physical measurements Accurate and reliable physical measures are used to: - Monitor the growth of an individual - Detect growth abnormalities - Monitor nutritional status - Track the effects of medical or nutritional intervention **IF YOU DO NOT FEEL COMFORTABLE WITH A MEASUREMENT YOU NEED TO REPEAT IT!**
Growth Charts – weight for age
Reflects body weight relative to age Influenced by recent changes in health or nutritional status. Not used to classify infants, children and adolescents as under or overweight. Used in early infancy for monitoring weight and helping explain changes in weight-for-length and BMI-for-age in older children.
Stature/Length-for-age
Linear growth relative to age Used to define shortness or tallness
BMI for age
Anthropometric index of weight and height Used to classify children and adolescents as underweight, overweight, or obese.
Weight for length/stature Head circumference
Weight-for-length/stature reflects body weight relative to length and requires no knowledge of age. Indicator to classify infants and young children as overweight and underweight Head circumference-for-age is critical during infancy and can be charted up to 36 months of age. Measurements reflect brain size.
Head circumference positioning
Proper positioning of measuring tape Widest circumference, avoiding ears
BMI for age
>95th percentile – Obese
>85th and <95th percentile = overweight
Weight for length/stature
>95th percentile – Obese
<5th percentile = underweight
Stature/length for age
<5th = short stature
Head circumference for age
95th percentile = developmental problems
BMI
Body fatness changes as children grow Girls and boys differ as they mature BMI declines and reaches a minimum around 4-6 years of age before beginning a gradual increase through adolescence and most of adulthood
BMI is a Screener
BMI is not a direct measure of body fatness.
However, BMI parallels changes obtained by direct measures of body fat such as underwater weighing and dual energy x-ray absorptiometry (DXA).
BMI can be considered a proxy for measures of body fat. BMI will change with age so it must be plotted
SGA
A birth weight and/or length greater than 2 SD below the mean It is below the 10th percentile in weight, length, or HC
LGA
babies are those babies who are greater than 2SD above the mean Birth weight (or length, or HC) lies above the 90th percentile for that gestational age
STATURAL growth
A complex process that is determined by the interaction of Genetics Nutrition Socioeconomic factors
Abnormally Rapid Growth Velocity Midparental height
Determining heights of biological parents is of critical importance
Girls: Father’s height + Mother’s height - 5 in.//2
Boys: Father’s height + Mother’s height +5 // 2
Target height = midparental height = 2SD
Physical exam for growth
Dysmorphic features
Midline defects
Skin
Neck
Sexual exam
Deciphering Problematic Growth Curves
Is the growth rate normal or abnormal? Look at as many points as possible Is there abnormal tempo of growth? Bone age Are there underlying reasons for intrinsic/genetic short stature? History, mid parental height, PE findings Do the answers to these questions fully explain child’s position on the growth curve? Convergence of multiple growth patterns in one child
Confounding Factors - Obesity
Obese children are taller With endocrinopathies, height is impaired If the child’s ht. is at or greater than mid parental height, an endocrine cause of the obesity is unlikely
Genetic Channeling
Upward to downward movement toward mid parental range Usually accomplished by 12-15 months
Constitutional growth delay - Risk Factors
- Family history
- The child is healthy, growing below but parallel to the 3rd percentile line
- Between 6-24 months, the linear growth and weight track downward to the 3rd percentile
- Slow growth rate between 12-30 months
- Delayed onset of puberty and a growth spurt and usually end up with heights in the lower half of the normal range.
- Bone age that is delayed by 2 or more years
Confounding Factors in Late Childhood Growth
Infrequent measurement opportunities Normal prepubertal growth deceleration Effects of medications for common disorder (ADHD, asthma, depression) Normal variation in onset of puberty