Growth in Childhood Flashcards
Why do you measure growth in children?
Poor growth is associated with high morbidity and mortality->growth indicates good health (best indicator)
Quite a few disorders exist
Obesity is a growing problem
What are the different things measured in children?
Head circum, weight, height, leg length, heigh velocity etc—
Height-cumulative, and split bewteen percentiles-what you wanna check is more that youre going along the same centile-
head circumferance-brain development- If slow/drop-brain not developing. if large increase-bleed/hydrocephalus
Height velocity-cm/yr-very high at first-stable around 2-10y/o then puberty sharp rises again. (heigh now-heigh lasst visit/age now-age last clinic)
What regulates the linear human growth?
Gh-IGF1 axis-
IGF1 produced in liver and growth plates-acts on IGF1 receptor
GH-pulsatile influences by nutrition/stress/etc
Describe growth in early infancy?
Rapid initial growth of 23-25cm is independent of GH
continuation of foetal growth
GH does not drive growth, nutrition does
Describe growth in early infancy in childhood
This time, growth rates of boys and girl is similar
Dependent of GH/IGF1 pathway-so need a good nutrient
Girls get the spike in height velocity at early adolescence, and male at end of adolescence
Combination of GH and sex hormones make the growth
What is bone age in children?
Looking at the maturation of bone-like bone plates/grwoth plates and if theyre working
Epiphyses fuse at puberty
Final part of growth occurs in spines, and the final fusing are in pelvis->can determin
What are we actually trying to look for on centiles?
Not which centile you belong too-not normal range
Most children settle on centile around 2 y/o
so what we look is pattern of growth-if stick to the same percentile-when change significant something tends to be worng
What are some causes of short stature?
Genetic-tall parents/short parents
Pubertal and growth delays
IUGR/SGA (Intrauterine growth retardation/)-usually catch up but some dont-25%
Dysmorphic syndromes-downs,
Endocrine disorders-GH deficiency, thyroid def
Chronic peadiatric disease-inflammation block intracellular signalling-not make as much IGF1-like bad crohns
Psychosocial deprevation-supression of GH pulsatility when envirnoement bad
Of course can be short and normal-short parents
What is a mid parental centile?
You do a corrected mean of the parents height-> allows to switch the normal centile down (for short families)
And for tall families, correct upwards
What are the most common endocrine causes of short stature?
Hypothyroidism
Corticosteroids excesss
GH deficiency
What test would you do to a child with short stature?
full blood count, CRP, serum iron Liver and Kidney function THYROID function coeliac-can retard growth IGF1 bone age
What are genetic causes to abnormal growth with normal hormones?
Turners syndrome (XO)-can actually be quite subtle-will need help for GH and puberty Down syndrome Skeletal dysplasia-genes that determine bone-achondroplasia (plot sitting height as well so the short legs dont impact)
non genetic non hormonal-significant illness
What chronic disease can affect growth?
Bad ashtma, sickle cell, arthiritis
Inflammatory bowel disease (Crohns, coeliac)
Cystic fibrosis, heart issues
What are some causes of tall stature?
Tall parents
Early puberty-like 6y/o
Syndromes eg: Marfans
Growth Hormone excess-not common
What is the barka’s hypothesis?
Birth weight is a major player in future health
people with low birth weight -higher chances of hypertension
also the case when too fat-overweight/obese also higher chance of disease
