Growth and Development Flashcards
Why is physical growth important to monitor?
Indicator of health
How is growth monitored?
Measuring weight and height and accurately plotting these on a growth chart
In terms of growth, what are indicators of concern?
- Very tall or short
- Exhibiting growth failure
- Out with their parental target growth
Name different equipment used to measure height accurately
- Harpenden Infant Measuring Table-110 cm and trolley
- Harpenden stadiometer, footboard and calibration stick
- Rollametre
What are some rules of technique used to measure height?
- 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
What are the measurement techniques in measure supine length?
- 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
How should the child be positioned when taken a sitting height?
- 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
What can affect sitting height measurement?
Some conditions cause asymmetry and disproportion to the skeleton eg achondroplasia.
Therefore necessary diagnostically to undertake sitting height or crown rump (CR) length measurements.
How is head circumference measured?
- Routine in children < 2yrs
* Tape round forehead and occipital prominence (maximal circumference
What is essential when measuring and recording height or length?
- Accurately measured using good equipment
- Recorded with the date in the child/young person’s health care records
- Plotted accurately on a centile chart
What is important when taking serial measurements?
- Choosing the interval between height measurements
* Interpreting growth rates measured over less than a year
How is the potential height of a child calculated?
Obtaineing mid-parental height (MPH)
How do you calculate MPH?
- Add together the father’s height and the mother’s height 2. Divide this by two
- Add 7cm to the total
In boys, height is normal +/- 10cm and in girls, +/- 8.5cm
How do you express height as a standard deviation score?
SD = (x - x*)/SD for reference population
x- child’s height
x*- mean height for that age
Describe the SDS of a child and the centile they would be grouped into
- 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
What do radiograph indicate about bone age?
Skeletal maturation: how much growth has taken place and how much there is left
Name four causes of delayed skeletal maturation
- Constitutional delay of growth
- Growth hormone deficiency
- Hypothyroidism
- Malnutrition/chronic illness
Name six causes of advanced skeletal maturation
- Tall stature
- Premature adrenarche
- Overweight
- Early puberty
- Congenital Adrenal Hyperplasia
- Overgrowth syndromes
What is it important to determine bone age?
- 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
What is the staging system for puberty?
Tanner Stages
What are the six different categories in the Tanner Stages?
- 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?
What is important to remember in breast staging in Tanner Stages?
- Initially unilateral
- Often tender
- Palpation necessary
- Beware of fat tissue
What is a prader orchidometer?
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.
How is testicular volume measured in Tanner Stages?
Prader Orchidometer
What condition are large testes (macroorchidism) a sign of?
Inherited generalised mental disability, fragile X syndrome
What is enquired about in the history?
- Birth weight and gestation
- PMH
- Family history/social history/schooling
- Systematic enquiry
- Dysmorphic features
- Systemic examination
What are the assessment tools used to measure growth and development?
- Height/ length/ weight
- Growth Charts and plotting
- MPH and Target centiles
- Growth velocity
- Bone age
- Pubertal assessment
What is ‘normal’ health?
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)
Name 12 factors influencing height
- Age
- Sex
- Race
- Nutrition
- Parental heights
- Puberty
- Skeletal maturity (bone age)
- General health
- Chronic disease
- Specific growth disorders
- Socio-economic status
- Emotional well-being
Give an example of specific health disorders
Growth hormone deficiency and hypothyroidism
What are the three phases of normal growth?
- Infantile
- Childhood
- Puberty
Describe the infantile stage
- Rapid growth from 0-2yrs
* Depends on nutrition and insulin-like growth factors
Describe the childhood stage
- Long phase of from from 2-12yrs
- Slower, slightly decelerating curve
- Dependent on GH and thyroxine
Describe pubertal phase
- From 12 to final height
- Dependent on sex steroid that cause an increase in GH secretion
- Variable: age of onset + duration + intensity
Describe relationship of growth and puberty in girls
- 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
Describe relationship of growth and puberty in boys
- 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
What are the most important pubertal stages?
• 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
What three factors cause men to end up taller than women?
- 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
Name six growth disorders which are indications for referral
- 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
Name three common causes of short stature
- Familial (parents short)
- Constitutionally delayed (bone age delayed, late puberty, final height lower)
- SGA/IUGR
How is SGA/IUGR?
Small for gestational age (SGA)
Name 6 pathological causes of short stature
- Undernutrition
- Chronic illness (JCA, IBD, Coeliac)
- Iatrogenic (steroids)
- Psychological and social
- Hormonal (GHD, hypothyroidism)
- Syndromes (Turner, P-W)
