Growth, Puberty and Adolescence

Question 1

What is the middle line called?

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Answer 1

Median/mean/50th centile

Question 2

What does the standard deviation measure?

Answer 2

Measure of variability

Question 3

What is a Z-score?

Answer 3

No. of SDs from the mean

Question 4

If 100 people are measured, how many are within 1 SD of the midline?

Answer 4

68

Question 5

If 100 people are measured, how many are within 2 SD of the midline?

Answer 5

95

Question 6

Define the height velocity?

Answer 6

No. of centimetres grown/year

Question 7

When does a child show normal growth?

Answer 7

• Measurements within the normal range compared with children of the age
• Rate of growth is within the normal range compared with children of their age

Question 8

If a child is growing normally, what does this mean?

Answer 8

Unlikely to have any major underlying problems

Question 9

Changes in weight growth charts over the years?

Answer 9

Recently, there has been:
• A shift to the right, as more people are obese
• Longer tail, as people are becoming more severely obese
• Increasing severe obesity
• Similar upward trend with height

Question 10

Instructions for measuring weight?

Answer 10

Babies should be weight without clothes/nappy

Children >2 years can be weighed in vest and pants but no shoes, footwear, dolls/teddies in hand

Question 11

Instructions for measuring head circumference?

Answer 11

Taken where the head circumference is widest

Question 12

Instructions for measuring length?

Answer 12

Measure length <2 years if concerned; measure without nappy/footwear

Question 13

Problems with measuring length?

Answer 13

Commonly shows wide variation in the same child

Question 14

Instructions for measuring height?

Answer 14

Measured from 2 years

Ensure heels. bottom, back and head touch apparatus with eyes/ears at 90 degrees

Do not stretch up and remove shoes

Measure on expiration

Question 15

Most common error when plotting the chart?

Answer 15

Age errors:
• Weeks for 1st 6-12 months
• Calendar months thereafter

Question 16

How to adjust age if premature (<37 weeks)?

Answer 16

E.g: if born at 36 weeks and measuring height and 1 year, plot it as though they were 11 months old

Question 17

How to describe where a child is in relation to centiles?

Answer 17

If exactly on the centile line, or within 1/2 of a space of the centile line - on the centile line, e.g: on the 91 st centile

If not - between centiles, e.g: between the 75th-91st centile

Question 18

How should falls/rises be described?

Answer 18

Multiples of centile spaces

Question 19

Average age for a girl to enter puberty?

Answer 19

11 years old; 6 months later for boys

Question 20

What is precocious puberty?

Answer 20

Early puberty; it is more common in girls

Question 21

When is puberty delayed?

Answer 21

Absence of secondary sexual development in a girl aged 13 or a boy aged 14 years

It is more common in boys

Question 22

Stages of puberty in girls?

Answer 22

Thenarche - breast budding

Adrenarche - body hair and odour

Menarche - periods begin (usually 2 years post-thelarche)

Question 23

Ix for growth problems?

Answer 23

Gonadotrophins, growth hormone (IGF-1), testosterone/oestradiol, thyroid, karyotype, etc

Bone age

Dynamic function tests

MRI brain, USS uterus

Question 24

6 different classifications of short stature causes?

Answer 24

1. Genetic short stature (parents were also short) - they have normal bone age and there is no underlying endocrine abnormality
2. Constitutional growth delay - late maturation causing short stature, usually with an unknown cause
3. Dysmorphic syndromes
4. Endocrine disorders
5. Chronic disease
6. Psychosocial deprivation

Question 25

Other features of constitutional growth delay?

Answer 25

May have a genetic short stature component

Tends to present around puberty with delayed onset

Also have delayed maturation and delayed bone age