growth in childhood

Question 1

why do we measure growth

Answer 1

poor growth is associated with high childhood morbidity and mortality

best indicator of ehalth

demonstration of normality of growth by age and stage of puberty

identify disorders of growth

assess obesity

Question 2

how do you measure height *

Answer 2

when child ois lying down - legs straight head and feet flat against a board

or stood up

Question 3

what is a centile chart *

Answer 3

a way of expressing variation within a population

they are cumulative

based on surveyrs of large numbers of children - use UK based and those from WHO that look at international population

age on x axis, height on y

Question 4

growth measurements that are taken *

Answer 4

HC
weight

height/length

leg length

BMI

growth velocity

specialist charts

Question 5

statistical distribution of height *

Answer 5

normally distributed

can have short and tall normals

people have to grow along a centile

Question 6

why do we measure head circumference

Answer 6

children’s heads have fontenelles so head growth reflects brain growth

if head not growing = brain not growing

if sudden growth suggest hydrocephaly/bleed

when skull fuses dont measure head circumference anymore

Question 7

describe height velocity chart *

Answer 7

expressed in cm/year

slow down at birth (very fast in utero)

increase in puberty because of GH and sex steroids

Question 8

describe the hormonal control of growth *

Answer 8

GH-IGF-1 axis is the regulator of human linear growth

GH is a single chain polypeptide produced bvy somatotrophs in anterior pit - pulsitile secretion

cause production of IGF1 at growth plates and liver

IGF1 is what causes you to grow

Question 9

what effects the production of GH *

Answer 9

nutrition

sleep

exercise

stress

Question 10

describe the GH-IGF1 axis *

Answer 10

GRHR and somatostatin released from hypothalamus

act on the pituitary - GH released from ant pit and is bound to GH binding protein

GH act on GH receptor = GH action = IGF1 production

IGF is bound to IGF binding proteins

IGF1 acts on IGF1 receptor

Question 11

growth in antenatal phase and factors that effect it *

Answer 11

most rapid phase

maternal health and placenta are the most important factors

Question 12

growth in infancy and the factors that effect it *

Answer 12

rapid growth addition of 23-25cm in year 1

continuation of fetal growth

nutritionally dependant

no GH until 9-12 months

Question 13

describe growth in childhood and the factors that effect it *

Answer 13

childhood is post-infancy to adolescence

boys born slightly bigger but growth rate in childhood is equal

GH/IGF1 axis drives growth - nutritions less important (as long as not malnurished)

Question 14

describe growth in puberty *

Answer 14

under control of sex steroids and GH

stimulate the pubertal growth spurt

happen in early puberty in girls and late puberty in boys

Question 15

describe bone age *

Answer 15

bones develop as cartilage then mature

IGF1 acts in the growth plates = osteoblasts get active and make bone

when stop growing, the growth plates fuse - happens at end of puberty

final part opf growth occurs to the spune and final epiphyses to fuse are in the pelvis

Question 16

what do you look for when assessing someone’s growth *

Answer 16

are they too short or tall for age - could there be a problem

has puberty started and is it progressing normally

is growth normal for the stage of puberty

is the child overweight or obese

Question 17

what can you learn by assessing growth*

Answer 17

centiles are not normal range - can be taller/shorter than the centile lines and still be completely normal

most children are on a centile by 2yrs and grow on same throughout childhood

patterns of growth are more important that the position on the centiles - most tall/short people are healthy and grow in a normal pattern

a child who falls significantly in a centile is not growing normally

Question 18

what are the causes of short stature *

Answer 18

genes

pubertal growth delay - girl normally 8-13, boy 9-13.5 - if delay you dont get the normal growth spurt

IUGR/SGA - 85% people catch up to normal

dysmorphic syndromes - down’s/turner’s/skeletal dysplasias (something wrong in genes for bone)

endocrine disorders - GH deficiency/hypothyroid/steroid excess

chronoc paediatric disease - inflammation effects growth - inflammatory mediators block the intracellular signalling of GF = dont grow

psychosocial depravation - reduce GH pulsitility = reduced GH = reduced IGF1

drugs - steroids

poor nutrition

Question 19

describe short stature (*

Answer 19

children have a normal growth pattern and mo medical problem

usually the children of short parents

not all children with IUGR catch up completely - growth will be normal in childhood but they have lost some growth in the antenatal period

Question 20

what do you do if someone is below the centiles (

Answer 20

look at birth history and weight

parental heights

medical history

previous measurements

Question 21

describe the mid-parental centile *

Answer 21

used to adjust the graph of centiles to the parents height

Question 22

investigations if someone is dropping off the centiles (

Answer 22

FBC - look if infection, CRP, serum iron

liver and kidney function

thyroid func

coeliac screen

IGF 1

bone age

MRI pit

Question 23

describe Turner’s *

Answer 23

normal intelligence

short

dont enter puberty

Question 24

describe achondroplasia *

Answer 24

measure full height and sitting height - subtract sitting height from full to find leg length

have normal sitting weight but short leg length

Question 25

describe, and list, chronic paediatric diseases *

Answer 25

asthma

sickle cell

juvenile chronic arthritis - inflammatory cytokines

inflam bowel disease - chron’s/coeliac

CF - not absorbing well and infection in chest

renal failure

congenital heart disease

Question 26

causes of tall stature *

Answer 26

tall parents

early puberty - the pubertal growth spurt occurs very early However growth stops early as well so they can be short adults.

syndromes - marfans or Soto syndrome

GH excess from pit tumour - grow more before the GH haev fused

Question 27

why is obesity an issue *

Answer 27

widespread - 2/3 adults, 1/4 of 2-10 yr olds and 1/3 of 11-15yr olds are overweight or obese

prevelence remains high

a high BMI is costly to health and social care

has wider economic and societal impacts

Question 28

effect of obestity on children *

Answer 28

emotional and behvioural effects

subject to stigmatisation, bullying, low self-esteem

school absence

high cholesterol and BP

pre-dm

bone and joint problems

breathing difficulties

increased risk of becoming overweight adults

risk of ill health and preature mortality in adult life

Question 29

complications of obesity *

Answer 29

T2dm - youger you are the more aggressive it is, the microvascular problems are more aggressive than in T1dm

orthopedic problems

PCOS

CVS

psychological problems

cancer

resp problems

Question 30

BMI in children (

Answer 30

should be lower than in adults

Question 31

describe the relationship between obesity and deprivation *

Answer 31

increased deprivation = increased obesity

probably because of diet and inability to exercise

Question 32

describe syndromes leading to obesity *

Answer 32

short obese usually indicates a syndrome

prader-willi - cant stop themselves eating

cushings

Bardet-Biedl syndrome

Question 33

describe the genetics of obesity *

Answer 33

polygenic inheritence

weight heritable trait - 40-70%

monogenic obesity syndromes are rare - leptin deficiency, leptin receptor deficiency, POMC deficiency, MC4R deficiency (increased muscle and fat), PC-1 deficiency

Question 34

effect of weight on mortality in children *

Answer 34

if underweight, risk of mortality increases

if overweight - also increases

Question 35

why is there an increase in obesity *

Answer 35

balance of food taken in and energy expenditure

hunger regulated by the hypothalamus and factors like leptin influence this

small number of people have single gene mutations that affect one of the hormones and can lead to severe obesity

In the population there are some gene variants (for example the FTO gene) which can affect eating behaviour and appetite and make an individual more likely to eat in a way that makes them gain weight.

Question 36

describe how you measure children *

Answer 36

The equipment should be accurate and maintained properly

Position the child properly to get an accurate height (read the instructions on the growth chart)

Make sure you get rid of things which interfere with measuring- shoes off, hair out of the way, clothes off to weigh.

Calculate the age and plot correctly on the chart.

Question 37

what can effect current height position on a centile chart *

Answer 37

events before birth - poor fetal growth, low birth weight, prematurity

medical issues in childhood - malnutrition, chronic disease, endocrine problems

genetic - family and inherited disorders

randomness - multiple genes determine height

Question 38

describe the pattern of normal growth *

Answer 38

fastest phase is 1st 2 yrs - children can move up and down the centiles at this phase

by 2 or 3 most will be at a centile - grow fast enough to keep on it

pubertal growth spurt - timing depends on when enter puberty

skeleton matures as child grows, the epiphyses fuse at the end of puberty and growth stops

Question 39

describe the process of monitoring height growth in children *

Answer 39

all children should have height and weight measured occaisionally and plotted in red book

if concerned the child should be measured accurately and plotted on a centile chart for at least a year

if fast enough to stay on centile unusual to have a problem, even if short

timing of puberty effect height - those late in puberty can fall behind in height

Question 40

how do we treat short stature

Answer 40

if growth is normal - cant do anything

if have confirmed GH deficiency - can treat

Question 41

define obesity *

Answer 41

For adults BMI of over 25 kg/m2 is overweight and over 30 kg/m2 is obese.

Children have lower BMI than adults and this changes with age so these figures do not apply, and obesity is assessed on the BMI centile position.

Question 42

describe obesity epidemiology *

Answer 42

rate has increased but may not go up at the same rate in the future

some nations higher rate than others - some cultures where overweight has traditionally been seen as a desirable feature indicating wealth and high status. In some areas of the world obesity is a feature of poverty and in others associated with affluence.

Some ethnic groups have less “tolerance” of obesity and are more likely to get complications like type 2 diabetes at a lower BMI