Growth Faltering, 121

Question 1

Hormones secreted by the anterior pituitary gland.

Answer 1

FSH.
LH.
ACTH.
TSH.
Prolactin.
Endorphin. (not growth related)
Growth Hormone

Question 2

Effect of GH

Answer 2

via IGF1, stimulates chondrocytes to undergo mitosis.

Question 3

Normal levels of PTH

Answer 3

stimulates osteoblast activity.

Question 4

High levels of PTH

Answer 4

stimulates osteoclast activity

Question 5

Phases of growth

Answer 5

Foetal.
Infantile.
Childhood.
Pubertal.

Question 6

What stops growth?

Answer 6

Oestrogen causes fusion of epiphyseal plates.

Question 7

How does growth stop in boys?

Answer 7

testosterone is converted into oestrogen, causing fusion of epiphyseal plates.

Question 8

Why is testosterone not given to boys who have faltered growth?

Answer 8

testosterone is converted into oestrogen and causes fusion of epiphyseal plates, therefore causing an early growth cessation.

Question 9

oxandralone

Answer 9

steroid given to boys to encourage growth. It is not converted into oestrogen, therefore will not stop bone growth.

Question 10

What is the main contributor to growth faltering in children under 2?

Answer 10

Poor feeding.

Question 11

Twin-twin transfusion

Answer 11

one twin receives a disproportional amount of blood. Growth is not equal.

Question 12

Foetal Alcohol Syndrome

Answer 12

low birth weight.
growth faltering.
developmental delay.
dysmorphic facial features.

Question 13

Main causes of foetal and childhood faltering

Answer 13

Nutrition (maternal/feeding).
Genetic.
Environment.

NB. Hormonal influences do not really have an effect - a child with low GH will have a normal birth weight and first year.

Question 14

4 Chronic conditions causing faltering

Answer 14

Coeliac.
Down’s.
Cystic Fibrosis.
Turner’s.

Question 15

How does Cystic Fibrosis cause faltering?

Answer 15

Increased secretions (in airways AND GI tract) - malabsorption in GI.

Question 16

Pubertal faltering is mainly caused by

Answer 16

oestrogen/testosterone levels.

Question 17

Adrenarche

Answer 17

adrenal androgen secretion - pubic and axillary hair.

Question 18

Gonadarche

Answer 18

GnRH secretion - LH/FSH - Testosterone/oestrogen - gonad development.

Question 19

Target Centile Range (how to calc)

Answer 19

average parents’ height, +7 for boys, -7 for girls. +/-8.5cm gives range.
94% expected to be in range.

Question 20

4 key factors in growth

Answer 20

Genetics.
Hormones.
Environment/Emotional/Economic.
Nutritional.

Question 21

Do precocious pubescent children end up taller?

Answer 21

NO. early initial growth, early epiphyseal fusion, shorter adults.

Question 22

Child with reduced weight to height ratio. Acute/chronic malnutrition?

Answer 22

Acute

Question 23

Child with normal height:weight ratio, but decreased height for age. Acute/chronic malnutrition?

Answer 23

Chronic

Question 24

Signs/symptoms of Marasmus

Answer 24

thin flaccid skin.
reduced fat and muscle.
alert, irritable.

Question 25

Signs/symptoms of Kwashiokors

Answer 25

``` Oedema. flaky dermatitis. thin, dry hair. hepatomegaly. apathy, misery, lethargy. ```

Question 26

1st line investigations for growth faltering

Answer 26

``` FBC. Iron. Vitamins. Real function. LFT. Bone age. Thyroid. ```

Question 27

normal weight gain for 0-3/12

Answer 27

200g/week

Question 28

normal weight gain for 4-6/12

Answer 28

150g/week

Question 29

normal feed for 0-3/12

Answer 29

150-200ml/kg/day

Question 30

normal feed for 4-6/12

Answer 30

140ml/kg/day

Question 31

normal feed for 1+ year

Answer 31

600ml/day, plus water

Question 32

Colostrum composition (compared to normal breast milk)

Answer 32

``` 9 X protein than normal. less fat. 80% Whey. 20% Casein (phosphoprotein). antiinfective agents. Growth Factors. ```

Question 33

Mature (normal) breast milk composition (compared to colostrum)

Answer 33

more fat. 60% Whey. 40% Casein (phosphoprotein). Lactose.

Question 34

Formula milk (compared to breast milk)

Answer 34

Higher in iron. iron has reduced bioavailability. fatty acids. more calories.

Question 35

when should a child start to be weaned onto food?

Answer 35

from 4-6 months. continue with milk feeding indefinitely.

Question 36

When should a child stop breast/formula milk?

Answer 36

1 year - switch to cows milk.

Question 37

Signs/symptoms of Cows Milk Protein (CMP) intolerance

Answer 37

after switching to cows milk: Months of irritability, crying, poor sleep. Loose stools, increased vomiting, reduced weight gain.

Question 38

Management of CMP intolerance.

Answer 38

stop feeding cows milk. improvement? regular re-challenges with cows milk. CMP intolerance often passes.