Growth and Development Flashcards
What are the two periods of rapid growth?
Two periods of rapid growth:
Infancy and adolescence
Brain growth is rapid during the first 6 years of life, with minimal change in head size after age 10
Lymphoid tissue volume increases rapidly before puberty
Growth of reproductive organs is slow until puberty
When does an infant regain birth weight?
When does an infant double thier weight?
When does an infant triple their weight?
When does an infant qudrulpe their birth weight?
Infants regain birth weight by 2 weeks
Doubles their birth weight by 4 months
Triples their birth weight by 12 months
Quadruples their birth weight by 24 months
What is the normal weight gain per year after 2 years old?
After 2 years old, normal weight gain is 5 lbs a year until adolescence
Failure to Thrive
Failure to gain weight appropriately
Weight less than 3rd percentile
Weight for height less than 5th percentile
Weight 20% or more below ideal weight for height
Weight gain less than 20 grams per day from 0-3months
Weight gain less than 15 grams per day from 3-6months
Downward crossing of 2 or more percentiles
What laboratory tests shoudl be included in a Metabolic screening?
- fasting plasma amino acids
- blood lactate
- blood pH and C02
- ammonia
- very long chain fatty acids
- urinary oligosaccharides
- urinary mucopolysaccharides
What percentage of children with mild mental retardation have identifiable chromosomal abnormalities?
4-8% of children with mild mental retardation have associated identifiable chromosomal abnormalities
When does birth lenght double by?
When does birth length triple by?
Birth length increases by 50% in the 1st year
Doubles by 4 years
Triples by 13 years
What is the average height increase after 2 years old?
After 2 years old, average height increase is 2’ per year until adolescence
Midparental Height in Children
Adult height for most children should be within 5cm above or below the calculated midparental height. Maximal growth occurs in the spring and summer
Height for girls:
(Father’s height-13cm) + (Mother’s height)/2
Height for boys:
(Mother’s height +13cm) + (Father’s height)/2
Head Circumference
50% percentile for head circumference of a full term infant at birth is 35 cm
Largest rate of head growth is between 0-2 months, 0.5cm per week
Head grows 1 cm per month for the first year, with most rapid growth in the first 6 months
Brain weight doubles by 6 months and triples by 1 year
What is the best initial diagnositic study for a child with macrocephaly?
For macrocephaly, the best initial diagnostic study is head ultrasound for hydrocephalus
Benign causes of macrocephaly is enlargement of the subarachnoid space
What is the best initial diagnositic study for a child with microcephaly?
For microcephaly, CT or MRI is the best test to determine underlying disease process.
Underlying brain growth is what leads to head growth, poor brain growth may result in premature fusion of the cranial bones
Plagiocephaly
Asymmetric head growth
flattening of the skull 2ndary to decrease change in position
stops progressing after 7 months since children can roll over and move their heads more
associated with torticollis and causes flattening of the occipitopariental area
may be severe enough to cause ipsilateral frontal prominence or anterior displacement of the ipsilateral ear
Craniosynosis
pathologic fusion of cranial sutures
Most common fused suture is sagittal synostosis
palpable thickened suture lines
Types of Cranisynosis:
Scaphocephaly/Sagittal suture: excessive anterior/posterior growth with long narrow head shape and frontal occipital prominence
Plagiocephaly/Coronal and sphenofrontal sutures: unilateral flattening of the forehead, elevation of the orbits and eyebrows
Trigonocephaly/Metopic sutures: hypotelorism, and keel shaped forehead
Turricephaly/Coronal, sphenofrontal
Frontoethmoidal sutures: cause a cone shaped head
What laboratory studies are necessary for short stature?
Short stature evaluation:
- CBC (chronic anemia)
- ESR (inflammatory bowel disease)
- CMP (kidney problems and acidosis)
- thyroid
- UA (diabeties)
- IGF1, IGFBP3
- celiac panel
- bone age
- get chromsomes for females
Caloric Insufficiency
Failure to gain weight or significant weight loss
Head circumference and height spared initially
Growth hormone deficiency
Normal length and weight at birth because insulin drives growth in utero
Bone age is delayed
See hypoglycemia due to lack of counter regulary affects of growth hormone
Direct hyperbilirubinemia due to sludging form growth hormone deficiency
In growth hormone deficiency, both weight and height drop off at the same time
In systemic illness, the weight velocity drops off first, then the height velocity
Any midline defects such as:
- Cleft lip and palate
- single central incisor
- cranipharygioma
- hypothalamic tumor
- ectopic posterior pituitary
- micro penis in males
Constitutional growth delay
variant of normal growth
Defined by the growth pattern
Usually familial
Bone age is delayed
Normal birth weight and length
Drop off during first 2 years
Achieves adult height in normal range
Delayed bone age prior to adolescent growth spurt
Before puberty, constitutional growth delay looks like familial short stature, however, bone age is normal in familial short stature and delayed in constitional growth delay
Silver-Russell Syndrome
short stature
frontal bossing
triangular facies
shortened and incurved 5th fingers and asymmetry
low birth weights
Soto syndrome
cerebral gigantism
not an endocrine abnormality
born >90%, LGA
grows to >97% for first 5 years, then slows down to normal rate
macrocephaly
prominent forehead
mental retardation
large hands and feet
