Growth and Development Flashcards

1
Q

Define the Following
fetal developement
somatic growth
puberty
development

A

Fetal Development
- changes that occur as a fertilized ovum progresses through prenatal growth

this continues through chidlhood and adults life with growth

SOmatic Growth = changes in th ebody as a whole or in its indivduals such as
- lenght/height
- weight
- head circumference

Puberty
- hormonal and gondal changes that occur as part of sexual development

Development
- changes int he body function and acuisition of skills in the following domains
- - social, langugae and self-help
- verbal langugae
- gross and finer motor skills

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2
Q

Growth During
- Fetal growth: when does it look like human
- neonatal growth : gestational age and how age is determined if we dont know

A

Fetal Growth
- the fetus looks like a human by the time of 9 weeks
- after this point: continued somatic growth

Neonatal Growth

Gestational age
- premie: < 34 weeks
- late preterm: 34-36 + 6
- early term: 37 - 38 +6
- later term: 41 - 41 +6
- postterm: > 42 weeks

determination of age
- antepartum: determined via US or FDLMP (first date of last menstrual period)
- postnal” Balalrd score

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3
Q

Growth: Birth weights & size for gestational age

A

Weights
normal : 3000-4000 grams
low: < 2500
very low: < 1500
extremely low < 1000

size
- small: SGA: < 10th percentile
- approproate (AGA)
- larget (LGA) : > 90th percentile

SGA

if they are symmetrically small, all parameters will be low
- low weight, length and head circumference
Reasons for SGA : if symmetrcailly
- matenal durg use
- chormosomal issues
- intrauterine infections

if they are asymmetrically small (onel 1 or 2 parameters are off)
- placental insufficiency: poor weight gain in pregnancy or multiple gestaitions
- advanced materal age

Larger for GA
- maternal DM
- excessive materal weight gain
- genetic syndromes (rarely)

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4
Q

Measurements to use for kids 0-2 years

A

anthropometrics
- length (supine laying)
- weight
- weight for length
- head circumference

WHO growth charts used
- these are better descrption of physiologic growth in infants

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5
Q

after the neonatal period: how is Growth measured

A

Growth Measurements
weight: considered most importnat for out 0-2 year olds
- do it without diaper or clothing

Stature:
- length from 0-2
- height 2+

Wegith
- wegith for length for 0-2 y/o
- BMI for 2+ year olds

head circumference
- measured just above the eyebrows, above the ears at the largest part of the occiput
- occipit-frontal diameter

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6
Q

Growth Charts/ Curves from the WHO and CDC

A

Charts
- used to track growth over time
- gender specific
- should plot according to actual age

O-2 year olds
- WHO growth charts
- weight for length
- weight
- length
- circumference

2+ year olds
- height
- weight
BMi

Premature and disese specific have their own charts

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7
Q

Weight Patterns of Gain in Infants and Kids

A

Weight Gain
- infants typically lose weight in theif first few days of life: but back to birth wegiht at 10 days
- by 4-6 monhts: should about 2x their birthwegith
- by 12 months: should be 3x their birthweight

Average weigh gain
-in first 3-4 months: 20-30 grams/day
5 pounds between 1-2 years olde
5 pounds a year from 2-5

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8
Q

Growth Faultering (Failure to Thrive)
etiology
Risk factors
possible reasons for it

A

Failure to Thirve: Etiology
- initally a weight disorder, but if it gets severe enoug, affects linear growth (head circum. and length)
- can lead to sever lack of max. adult height and cognitive skill if not addessed in teh first 2 years of life

Risk Factors
- low SES
- refugees
- developmental delays
- lowe birthweight bb
- fetal growth restriction
- chronic/recurring infections
- GI disorders
- congenital disorders

Reasons for It
- inaequated caloric intake: negelt, poor patching, reflux, GI issues, etc.
- inadequate absorption of nutreinty: celiac, metabolsim, infection, milk protein allergy
- excessive use of energy: infections, cardiac or lung disease, CF, hyperthyroid, malignancy,

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9
Q

Growth Faulturing
Diagnosis

A

Diangosis
- anthropometric z scores make the diagnosis
- calculated by weight for length or BMI
- can be diagnosed with a single measurement set
- the z-score range : -3 to 3+ : negative implying lower percentiles
- a decreased in a Z score of 1 or more shoes those who will develop growth faultring

this helps assess response to treatment and how to treat

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10
Q

Growth Faultering
appraoch to treatment
hX. qs
PE

A

Need a good Hx. in order to properly treat
- figure out the underlying cause
- what are they being fed
- when, how often, symptoms after feeding
- psychosocial facotrs, specific food peferences

PE
- vitals, all measurements
- muslce and fat depostion: mmid-arm circumference can help
- hari thinning, skin changes
- dental and neuro exams, look for dysmorphism
- cardiac murmurs, organomegaly, look for neglect
- **diagnosis studies not needed if there is a normal H&P*8

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11
Q

Growth Faultering
Treatment
initiala and if that fails what labs

calori def. corrections for breast fed v bottle

A

Treament: Inital
- behavior modification: adjust feeding practices
- increasing calorie consumption
- close monitoring

If inital treatmnet fails
- CBC
- chemc, celiacl
- lead, iron, UA and ESR

Calorie Defict Correction
Breast Fed babies :
- give breast milk (pump and measure) 22cal/oz
- supplement with formula feeds

Formula fed
- give formula 19-21 cal/oz
- swap to calorie dense or concentrated formula

toddlets
- high quality diet
- supplement with high cal. snacks and supplements

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12
Q

Growth Faultering
Monitoring

A

Monitoring
- monitor Q1weeks to 2 weeks
- until Z score is corrected and the normal growth trajectory consisent and normal weight

Consultation
- nutrition/behavior intervention if conservative measures fails
- hospitalization in severe nutrtion

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13
Q

Overweight & Obesity in Children
- normal growth guidelines
- how is it determined
- obesity and overweigh tby percentile BMI

A

Normal growth
- at 3 years: child should be approx. 4x their birth wegith
- then grow about 5 pounds a year from age 2 until puberty

Calculate Weight
- usually using BMI: newer push for Z scores
- obersity more likely to be a problem for those over 2 years old
- normal BMI: shold grow, take a little dip during preschol as they run around so much; then remain increasing until levling off in adulthood

BMI for overweight and obestiy

5th-84th percentile = normal
85-95th percentile = overweight
> 95th percentile = obese
> 120% of the 95th percentile = severe obesity

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14
Q

Overweight/Obestiy in Children

Causes

prevention: for..
- newbrons
- toddle
- preschool
- school age
- adolescent

A

Causes
- calroires in > out
- genetics
- endocrine disorders
- medications (atypicals.)

Prevention

Newborn
- promote breast feeding & teach parents to assess feeding cues

Toddler
- encourgae proper proportions
- but toddler choses how much to eat; dont force feed
- NO sugar beverages (juice)

Preschool
- PARENTS make food choice
- no sugar beverages; limit juice to 4-6 oz day

School age
- watch school lunchchoices
- less junk foor or sugar sweented
- only food in the house that is good choices

Adolescents
- encourage family eating
- ensure they eat breakfast
- limit fast food

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15
Q

Overweight/Obestiy in Children

Ways to prevent overeating in terms of food intake and exercise and screen time

Complications of overweight/obese kids

A
  • no food and eating
  • no tv in their room
  • 2 or less hours of screen time

1+ hour of activity daily
no sugar sweeted beverages
5+ fruits and veggies

Complications that can arise
- HTN
- OSA, asthma
- T2DM
- insulin resistnace
- hyperlipidemia
- PCOS
- blounts disease (bowing of legs)
- hip issues
- back pain
- NASH
- Gallbladder disease
- depression and poor self esteem
- pseuotumor cerebir (increase ICP)

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16
Q

Overweight/Obestiy in Children

further evalautions to do if you susspect its not a primarily lifestyle choices issue

A

Further Eval.
- EVERYONE OBESE needs a further evaulation and workup
- everyone with is overweight with other risk factors (ipids, HTn, etc.)
- consider a work up for those increasing thier BMI by 3-4 units a year

Evaulation with
- TSH
- glucose
- lipids
- LFTs
- endcrine referral if unable to control

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17
Q

Overweight/Obestiy in Children

Management in terms of growth goals and charts
mild obestiy
moderate
severe

A

Mild Obestiy
- the goal should to “maintain” the weight and allow their linear growth (height) to increase to balance it out
- takes 1-2 years

Moderate to Severe Obestiy
- 2-11 year olds = drop 1 pound a month
- those 11+ = can drop up to 2pounds/week or 2 pounds/month

Dietary and Exercise
- general preventivne mananngemetn
- encourage support gropus and management tools

Severe Obesity
- dietician
- comprehensive weight manamgenet
- comorbi management
- specialits (ortho, endo, etc.)
- behavioral management

for adolecents
- semiglutaide has best evidence
- can consider bariatric surgery

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18
Q

what is stature

typicl velocity of growth

average growth men/women at puberty

A

Typical growth velocity
- this changes over time
- rapid in infant and early childhood
- slows down to 5cm/year
- puberty hits: growth spurt

Puberty
men- average 7-12 cm per year
women - average 6-10.5 cm per year

Abnormal growth
- growth mimics family but nayone with short or tall stature : warrents a workup

after age 2 = start measureing growth on a chart yearly

19
Q

Predicting height: midparental height

what is stature and its relation to bone age

A

females = dads height - 13 cm + moms /2
males = dads height + moms + 13/2

Bone Age
- left wrist and hand can be good area to take look at bone age to determine growth
- skeletal maturity is predictable for those > 5
- xray of left hand can indicated the adult height and can be used to evaluate abnormal stature

20
Q

Short Stature
- define
- some conditions that have it
- evaulation: hx. pearls

A

Define
- short stature = 2 SD below the mean heigth for the age/gender

COnditions (some)
- consitutional delay: late bloomers
- GH deficient/hypothyroid
- genetic: downs, turners
- chronic medical: celaicl, CKD, IBD
- malignancy, pulmonary and immune diseases

HIstory and Evaluation
- SGA
- hypoglycemia
- poor feeding
- meconium ileus (think CF)
- glucocorticoid use (cushings)
- stimulants (ADHD)
- pituitary issue, HA, vision issue, etc

21
Q

Short Stature
- evaluation: PE and labs?

A

PE
- evaluate the growth curve since birth: see the prediction and outcome
- dysmoprhia
- boyd segment distrubution
- pubertal devleopment (sexual matuirty)

Labs
- CBC, CMP,
- TSH
- ESR/CRP
- celiac
- IGF for GH deficiency
- UA
- bone analysis
-

22
Q

SHort Stature: Idopathic Short Stature

A

diagnosis of exclusion: need to rule out all other reasons for short stature first

defined as
- short starture with normal size for gestaional age at birth

No
- chronic disease
- endocrine
- chromosomal issues
- nutrtional issues

Bone age: variable

Management
- refer to endocrine for eval of other causes and can consider GH therapy

23
Q

Short Stature: Familial short stature

A

Familial
- this is normal
- but the child is still less than 2 SD below the mean of height; however they are on target to meet the midpoint of parental height

Curve
- they will be lower to normal in terms of velocity of growth
- just below, but parallel to the normal curve

Puberty = normal development

normal labs and bone age is consistent with age

can sondier genetic testing & +/- GH therpay

24
Q

Constitutional Delay: Short Stature

A

these kids just are small and dont grow as much when young, but when they hit pubertythey catch up with noral curves “late Bloomer”

  • often familail
  • normal stature at birth
  • slower velocity of growth 3-5 years old; then normal growth but theyre behind
  • but puberty is delayed : once met they catch up

Bone age = delayed: bone is less than chronologic age

eventually, growth spurt = reach normal hegith

25
Q

Small for Gestational Age : Short Stature

A

SGA babies are at risk for short stature
at BIRTH: their length and weight are 2 SD below the mean for their gestaional age

15% of these babies never “catch up” in growth: they may remain small

then reason for grwth failure is unknown; can use GH to help

26
Q

Acquired Hypothyroidism: Short Stature

A
  • normal growth curve until disase strats
  • hashimotos thyroiditis
  • most kids = no symptoms, so in ALL kids of short stature, you should screen for this

the Height velocity usually responds well to thyroid replacement meds

27
Q

Glucocorticoid Excess: Short Stature
diagnosis and treatmetn

A

chronic expsoure to steroids = big effect on linera growth with concurrent weight gain

most commonly used for IBD, arthritis of kids, etc.

Cushing’s disease presentations ofpt.

Diagnosis
- 24 hour urine cortisol
- midnight salivary cortisol
- low dexatmethasonde sup. test
- need 2+ tests of the above

Treatment
- endo: for treatment

28
Q

GH deficiency: Short Stature

Diagnsosi and treament

A

what is it = a below avearge growth rate crossing percentile lines
pt. will have delayed bone age

Causes
- head trauma
- CNS infection/radiation
- unknown

Diagnosis
- IGF-1
- IGF binding protien level
- GH stim test

Treatment = GH supplement

29
Q

Congential GH Deficiency : SHort Stature

A

Congenital GH
- typically normal size at birht, but they have signf of other hormone deficienices (micropenis)

midline structural defects
- prolonged jaundice
- hypoglycemia

Diangosis
- low GH with low glucose

30
Q

FDA aprroved conditions to use GH in kids

A
  • GH deficiency
  • growth failure due to CKD
  • growth failure for SGA
  • turner, nonon, prader willi
  • idopathic short stature
  • short bowel
  • AIDS wasting

a rx. for GH should ONLY COME FROM ENDO: nerv anyone else

31
Q

Tall Stature
define
causes
Evaluation (hx. and workup) & tests

A

Tall Stature = 2 SD above the mean for the age/gender

Causes
- common = familial/constitutional or overnutrtion
- hyperthyroid
- percious puberty
- CH excess
- Kleinfelters
- Genetics: marfans, homocysterin, elhers dan.

Evaluation
- detail history = find out timin of growth
- family hx. = include extended!

PE
- dysmoprhias?
- pubert status
- dysproprtional growth? arm span and fingers/toes

Dx. Eval
- TSH
- IGF-1
- bone age assessment
- genetic testing if deemed necessary

32
Q

Constitutaionl Tall Stature

A

Constitutional
- begin average length as baby
- accelerated linear growth until they are about 4, then they parallerl normal gorwht patterns, just above
- no disproportional growth:normal PE
- lilkey to have familial influence
- no treatment needed

33
Q

Overnutrtion: Tall Stature

A

OVernutrtion
- leads to obesity and accelerated linear growth: eventaully height consistent with predicted

Hormonal influences
- low GH
- normal IGF-1

- abnormal grehelin, leptin an GH secretogogies
- hyperinsulinemia

treament = focuse on wight management: it will eventaully deccelerate

34
Q

Hyperthyroid: TAll Stature
tests
treatment

A

Hyperthyroid
- accelerated growth with weight loss

Causes
- graves disease (common)
- hyperthyroid phase of lymphcytic throiditis
- thyroid nodules

Labs - TSH, T3/4
RAI study

Treatment: methimazole (avoid RAI treatment because of gonadal impact)

35
Q

Percious Puberty: Tall Stature

A

Percoucious Puberty
- development of secondary sex characteristics before the age of 8 in females, before 9 in males

Estrogen is responsible for pubertal growth purty: in females AND males = increase linear growth

36
Q

GH Excess: leading to Tall Stature

A

GH Excess
- rare; but a hormonal secreting pituitary adenoma
- increase linear growth while the growth plates are still open

Feature s
- large jaw
- hands and feet are large

Diagnosis
- IGF-1
- GH suppression test = confiratory
- if suppression test + = get MRI of pituitary
- check prolactin (prolactioma)

Treament = medical or surgical or radiotherapy

37
Q

Terminology og Puberty

Thelarche
Pubarche
Menarche
Adrenarche

A

Thelarche
- development of breast tissue = first onset of puberty in females

Pubarche
- pubic hair development with or without breast development in females

menarche
- onset of menstratution

Adrenarche
- adrenal gland “awakens” increased production of androgens (males and females)
- develop pubic hair, oily skin and body odor

38
Q

Physiology of Puberty: Male

A

Male : Pre-Puberty
- pituitary and gonadal hormone levels LOW

Onset of Puberty
- inhibition of GnRH is removed: allowing GnRH to trigger in pusatile fashion
- pulsatile LH and FSH release to the testis
- as the adolecent ages, these puslatile waves of release lead to increased frequency and amount of FSH and LH released
- increased levels of FSH and LH = stimulate the testis to produces testosterone
- LH to leydig cells = testosterone
- FSH to sartoil cells = sperm

39
Q

Male: Sexual Maturity Rating

A

Prepubetal = Rating 1
- no hair
- no genetial development

Rating 2
- enlarged scrotum and testis but NOT PENIS
- sparse hair at base

Rating 3: peak height
- continued growth
- penil growth
- darker, course hair thicken
- sperm production

Rating 4
- continued growth
- glans penis grwoth
- adult ahir
- facial hair and voice change

RAting 5
- full adult mature sexual matuirty

40
Q

Femal Puberty: Physiology

A

prepuberty: pituitary anf gondal hormone levels low

onset of puberty
- inhibition og GnRH is turned off
- leads to pusatile release of LH and FSG to produce estrogen

as age increases: frequency and intestiny of puslatile hromonal release

FSH: stimulates ovary maturation, granulosa cell function & estradiol prodcution
LH : stimultes ovluation, corpus lutem and progesterone production

Estradiol
- initially: ealy on at lower levels inhibits LH and FSh
- then later in puberty: becomes stimulatory and the cyclical nature begins

41
Q

Female Puberty: Sexual Maturity Scale

A

Rating 1
- perpubetal

Rating 2
- subareolar buds
- sparce long hair in medial labia
- peak height velocity

Rating 3
- breast begin to develop contour
- darker hair beigns to fill in on mons pubis

Rating 4
- breat enlarge more,
- areola and nipple form second rounded contour on breast
- adult type hair but not to legs
- menarche begins

Rating 5
- mature adult breats; nipple projection
- adult type and quintiy of hair to leds

42
Q

Abnormal Puberty
delayed and precious

A

more commony to see balck children develop earlier

Delayed
- femleas = no breasts by 13, no period within 3-5 years after that
- males = no testicualr enlargement by 14, maturiaonal arrest

Precious puberty
- puberty 2 SD before the mean expected onset
- commony early that 8 in females
- commonly earlier than 9 in males

43
Q

Delayed Puberty: reasons/conditions

A

Reasons
- constitutional delay
- anatomic abnorm.
- hypogonadism: turners, permature ovarian failure, glactosemia
- central hypogonadims: pitutairy tumonr, congential, cushings, hypothyroid, hyperprolactinomia (prolactin = no period)

FEmales
- if delated menarch only = check preg. test
- FSH/LF not helpful, get karyotying if needed
- cranial MRI for prolactinoma if sus.

Males
- testicular exma: nondisteneded?
- LH/FSH
- inhibin B

mange via refer to endo

44
Q

Percious Puberty
causes
workup and treatment

A

Causes

central
- CNS tumor
- hydrocepha.
- CNS radiation or trauma
- mcune albright
- adrenal hyperplasa
- hypothyroif

peripheral
- adrenal/pituitary tumor
- expsoure to OCPs or exogensou hormones
- ovarian cyst
- tumor
- genetic defect

precious puberty = often idopathi
increased rates due to Covid!