Growth in childhood Flashcards
How is growth in a child monitored and what would you expect?
this is a very linear growth along the same centile in growth charts.
what factors can negatively affect growth in height?
nutrition, hormone problems and genetic diseases.
what does a centile chart tell you?
used for the height, weight, BMI and head circumference.
these were made using a survey of large children in the UK.
25 centile = 25% of the population is shorter than this.
how do you measure children?
this must be through accurate equipment that is maintained properly.
make sure to get rid of the things that interfere such as clothes, shoes and hair.
How do you gather a full picture in the growth in height?
the centile charts are for the cumulative height - i.e. what height they are now.
height velocity is how fast the child is growing per year
compare to the height of other family members.
what factors can determine the growth of a child?
events before birth - poor fetal growth, LBW, prematurity
problem in childhood - lack of nutrition, chronic disease, endocrine problems - lack of growth hormones.
genetic - tall parents will typically have tall children.
random - some tall parents can have short children as there are multiple genes for height.
describe child growth:
the fastest phase of growth is in the first 2 years.
Here it is normal to move from centiles.
They will then continue along the same centile throughout childhood.
there is a phase of fast growth at puberty - this depends on when they go through puberty.
at the end of puberty the skeleton matures, the epiphyses will fuse and growth stops.
what is the hormonal control of growth?
GHRH is released by the hypothalamus and this triggers the release of somatotrophin (growth hormone).
This then triggers the release of things like IGF-1 and will go round the body and bind to protein stimulating growth in all tissues.
somatostain will stop the release of the growth hormone.
why may a child be shorter than expected?
NB: THIS IS WHEN THEY FALL IN CENTILE.
> Poor nutrition
chronic disease
endocrine causes - GH deficiency, thyroid hormone deficiency.
genetic disorders affecting bone growth - downs, turners
psychological distress and neglect
why may a child be taller than expected?
syndromes of overgrowth such as marfans
GH excess
precocious puberty - just seem tall at the time comparative to their peers
what is the definition of obesity?
BMI > 30 kg/m2
some cultures are more likely to be overweight than others.
BUT IN CHILDREN YOU WILL USE BMI CENTILES
what are the complications of obesity?
more likely to get a range of disorders including type 2 diabetes, CVD, cancers and orthopedic problems.
how do you asses child development?
History:
-antenatal - illness/infections, medications, drugs, environmental exposures
-birth - prematurity, prolonged/complicated labour
-postnatal - illness, infection, trauma
-consanguinity - increased chance of chromosomal or autosomal recessive conditions.
developmental milestones
examination:
growth parameters - height weight + HC
dysmorphic features
neurological examination of the skin
systems examination to identify association syndromes
standardised developmental assessment
what are investigations if there is suspected abnormal development?
cytogenetic studies
metabolic screen
blood ammonia
blood lactate
urine
AA
creatine kinase
imaging
nerve and muscle biopsy
what is cerebral palsy?
disorder of movement and posture arising from non-progressive lesions of the brain acquired before 2 years of age.
most causes are antenatal.
leads to: learning difficulties, epilepsy, visual impairment, hearing loss, feeding difficulties, poor growth and resp problems
