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Growth and development in children Flashcards

1
Q

What is growth?
Timeline?

A

Growth represents the summation of all the processes (interaction of hormones and nutrients0 that convert the fetus through childhood into a sexually mature adult

Not a steady process
Rapid in utero, then slows from birth until about 2-3 years
Fairly constant growth rate until growth spurt at puberty

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2
Q

What is hyperplasia?

A

Enlargement of an organ or tissue caused by an increase in organic tissue from cell proliferation
Increase
An increase in the number of cells and rate of cell division

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3
Q

What is hypotrophy?

A

A degeneration in the functioning of an organ due to the reduction of the volume in cells

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4
Q

What is hypertrophy

A

Increase in cell size

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5
Q

What is the difference in puberty growth spurt between genders?

A

Girls enter puberty earlier than boy - have an earlier peak in height velocity

Puberty often lasts longer for boys - has a later and longer peak in height velocity

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6
Q

What influences growth?

A

Genetics
- Basic guideline for height and timing of growth spurt
- Inheritance of height from parents
- Environment does influence the expression of genes, epigenetics, study of changes caused by the environment, and modification of how the gene code is expressed

Endocrine
- Growth hormones
- Sex hormones
- Thyroid hormones
- Insulin-like growth factors

Emotional
- Emotional impairment can reduce growth
- Mediated by high amounts of stress hormones
- Reduction in growth from high levels of stress

Nutritional
- Enough nutrition?
- Malnourishment can shunt growth

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7
Q

Describe the different phases of growth in fetal life

A

1st trimester
- Differentiation of cells into tissues and organs
- Critical period, organeogensis
- Hyperplasia - cell division

2nd and 3rd trimester
- Slowing of cell division
- More hypertrophy

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8
Q

What controls foetal growth?

A

Insulin-like growth factors (IGFs)
- Structurally similar to insulin, slightly different to AA length chains
- Mitogens, trigger mitosis and stimulate cell division

Amount of IGF controls growth and the amount of binding proteins.

IGF II main growth factor for embryo
IGF I regulates growth in later gestation

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9
Q

What influences IGF levels

A

More glucose –> More insulin –> More IGF

Good nutrition supplies a steady stream of glucose to produce insulin then IGF I

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10
Q

What happens to growth around the time of birth?

A

Foetal growth is limited by substrates - the ability of the placenta to be able to supply the substrates

Cortisol and glucocorticoids increase to influence the maturation of organs to prepare to birth. Laying down of fat and maturation of organs.

Increases in growth hormone receptors. Earlier on in pregnancy GH are present by the receptors arent so they cant have as much effect, the increase in receptors allows more of an effect of GH

Increase in thyroid hormone, T3 increases

Rapid acceleration of growth until 2-3 years

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11
Q

What happens to growth during childhood?

A

More of an effect of GH
Requirement of normal thyroid functioning from 1st year
Localised growth, end of long bones in legs and arms, sensitive to GH
Puberty - interactions of GH and sex hormones in teens

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12
Q

Discuss the growth hormone

A

Released from the pituitary in response to Growth Hormone Releasing Hormone from the hypothalamus
Stimulated by high levels of insulin
Reduced by adrenal glucocorticoids - involved in the metabolism of carbohydrates, proteins, and fat, have an anti-inflammatory activity
Oestrogens increase sensitivity to the pituitary to GHRH which is why puberty occurs earlier in girls.
Negative feedback loop control

The function is to increase protein synthesis and mobilise fat stores to provide energy.

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13
Q

Why does puberty occur earlier in girls?

A

Oestrogen increases sensitivity of pituitary to growth hormone-releasing hormone, as girls have more oestrogen that boys they cause more of a sensitivity to GHRH

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14
Q

Describe the different pathways of indirect and direct effects of growth hormone

A

Direct:
GH –> Tissue e.g Fat (adipocytes) –> Mobilising energy from adipocyte
GH –> Chondrocytes (cartilage cells) –> promote long bone growth
GH –> Myoblasts –> Muscle growth

Indirect:
GH –> Liver –> IGF I –> Bones –> Increase bone length

The production of IGF I causes the effect to be indirect as its not GH acting itself

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15
Q

Describe the feedback loop system of GH

A

Somatostatin is produced by hypothalamus to reduce the release of GH so not too much is released
Growth hormone-releasing hormone is released by hypothalamus

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16
Q

How does GH have an effect?

A

GH binds to surface receptor on plasma membrane
Activates membrane bound tyrosine kinases which phosphorylate a group of proteins that activate gene transcription
Stimualtes lipolysis making fatty acids available for oxidation
Facilitates amino acid uptake for protein synthesis
Stimulation of chondrocytes to cause bone growth

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17
Q

What is considered a low birth weight?

A

Less than 2.5kg
Preterm less than 37 weeks gestation

18
Q

What is considered a normal birth weight?

A

3-5kg
37-42 weeks gesation

19
Q

Why is weight loss seen in the first few days after birth?

A

Breast milk is just coming in, catching up on colostrum
Catches up after a few days/ 1 week as more breast milk is being produced. Birth weight is normally regained by 10-14days.

20
Q

What weight gain is expected over the first year of a baby’s life

A

0-3 months –> 200g/week
3-6months –> 150g/week
6-9months –> 100g/week
9-12months –> 50-75g/week

Velocity of weight gain decreases
Adiposity is increasing

21
Q

What happens with adiposity in children

A

Increases during 1st then decrease
Adiposity rebound (rise in adiposity after a reduction) at 4-6years, continues throughout adolescence and most of childhood.
Different for males at end of puberty there then becomes a reduction in adiposity due to more muscle mass

22
Q

What are Tanner stages?

A

Stages of development to describe levels of sexual development in both boys and girls.
Follows pubertal growth spurt and sexual organ development.
Identifies a potential target future risk

Stage one –> Pre-pubertal
Stage five –> Full adult development, full sexual maturity

23
Q

Describe progression through adolescence in girls

A

Early
- Early puberty –> breast bud and pubic hair development, start growth spurt
- Mean age 11-12 years

Mid
- Mid-late puberty –> Menarche (starting of period), development of female body shape with fat deposition
- End of a growth spurt
- The timing of menarche and puberty is getting earlier, which can be linked to being overweight and a higher risk of type 2 diabetes and CVD. Can be

24
Q

Describe progression through adolescence in boys

A

Early
- Testicular enlargement, the start of genital growth

Mid
- Mid-puberty –> spermarche, voice breaks, start of growth spurt
- Mean age 14 years

Late
- End of puberty
- Continues increase in muscle bulk and body hair
- Continues later for boys

25
What does early puberty have links to for both genders
Angina, hypertension, type 2 diabetes. Some specific for women - gynaecological obstetrics
26
What can cause a delay in puberty?
- Poor nutrition - Chronic illness - Eating disorders - Severe psychological stress - Disorder of hypothalamic-pituitary-gonadal axis
27
What can cause early puberty?
- Obesity (girls) - Normal variants of pubertal time - Isolated thelarche (early breast development), premature adrenarche (early pubic hair development - Abnormalities of CNS that disrupt the hypothalamic-pituitary-gonadal axis - sex hormone control system
28
What measurements is taking for measuring growth? Why are these measurements taken?
- Weight - Length/ height - Head circumference Special measurements are a priority in child health programs -Child health records Looking for growth failure - Stunting (less than 90% expected value for height and age) - Undernutrition
29
What do growth charts show?
Plot weight for height and weight for age Different ones for boys and girls Can be BMI charts too Specific for breastfed infants - shows a slower normal growth pattern from 2-3 months - reduces the number of women who stop breastfeeding or who introduce formula due to crossing centiles - a different pattern of growth for formula-fed babies - standard chart for breastfed babies
30
How and why is obesity measured in children?
BMI centile charts - work out BMI and then plot on the chart, define obesity or overweight according to the centile cut-offs Different charts for different countries UK - National child measurement program - 95th centile --> obese - 91st centile --> overweight Measure of adiposity In children, the cut-off doesn't directly correspond with the risk of disease (T2D, CVD) like with adults. Can occur but is rare.
31
What is the adiposity rebound?
A large increase in adiposity after a decrease Often found ages 4-6 after the decrease from 1year
32
What are Z scores?
Used for monitoring children's growth in clinics. Allows more accuracy, for age/BMI. 0 green line is the median, corresponds to the 50th centile Minus Z scores show lower than the median Higher than the median shows overweight/obesity - 1 --> monitor weight, at risk of overweight - 2 --> overweight - 3 --> obese Shows who is at risk
33
What are some advantages of breastfeeding for babies?
- Immunity --> fewer hospitalisation, reduced infection risk, antibody transfer - Bonding - Complete nutrition, tailored for the baby, correct nutrients - Gut microbiome, gut bacteria stimulation - Less risk of allergies - No sterilisation risk - Correct temperature
34
What are some advantages of breastfeeding for mothers?
- Bonding - Reduce the risk of breast cancer - Cheaper, ready-made
35
When should weaning begin? What nutrients are at concern if weaning late?
Babies don't require complementary feed before 6 months, however, some people do. Shouldn't do before 4 months/ 17.5 weeks Breastfeeding in isolation should be encourages Gut is not developed or mature enough to cope with food Breastfed babies are using iron stores as iron isn't within breast milk Important to give iron-rich foods when weaning if after 6 months Vitamin D is also not in milk so needs to be supplemented, can have vitamin D drops. Not the same for formula as they have iron and vitamin D.
36
What factors influence if a mother will breastfeed? What percentage keeps breastfeeding?
High incidence associated with - Higher occupation - Higher education - >30 years - Ethnic minority backgrounds are more likely to breast feed - First-time mums At 6 weeks: 55% of mums BF At 6 months: 34% of mums BF At six weeks prevalence of exclusive breastfeeding was 23% and 6 months <1%
37
When can whole milk be given to a baby?
From 1 year Can move to semi-skimmed from 2 years, if eating and growing well
38
What is the dietary advice for preschool children? (1-3yrs)
- Important to keep a variety - Don't give food choices as it can make a child fussy, give them food don't ask. Prevents food variety, not good at trying new foods or picking healthier options - Provide water and milk to drink - avoid sugary drinks like juice - Family foods - Protein --> 14.5g/day / 1.1g/kg/day
39
What is the dietary advice for school-age children?
- Encourage 5 a day (very few meet this, 8%) - Increasing protein with age 4-6 --> 19.7g 7-10 --> 28.3g 11-14 --> 41-42g 15-18 --> 45-55g - Encourage not too much free sugar, especially with drinks, choose water or milk
40
What are some nutritional concerns for children?
- Obesity - Iron and vitamin D deficiency - Tooth decay - Increasing risk of chronic disease from high salt, and low fruit and veg
41
What is the national school measurement program?
Aims to record the height and weight of all children in reception and year 6 - informs local area of the prevalence of childhood obesity and planning and delivery for children - population-level data, trends, growth patterns etc - enable local authorities to set goals - inform parents and professionals/ public From 2008/9 many authorities will send parents the results, previously only on request Shows a jump in obesity between reception to year 6

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