Growth ☺️ Flashcards
Determinants and % of growth
- fetal
- infantile
- childhood
- adolescence
Uterine environment - 30% (fastest)
Nutrition, insulin - 15%
GH, T3,4 - 40%
GH, sex steroids - 15% (fusion of epiphyseal plates)
Normal weight gain
- when to check weight
- closer monitoring
Some birth weight lost but regained over 5 days(loss of fluids but feeding well)
- Tracks 1 centile
- Loss due to acute illness regained
Weighed
- birth
- D5
- 8wk, 12-16wk, 1year
If closer monitoring needed
- once a month before 6months
- once every 2 months before 1 year
- once every 3 months after 1 year
When should you monitor more closely
Below 0.4/above 99.6th centile
Above midparental range
Faltering growth
- <9.8 and falling by 1 centile
- 9-91 and falling by 2 centile
- 91< and falling by 3 centile
- <2 for age
How would you measure height
- under 2 year olds
- over 2 year olds
- midparental height and range
Under 2 year olds (crown heel length)
- naked, lying down on board
- heels at 90, support head at Frankfort plane
Over 2 years old (stadiometer)
-heels at 90, head at Frankfort plane
MPH
- mean of heights
- +7 for boys, -7 for girls
MPR
- boys +-10
- girls +-8.5
How would you measure weight
- under 2 years
- over 2 years
How would you measure head circumference
Under 2 => no nappy, no clothes
Over 2 => nappy off, clothes on
Head circumference, up to 2
-frontooccipital, 3x, mean
What else would you need to ask about in a history
Consumption (amount, frequency)
Absorption
Higher caloric demand (due to illness)
Genetics
- Prader Willi
- Downs
Hormonal
-hypothyroidism
Birth
-growth catch-up by 4 if premature
Sleep patterns
-GH pulses at night
Social
-deprivation, neglect
What are the possible reasons for short stature
Skeletal Familial/idiopathic IUGR/SGA, poor catch-up if premature Constitutional Endocrine => short, fat Chromosomal Psychological deprivation Inflammatory/chronic disease => thin, short
What is premature thelarche, pubarche/adrenarche?
How would you manage this
Thelarche at 6-24months
Adrenal puberty in 6-8years
Often in Asian, African American
Self limiting
Turners
- presentation
- investigations
- management
45XO, no puberty
Neck webbing Low set ears, hairline Craniofacial, dental abnormalities Short stature AI Renal, CV defects
Karyotyping
Bone age
Coeliac, TFT
IGF
GH treatment
Late puberty
- definition
- investigations
- management
No pubertal dev
- female 14+
- male 15+
FHx
Physical exam
X-ray of non dominant hand for bone age
Constitutional delay
Self limiting but refer to specialist if no change
Coeliac disease
- presentation
- investigations
- management
Tiredness, anaemia
+ve AB, jejunal biopsy
Wasted bottom, round tummy
Response to gluten
Bone age
Karyotyping
GH stimulation test
Gluten free diet
Tracking premature development on growth chart
Why do centile values change at 4
Start and endpoints of puberty charts
4 conditions with specific growth charts
Note down values
Draw line back to chronological age up to 1 year
Specific growth charts
Centiles move down, gravity pulls height down
Females
-8-18
Males
-9-18
Noonans
Turners
Downs
Achondroplasia
Adult height predictor method
Use height centile to predict adult height
+-6cm
How would you use the BMI centiles
Uses height and weight centiles to calculate BMI centile
<2nd - undernutrition/small frame/low muscle mass
25-75th - healthy
>91 - overweight
>98 - obese
In what conditions would you use GH
GH deficiency Turner XO Prader Willi SGA, poor catch-up CKF => GH resistance SHOX deficient Noonan
