Growth, puberty and Paediatric Problems Flashcards
what measurement techniques are available for height?
stadometre
lestre metre
avoid measuring tapes
ask to take deep breath - adds a few mm to height
how are children under two measured?
by legnth
when is sitting height useful?
short spine
when is head circumference measured in children?
Routine in children <2
years
Tape round forehead and
occipital prominence
(maximal circumference)
how important is it to be accurate in measuring and plotting on a graph?
make every dot and contact count
very important
what does a girls versus a boys centile chart look like?
can you get condition specific growth charts?
yes
how do you calculate Target Height and Mid Parental
Height (MPH)?
The mid parental height is calculated in males, by adding 7cm to the mean of parental heights; in females by subtracting 7cm.
how is BMI calculated?
Body Mass Index (BMI) is a person’s weight in kilograms (or pounds) divided by the square of height in meters (or feet)
what is bone age?
Bone xray of left wrist
Tana white house - 20 bones long and round - compare bone maturation to different stages of maturation in the atlas give a score to each bone and that gives you bone age
Bone age very close to pubertal timing
how is puberty staged using the tanner method?
describe the tanner stages?
how is testicular maturation measured?
Prader Orchidometer
what should be covered in history and examination in relation to a childs height?
Birth weight and gestation
* PMH
* Family history/social history/schooling
* Systematic enquiry
* Dysmorphic features
* Systemic examination
summarise available assessment tools?
- Height/ length/ weight
- Growth Charts and plotting
- MPH and Target centiles
- Growth velocity
- Bone age
- Pubertal assessment
what is classed as ‘normal’ growth?
– Wide range within healthy population
– Different ethnic subgroups
– Inequality in basic health and nutrition
– Normality may relate to individuals or
populations (genetic influence)
what are factors that can influence height?
how is the shape of normal growth?
infantile
childhood
pubertal
what are hormones involved in puberty?
what is the relationship between growth and other changes in puberty in males and females?
what are the most important pubertal stages in a girl?
Breast budding (Tanner Stage B 2) in a girl
what are the most important pubertal stages in a boy?
Testicular enlargement (Tanner Stage G2 -T 3- 4 ml) in boy
what are the different growth patterns in a girl versus a boy?
what are implications of obesity for growth and puberty in girls?
Children who are obese put on weight much faster - little bit of growth acceleration
Tend to go into puberty earlier
End up same height at end of day
Obese children always tall grow well
what are indications for referral?
Extreme short or tall stature (off centiles)
* Height below target height
* Abnormal height velocity (crossing centiles)
* History of chronic disease
* Obvious dysmorphic syndrome
* Early/late puberty
what are common causes of short stature?
- Familial
- Constitutional
- SGA/IUGR
what does the centile chart for familial short stature look like?
what does the centile chart for constitutional short stature look like?
what can be given if a patient is short for gestational age?
growth hormone
what are pathaological causes of short stature?
- Undernutrition
- Chronic illness (JCA, IBD, Coeliac)
- Iatrogenic (steroids)
- Psychological and social
- Hormonal (GHD, hypothyroidism)
- Syndromes (Turner, P-W)
describe the appearance of growth hormone deficiency?
what is thyroid deficiency?
fallen several centriles iver number of years weight maintained but height reduced
what are some examples of syndromes that may affect growth but benefit from GH?
glucocorticoid excess
turner syndrome
prader-willi syndrome
noonans syndrome
achrondroplasia
what is classed as early and delayed puberty in a boy?
early < 9 years (rare)
delayed >14 (common, especially
CDGP)
what is classed as early and delayed puberty in a girl?
– early <8 years
– delayed >13 (rare)
Constitutional Delay of Growth
and Puberty (CDGP)?
Boys mainly
* Family history in dad or brothers
(difficult to obtain!)
* Bone age delay
* Need to exclude organic disease
what are some other causes of delayed puberty?
- Gonadal dysgenesis (Turner 45X,
Klinefelter 47XXY) - Chronic disease (Crohn’s, asthma)
- Impaired HPG axis (septo-optic dysplasia,
craniopharyngioma, Kallman’s syndrome) - Peripheral (cryptorchidism, testicular
irradiation)
what can be reasons for early sexual development in girls?
what is Central Precocious Puberty?
- Pubertal development
– Breast development in girls
– Testicular enlargement in boys - Growth spurt
- Advanced bone age
Central Precocious Puberty investigations in girls versus boys?
Girls:
– Usually idiopathic
– Pituitary imaging
- Boys:
– Look for underlying cause, i.e. brain tumor?
what is treatment for central precocious puberty?
– GnRH agonist
what is Precocious Pseudopuberty?
- Gonadotrophin independent
(low/prepubertal levels of LH and FSH) - Abnormal sex steroid hormone secretion
- Virilasing or feminasing
- Clinical picture: secondary sexual
characteristics
what may make identifying the sex of a newborn baby difficult?
The newborn with ambiguous
genitalia
what is the management approach for ambiguous genitalia?
- Do not guess the sex of the baby!
- Multidisciplinary approach (paed endo, surg,
neonatologist, geneticist, psychologist) - Exam: gonads?/ internal organs
- Karyotype
- Exclude Congenital Adrenal Hyperplasia!-
risk of adrenal crisis is first 2 weeks of life
what is congenital hypothyroidism?
- 1 in 4000 births
- Causes:
– Athyreosis/ hypoplastic/
ectopic
– Dyshormonogenic - Newborn screening
- Start treatment within first
2 weeks
what is aquired hypothyroidism?
- Most common cause: Autoimmune
(Hashimoto’s) thyroiditis - Family history of thyroid/ autoimmune
disorders - Childhood issues:
– Lack of height gain
– Pubertal delay (or precocity)
– Poor school performance (but work steadily)
what is thyroid deficiency?
fallen several centriles over number of years weight maintained but height reduced
how prevalent is obesity in children?
- Nearly a third (31%) of children aged 2–15
are overweight or obese1 - The direct cost of obesity to the NHS is
estimated to be £4.2bn a year2 - At Reception and Year 6, children in the
poorest decile are almost twice as likely to
be obese compared those in the most
affluent decile3
define overweight?
(BMI >85th centile or SD
>1.04)
define obese?
(BMI >97.5th centile or SD >2)
how is a child assessed for obesity?
- Weight
- Body mass index (BMI) (kg/m2
) - Height
- Waist circumference
- Skin folds
- History and examination
- Complications
what should be covered in the history for an obese patient?
- Diet
- Physical activity
- Family history
- Symptoms suggestive of
– Syndrome
– Hypothalamicpituitary pathology
– Endocrinopathy
– Diabetes
what are complications of obesity?
Metabolic syndrome
Fatty liver disease (nonalcoholic steatohepatitis)
Gallstones
Reproductive dysfunction (eg, PCOS)
Nutritional deficiencies
Thromboembolic disease
Pancreatitis
Central hypoventilation
Obstructive sleep apnea
Gastroesophageal reflux disease
Orthopaedic problems (slipped capital femoral epiphysis, tibia vara)
Stress incontinence
Injuries
Psychological
Left ventricular hypertrophy
Atherosclerotic cardiovascular disease
Right-sided heart failure
what are causes of obesity?
- SIMPLE OBESITY
- Drugs
- Syndromes
- Endocrine disorders
- Hypothalamic damage
what drugs can cause obesity?
- Insulin
- Steroids
- Antithyroid drugs
- Sodium Valproate
what syndromes can cause obesity?
Prader Willi syndrome
Laurence-Moon-Biedl syndrome
Pseudohypoparathyroidism type 1
Down’s syndrome
what endocrine disorders can cause obesity?
Hypothyroidism
Growth hormone deficiency
Glucocorticoid excess
Hypothalamic lesion
(tumour/trauma/infection)
Androgen excess
Insulinoma
Insulin resistance syndromes
Leptin deficiency
how is diabetes treated?
- Diet
- Exercise
- Psychological input
- Drugs???
