Growth and Clinical Practice

Question 1

What assessments are important to determine a child’s growth? (9)

Answer 1

Height 
Length
Sitting height
MPH and Target Centiles
Growth velocity 
Head circumference 
BMI
Bone age  (Tanner Whitehouse method)
Puberty assessment

Question 2

How is the Tanner Whitehouse method used to measure bone age?

Answer 2

Tanner Whitehouse method uses left wrist - requires good quality radiographs and skilled interpretation

Question 3

What can affect a child’s growth? (12)

Answer 3

Ethnicity
Inequality in Health 
Nutrition
General Health
Age 
Sex 
Parental heights
Puberty 
Skeletal maturity
General health 
Specific Growth disorders
Genetic influence

Question 4

What may you need to ask in a growth related history?

Answer 4

Birth weight and gestation
PMH
FMH/SH/Schooling
Systematic enquiry

Question 5

How do you calculate the MPH for a boy/girl?

Answer 5

Add mother and father’s height and divide by 2 and add 7cm if it is a boy/minus 7 if its a girl.
Normal height for a man will deviate by 10cm and 8.5cm for a woman.

Question 6

What are the three phases of rapid growth?

Answer 6

Infantile
Childhood
Pubertal

Question 7

What hormones most strongly influence growth between 2 and 12 years?

Answer 7

Thyroxin and GH

Question 8

What are the five aspects involved in the Tanner method for staging secondary sexual characteristics?

Answer 8

Breast development
Genital development
Pubic hair
Axillary hair
Testicular volume

Question 9

What are the earliest objective stages of puberty?

Answer 9

Boy - testicular enlargement (G2, T 3-4ml)

Girl - breast budding (B2)

Question 10

When is early and delayed puberty in boys?

Answer 10

9 years (early) and 14 years (delayed)

Question 11

What is constitutional delay of growth and puberty?

Answer 11

Boy’s mainly affected
Bone age delay
Normally also seen in father and brothers

Question 12

What diseases can cause delayed puberty?

Answer 12

CDGP
Gonadal dysgenesis 
Chronic disease (Crohn's and asthma)
Impaired HPG axis 
Testcular irradiation/cyrptorchidism

Question 13

What are the pathological causes of short stature?

Answer 13

Undernutrition
Chronic illness (IBD, JCA)
Iatrogenic (steroids)
Psychological and social
Hormonal 
Syndromes 
Achondroplasia

Question 14

What is central precocious puberty?

Answer 14

Involves advanced bone age, growth spurts and pubertal development
Boys may need pituitary imaging
In girls it is usually idiopathic