Growth and puberty Flashcards
What is size at birth determined by?
Maternal factors e.g maternal weight and placental nutrient supply.
Placental nutrient supply is dependent on an adequate maternal diet.
Placental nutrient supply modulates fetal growth factors such as insulin like growth factor 2, human placental lactogen and insulin
What other phrase is used to describe failure to thrive?
What is it?
Faltering growth
It is suboptimal weight gain
In what period of a child’s life is ‘faltering growth’ said to occur?
If faltering growth is prolonged what can this result in?
In infants and young children
It can result in reduction in height or length (stunting) and reduction in head growth and may be associated with delayed development
How often should babies be weighed in their first year of life?
After their first year of life?
They should be measured within the first week (usually at day 5)
No more than once a month in the first 6 months
No more that once every 2 months in the second 6 months of life
Routinely at 12-13 month immunisations
After their first year of life they should be measured no more than once every 3 months
When you are looking at a growth chart what are the significant points you should remember?
That a centile space is the distance between 2 centile lines - So you should count the number of spaces moves, not the number of lines.
If the dot is within 1/4 above or below a line you say that a child is within that percentile.
If the dot is in the middle of the band you describe the child as being between the 2 lines.
What are concerning features on a child’s growth chart?
If they move across 2 or more centile spaces over time
If the child’s weight in below the 0.4th centile
If the child has more than 10% weight loss (especially in the first week - max expected is 10%)
How are pre-term babies adjusted for on growth charts? How long are adjustments made for?
A line is drawn back the number of weeks they were premature.
Adjustments are made until the child is 2 years of age
If weight faltering is confirmed a dietary history is taken. What should this include?
Milk history Age of weaning Types of food eaten now Mealtime routine and eating and feeding behaviours A food diary for 3 days Ideally watching the child eat
How often should toddler’s eat?
They should eat 3 meals and 2 snacks each day
What are some causes of inadequate intake which lead to growth faltering in children?
Environmental: - Inadequate availability of food (either due to feeding problems, problems with shopping, lack of regular feeding times) - Psychosocial deprivation - Neglect or child abuse Underlying pathology - Impaired suck or swallow - Chronic illness leading to anorexia
In GENERAL TERMS what are the 5 different causes of growth faltering?
Inadequate intake Inadequate retention Malabsorption Failure to utilise nutrients Increased requirements
What are some causes of inadequate retention which lead to growth faltering in children?
Vomiting
Severe GORD
What are some causes of malabsorption which lead to growth faltering in children?
Coeliacs disease, CF, Cow’s milk protein allergy, cholestatic liver disease, shirt gut syndrome, post-necrotising enterocolitis
What are some causes of failure to utilise nutrients which lead to growth faltering in children?
Chromosomal disorders e.g down syndrome, intrauterine growth restriction or extreme prematurity, congenital infection, metabolic disorders, storage disorders, amino and organic acid disorders
What are some causes of increased food requirements which lead to growth faltering in children?
Throtoxicosis, CF, malignancy, chronic infection e.g HIC/immune deficiency, congenital heart disease, chronic kidney diseae
What is post-necrotising enterocolitis?
A condition seen in pre-term neonates
Seen in the first few weeks of life
The wall of the intestine is invaded by bacteria, which cause local infection and inflammation that can ultimately destroy the wall of the bowel
If organic disease is the cause of the weight faltering what signs may be present?
Dysmorphic features
Signs suggestive of malabsotpion (distended abdomen, thin buttocks, misery)
Signs suggestive of chronic respiratory disease
Signs of heart failure
Evidence of nutritional deficiencies (koilonychia, angular stomatitis)
What is the usual management of weight faltering?
Health visitors - food diaries and direct observation of food eating
Paediatric dieticians can advice on how to increase calorie intake
Speech and language can get involved with patient who have eating disorders
Social services and psychologists may need to get involved
What is microcephaly?
What are some causes of microcephaly?
Occipital-frontal circumference <2nd centile
Causes include:
- Normal variation e.g small child with small head
- Familial e.g parents with small head
- Congenital infection
- Perinatal brain injury e.g hypoxic ischaemic encephalopathy
- Fetal alcohol syndrome
- Syndromes: Patau
- Craniosynostosis
What is short stature usually defined as?
How may short stature be defined as otherwise?
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How is a child’s genetic expected height calculated?
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What is skeletal dysplasia?
It is the medical term for dwarfism. It is a disorder of the development of bone and cartilage.
What chromosomal disorders are associated with short stature?
Down syndrome
Turner syndrome
Russel-Silver syndrome
What are the 5 chronic illnesses that may present with short stature?
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What endocrine disorders may result in short stature?
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How much milk does a baby require at different stages of life?
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