Growth and development

Question 1

How is measurement assessed?

Answer 1

• Length
  ○ up to 2 years of age
  ○ Make sure the child is lying completely straight
• Hight
  ○ 2+ years
  ○ The plastic measuring pole is the most accurate
  ○ Shoes and socks have to be off
• Sitting height
  ○ Only when there is a possible body disproportion
  ○ Measured similarly to height but sitting down
• Head circumference
  ○ Routine in children <2 years
  ○ Tape round forehead and occipital prominence (maximal circumference)
• Bone age: TW 20
  ○ To see if the growth plates are still open to tell the bone age
  ○ Bone age is usually near the actual age but never really exactly the same
  ○ Bone age is directly related to puberty
  ○ Radiographs must be of high quality
  ○ Evaluation by a skilled practitioner
  ○ Pathological conditions can distort
  ○ Severe osteopenia confuses interpretation

Question 2

What are the assessment categories for puberty?

Answer 2

○ B 1-5: breast development (girls)
○ G 1-5: genital development (boys)
○ PH 1-5: pubic hear
○ AH 1-3: auxiliary

Question 3

What history and (further) examination would you take?

Answer 3

• Birth weight and gestation PMH
• Family/ social history/ schooling
• Systemic enquiry
• Dysmorphic features
• Systemic examinations

Question 4

What is the definition of normal growth?

Answer 4

• Exact definition is difficult
• Wide range within healthy population
• Different ethnic subgroups
• Inquiry in basic health and nutrition
• Normality may relate to individuals or populations (genetic influences on growth)

Question 5

What are the factors that influence growth?

Answer 5

• Age
• Sex
• Race
• Nutrition
• Parental heights
• Puberty
• Skeletal maturity (bane age)
• General health
• Chronic disease
• Specific growth disorders
• Socio-economic status
• Emotional well being

Question 6

What is the shape of normal growth?

Answer 6

• Most girls finish growing at around 15-16 years
• Most boys finish growing at around 16-17 years
• Boys tend to be 12.5cm taller than girls
• Periods happen at the very end of puberty
• Girls have a growth spurt at the start of puberty
• Facial hair and voice breaking are the last things to happen in puberty
• Boys have a growth spurt towards the end of puberty