Growth, puberty and adolescence Flashcards
What is the middle line in a normal distribution curve called?
Mean/ median/ 50th centile
if it isn’t symmetrical, it is skewed and there isn’t a mean in it
What does the standard deviation measure?
measure of variability
if small, less variability,
what is a z-score?
standard deviation score - number of standard deviations away from the mean (mean - 1 mt, child 110 m, 1 SD away form the median)
Z = sds = (x-μ)/σ = number of sd from the mean
If there are 100 people measured, how many are within 1 SD from the middle line?
68%
How many are within 2SD from the middle line?
95% (5% of people have whatever it is not in that range)
What are centile lines?
Centile lines are spaced 2/3 of a standard deviation apart
From one point in a chart can you say that the child is growing at the right rate or not?
no, you need to chart the growth rate over the years
What is the low pointin the growth chart?
if it’s less then it comes as a knock off later on (higher obesity early puberty)
When do the height velocities peak?
infant and puberty phase
When does a child show normal growth?
- Their measurements are within the normal range compared with children of their age
- Their rate of growth is within the normal range compared with children of their age
Would it be a serious concern in a child if a child grows normally in a year but has tummy pain?
not really concerned, as a child growing normally is unlikely to have any major underlying problems.
not ruling out anything, but decreases the risk of coeliac and atopic disease
How has the growth chart shifted over the years?
The curve has shifted towards the right.
skweded to the right as there are more people who are obese
How should kid’s weight be measured?
- without any clothes or nappy
- no shoes/ footwear/ dolls/ teddies in head (kids older than 2 years)
- only class III electronic scales with metric setting should be used
How to measure head circumference?
using a narrow plastic or disposable paper tape,
- taken when the head circumference is the widest, three time sand then take the average
When should you be worried if a child a specific centile?
if they’ve falled/ crossed 2 centile lines
The average age for a girl to enter puberty in UK?
11 years - girls
(reference range - anything after the age of 8 is okay)
boys –> 6 months / 11.5 years later on average
(reference range - aynthing over the age of 9 years)
What are gonadotrophins?
FSH and LH
What is precocious puberty?
True central precocious puberty (TCPP) is normal pubertal development occurring abnormally early: <8 years for girls, <9 years for boys. Girls»boys
When is puberty delayed?
Pubertal delay is the absence of secondary sexual development in a girl aged 13 or a boy aged 14 years. Boys»girls.
What is the average height difference between adult males and females
Average height difference between men and women is 12.5-14cm. Due to:
Boys have delayed PHV
Boys PHV > girls
Boys taller in pre-puberty
What ate the staging centiles for puberty in girls?
thelarche - breat budding
adrenarche - body hair and odour
menarche - periods usually staty (2 yrs post thelarche)
When is the peak height velocity in girls?
Girls PHV at B2-3 (average 12 yrs
When is the peak height velocity in boys?
delayed PHV
Boys PHV at G4-5 (average 14 yrs)
What is the initial approach if there is a growth problem?
*History
-ICE - ask the kids if they are bothered by it or not
-Birth - placental insuffieicny of not
-PMH - chronic heart/ lung disease that causes the use of more energy
-Pubertal symptoms - short stautre child above 12/13 y/o
-FH
*Parental heights
*Parental puberty -if the mom had a late puberty, then girl would have a late one too
Examination
Height, weight, height velocity
Signs suggestive of pathology
Pubertal status
What is mid-parental height?
draw a line btw the dad’s and mom’s height
- 4/5 children will be within 2 centiles plus or above it
What do you investigate a growth problem?
blood - IGF -1 (liver)
gonadotrophins, growth factors, testosterone/oestradiol, thyroid, karyotype, other pathology
Bone age : X-ray - of non-dominant hand to see the bone age relative to the chronological age 9slightly a random number generator, subjective differences)
Dynamic function tests - pituitary functions
MRI brain, USS uterus (to check for endometrial thickening)
What is genetic short stature?
healthy, well child who has inherited short stature from parents. No underlying endocrine abnormality and normal bone age.
What is constitutional growth delay?
late maturation causing short stature. Cause usually unknown. May be genetic short stature component. Tends to present around puberty with delayed onset. Children have delayed maturation and delayed bone age. Can be very stressful.
Why does height matter?
Growth is a marker of health
What are the consequences of abnormal growth?
- Psychosocial aspects
- Socioeconomic status
