Growth and Development Flashcards by Peter Savage

Give a generic list of growth measurement techniques?

Height/Sitting height
Length (<2yrs)
Head circumference 
Comparison with parent height
BMI

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Why might sitting height be useful?

Spinal radiotherapy - causes spine to not grow properly

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What age is head circumference measured and how?

<2yrs

Forehead and occipital prominence

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Which growth chart is used in the uk?

RCPCH UK 2-18
WHO standards <4
UK90 >4

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What is bone age measuring?

Looking at long bones and round bones of hand for distortion/growth

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Outline the Tanner method for puberty staging?

B 1-5 (breast)
G 1-5 (genitals)
PH 1-5 (pubic hair)
AH 1-3 (axillary hair)
T 2ml-20ml
SO

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What is testicular maturation?

Measuring testicle size with a Prader Orchidometer

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How is a testicular orchidometer used?

Black beads for pre-pubertal size

15+ for post-pubertal size

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What history is taken for growth?

Birth weight/gestation
PMH
FH/SH/Schooling
Systematic enquiry 
Dysmorphic features

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What assessment tools are used for growth?

Height/length/growth
Growth charts
MPH + Target centiles
Growth velocity 
Bone age
Pubertal assessment

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What factors influence height?

Age/Sex/Race
Nutrition
Parent height
Puberty + skeletal maturity
Health/disease/disorders

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What are the 3 stages of normal growth?

Infantile
Childhood
Pubertal

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What is the pattern of infantile growth?

Starts very fast and slows down rapidly towards childhood

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What is the pattern of childhood growth?

Starts moderately fast from 4+ and slows down to 11-14

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What is the pattern of pubertal growth?

Sharp rapid burst at puberty which then drops down to standstill at ~20yrs

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When does testicular growth take place in puberty?

Right at the start

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When does penile growth take place in puberty?

Just after the start before maximum growth

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When does advanced growth take place in puberty?

At the peak of growth rate

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When does facial hair growth take place in puberty?

Towards the end of puberty

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When does breast budding take place in puberty?

Start of puberty

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When does early breast development take place in puberty?

At the peak of growth rate

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When does menarche take place in puberty?

Towards the end of puberty

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What are the most important stages of puberty?

Breast budding
Testicular enlargement
(earliest signs of puberty)

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At what Tanner stage does breast budding take place?

Tanner Stage B2

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At what Tanner stage does testicular enlargement take place?

Tanner stage G2 - T3-4ml

What effect does obesity have on pubertal development in girls?

Taller, earlier (end height the same)

What signs are indicative of growth disorders and referral?

``` Extreme short/tall Height below target height Abnormal height velocity Hx chronic disease Obvious dysmorphia Early/late puberty ```

How is abnormal height velocity detected?

Crossing of centiles on charts

What are the common causes of short stature?

Familial Constitutional (delay of growth and puberty) SGA/IUGR

Pathological causes of short stature?

``` Chronic illness (JCA/IBD/Coeliac) Undernutrition Iatrogenic (steroids) Psychosocial Hormonal (GHD,hypothyroidism) Syndromes ```

Which syndromes can cause short stature?

Turner syndrome Prader-Willi syndrome Noonan's syndrome Achondroplasia

When is puberty early and late in a boy?

Early <9yrs | Delayed >14yrs

When is puberty early and late in a girl?

Early <8yrs | Delayed >13yrs

What is Constitutional delay of growth and puberty?

More common in boys Family history in dad/brothers Bone age delay EXCLUDE ORGANIC DISEASE

What are the causes of delayed puberty?

``` CDGP Gonadal dysgenesis Chronic disease Impaired HPG axis Peripheral ```

What are the causes of early breast development?

Infanctile thelarche Thelarche variant True central precocious puberty

What are the causes of early secondary sexual characteristics?

Exaggerated adrenarche | Precocious pseudopuberty

What are the causes of early PV bleeding?

Premature menarche

What is central precocious puberty?

``` Early puberty Growth spurt Advanced bone age Idiopathic in girls (pituitary imaging) Underlying cause in boys ```

What is the treatment for central precocious puberty?

GnRH agonist

What is Precocious pseudopuberty?

Gonadatrophin independent (Low levels of LH/FSH) Abnormal sex steroid hormone secretion Early secondary sexual characteristics

How is a birth with ambiguous genitalia managed?

``` DO NOT GUESS SEX Multi-disciplinary Exam of gonads/organs Karyotype Exclude Congenital Adrenal Hyperplasia ```

What is congenital hypothyroidism?

Athyreosis/hypoplastic/ectopic Found in newborn screen 1 in 4000

What causes acquired hypothyroidism?

Autoimmune (Hashimoto's) thyroiditis | FH of thyroid/autoimmune diseases

How does acquired hypothyroidism present?

Lack of height gain Pubertal delay Poor school performance

How is overweight defined?

BMI >85th centile | SD >1.04

How is obesity defined?

BMI >97.5th centile | SD >2

How is weight assessed?

``` Mass + BMI Height Waist circumference Skin folds Hx ```

When is obese abnormal?

WHEN COMBINED WITH SHORT LOL

What symptoms must you be aware in the obese child?

Suggestive of Syndromes, Hypothalamic-pituitary pathology Endocrine issues Diabese

What are the common causes of obesity?

``` SIMPLE OBESITY Drugs Syndromes Endocrine disorders Hypothalamic damage ```

Which drugs increase the risk of obesity?

Insulin Steroids Antithyroid drugs Sodium valproate

Which syndromes increase the risk of obesity?

Prader-Willi Laurence-Moon-Biedl Pseudohypoparathyroidism Type 1 Down's

Which endocrine disorders increase the risk of obesity?

``` Hypothyroidism Growth hormone deficiency Glucocorticoid excess Hypothalamic lesion (tumour/trauma/infection) Androgen excess Insulinoma Insulin resistance syndromes Leptin deficiency ```

Endocrine causes of obesity typically present with what?

Growth failure

Syndromes causing obesity typically present with what?

Learning difficulties

Hypothalamic causes of obesity typically present with what?

Loss of appetite control

What are the 4Ts of childhood diabetes?

Thirsty Thinner Tired Toileting more

How do you respond in suspected childhood diabetes?

Prick test [Glc] > 11mmol/L REFER

What is the red flag symptom for diabetes in a child?

Return to bedwetting and day-wetting

What other factors are suggestive of diabetes under five?

``` Nappies heavier than usual Blurred vision Candidiasis Constipation Recurring skin infections Irritability ```

What are the symptoms of diabetic ketoacidosis?

``` N&V Abdominal pain Ketotic breath Drowsiness Rapid/deep respiration Coma ```

Growth and Development Flashcards

(62 cards)