Growth and Development Flashcards
What are some common measurement and assessment tools used to determine whether babies / children are developing normally?
- Height (standing and sitting)
- Length (babies)
- Head circumference (<2 years old)
- BMI
- Bone age
What are some important practices when taking measurements of children during development?
- Being accurate (use dots instead of crosses)
- Serial measurements: more data = easier analysis
What is bone age? What can it be used to predict?
- The average age at which a child reaches a specific level of bone maturation. Usually equal to biological age but can be greater or lesser for those who hit early / late growth spurts
Bone age + height of a child can be used to predict adult height
What is another way to analyze the development of adolescents? Tools / criteria used?
- Pubertal assessment
- Tanner method (stages pubertal development according to breast development, pubic hair, axillary hair and genital development)
- Prader Orchidometer (tool for measuring testicular volume)
Why is it hard to precisely define “normal development”?
- Wide range (genetic diversity)
- Differences in ethnic subgroups
- Inequality in basic health and nutrition
What are the three important stages in normal growth? What rate of growth occurs at each?
- Infantile: starts with a high rate of growth, decreases into childhood
- Childhood: Rate of growth still slowly decreasing from highest infantile stage
- Pubertal: Large spike in growth rate, decreases to zero into adulthood
Which gender reaches puberty earlier? What are the earliest signs of puberty based on gender?
Why are these signs important?
- Females reach puberty earlier
- Breast budding (tanner stage B2) in females
- Testicular enlargement (Tanner stage G2) in males
- Once these signs are present, usually confirms puberty will progress onwards
What are some indications for referral if growth disorder is suspected?
- Extreme tall or short stature
- Abnormal height change velocity
- Obvious dysmorphic syndrome
- Early / late puberty
What are some pathological causes of short stature?
- Undernutrition
- Chronic illness (JDA, IBD, Coeliac)
- Iatrogenic (steroids)
- Hormonal (GHD, hypothyroidism)
- Syndromes (turner / P-W)
Signs of Growth Hormone Deficiency?
- Child’s face appears younger
- Short stature
- Increased fat around face and stomach
- Delayed puberty / tooth development
What can excess glucocorticoid exposure lead to?
- Cushing’s syndrome
- Rapid weight gain can be seen in children with the condition
Developmental signs of Turner Syndrome?
- Short stature
- Thick neck tissue
- Swollen extremities at birth
Developmental signs of Prader-Willi Syndrome?
- Excessive weight gain
- Short stature
- Lack of genital development
Developmental signs of Noonan Syndrome?
- Unusual facial features (drooping eyelids and wide distance between eyes, large forehead)
- Short stature
Developmental signs of Achondroplasia?
- Dwarfism
- Small fingers
- Limited range of motion at elbows
Most important pubertal stages in boys and girls? (Tanner stages)
- B2 in girls
- G2 (T 3-4mL) in boys
What is considered early and late puberty in boys?
- Early < 9 years
- Late > 14 years (more common)
What is considered early and late puberty in girls?
- Early < 8 years
- Late >13 years (more common)
What is GDGP? Which gender is it more common in? Signs?
- Constitutional Delay in Growth and Puberty, usually resumes after delay period
- More common in males
- Short stature
- Delayed puberty
List some causes of delayed puberty
- Gonadal dysgenesis (Turner / Klinefelter)
- Chronic Disease (Crohn’s, Asthma)
- Impaired HPG axis
What does the term menarche refer to?
- First occurrence of menstruation
What is Central Precocious Puberty? List some signs
- Early onset puberty
Signs:
- Breast development at an early age
- Testicular enlargement in boys
- Growth spurts
- Advanced one age
What are some investigations for Central Precocious Puberty? Treatment?
- MRI head: look for brain tumour / pituitary abnormalities
- GnRH antagonist
What is Precocious Pseudopuberty? Signs?
- Partial pubertal development resulting from autonomous (Gonadotropin independent) secretion of sex hormones
- Early development of secondary sexual characteristics (but not sperm)
