Growth and puberty

Question 1

what are factors that can influence q child’s growth

Answer 1

genetic potential 
nutritional intake 
endocrine rgulation 
comorbidities 
emootional health

Question 2

how do you assess growth in the UK

Answer 2

measure height (>2yo) OR length (<2yo) + weight + head circumference (in infants)

Plot on UK-WHO chart

Different charts for girls, boys, trisomy 21

Question 3

when do you correct growth for prematurity until

Answer 3

until 2 yo

Question 4

when do you start tracking centiles for babies

Answer 4

from birth

Question 5

what about centiles will concern you in a baby

Answer 5

if the baby crosses 2 or more centile iness

Question 6

how much of their birthweight is it normal for babies to lose in their first 10 days of life

Answer 6

10% max

Question 7

what is the order of development of puberty in girls

Answer 7

thelarche (breast development) > adrenarche (pubic hair) > menarche (menstruation)

Question 8

what do you call breast development

Answer 8

thelarche (mnemonic: tette)

Question 9

what do you call pubic hair development

Answer 9

adrenarche (Axillary, pubic hair growth)

Question 10

when i the average age for menarche

Answer 10

12.5 years

Question 11

what is the rage of age for puberty in females, and the average age

Answer 11

8-13 yo

average: 11

Question 12

when does puberty develop in males compared to females

Answer 12

18 months after females

Question 13

what is precocious pubry

Answer 13

secondary sex characteristics developing at <8 years in girls and <9 years in boys

Question 14

what are causees of precocious puberty

Answer 14

Central (GnRH dependent)

• idiopathic
• familial
• CNS tumour (e.g. optic glioma with NF1)
• developmental abnormality
• encephalitis, brain abscess
• hydrocephalus

Peripheral (GnRH independent)

• increased androgen secretion (CAH, leidig cell adenoma)
• gonadotrophin secreting tumour
• Ovarian cyst
• McCune-Albright syndrome
• iatrogenic / exogenous sex hormones

Question 15

What are causes of global developmental delay

Answer 15

Antenatal:

• GENETIC (Downs, NF, Fragile X, Duchenne muscular dystrophy, TS)
• METABOLIC/ENDO (hypothyroid, PKU, MCAD)
• Toxin: drugs, alcohol

Perinatal/PN:

• infection
• trauma/ischaemia> cerebral palsy
• neglect

Question 16

what are causes of specific delay - gross motor

Answer 16

spina bifida

cerebral palsy

Question 17

what are causes of specific delay - fine motor and vision

Answer 17

retinoblastoma

retinopathy of premturity

Question 18

what are causes of specific delay - speech and language

Answer 18

hearing problems (otitis media with effusion, deafness)

Question 19

what are causes of specific delay - social

Answer 19

autism

Fragile X

Question 20

What is the broad initial mx if you are suspecting NAI

Answer 20

1. Gather information from other professionals who may know the child
2. Check if the child is on the child protection register
3. Contact senior / lad pediatrictian in child protection
4. Take photographs if necessary
   Document everything carefully

Question 21

What do you do if suspecting NAI

Answer 21

Inform parents of what is happening

but do NOT accuse anybody of harming the child

Question 22

Who do you refer to if suspecting child abuse

Answer 22

• Refer to SOCIAL SERVICES ALL cases of suspected abuse or neglect
• Refer to police if allegations of rape/sexual assault, severely injured child from abuse, perpetrator is threatening to remove the child from the hospoital where the child is believed to be in danger

Question 23

delayed puberty in boys

Answer 23

no testicular development by 14

Question 24

delayed puberty in girls

Answer 24

no telarche by 13/ no menarche by 15