Growth and Development Flashcards

1
Q

Why is physical growth important to monitor?

A

Indicator of health

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2
Q

How is growth monitored?

A

Measuring weight and height and accurately plotting these on a growth chart

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3
Q

In terms of growth, what are indicators of concern?

A
  • Very tall or short
  • Exhibiting growth failure
  • Out with their parental target growth
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4
Q

Name different equipment used to measure height accurately

A
  • Harpenden Infant Measuring Table-110 cm and trolley
  • Harpenden stadiometer, footboard and calibration stick
  • Rollametre
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5
Q

What are some rules of technique used to measure height?

A
  • A child should be measured supine until 2yrs
  • A child unable to stand should also be measured supine.
  • A child who has one leg shorter than the other should be measured standing on the longest leg. They should always be measured on the same leg.
  • Children who are measured supine should have their crown rump measured (head to bottom) and subtract this from total length
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6
Q

What are the measurement techniques in measure supine length?

A
  • Two people required
  • Child may require play and distraction techniques
  • Place board on firm, flat surface
  • One person to ensure head is in contact with headboard and other person positing feet together
  • Record to last mm
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7
Q

How should the child be positioned when taken a sitting height?

A
  • Backs of the knees resting on the edge of the table
  • Feet supported on adjustable step
  • Thighs horizontal
  • Back must be straight
  • Buttocks against the backboard
  • Scapula, wherever possible, against the backboard
  • Hands on knees
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8
Q

What can affect sitting height measurement?

A

Some conditions cause asymmetry and disproportion to the skeleton eg achondroplasia.

Therefore necessary diagnostically to undertake sitting height or crown rump (CR) length measurements.

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9
Q

How is head circumference measured?

A
  • Routine in children < 2yrs

* Tape round forehead and occipital prominence (maximal circumference

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10
Q

What is essential when measuring and recording height or length?

A
  • Accurately measured using good equipment
  • Recorded with the date in the child/young person’s health care records
  • Plotted accurately on a centile chart
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11
Q

What is important when taking serial measurements?

A
  • Choosing the interval between height measurements

* Interpreting growth rates measured over less than a year

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12
Q

How is the potential height of a child calculated?

A

Obtaineing mid-parental height (MPH)

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13
Q

How do you calculate MPH?

A
  1. Add together the father’s height and the mother’s height 2. Divide this by two
  2. Add 7cm to the total

In boys, height is normal +/- 10cm and in girls, +/- 8.5cm

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14
Q

How do you express height as a standard deviation score?

A

SD = (x - x*)/SD for reference population

x- child’s height
x*- mean height for that age

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15
Q

Describe the SDS of a child and the centile they would be grouped into

A
  • Child/young of average height will have an SDS of 0
  • Child near the 98th centile would have a SDS of about +2
  • Child near the 2nd centile would have a SDS of -2

Refer to their doctor if their height:
• Falls below the 0.4th centile
• Above the 99.6th centile
• Outside of their target centile range

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16
Q

What do radiograph indicate about bone age?

A

Skeletal maturation: how much growth has taken place and how much there is left

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17
Q

Name four causes of delayed skeletal maturation

A
  • Constitutional delay of growth
  • Growth hormone deficiency
  • Hypothyroidism
  • Malnutrition/chronic illness
18
Q

Name six causes of advanced skeletal maturation

A
  • Tall stature
  • Premature adrenarche
  • Overweight
  • Early puberty
  • Congenital Adrenal Hyperplasia
  • Overgrowth syndromes
19
Q

What is it important to determine bone age?

A
  • To confirm diagnosis of variants of growth (familial short stature and constitutional growth delay)
  • Interpret hormone blood levels
  • Diagnosing precocious puberty and congenital adrenal hyperplasia and deciding whether to treat
  • Predicting adult height
20
Q

What is the staging system for puberty?

A

Tanner Stages

21
Q

What are the six different categories in the Tanner Stages?

A
  • Breast development - 1 to 5
  • Genital development - 1 to 5
  • Pubic hair - 1 to 5
  • Axillary hair - 1 to 5
  • Testicular volume - 2ml to 20ml
  • SO?
22
Q

What is important to remember in breast staging in Tanner Stages?

A
  • Initially unilateral
  • Often tender
  • Palpation necessary
  • Beware of fat tissue
23
Q

What is a prader orchidometer?

A

It consists of a string of twelve numbered wooden or plastic beads of increasing size from about 1 to 25 ml.

The beads are compared with the testicles of the patient, and the volume is read off the bead which matches most closely in size.

24
Q

How is testicular volume measured in Tanner Stages?

A

Prader Orchidometer

25
Q

What condition are large testes (macroorchidism) a sign of?

A

Inherited generalised mental disability, fragile X syndrome

26
Q

What is enquired about in the history?

A
  • Birth weight and gestation
  • PMH
  • Family history/social history/schooling
  • Systematic enquiry
  • Dysmorphic features
  • Systemic examination
27
Q

What are the assessment tools used to measure growth and development?

A
  • Height/ length/ weight
  • Growth Charts and plotting
  • MPH and Target centiles
  • Growth velocity
  • Bone age
  • Pubertal assessment
28
Q

What is ‘normal’ health?

A

Precise definition difficult:
• Wide range within healthy population
• Different ethnic subgroups
• Inequality in basic health and nutrition
• Normality may relate to individuals or populations (genetic influence)

29
Q

Name 12 factors influencing height

A
  • Age
  • Sex
  • Race
  • Nutrition
  • Parental heights
  • Puberty
  • Skeletal maturity (bone age)
  • General health
  • Chronic disease
  • Specific growth disorders
  • Socio-economic status
  • Emotional well-being
30
Q

Give an example of specific health disorders

A

Growth hormone deficiency and hypothyroidism

31
Q

What are the three phases of normal growth?

A
  1. Infantile
  2. Childhood
  3. Puberty
32
Q

Describe the infantile stage

A
  • Rapid growth from 0-2yrs

* Depends on nutrition and insulin-like growth factors

33
Q

Describe the childhood stage

A
  • Long phase of from from 2-12yrs
  • Slower, slightly decelerating curve
  • Dependent on GH and thyroxine
34
Q

Describe pubertal phase

A
  • From 12 to final height
  • Dependent on sex steroid that cause an increase in GH secretion
  • Variable: age of onset + duration + intensity
35
Q

Describe relationship of growth and puberty in girls

A
  • Grow fast at start of puberty
  • Peak height velocity at 12 yr (B2-3)
  • Slow down in later stages of puberty when breast development is mature
  • When menarche (period) occurs (13-13.5 yr) girls are close to final height
36
Q

Describe relationship of growth and puberty in boys

A
  • Grow slowly at start of puberty (G2) – still in childhood growth phase
  • Accelerate in mid-puberty (coincides with growth of penis, G3)
  • Peak height velocity at 14 yr
37
Q

What are the most important pubertal stages?

A

• Breast budding (Tanner Stage B 2) in a girl
• Testicular enlargement (Tanner Stage G2
- T 3- 4 ml) in boy

These are the earliest objective signs of puberty and when present puberty will usually progress onwards

38
Q

What three factors cause men to end up taller than women?

A
  • Pubertal growth spurt starts 2 years later than in girls (14 yr cf 12 yr)
  • Pubertal growth spurt is more intense in boys
  • Boys are slightly bigger than girls during childhood
39
Q

Name six growth disorders which are indications for referral

A
  • Extreme short or tall stature (off centiles)
  • Height below target height
  • Abnormal height velocity (crossing centiles)
  • History of chronic disease
  • Obvious dysmorphic syndrome
  • Early/late puberty
40
Q

Name three common causes of short stature

A
  • Familial (parents short)
  • Constitutionally delayed (bone age delayed, late puberty, final height lower)
  • SGA/IUGR
41
Q

How is SGA/IUGR?

A

Small for gestational age (SGA)

42
Q

Name 6 pathological causes of short stature

A
  • Undernutrition
  • Chronic illness (JCA, IBD, Coeliac)
  • Iatrogenic (steroids)
  • Psychological and social
  • Hormonal (GHD, hypothyroidism)
  • Syndromes (Turner, P-W)