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Y4: Paeds > Growth and nutrition > Flashcards

Growth and nutrition Flashcards

1
Q

Treatment for constitutional delay in growth and puberty

A

SOMETIMES small dose testosterone purely for QOL/psychological reasons to speed up process/initiate puberty

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2
Q

Treatment for short stature due to SGA/extreme prematurity

A

GH may be indicated if insufficient catch-up growth by 4yrs

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3
Q

If overweight children are relatively short (centile-wise) this suggests…

A

endocrine problem

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4
Q

If overweight children are relatively tall (centile-wise) this suggests…

A

nutritional obesity

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5
Q

Treatment for short stature due to growth hormone deficiency

A

biosynthetic GH given SC, usually daily

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6
Q

What is laron syndrome characterised by?

A

GH insensitivity (due to defective GH receptors): high GH, low IGF-1

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7
Q

How to calculate mid-parental height

A

MPH = (mother’s height + father’s height in cm)/2

+7cm if male
or -7cm if female

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8
Q

How to calculate target parental range

A

TPR = MPH +/- 10cm if male, or +/- 8.5cm if female

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9
Q

How to calculate height velocity

A

change in height/time

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10
Q

How long should prematurity be taken into account for when assessing growth?

A

1-2yrs depending on degree of prematurity

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11
Q

Criteria for weight faltering

A
  1. a sustained drop down 2 centile spaces (crossing 2 lines)
  2. weight <0.4th centile
  3. BMI <2nd centile (in children >2yrs)
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12
Q

What do tanner stages describe?

A
  • stages of puberty from prepubertal/preadolescent to adult

- 5 stages for breast, pubic hair and male genitals

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13
Q

1st sign of puberty in females and when it occurs

A

breast bud development, between 8.5-12.5yrs

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14
Q

1st sign of puberty in males

A

testicular enlargement to >4ml

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15
Q

Sequence of puberty in females

A
  1. breast development
  2. pubic hair growth and rapid growth spurt
  3. menarche
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16
Q

Sequence of puberty in males

A
  1. testicular enlargement
  2. pubic hair growth
  3. rapid growth spurt
17
Q

What is premature sexual development?

A

development of secondary sexual characteristics <8yrs in females, or <9yrs in males

Includes: precocious puberty and isolated development of breasts/pubic hair/menarche

18
Q

Types of precocious puberty

A

Gonadotrophin-dependant (central (pituitary-driven) ‘true’ precocious puberty)

  • premature activation of hypothalamic-pituitary-gonadal axis
  • sequence is normal (consonant)

Gonadotrophin-independent (pseudo ‘false’ precocious puberty)

  • excess sex steroids from outside pituitary gland
  • sequence is abnormal (dissonant)
19
Q

How are the types of precocious puberty distinguished from one another?

A
  • sequence of puberty (consonant or dissonant)

- gonadotrophin levels (LH/FSH)

20
Q

What is seen in true precocious puberty

A
  • LH ++
  • FSH +
  • consonant puberty
21
Q

What is seen in false precocious puberty

A
  • low LH
  • low FSH
  • dissonant puberty
22
Q

What is true precocious puberty usually due to?

A

Girls: premature onset of normal puberty, idiopathic/familial

Boys: often pathological cause, brain tumour (usually pituitary: craniopharyngioma)

23
Q

Assessing precocious puberty in females

A
  • true PP fairly common - usually idiopathic/familial
  • if dissonant (false), consider CAH/adrenal tumours
  • US of ovaries and uterus
  • ?cranial MRI
  • can do bone age measurement
24
Q

Assessing precocious puberty in males

A
  • true PP is uncommon
  • exclude pathological causes - craniopharyngioma
  • bilateral testicular enlargement >4ml suggests true PP
  • prepubertal testes suggest false PP e.g. adrenal tumour, CAH
  • unilateral enlarged testis suggests gonadal tumour
  • cranial MRI
  • can do bone age measurement
25
Q

Treatment for precocious puberty

A

MAY involve:

  • GnRH analogues: to suppress gonadotrophin release
  • inhibitors of androgen or oestrogen production or action
26
Q

What is delayed puberty?

A

absence of pubertal development by 13y in females (or no periods by 15y), or 14y in males

27
Q

Consequences of vit A deficiency

A
  • increased susceptibility to infections (espeically measles)
  • night blindness, dry eyes/excessive blinking due to xeropthalmia
28
Q

Consequences of vit D deficiency

A
  • rickets

- hypocalcaemia

29
Q

Signs of vit D deficiency

A
  • sensation like pressing pingpong ball when pressing back of head (craniotabes)
  • frontal bossing of skull
  • rachitic rosary (palpable costochondral joints)
  • widened wrist and ankle joints
  • Harrison’s sulcus
  • bowed legs
  • poor growth/short stature
  • features of hypocalcaemia: seizures, neuromuscular irritability, apnoea, stridor, cardiomyopathy
30
Q

Definitions of overweight and obese in children

A

overweight: BMI >91st centile
obese: BMI >98th centile

31
Q

When to look for non-nutritional cause of obesity, and what to look for

A
  • obese and short: endogenous cause e.g. Cushing’s, hypothyroidism
  • LD/dysmorphic: syndrome e.g. Prader-Willi
  • severely obese <3y: gene defect e.g. leptin deficiency

Y4: Paeds (7 decks)

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