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RDA > Growth In Childhood > Flashcards

Growth In Childhood Flashcards

1
Q

List some things which can be measured in children as a marker of their growth

A 
Head circumference 
Weight
Height/length
Leg length 
BMI
Growth velocity
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2
Q

What does cumulative mean?

A

Plotting something continually over time

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3
Q

What is the equation for height velocity?

A

Height now - height of last visit / age now - age of last visit

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4
Q

How often is height velocity calculated?

A

Every 6 months

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5
Q

What is the unit of height velocity?

A

Cm/yr

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6
Q

Describe the production of the hormone which controls growth

A

Hypothalamus - GHRH
Anterior pituitary - GH
GH binds to GH receptor in liver and produces IGF-1

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7
Q

Where does IGF-1 act?

A

Via the IGF-1 receptor on osteoblasts of growth plate/epiphyses of bones

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8
Q

Which cells exist in the growth plate?

A

Osteoblasts

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9
Q

What kind effect does IGF-1 have on the bones?

A

Autocrine and paracrine effect

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10
Q

When is the most rapid phase of growth?

A

Antenatal (in the womb)

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11
Q

Name some important factors for fetal growth

A

Maternal health
Placenta
IGF-2 (reason for big babies)

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12
Q

Which parent does IGF-2 come from

A

The father - it’s paternally imprinted

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13
Q

What is important for growth in the first year?

A

Nutrition!

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14
Q

What is important for growth after the first year?

A

GH

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15
Q

What are the axes of the growth chart?

A

Height

Age

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16
Q

If you saw a plateau on an infant’s growth chart, what would it suggest?

A

GH deficiency

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17
Q

What drives the growth of children between infancy and adolescence?

A

GH
IGF-1
(Nutrition has less of an impact)

18
Q

What drives growth at puberty?

A

Sex steroids

GH

19
Q

What do the sex steroids do to bones at the end of puberty?

A

They fuse epiphyseal growth plates

20
Q

Compare male and female puberty and growth spurt

A

Girls hit puberty earlier so their growth spurt is earlier than boys

Boys - 13-14cm higher than males

21
Q

Which bones fuse first at the end of puberty?

A

Feet>Long bones

22
Q

Where does the final part of growth occur?

A

Spine

23
Q

Which epiphyses are the last to fuse?

A

The ones in the pelvis

24
Q

What is most important about where you are on a centile?

A

The pattern of growth is more important than the position on a centile

25
Q

What would be a marker of growth abnormality?

A

If a child falls from a centile position / cross centiles

26
Q

List the causes of short stature

A 
Genetics
IUGR/SGA
Endocrine disorders (GH deficiency)
Pubertal/growth delay
Dysmorphic syndromes (Down's)
Chronic paediatric diseases
Psychosocial deprivation
27
Q

List specific endocrine causes of short stature

A

Hypothyroidism
GH deficiency
Steroid excess

28
Q

List three genetic causes of growth stature despite having normal growth hormone levels

A

Turner syndrome
Down syndrome
Skeletal dysplasia

29
Q

What is important to know before plotting a growth chart?

A 
Birth history 
Weight
Parental heights
Medical history
Previous measurements
30
Q

How can you adjust to genetic differences in height?

A

Work out mid parental centile

31
Q

List three things about illness which can interfere with growth?

A

Inflammation, poor nutrition and effects of drugs e.g. steroids can interfere with growth

32
Q

List some blood tests you’d do if a child seemed to be growing slowly

A 
FBC
CRP
Serum iron
LFT
Kidney function tests
TFTs
Coeliac screen
IGF1
33
Q

List some examinations done if a child appears to be growing slowly

A

Bone age
MRI of pituitary
Pituitary function testing

34
Q

List some chronic paediatric diseases which may cause growth abnormalities and explain how these interfere with growth

A 
Asthma 
Sickle cell 
Juvenile chronic arthritis 
IBD (Crohn's, coeliac)
CF
Renal failure
Congenital heart failure

Inflammation interferes with intracellular IGF-1 production

35
Q

List four causes of tall stature

A

Excess growth hormone
Marfan syndrome (connective tissue disorder)
Early puberty
Tall parents

36
Q

List some complications of obesity

A 
T2DM 
Orthopaedic problems
Polycystic ovarian disease 
CV risk 
Psychological problems 
Cancer
Respiratory difficulties
37
Q

Name some syndromes associated with obesity

A

Cushings
Prader Willi
Lawrence-Moon-Biedl

38
Q

List some genetic causes of obesity

A 
Leptin deficiency 
Leptin receptor deficiency 
POMC deficiency 
PC-1 deficiency 
MC4R deficiency
39
Q

Discuss the Berka hypothesis

A

The more underweight you are as a child, the most likely you are to become obese as a child

40
Q

What is the genetics of obesity?

A

It’s polygenic, highly inheritable

RDA (13 decks)

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