Growth Flashcards
Factors affecting growth
Genetics (apoptosis genetically defined)
Nutrition
Hormones - GH, oestrogen and testosterone
Environment - neglect
Chronic illness e.g asthma, coeliacs, cystic fibrosis
When is rate of growth highest
Second trimester
How to measure growth in <3 years
Infantometer
measures length so will be overestimate of height
How to measure growth in >3 years
Stadiometer
Measure with head in straight plane and always measure at the same stage of breathing e.g on full inspiration
Points of contact with the stadiometer
Buttocks
Top of back
Back of head
How to calculate mid parental height
(Fathers height + mothers height) / 2
+ 7 for boy
-7 for girl
What is an acceptable level of growth in relation to mid parental height
Mid parental height +/- 8.5cm
Adjust for age of child by using mid prenatal height range of percentiles
When to refer for low growth
If height/weight static for 6 months
No catch up growth in someone born with low birth weight
Below lower range of mid parental height
History for abnormal growth
Antenatal history - anomaly scans, APH, PPH, complications Nutrition Social history Family history Symptoms of hypothyroidism Symptoms of hypopituitarism Pubertal development Is growth disproportional?
Baseline investigations for abnormal growth
TFTs IGF1 (marker of GH) Vit D and calcium FBC U+Es LFTs Bone age X-ray of non dominant hand
Normal variants of low growth
Constitutional delay in growth and puberty - most common cause in boys
Familial short stature - 1/3 of all cases
Most likely causes of static height but increasing weight
Endocrine:
GH deficiency
Hypothyroidism
Cushing’s
Most likely causes if height increasing but low weight
Poor nutrition
Poor gut absorption - coeliac
Appearance in GH deficiency
Short stature
Frontal bossing
Prominent eyes
Short hand and fingers
Appearance in congenital adrenal hyperplasia
Tall stature
Precocious puberty - use Tanners score
