growth evaluation Flashcards
When should height and weight be measured
birth, 2-4 days, 1, 2, 4, 6, 9, 12, 15, 18, 24 months and every year thereafter through age 21
- Define “worrisome growth.”
- height: short stature (heigh below -2 SD for age and gender or below 2 SD of the midparental target height), Dwarfism (height below -3SD for age), Midget (dwarf with normal body proportions). 2. growth velocity: abnormally slow linear growth velocty dropping across two major centile lines on growth chart
Calculate genetic height potential for boys and girls
Boys: (mom heigh + 5in + dad height)/2. Girls: (dad height - 5in + mom height)/2
Skeletal maturation and height
There is a direct correlation between the degree of skeletal maturation and the time of epiphyseal closure. The greater the bone age delay, the longer the time before epiphyseal fusion ceases growth
Body proportions over time
Upper to lower body ratio starts at 1.7 at birth and falls to 1.0 by 10 years of age.
Arm span over time and average male/female arm span
Arm span is shorter than height in boys before 10 – 11 years and girls before 10 to 14 years after which arm span exceeds height. Avg adult male has arm span 5.2 cm > ht and adult female 1.2 cm >ht
Define constitutional growth delay
Characterized by growth deceleration during first 2 years of life followed by normal growth paralleling lower percentile curve throughout prepubertal years
Final height in constitutional growth delay
Generally end up along lower end of normal height range for families. Skeletal maturation is delayed but catch up growth is achieved by late puberty and fusion of growth plates is delayed.
Constitutional growth delay family history
Polygenic trait- positive family in 60-80% of pts
Treatment of constitutional growth delay
Can treat boys with testosterone if bone age ≥11-1/2 years to avoid compromising final height. Can treat girls with estrogen (less common)
Define familial short stature
Children who have normal growth velocity and height that are within normal limits for parent’s heights. Initially will have decrease in growth rate between 6 and 18 months of age. Some families may have tubular bone alterations
Define failure to thrive
Infants/young children with deceleration of weight gain to a point <3%. Fall in weight across 2 or more major percentiles.
Most common causes of failure to thrive
poor nutrition and psychosocial factors
Which condition does failure to thrive look like on a growth chart?
constitutional growth delay
Define nutritional growth retardation
Linear growth stunting from poor weight gain in children over 2 years of age. May be secondary to systemic illnesses such as celiac dz, IBD, stimulant meds.
What condition does nutritional growth retardation look like on growth chart
constitutional growth delay and constitutional thinness
Define children born small for gestational age
Less than -2 SD for birth weight or length (less than 2.3 percentile)
Etiologies of children born small for gestational age
- Maternal – infection, nutritional deficiencies, uterine abnormalities, smoking, alcohol, drugs. 2. Placental – Previa, abruption, infarcts, structural, multiple gestation. 3. Fetal – Chromosomal abnormalities, metabolic, infections,
malformations1. Maternal – infection, nutritional deficiencies, uterine abnormalities, smoking, alcohol, drugs. 2. Placental – Previa, abruption, infarcts, structural, multiple gestation. 3. Fetal – Chromosomal abnormalities, metabolic, infections,
malformations
Which growth curves are used to classify infants as small for gestational age
Usher and McLean growth curves-
Catch up growth in infants born small for gestational age
Most healthy infants born SGA achieve catch-up in height by age 2 years. Most catch up growth is achieved within 6 months of birth. 10-15% will remain short as adults. Final height may be compromised by early puberty
Pathophys of SGA
Fetal response to prolonged nutritional deficiencies late in gestation may be to prematurely reset to a slow growth rate with a degree of resistance to GH, IGF-1, and insulin
Treatment for SGA children
growth hormone is approved for SGA children who fail to have catch up growth by 2 years. May increase final heigh by avg of 3 inches
Hormonal causes of worrisome growth
Usually weight is spared. Hypothyroidism, GH/ IGF-1 abnormalities, cushing syndrome, rickets
hypothyroidism in children vs adults
Many clinical features that are seen in hypothyroid adults are lacking in children
Causes of congenital GH deficiency
Hypothalamic-pituitary malformations: holoprosencephaly, isolated cleft lip or palate, septo-optic-dysplasia, optic nerve hypoplasia, empty sella syndrome
Causes of acquired GH deficiency
trauma, CNS infection, hypophysitis, CNS tumors, Cranial irradiation
GH deficiency growth chart
abnormal growth velocity
Clinical sx and signs of GH deficiency
decreased muscle, increased subq fat around trunk, immature face for age, prominent forehead, depressed midface, small phallus in males, midline facial defects, prolonged jaundice or hypoglycemia in newborn period
Evaluation for GH deficiency
- bone age. 2. low IGF-1 (note will be low in underweight children regardless of GH status). 3. Stimulating tests- clonidine, arginine, glucagon, L-dopa. Never draw random GH level
What causes short stature in Turner syndrome
Haploinsufficiency of SHOX genes cause skeletal and growth abnormalities
What causes short stature in Prader Willi syndrome
GH deficiency
What causes short stature in Noonan syndrome
abnormal GH post-receptor signaling
Stature in Turner syndrome
Virtualy all girls with turner syndrome have short stature. Final heigh is about 20cm less than target height, if untreated. Weight is low to normal
Treatment of Turner syndrome
Growth hormone improves growth and final adult height. Early treatment is important
Describe skeletal abnormalities in Turner syndrome
short stature, increased carrying angle of forearms, short neck, micro or retrognathia.
Describe lymphatic abnormalities in Turner syndrome
low hairline, webbed neck, lymphedema
Describe cardiac, renal, reproductive, endocrine and neuro abnormalities in Turner syndrome
cardiac: bicuspid aortic valve, coarctation. Renal: horeshoe kidney. Repro: ovarian insufficiency. Endocrine: hypothyroid, celiac dz. Neuro: non verbal learning disability. Also otitis media and hearing loss
Evaluation of worrisome growth
- bone age (left hand and wrist). 2. screening labs: metabolic panel, CBC, UA, karyotype in girls, TSH, IGF-1. 3. If nutritional: check ESR, tissue transglutaminase Ab and IgA
FDA approved uses of recombinant human GH
GH deficiency, chronic renal insufficiency, adult GH deficiency, Turner syndrome, Prader Willi syndrome, small for gestational age, idiopathic short stature, SHOX deficiency, Noonan syndrome
Potential side effects of GH
slipped capital femoral epiphysis, pseudo tumor cerebri
