Growth & Puberty

Question 1

Implications of atypical growth

Answer 1

• Due to unnderlying pathology (i.e. neoplastic conditions. endocrine dysfunction, chjronic diseases)
• Due to genetuics and inheritence
• Due to abnormal stature itself

NB - Growth is not the same as stature

Question 2

Reasons for unerliability of measurements

Answer 2

• Faulty technique
• Faulty equiptment
• Uncooperative children
• Different observers
• Different times of day

Question 3

Genetic target height

Answer 3

• Target height estimate = mid-parental height corrected
• Boys target height (cm) = (FH + MH)/2 + 7
• Girls target height (cm) = (FH + MH)/2 - 7

Question 4

When to be concerned?

Answer 4

• Is the child short?
• Is the child short for parents?
• Is the child growing slowly?

Question 5

Common conditions to consider in a short child

Answer 5

• Is the child small at birth? - IUGR/small for gestational age or underlying condition
• Is the child unwell? - underlying chronic disease
• Is the child dysmorphic? - underlying syndrome
• Is the child disproportionate? - underlying syndrome/skeletal dysplasia

Question 6

Pathological conditions which produce abnormal growth

Answer 6

• Adverse antenatal influences - abnoormal size at birth
• Undernutrition
• Chronic ill health
• Iatrogenic
• Physiological and emotional factors - deprivation and neglect
• Endocrine issues - hypothyroidism, GHD, Cushings
• Syndromes associated with aberrations in growth

Question 7

Reasons why chronic disease causes poor growth

Answer 7

Question 8

Pubertal abnormalities

Answer 8

• Definition and timing
  
  • Breast development
    
    • Precocious < 8 years
    • Early 8-10 years
    • Delayed >13 years
  • Testicular enlargement
    
    • Precocious <9 years
    • Early 9-11 years
    • Delayed >14 years
  • Breast development first followed by menarche
  • Testicular development first followed by penile growth then facial hair
  • Assess puberty in older child/adolescent growing slowly
  • Diagnosis with clinical assessment and biochemical testing to find cause

Question 9

Causes of short stature (remember NIDSCED)

Answer 9

• Normal genetic short stature
• Constitutional delay in growth and/or adolescence (child/adolescent is short and looks young for age)
• Intrauterine growth retardation (i.e. longstanding placental insufficiency, exposure to alcohol)
• Dysmorphic syndromes (i.e. Down’s, Turner’s)
• Skeletal dysplasias (i.e. achondroplasia)
• Chronic systemic diseases (i.e. IBD, CKD, CF)
• Endocrine disorders
• Dire social circumstances (sever psychological deprivation can effect growth)

Question 10

Disorders of hypothalamic-pituitary axis

Answer 10

• • See Endocrinology section for causes

Question 11

Early growth

Answer 11

• Average birth weight 3.3-3.5kg
• Usually some weight loss in first 5-7 days but regained by days 10-14
• Average infant weight doubles by 4 months and triples by 12 months
• By age 2 should have achieved around 50% of their adult height