Growth and Development Flashcards
(Paediatric endocrinology and diabetes)
Name some protocols for accurate height measurement of a child
- Shoes n socks off
- Heels together, legs straight, shoulders released
- Heels, buttocks, scapulae against wall
- ‘breathe in and stand tall’
- Height to last complete mm
How is height measured in children under 2 years, or when something is preventing you from measuring height?
Length is measured instead
When is sitting height measured?
When the body is disproportionate e.g. in people with skeletal dysplasia
Who is head circumference measuring routine in?
Children <2 years
How is head circumference measured?
Tape round forehead and occipital prominence
What does ‘make every contact count’ refer to?
Every time a child visits the GP or hospital, they should be measured; important to track growth to flag up any problems
Name a few different growth charts
Mid-parental height and target height
Condition-specific charts e.g. for Downs, Turners
BMI
How is bone age measured?
Radiographs usually of left wrist, hand and fingers
Measured from epiphyseal plates
Name the 5 components of puberty staging in the Tanner method
B = 1 to 5 G = 1 to 5 PH = 1 to 5 AH = 1 to 3 T = 2ml to 20ml
What do the stages of the Tanner method roughly mean in relation to stages of puberty?
Stage 1 = prepubertal
Stage 3 = early puberty
Stage 5 = adult
What is the tool used for testicular maturation measurement?
Prader orchidometer
Name 6 features of history and further examination when investigating growth and development
- birth weight + gestation
- PMH
- fam history/social history/schooling
- systematic enquiry
- dysmorphic features
- systemic examination
What factors influence 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
Which gender enters puberty earlier?
Female
For which gender does puberty last longer?
Male
What is the earliest objective sign of puberty in females?
Breast budding (Tanner stage B2)
What is the earliest objective sign of puberty in males?
Testicular enlargement (Tanner stage G2 + T3-4ml)
Give 6 indications for referral about a possible growth disorder
- extreme short/tall stature (off centiles)
- height below target height
- abnormal height velocity (crossing centiles)
- history of chronic disease
- obvious dysmorphic syndrome
- early/late puberty
What is the common link between obesity and growth?
Obese children are generally taller; short obese children are worrying
Give 3 common causes for short stature
Familial
Constitutional
SGA/IUGR
Give some pathological causes for short stature (6)?
Undernutrition Chronic illness (JCA, IBD, Coeliac) Iatrogenic (steroids) Psychological + social Hormonal (GHD, hypothyroidism) Syndromes (Turner, P-W, Noonans, achondroplasia)
What is considered early and late puberty in boys?
EARLY < 9 yrs
LATE > 14 yrs
What is considered early and late puberty in girls?
EARLY < 8 yrs
LATE > 13 yrs
What is CDGP?
Constitutional Delay of Growth and Puberty
Who is CDGP most common in?
Boys; fam history in dad or brothers; bone age delay (need to exclude organic disease)
Give 4 causes of delayed puberty
Gonadal dysgenesis (Turner, Klinefelter)
Chronic disease (Crohn’s, asthma)
Impaired HPG axis (septo-optic dysplasia, craniopharyngioma, Kallman’s syndrome)
Peripheral (cryptorchidism, testicular irradiation)
What is central precocious puberty?
Early pubertal development; breast development in girls and testicular enlargement in boys
Give a couple more features of CPP
Growth spurt
Advanced bone age
What is the cause of CPP in girls?
Usually idiopathic; do pituitary imaging
What is the cause of CPP in boys?
Look for underlying cause e.g. brain tumour, genetics
What is the treatment for CPP?
GnRH agonist (Gonadatrophin-releasing hormone agonist)
What is different between precocious pseudopuberty and CPP?
PP is gonadotrophin independent (low/prepubertal levels of LH and FSH)
Give some features of precocious pseudopuberty
Abnormal sex steroid hormone secretion
Virilasing/feminasing
Secondary sexual characteristics
What is the management for a newborn with ambiguous genitalia?
Do NOT guess sex of baby
MDT approach
Exam: USS? gonads/internal organs
Karyotype
What is it important to exclude in newborns with ambiguous genitalia?
Congenital Adrenal Hyperplasia (risk of adrenal crisis in first 2 weeks)
Give 2 causes of congenital hypothyroidism
- Athyreosis/hypoplastic/ectopic
- Dyshormonogenic
When should treatment of congenital hypothyroidism commence?
Within first 2 weeks
What is the most common cause of acquire hypothyroidism?
Autoimmune (Hashimoto’s) thyroiditis
What is the expected history in someone with acquired hypothyroidism?
Fam history of thyroid/autoimmune disorders
Childhood issues like lack of height gain, pubertal delay, poor school performance
What percentage of children aged 2-15 are overweight/obese?
31%
What centile is considered overweight?
BMI >85th centile
What centile is considered obese?
BMI >97.5th centile
What is important to keep in mind when looking at an obese child?
Obese + short = abnormal
Name a few complications of obesity
Metabolic syndrome Fatty liver disease Gallstones Thromboembolic disease Pancreatitis GRD Stress incontinence Orthopaedic problems Left ventricular hypertrophy RSHF etc
Name 5 causes of obesity
SIMPLE OBESITY (99%) Drugs Syndromes Endocrine disorders Hypothalamic damage
Name 4 drugs that can cause obesity
Insulin
Steroids
Anti-thyroid drugs
Sodium valproate
Name 4 syndromes that can cause obesity
Prader Willi syndrome Laurence-Moon-Biedl syndrome Pseudohypoparathyroidism type 1 Down's syndrome (there will be obvious pointers towards syndrome anyway)
Name some treatments for obesity
Diet
Exercise
Psychological input
Drugs (??)
What is the most common form of diabetes in children?
Type 1
Why is it important to diagnose children with diabetes early?
To prevent DKA (diabetic ketoacidosis) occurring
What are the THINK symptoms of diabetes (4 Ts)?
Thirsty
Thinner
Tired
Using the toilet more
What is the immediate test for diabetes?
Finger prick capillary glucose test (result >11mol)
What is a ‘red flag’ symptoms of diabetes?
A return to bedwetting or day-wetting in a previously dry child
What are some other symptoms of diabetes in children under 5?
- heavier than usual nappies
- blurred vision
- candidiasis (oral, vulval)
- constipation
- recurring skin infections
- irritability, behaviour change
What are some symptoms of DKA?
Nausea + vomiting Abdominal pain Sweet smelling, 'ketotic' breath Drowsiness Rapid, deep 'sighing' respiration Coma
What do you NOT request to diagnose DKA?
Returned urine specimen
Fasting blood glucose
Oral glucose tolerance test
DO NOT WAIT for lab results
