Growth Flashcards
Respiratory Rate and Heart Rate (2)
- Should be counted for a full minute with child calm and at rest
- Each degree of Farenheit increases the HR 8-10 beats/minute (apical HR and degree of fever should correlate)
Blood Pressure (2)
- Have patient raise their arm if it’s too quiet to hear the BP with their arm down
- There is increased BP in taller children, males, and older children
Head ultrasound
Non-invasive way to evaluate head changes in first year of life when fontanel is still present
*Tells you whether or not child’s ventricles are normal or if there is external hydrocephalus, which will cause increased growth
Weight-for-age (4)
- Reflects body weight relative to age
- Influenced by recent changes in health or nutritional status
- NOT used to classify 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 (BMI is done at 2 years and older)
Stature/length-for-age (2)
- Linear growth relative to age
- Used to define shortness or tallness
* Be sensitive to cultural differences, may be at lower percentiles in certain cultures but doesn’t mean there is a problem
BMI-for-age (3)
- Antrhopometric index of weight and height combined with age
- Used to classify children and adolescents as underweight, overweight, or obese
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
*For birth-3 years old
Head circumference-for-age
Critical during infancy and can be charted up to 36 months (3 years old)
*measurements reflect brain size
Primary microcephaly vs. Secondary microcephaly
Primary: occurs before birth, in utero (ex: Zika)
Secondary: occurs after birth; could be due to injury
BMI-for-age percentiles: obese, overweight, underweight
Obese: Above 95th percentile
Overweight: Between 85th and 95th percentile
Underweight: Under 5th percentile
Weight for length/Stature percentiles: obese
Above 95th percentile
Stature/Length-for-age: short stature
Under 5th percentile (usually familial)
Head circumference-for-age: developmental problems
Less than 5th percentile or above 95th percentile
*Being micro or macrocephalic puts you at risk for developmental delays
BMI (4)
- Body fatness changes as children grow
- BMI declines and reaches a minimum around 4-6 years of age before beginning a gradual increase through adolescence and most of adulthood
* Increase in body fat that occurs earlier on puts child at risk for obesity - BMI is NOT a direct measure of body fatness, but it parallels changes obtained by direct measures of body fat such as underwater weighing and DXA
- BMI can be considered a proxy for measures of body fat
Small for gestational age (SGA)
A birth weight and/or length greater than 2 standard deviations below the mean
*Below the 10th percentile in weight, length, or head circumference
Large for gestational age (LGA)
Greater than 2 standard deviations in weight and/or length
*Birth weight, length, or head circumference lies above the 90th percentile for gestational age
Mid-parental Height Calculation in girls
*Determining heights of girls by the heights of biological parents
(Father’s height + Mother’s height - 5 inches) / 2
*If doing it in centimeters:
(father’s height - 13cm) + mother’s height / 2
Mid-parental Height Calculation in boys
(Father’s height + Mother’s height + 5 inches) / 2
*If doing it in centimeters:
(father’s height + 13cm) + mother’s height / 2
Statural growth
A process that is determined by the interaction of genetics, nutrition, and socioeconomic factors
History taking for growth: maternal pregnancy
Emphasize medications used, infections, and nutrition during pregnancy
History taking for growth: perinatal history
Emphasize duration of gestation, perinatal information, growth (weight and length)
- Need to know if child was SGA, AGA, LGA
- Perinatal history may point in specific pathologies, such as hypopituitarism or hypothyroidism
- Birth measurements reflect intrauterine conditions
- Duration of gestation determines pre or post maturity
History taking for growth: growth pattern in first 3 years
Establish a pattern of growth! Many children have catch-up or catch-down growth between 18-24 months of age. Growth rate percentile shifts linearly (up or down, depending on parents heights) until the child reaches his or her genetically determined growth channel or height percentile
*Patterns of growth are established in first 3 years of life, which are all about nutrition
History taking for growth: growth patterns after 3 y/o (3)
- Emphasis: prepubertal and pubertal growth velocity
- Most children with normal growth usually do not cross percentiles after two years of age
- Peak height velocities typically occur at Tanner stage III in girls and IV in boys
History taking for growth: family history
Know father’s height and age during pubertal growth spurt, mother’s height and age at menarche, heights of siblings, grandparents, etc., and medical conditions of family members
*Heights of parents determines heights of children and follow parent’ pubertal tempos