Growth Faltering - 121

Question 0

What is the main contributor to faltering growth?

Answer 0

Poor feeding techniques - e.g. suckling and limited parental support

Question 1

What are the 4 phases of growth in childhood?

Answer 1

Fetal
Infantile
Childhood
Pubertal

Question 2

According to population studies what % of children will fall through 2 centiles on a growth chart? Of that percentage what percentage will have an organic root cause to faltering growth and what percentage will be due to neglect?

Answer 2

~

Question 3

What does growth most heavily rely on during phases I and II of development? (Fetal and infantile phases). What happens if this factor is inadequate?

Answer 3

Nutrition. If it is inadequate/limited faltering growth is seen.

Question 4

In phases III and IV (childhood and pubertal) what does growth most strongly rely on?

Answer 4

Hormones.

Question 5

What is asymmetrical intrauterine growth and when might it be seen?

Answer 5

This is when during fetal development the fetus does not receive adequate nutrition. The cerebrum is spared which implies later placental dysfunction. The baby would appear very small with normal head growth but poor abdominal growth.

Question 6

How would a baby with foetal alcohol syndrome present?

Answer 6

Low birth weight, faltering growth,developmental delay, behavioural problems. Distant facial characteristics: small eye openings, smooth philtrum, thin upper lip, upturned nose, ‘railroad ears’.
The main effect of FAS is permanent CNS damage.

Question 7

How does growth hormone cause growth in children?

Answer 7

It promotes protein synthesis, inhibits fat and carbohydrate formation and is essential for the proliferation of chondrocytes at the epiphyseal plate necessary for liner growth.
Children with GH deficiency have a short stature and tend to be overweight.

Question 8

How does thyroid hormone influence growth? What will children with hypothyroidism exhibit?

Answer 8

It influences the effect of GH and helps promote cartilage and bone formation. Children with hypothyroidism will have delays in physical and intellectual growth.

Question 9

What are the most influential factors during the pubertal phase of growth?

Answer 9

GH and testosterone/oestrogen

Question 10

What happens during adrenarche and gonadarche?

Answer 10

Increased adrenal androgen secretion. During gonadarche (onset of puberty) there is an increase in nocturnal secretion of gonadotropin releasing hormone (GnRH). This leads to an increase in LH and FSH secretion from the pituitary and increased oestrogen/testosterone secretion in females and males respectively.

Question 11

What is Turner’s syndrome and how would you recognise it?

Answer 11

Mild skeletal dysplasia resulting in poor growth in phases II and III. There is a lack of puberty due to gonadal dysgenesis and inadequate tissue response to normal levels of GH. Turner’s only affects females and the karyotype is a single X chromosome.

Question 12

Name 2 pathological causes of tall growth

Answer 12

Marfens - mutation in chromosome 15.

Klinefelters - extra X chromosome in males.

Question 13

Name 5 different types of neglect

Answer 13

Emotional
Abandonment
Medical
Nutritional
Educational
Pyhsical

Question 14

What possible causes must be considered with faltering growth?

Answer 14

Excessive caloric utilisation (e.g. hyperthyroidism, chronic disease)
Inadequate calorie intake
Inadequate absorption
Psychosocial factors (e.g. parental depression)
Other medical causes

Question 15

What is a patent ductus arteriosus and what are some of the problems it can cause?

Answer 15

After birth the ductus arteriosus usually closes and fibroses. Sometimes this is not the case and it remains patent. The severity of the consequence depends on the size. Can cause L atrium and ventricle dilation, systolic-diastolic murmur, tachycardia, pulmonary oedema, hepatomegaly.

Question 16

What is the mechanism by which PDA causes hepatomegaly?

Answer 16

There is a ‘backing up’ of pressures into the IVC and hepatic veins. With this increasing pressure the liver becomes enlarged.

Question 17

What is vasoconstriction of skin vessels due to?

Answer 17

Catecholamine activation (hormones made by the adrenal glands, e.g. dopamine, adernaline, noradrenaline).

Question 18

What causes catecholamine activation?

Answer 18

• Blood loss
• acute illness
• low cardiac output

Question 19

What is aortic incompetence?

Answer 19

Leakage of blood back through the aortic valve of the heart

Question 20

What is the mechanism by which PDA can cause pulmonary oedema?

Answer 20

Pressure in the left atrium rises because there is too much blood coming back into the left atrium. It cannot completely empty in L ventricle, causing ventricular pressure to rise. This increases pulmonary pressure and causes blood to pool in pulmonary vessels. Fluid leaks into spaces between tissues of the lungs and accumulates.