Growth in childhood

Question 1

What is commonly plotted in centile charts?

Answer 1

• head circumference
• weight
• height/length
• leg length
• BMI
• growth velocity

Question 2

How is height velocity calculated and what are its units?

Answer 2

• (height now - height last visit) / (age now-age last visit)
• cm/yr

Question 3

Describe the hormonal growth axis

Answer 3

• Hypothalamus releases Somatostatin (-) or GHRH (+)
• Acts on somatotrophs of the anterior pituitary
• Releases growth hormone
• Acts on GH receptors to have its action and to stimulate IGF-1 production
• IGF-1 acts on IGF-1 receptor to have its action

Question 4

In what manner is GH released?

Answer 4

Pulsatile

Question 5

What influences GH secretion?

Answer 5

• Nutrition
• Sleep
• Exercise
• Stress

Question 6

What kind of hormone is GH?

Answer 6

Single chain polypeptide

Question 7

What is infant growth dependent on?

Answer 7

• Nutritionally dependent
• GH dependent for 9-12 months

Question 8

What is childhood growth dependent on?

Answer 8

• Less dependent on nutrition
• GH/IGF-1 axis main driver of growth

Question 9

Explain this height velocity graph

Answer 9

• Growth is highest in the antenatal phase
• Decreases during infancy into childhood
• Spikes again during puberty (driven by GH and sex steroids)
• girls puberty is earlier than boys
• Decreases again to a standstill after puberty

Question 10

What happens to the bones when we stop growing?

Answer 10

• The bones mature and epiphyses fuse at the end of puberty.
• The final part of growth occurs in the spine
• The final epiphyses to fuse are in the pelvis.

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Question 11

What is the use of centiles?

Answer 11

• Centiles are not a “normal range”
• Most children set out on a centile by about 2 years and grow on the same centile during childhood.
• Pattern of growth is more important than position on the centiles.
• A child who falls significantly in centile position is not growing normally, whatever their height.

Question 12

What are some causes of short stature?

Answer 12

• Genetic (main one)
• Pubertal and growth delay
• IUGR/SGA
• Dysmorphic syndromes
• Endocrine disorders
• Chronic paediatric disease
• Psychosocial depravation

Question 13

What can be the consequence of IUGR on growth?

Answer 13

• Not all children with intrauterine growth restriction catch up completely.
• Growth will be normal in childhood but they have “lost” some height in the antenatal period.

Question 14

What endocrine problems can cause short stature?

Answer 14

• hypothyroidism
• growth hormone deficiency
• steroid excess

Question 15

What syndromes can casue short stature?

Answer 15

• Turner syndrome XO
• Down syndrome T21
• skeletal dysplasias

Question 16

Why do significant childhood illnesses cause short stature?

Answer 16

Significant illnesses can interfere with growth because of:

• Inflammation
• Poor nutrition
• The effects of drugs such as steroids.

Question 17

Give some examples of chronic paediatric diseases that cause short stature

Answer 17

• Asthma
• Sickle cell
• Juvenile chronic arthritis
• Inflammatory bowel disease

–Crohns disease

–Coeliac disease

• Cystic fibrosis
• Renal failure
• Congenital heart disease

Question 18

What are the causes of tall stature?

Answer 18

• tall parents
• early puberty
• syndromes eg Marfans
• growth hormone excess

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Question 19

What are the negative impacts of obesity?

Answer 19

Emotional:

• Stigmatism
• Bullying
• Low self-esteem

School absence

Health:

• High cholesterol
• High bp
• Diabetes
• Bone and joint issues
• Breathing difficulties

Question 20

What conditions does obesity pre-dispose you to?

Answer 20

• Type 2 diabetes
• Orthopaedic problems
• Polycystic ovarian disease
• Cardiovascular risk
• Psychological problems
• Cancer
• Respiratory difficulties

Question 21

How is obesity assessed in children?

Answer 21

Position on the BMI centile for their age

Question 22

What syndromes are associated with obesity?

Answer 22

• Cushings
• Prader-willi
• Lawrence-moon-biedl

Question 23

What are the genetics of weight?

Answer 23

Polygenic inheritance

Weight is highly heritable

Question 24

List examples of monogenic obesity syndromes

Answer 24

• Leptin deficiency
• Leptin receptor deficiency
• POMC deficiency
• PC-1 deficiency
• MC4R deficiency

Question 25

Why is childhood obesity on the rise?

Answer 25

• Decreased exercise/ increased calorie consumptiont
• Association with increased TV watching
• Consumption of soft drinks
• Parental obesity

Question 26

What are ‘limit’ ages in child development?

Answer 26

Upper age by which a development milestone should be achieved

Question 27

Why is growth measured?

Answer 27

• poor growth in infancy is associated with high childhood morbidity and mortality.
• Growth is best indicator of health
• Demonstration of normality of growth by age and stage of puberty
• Identify disorders of growth
• Assess obesity

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Question 28

What is the difference between height velocity and cumulative growth?

Answer 28

• Height velocity = how fast a child is growing in cm/yr
• Cumulative growth = total growth at any given point

Question 29

What milestone is a 2 year old child expected to reach?

Answer 29

Join 2-3 words when talking

Know some body parts

ID objects in a picture

Question 30

What milestone would a child be expected to reach at 12 months?

Answer 30

Pulls to stand

May walk alone breifly

Put blocks in a cup

Say 1-2 words