Growth

Question 1

What are the most important determinants of growth in infancy, mid-childhood and puberty?

Answer 1

• Infancy: intrauterine pattern and nutrition
• Mid-childhood: thyroid hormone and growth hormone
○ Therefore GH deficiency may not become apparent until 3-4yo
• Puberty:
○ sex hormones predominantly stimulate growth
○ Oestrogen is the major determinant of the pubertal growth spurt in both boys and girls

Question 2

When does the pubertal growth spurt occur in girls vs boys?

Answer 2

• girls: beginning of puberty (Tanner Stage 2)

- boys : towards the end (Tanner Stage 4; testicular volumes 10 -12mls )

Question 3

When is precocious puberty normal and pathological?

Answer 3

Precocious puberty is usually normal in girls (commonly idiopathic) but always pathological in boys

Question 4

When assessing growth using charts, what is usually considered ‘normal’ growth?

Answer 4

• Mean +/- 2SD

- Tracking along same centile trajectory: increasing/decreasing trajectory indicative of pathology

Question 5

How can you predict children’s height using parental height?

Answer 5

• Girls: average of parents height in cm - 6.5cm

- Boys: average of parents height in cm +6.5cm

Question 6

Briefly outline a history for exploring a child’s growth.

Answer 6

• Parental:
• Heights
• Timing of parental pubertal development
○ Inc. menarche for mum

• Feeding history

• Complete medical Hx, looking for underlying systemic illnesses
○ Poor nutrition/GIT abnormalities
○ Chronic respiratory conditions (e.g. asthma, CF)
○ Chronic renal disease
○ Congenital heart disease

• Psychosocial: 
	○ Finances
	○ Housing
	○ Family/community support
	○ Refugee/recent immigrant background
	○ Parental mental health
	○ Child protection issues

Question 7

What kind of a feeding history might you ask, depending on the age of the child?

Answer 7

○ Breastfeeding: difficulties with feeding/settling, vomiting, supply problems
○ Formula feeding: volumes, change formula, V/D, dilutions
○ Solids: what, timing, force feeding
○ Toddlers: mealtime problems, parental attitudes

Question 8

What are the major parameters of growth from birth?

Answer 8

• height/length
• weight
• head circumference

Question 9

What charts are required to measure height/length?

Answer 9

• <2yo - WHO

- >2yo - CDC

Question 10

Using an orchidometer, what are the sizes of a normal male testes at pre-puberty, during puberty, and as an adult?

Answer 10

○ 1 – 3 mls: prepubertal
○ 4 – 15 mls: pubertal - pituitary gonadotrophins responsible
○ 20 – 25 mls: adult

Question 11

What is the usual weight gain for the following age groups:

• 0-3 months
• 3-6 months
• 6-12 months
• between birth and one year
• 1-2 years
• 2-5 years

Answer 11

• 0-3 months: 150-200g/week
• 3-6 months: 100-150g/week
• 6-12 months: 70-90g/week
• between birth and one year: birth weight at least doubles
• 1-2 years: 2-3kg/year
• 2-5 years: 2kg/year

Question 12

Briefly outline Tanner staging of breast development

Answer 12

1: pre-puberty
2: breast bud - breast elevation and enlargement of areola diameter
3: more growth - but no separation of breast/areola countour
4: areola and papilla project -> 2nd mound
5: adult

Question 13

Briefly outline Tanner staging of female pubic hair development

Answer 13

1: pre-puberty
2: sparse, slightly pigmented along labia
3: sparse over pubic region, more pigmented/coarser
4: adult type hair but not in distribution
5: adult - inverse triangle, can spread to medial surface to thighs

Question 14

Where does female pubic hair not normally grow, and if it grew there, what would it indicate?

Answer 14

pubic hair doesn’t extend past medial thigh/belly button - indicates hirsutism

Question 15

Briefly outline Tanner staging of male sexual development

Answer 15

1: pre-puberty
2: testes and scrotum grow, sparse hair growth at base of penis
3: further testes/scrotum growth, penile growth length > width, hair coarser/darker/spread more
4: further testes/scrotum/penile growth, adult type hair but not spread to medial thighs
5: adult - inverse triangle, can spread to medial surface to thighs

Question 16

Bone age:

• How can we calculate it?
• What can delayed bone age be due to?
• What can accelerated bone age be due to?

Answer 16

• from left wrist using a radiographic bone atlas
• Delayed bone: constitutional delay in growth and development, hypothyroidism, glucocorticoid excess, GH deficiency, chronic disease
• Accelerated bone age: obesity, early puberty, hyperthyroidism, excess androgen

Question 17

Using growth charts, what might be some indicators of poor growth?

Answer 17

• weight dropping percentile lines
• weight and length are more than 2 percentile lines apart
• Weight or length for age below the 3rdcentile