growth assessment in children Flashcards
What are the percentile curves?
Assesses normality of growth
Distribution of heights through a given age and sex
Mean height shown by 50th line
Abnormality= <3 or >97
What can percentile curves tell us?
0-2 years- end of intrauterine events (based on size and health of mother, health of fetus, efficiency of placenta)
There’s a line of discontinuity at 2 yrs due to change from lying down to standing (spinal compression)
Childhood- determined by genetic background, interaction of growth hormones w peripheral hormones, growth plates at end of long bones, environment and nutrition, chronic ill health= growth suppression
Puberty- increased secretion of growth and sex hormones (oestrogen and testosterone), boost growth of back (fuse growth plates)
How is a parent determined height percentile calculated?
Height in cm
Boy- mum+13cm + dad = x
x/2 = height percentile
Girl- dad-13cm + mum = x
x/2 = height percentile
Should fall 10cm either way
What should history taking include?
Pregnancy details Birth weight of child Any chronic ill health/med during childhood Social details Parent height Sibling/grandparent height Neglect and abuse
How do you physically examine a child?
Stature Hands (size, shape, pattern of creases) Carrying angle of arms (Downs [one crease], Marfans [tall, long fingers], Turners [swollen, XO chromosome in girls] syndrome Neck, face Palate (underlying pituitary problems- high arched) Midline Chest (respiratory, heart, abdomen, CNS) Sexual development
How should height be measured?
Remove shoes and socks
Use a wall mounted stadiometer
Heels against base plate in same vertical plane as instrument
Hands held loosely at sides
Head in horizontal plane
Take breath in and gentle pressure to mastoid processes to minimise spinal compression
Breath out and measure
What additional information can be taken?
X ray of left hand and wrist to measure maturity (bone age estimation)
Appearance and degree of fusion of epiphysis
Unclothed weight and relationship to height
Skinfold thickness
Short and fat- endocrine problems
Sitting height to calculate leg and back length
Discrepancy between short back and long leg height= lack of sex hormones
Long back and short leg= short limbed dwarfism- autosomal dominant inheritance
Head circumference
How are velocity percentile curves measured?
Cm/year
Observe distribution of rates of growth in small nos of children measured longitudinally from year to year
Average- variations in height velocity in 50th percentile
Short but growing normally- 25th percentile
Tall but growing normally- 75th
Abnormal- <25th and >75th and <4cm velocity year
At least 2 plots at 6 month intervals
What does an average height:age growth chart look like?
Rapid infancy
Slow and steady childhood
Rapid puberty
What relevance is the 50th percentile in relationship to the height of a child?
Mean height centile for 50% of population- if on it= average height for age
What limitations are there with current growth charts?
Not available for ethnic minorities
Don’t take into account gradual population changes
What relevance is this to dentistry?
Identification of gross pathology- referral to appropriate centre/neglect
Orthodontic planning- coincide w puberty growth spurt
Planning for orthognathic surgery/implants- only when growth complete
Fitness for GA
