Growth Disorders Flashcards
What methods do we use to assess growth?
- Height/length and weight
- Growth charting
- Midparental height & target centiles
- Growth velocity
- Bone age
- Pubertal Assessment i.e. Tanner’s Stages
How is growth charted?
Age vs height graphs with pre-drawn centiles.
You want to see a child is growing within the centiles and at a normal velocity (i.e. not crossing centiles)
There are also condition-specific charts for illnesses that affect growth such as Turner’s syndrome of Down’s Syndrome
What are the parts of Tanner’s pubertal assessment?
Breast size 1-5 Genital Development 1-5 Pubic Hair 1-5 Axillary Hair 1-3 Testicular volume 2-20ml
The hairs are examples of secondary sexual characteristics (i.e. brought on by androgens not sex steroids)
Describe a pattern of normal growth from birth to 20?
- High height gain at birth decreasing through infancy
- Plateu/steadily decreasing height gain during childhood
- Huge growth spurt during puberty (girls before boys)
What factors are important when considering growth patterns?
- Race
- Gender
- Parental Heights
- early/late onset puberty
- Poor health
- Socio-economic factors (e.g. poor nutrition)
- Psycho-social deprivation (Can profoundly stunt growth)
What are the earliest signs of puberty & when does it start?
Breast budding in girls and testicular enlargement in boys.
Normal puberty occurs at 8-13 in girls and 9-14 in boys
How does obesity affect growth and puberty?
Obese children tend to hit puberty earlier, so growing taller earlier.
But will stop growing earlier and so end up the same height as non-obese children
What are the indications for referal (in reference to growth)?
- Off centiles in height
- Crossing centiles (abnormal velocity)
- Chronic disease stunting growth
- Obvious dysmorphic features
- Early/late puberty
What can cause childhood obesity?
- Simple obesity
- Drugs e.g. insulin or steroids, antithyroid drugs
- Syndromes e.g. Downs, Praeder Willi
- Endocrine disorders e.g. hypothyroidism
- Hypothalamic damage (loss of appetite control)
How do you treat childhood obesity?
Diet
Exercise
Psychological Input
What are the normal non-pathological causes for a short stature?
- Familial (your families just short)
- SGA (small for gestational age)
- Constitutional delay in growth and puberty (CDGP)
What is CDGP?
Mainly occurs in boys so look for a family history from brothers/dad
Its where you go through puberty a year or two late and have a bone-age delay. Perfectly normal and not worrying.
What are the non-normal causes of a short stature?
- Undernutrition
- Chronic illness
- psychosocial
- Hormonal (hypothyroidism or GH deficiency)
- Syndromes (turner or Prader-Willi)
What could cause delayed puberty? (mainly in boys)
- CDGP
- Gonadal Dysgenesis (e.g. Turner 45X or Klinefelter 47XXY
- Chronic disease
- Impaired HPG axis
- Cryptorchidism (no testes) or Testicular irradiation (cancer patient)
What are the types of early puberty? (mainly girls)
- Infantile or premature thelarche (breast buds), the rest of puberty occurs at the normal age
- Exaggerated adrenarche
- Precocious pseudopuberty (Early adrenarche)
- Premature Menarche
- True Central Prococious Puberty
