Growth in Childhood + development Flashcards
why is growth measured?
- poor growth in infancy = associated with high childhood morbidity / mortality.
- Growth = best indicator of health
- Demonstration of normality of growth by age and stage of puberty
- Identify disorders of growth
- Assess obesity
How do you measure length of a baby?
- legs straight
- head and feed against board
What is a centile chart?
- what do they measure ?
centile chart = a way of expressing variation within the population.
- head circumference
- weight
- height/length
- leg length
- BMI
- growth velocity
- specialist charts
Height / Velocity chart is expressed in =
cm/ year
how do you calculate height velocity ?
(height now - height last visit) / (age now - age last visit)
What is the main endocrine component that controls growth?
- GH release
- causes release of IGF1
- which acts on IGF 1 receptor
- -> and triggers growth
________ axis = regulator of human linear growth
- GH-IGF-1 axis
What factors influence pulsatile secretion ?
- nutrition
- sleep
- exercise
- stress
what is the most rapid phase of growth ?
antenatal
- maternal health + placenta = important factors of growth
describe growth in infancy
- there is initial growth of approximately 23 - 25 cm in the 1st year
- there is continued growth
- nutritionally dependent
- 9-12 months influence of GH
describe growth from infancy - adolescence
- there is similar growth rate in boys + girls
- GH/IGF1 axis –> drives growth
- nutrition = less impact
NOTE:
girl - get puberty just before puberty
boys - get puberty just after / towards end of puberty
-
what stimulates pubertal growth spurt?
- sex steroids
- GH
How does a child stop growing?
- bones mature
- epiphyses fuse at end of puberty
- final growth –> occurs in spine
- final epiphyses fuse –> in pelvis
Note:
- most children settle on a centile by about 2 years (until puberty)
- pattern of growth = more important than position on centiles
-
What are the 7 causes of short stature?
- Genetic
- Pubertal and growth delay
- IUGR/SGA (intrauterine growth restriction)
- Dysmorphic syndromes (e.g down syndrome)
- Endocrine disorders (hypothyroidism, growth hormone deficiency, steroid excess)
- Chronic paediatric disease
- Psychosocial depravation
NOTE
thyroxine = important for brain development
under 2 hypothyroid –> affects brain development
over 2 hypothyroid –> affects height
-
What 3 main endocrine problems can cause short stature?
- hypothyroidism
- growth hormone deficiency
- steroid excess
what is one method to estimate height of an individual
mid parental centile
What syndrome can cause short stature?
- down syndrome
- turner syndrome
- skeletal dysplasia
how would you diagnose achondroplasia?
measure leg length
- subischial length
- compare to normal centiles
What are some chronic paediatric disease can deter growth?
Asthma Sickle cell Juvenile chronic arthritis Inflammatory bowel disease Crohns disease Coeliac disease Cystic fibrosis Renal failure Congenital heart disease
What are some causes of tall stature?
tall parents
early puberty
syndromes eg Marfans
growth hormone excess
What are complications associated with obesity?
Type 2 diabetes Orthopaedic problems Polycystic ovarian disease Cardiovascular risk psychological problems Cancer Respiratory difficulties
What are syndromes associated with obesity?
- cushings
- prader willi syndrome
- lawrence moon biedl syndrome
weight
usually shows monogenic / polygenic inheritance
- weight
usually shows polygenic inheritance
–> highly heritable - monogenic = rare
(e. g leptin deficiency, leptin receptor deficiency)
NOTE
BMI is centile led in children
-
define growth
- complex interplay between somatic and neurological transformation, psychosocial and environmental influences.
What are examples of assessment tools for child growth
- standardised tests
- schedule of growing skills
- Griffiths developmental scale
- bailey developmental scale
NOTE
regression of development
e.g could speak –> but now cant
= e.g autism
-
What are common presenting symptoms of developmental problems in children?
- delayed walker
- delayed talker
- hyperactive
What are the 2 MAIN types of developmental delay?
- global
- specific
in specific developmental delay what are the 5 different parts?
???
what are some post natal factors influencing developmental delay
- ill health
- sensory morot impa
- reduced inherent potential
What are causes of global
- chromosomal abnormalities
- metabolic problems
- antenatal and perinatal factors
- environmental / social problems
- chronic illness
what are some causes of language delay?
- hearing loss
- leanring disability
- autistic disorder
- lack of stimulation
how would you manage problems in development in children?
- maximise mobility
- minimise development
- promote speech and language
- promore social and emotional health
autism
impairment in what 3 domains:
- social interaction
- communication
- behaviour, interests, activities
WHat are characteristics of ADHD ?
- inattention / increased distractibility
- poor impulse control (feel very aggressive)
- motor overactivity and motor restlessness
WHat are characteristics of Autism?
- repetitive behaviour
- gait abnormalities (tip toe)
