Growth in childhood Flashcards
How do you measure height and plot centile charts?
Equipment should be accurate + maintained properly
Position child properly to get accurate height
Remove things that interfere w/measuring e.g. shoes off
Calculate age + plot correctly on chart
What is the difference between height velocity and cumulative height?
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
How do children grow?
Fastest phase of growth after birth, till 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 through childhood
Phase of fast growth at puberty (pubertal growth spurt) - timing depends of age of onset
Skeleton matures as child grows, epiphyses fuse at end of puberty, growth stops
What are the common causes of short stature?
Poor nutrition
Chronic disease (chronic inflammation disrupts IGF1 action)
Endocrine causes: GH deficiency, thyroid hormone deficiency
Genetic disorders - achondroplasia, Turner’s, Down’s
Psychological distress + neglect
Describe the endocrine control of growth
Hypothalamic GHRH (increases) + somatostatin (inhibits) GH secretion
GH from anterior pituitary has some growth effect
GH stimulates IGF1 release
IGF1 circulates bound to IGF1 binding proteins + stimulates growth in all tissues
What are the main factors linked to increasing obesity?
Decreased exercise/ increased calorie consumptiont Association with increased TV watching Consumption of soft drinks Parental obesity Education + social factors
List 7 complications and associated features of obesity
T2DM CVD Cancer Orthopaedic problems Psychological problems Respiratory difficulties PCOS
What influences cumulative growth?
- Events before birth: poor foetal growth, low birth weight, prematurity
- Medical issues in childhood - malnutrition, chronic disease, endocrine problems inc. GH deficiency
- Genetic factors - height of family + inherited disorders of growth
- Randomness - not every child of same parents will be same height; multiple genes randomly distributed at conception influence
Why measure growth?
Poor growth in infancy is associated with high childhood morbidity + mortality.
What are the common causes of tall stature?
Syndromes of overgrowth -e.g. Marfan syndrome
GH excess from pituitary tumour
Precocious puberty
Tall parents
What external factors can influence the pulsatile secretion of GH?
Nutrition
Sleep
Exercise
Stress
What is the most rapid phase of growth? What can influence this?
Antenatal phase
Maternal health + placenta
When is growth most dependent on nutrition? Thus when would you start to suspect GH deficiency?
Birth-9 months
Between 9-12 months as GH becomes the more dominant influence
When do boys and girls have their pubertal growth spurt?
Boys: End of puberty
Girls: Start of puberty
What happens in the final part of growth?
Bones mature + epiphyses fuse at the end of puberty.
The final part of growth occurs in the spine + final epiphyses to fuse are in the pelvis.
