Growth and Growth Disturbances Flashcards
What is the most common cause of short stature in children?
familial short stature
What is the definition of short stature?
height below the 3rd percentile
What is the difference bw growth and stature?
growth = velocity stature = height
What is the period of fastest growth in children?
puberty
What are the 5 stages of growth?
1) intrauterine/neonatal
2) infancy
3) toddler
4) childhood
5) adolescence
What is the most influential factor in intrauterine/neonatal growth?
maternal factors (obesity)
What is toddler aged and what is growth like during this time?
1) 12-36 months
2) fairly constant rate of about 3.9 inches/yr
What happens to a childs growth after age 3?
After age 3, kids follow a percentile channel that tracts toward genetic potential
When do growth spurts occur for girls and boys respectively during puberty?
1) girls - early in puberty
2) boys - late in puberty
On what two scales are an infant/toddler assessed on?
1) head circumference
2) weight for length
What is the first physical change in puberty for boys?
gonadal enlargement
What is the first physical change in puberty for girls?
thelarchy (breast development)
What does the American Academy of Pediatrics recommend for assessing length in infants/toddlers?
1) 3 times in the first 6 months of life
2) then every 3-4 months until 2 years of age
3) toddlers should be measured/weighed at least twice per year
What constitutes “normal” growth?
1) proportionality
2) values track after age 3
3) relative final height estimated and compared to AMPH
How does the growth chart add up as an index of overall health?
1) high sensitivity (you can tell if something is wrong)
2) low specificity (don’t know what the diagnosis is)
What are the three phases of human growth?
1) infancy
2) childhood
3) puberty
What influences growth the most during infancy?
entirely dependent on nutrition
What is catch up and catch down growth?
1) occurs bw 1-3 years of life
2) represents a readjustment to the genetic blueprint for growth
3) often a cause for concern by parents
4) usually benign
What is AMPH (adjusted mid parental height) and what is its limitations?
1) purpose is to estimate a target adult height for a given child
2) it adjusts the stature chart for a child’s parent’s height
3) limitation - its just a guide - not a final height predictor
How do you calculate AMPH?
1) find MPH (mid parental height)
2) add 6.5 cm for boys and subtract 6.5 cm for girls
What is the standard deviation for AMPH?
+/- 4 inches (10cm)
Why are men generally tallers than women?
more pre-pubertal growth
higher maximum peak growth rate
How do you calculate growth velocity?
(visit 2 - visit 1) / (time interval) = growth velocity
What is the difference between growth and height?
growth is relative
height is cumulative
What are growth chart red flags?
1) rounded off plotting (points at even years)
2) crossing channels after age 3
3) proportionality (low height for weight)
4) height falling off before weight
5) “overweight, overtall for age” common in exogenous obesity
What are the practical applications of the bone age assessments?
1) bone age value can be used to correct actual height (young bone age gives you more time to grow and visa versa)
2) growth correlates more with bone age than chronologic age
When is a head MRI or CT recommended on a kid?
with proven GH deficiency
What is the typical order of secondary sexual development in boys?
1) pubic hair
2) gonadal enlargement
3) growth spurt
4) voice change
5) penile growth
What is the typical order of secondary sexual development in girls?
1) pubic hair
2) menarche
3) growth spurt
4) breast budding
5) acne
what are the clinical features of classic constitutional delay?
1) borderline short stature
2) marked bone age delay (1-4 years)
3) normal predicted adult height
4) family history of constitutional delay
5) delayed puberty (after 14 in boys, 13 in girls)
6) late growth spurt
7) eventual attainment of adult height
What characterizes familial short stature?
markedly short, but otherwise healthy
falls within normal genetic expectations
What characterizes growth delay/constitutional delay of growth and puberty (CDGP)
biological age delayed 2 years
decline in growth velocity at ages 2-3
family history
what is psychosocial short stature due to?
1) deprivation
2) psychosocial dwarfism
What characterizes short stature due to psychosocial deprivation?
1) lack of nurturing
2) often results in a failure to thrive
3) children generally recover with sufficient nourishment and attention
What characterizes short stature due to psychosocial dwarfism?
1) abnormal parent-child interaction leads to functional hypopituitarism
2) when removed from home may exhibit catch-up growth
What are systemic diseases that can affect growth?
1) chronic anemia
2) cardiac disease
3) immune system diseases
4) renal disease
5) cystic fibrosis
What are some nutritional diseases that can affect growth and development?
1) IBD and celiac disease
2) chronic liver disease (insulin like GF)
3) malnutrition
4) malabsorption
What is the primary cause of growth failure?
malnutrition
What is turner syndrome?
missing or abnormal X chromosome
What are the symptoms/consequences of turner syndrome?
1) short stature
2) delayed sexual development
3) infertility
4) cardiovascular disease
5) renal anomalies
What characterizes prader-willi syndrome?
1) itrauterine and early post natal growth retardation
2) hypotonia
3) poor linear growth
4) delayed sexual development
5) development delay
6) hyperphagia - obesity
7) behavior problems
8) sleep and respiratory difficulties
What is Kleinfelter syndrome?
XXY
What are the symptoms of kleinfelters?
1) tall stature
2) less muscular
3) decreased level of testosterone
4) gynecomastia during puberty
5) infertile
What are the symptoms of Noonan syndrome?
1) short stature
2) delayed puberty
3) webbed neck
4) developmental delay may occur
5) heart defects
How is noonan sydrome diagnosed?
diagnosed via clinical assessment
What are the symptoms of silver-russell syndrome?
1) intrauterine growth retardation
2) small triangular face
3) short stature
4) macrocephaly
5) skeletal asymmetry
6) genital anomalies
What is Marfan syndrome?
abnormality in fibrilin-1 gene
What 3 systems are affected by marfans?
1) skeletal
2) eyes
3) cardiovascular
What are the characteristics of marfans?
tall stature
long, thin limbs and fingers
subluxation of the lens of the eye
