Growth in childhood

Question 1

How do you measure height and plot centile charts?

Answer 1

• Equipment should be accurate and maintained properly
• Position child properly to get accurate height (read instructions on growth chart)
• Remove things that interfere w/measuring - shoes off, hair out of the way
• Calculate age + plot correctly on chart

Question 2

What is the difference between height velocity and cumulative height?

Answer 2

Cumulative height = how tall child is now (total of all growth from conception)

Height velocity = how fast a child is growing in cm per year

Question 3

How do children grow?

Answer 3

• Fastest phase of growth after birth = first 2 years
• Children move up + down through centiles at this phase
• Most children move into a centile position by 2/3yrs
• Normal children grow fast enough to keep on same centile thr childhood
• Phase of fast growth at puberty (pubertal growth spurt) - timing depends of age at which child enters puberty
• Skeleton matures as child grows, epiphyses fuse at end of puberty, growth stops

Question 4

What are the common causes of abnormal growth?

Answer 4

Short stature:

• Poor nutrition
• Chronic disease
• Endocrine causes - GH deficiency, thyroid hormone deficiency
• Genetic disorders affecting bone growth - achondroplasia, Turner’s, Down’s
• Psychological distress + neglect

Tall stature:

• Syndromes of overgrowth - Marfan syndrome, Soto syndrome
• GH excess from pituitary tumour
• Precocious puberty

Question 5

How do hormones affect growth?

Answer 5

• Hypothalamic GHRH (increases)+ somatostatin (inhibits) GH secretion
• Growth hormone from anterior pituitary has some growth effect
• GH stimulates IGF1 release
• IGF1 circulates bound to IGF1 binding proteins + stimulates growth in all tissues

Question 6

What are the main factors linked to increasing obesity?

Answer 6

• Higher energy intake vs energy expenditure
• In some cultures, overweight has traditionally been seen as a desirable feature indicating wealth + high status
• In different areas, feature of poverty/affluence

Question 7

Why is increasing obesity a concern?

Answer 7

• More likely to get T2DM, cardiovascular disease, some cancers, orthopaedic problems
• Some ethnic groups have less “tolerance” of obesity - more likely to get complications, e.g. T2DM at lower BMI

Question 8

What influences cumulative growth?

Answer 8

1. Events before birth - poor foetal growth, low birth weight, prematurity
2. Medical issues in childhood - malnutrition, chronic disease, endocrine problems inc. GH deficiency
3. Genetic factors - height of family + inherited disorders of growth
4. Randomness - not every child of same parents will be same height; multiple genes randomly distributed at conception influence