Growth and nutrition Flashcards
Treatment for constitutional delay in growth and puberty
SOMETIMES small dose testosterone purely for QOL/psychological reasons to speed up process/initiate puberty
Treatment for short stature due to SGA/extreme prematurity
GH may be indicated if insufficient catch-up growth by 4yrs
If overweight children are relatively short (centile-wise) this suggests…
endocrine problem
If overweight children are relatively tall (centile-wise) this suggests…
nutritional obesity
Treatment for short stature due to growth hormone deficiency
biosynthetic GH given SC, usually daily
What is laron syndrome characterised by?
GH insensitivity (due to defective GH receptors): high GH, low IGF-1
How to calculate mid-parental height
MPH = (mother’s height + father’s height in cm)/2
+7cm if male
or -7cm if female
How to calculate target parental range
TPR = MPH +/- 10cm if male, or +/- 8.5cm if female
How to calculate height velocity
change in height/time
How long should prematurity be taken into account for when assessing growth?
1-2yrs depending on degree of prematurity
Criteria for weight faltering
- a sustained drop down 2 centile spaces (crossing 2 lines)
- weight <0.4th centile
- BMI <2nd centile (in children >2yrs)
What do tanner stages describe?
- stages of puberty from prepubertal/preadolescent to adult
- 5 stages for breast, pubic hair and male genitals
1st sign of puberty in females and when it occurs
breast bud development, between 8.5-12.5yrs
1st sign of puberty in males
testicular enlargement to >4ml
Sequence of puberty in females
- breast development
- pubic hair growth and rapid growth spurt
- menarche
Sequence of puberty in males
- testicular enlargement
- pubic hair growth
- rapid growth spurt
What is premature sexual development?
development of secondary sexual characteristics <8yrs in females, or <9yrs in males
Includes: precocious puberty and isolated development of breasts/pubic hair/menarche
Types of precocious puberty
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)
How are the types of precocious puberty distinguished from one another?
- sequence of puberty (consonant or dissonant)
- gonadotrophin levels (LH/FSH)
What is seen in true precocious puberty
- LH ++
- FSH +
- consonant puberty
What is seen in false precocious puberty
- low LH
- low FSH
- dissonant puberty
What is true precocious puberty usually due to?
Girls: premature onset of normal puberty, idiopathic/familial
Boys: often pathological cause, brain tumour (usually pituitary: craniopharyngioma)
Assessing precocious puberty in females
- 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
Assessing precocious puberty in males
- 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
Treatment for precocious puberty
MAY involve:
- GnRH analogues: to suppress gonadotrophin release
- inhibitors of androgen or oestrogen production or action
What is delayed puberty?
absence of pubertal development by 13y in females (or no periods by 15y), or 14y in males
Consequences of vit A deficiency
- increased susceptibility to infections (espeically measles)
- night blindness, dry eyes/excessive blinking due to xeropthalmia
Consequences of vit D deficiency
- rickets
- hypocalcaemia
Signs of vit D deficiency
- 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
Definitions of overweight and obese in children
overweight: BMI >91st centile
obese: BMI >98th centile
When to look for non-nutritional cause of obesity, and what to look for
- 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
