module 3 peds growth and development Flashcards
pediatric PMH
chronic illness problems with organs cancers food allergies any medication
pediatric birth hx
full term
SGA?
LGA?
any complications prenatally or after delivery? infection?
pediatric family hx
obesity
short or tall?
delayed puberty
genetic or metabolic disorders?
hormones affecting growth during childhood
insulin-like growth factor 1
- birth till 20
- pulsatile secretions, 70% during sleep
thyroid hormone
- birth till 20
- stimulates GH, bone formation and reabsorption
Growth Hormone
- low at birth, peak around 5 and slow decline
Gonadal hormone
- 10-20, puberty
organ systems and weight
closely related to growth in stature and organ development.
influenced by: nutrition -> inc. number and size of adipose cells.
organ systems and length
skeletal growth is complete with epiphyses of long bones fuse: 90% or more of skeletal mass is present by 18.
lymph system growth
well developed at birth
grows rapidly, adult size by age 6, peak at 10-12
during adolescence the tissues decrease and stabilize
reproductive organ growth
grow slowly in prepubertal child but double in size during adolescence, full function and maturation during this time.
organs with quickest physical development
brain
skull
eyes
ears
fetal period growth of what dominates
head
infant period growth of what dominates
trunk
fat content and fetus
fat content of body increases slowly during fetal development, then rapidly accelerates the first 9 months of life
fastest growing during childhood
legs
- wt gained at a steady rate
fat and child growth
fat tissue inc. slowly until 7 years of age, then a prepubertal “fat spurt” occurs prior to the true linear growth spurt of puberty
adolescence growth
trunk and legs elongate
skeletal mass and organ systems double in size
males: broader shoulders and greater musculature
females: wider pelvic outlets
Height for infants
linear growth or recumbent length
- use from birth to 3 years
- measure to nearest 0.5cm or 1/4in
head circumference
measure until 3 years old
put tape around occipital protuberance and the supraorbital prominence
BMI and children
most common method used to assess nutritional status
< 5th percentile underwt
>85% over weight
>95% obese
CDC growth chart
2 years and up
WHO growth chart
birth to 2 years
arm span in children
arm span = height in most children
failure to gain wt or ht may be due to
inadequate calories
congenital problems
constitutional delays
familial or other endocrine problems
age where height is most predictive
2, 3, 4
puberty for females
age at which breast is stage 2 or pubic hair is stage 2
complete by breast stage 4 or pubic hair stage 5
Peak height velocity occurs the year before menarche
puberty for males
external genital changes usually precede pubic hair development
Ejaculation occurs at Tanner 3, semen production by Tanner 4
Peak height velocity is at a mean age of 13.5 years of age
precocious puberty female
development of breast tissue or pubic hair in girls
- younger than 6 years for black females
- younger than 7 years for white females
precocious puberty male
development of genitals or pubic hair in boys younger than 9
Tanner 1 breast
preadolescent
Only the nipple is raised above the level of the breast
Tanner 2 breast
Budding stage
bud-shaped elevation of the areola
areola increased in diameter and surrounding area slightly elevated
Tanner 3 breast
breast and areola enlarged
no contour separation
Tanner 4 breast
inc. fat deposits
areola forms a secondary elevation above that of the breast, this occurs in half of all girls.
Tanner 5 breast
Adult stage
areola is part of general breast contour and is strongly pigmented, nipple projects.
Tanner 1 female pubic
preadolescent
no pubic hair
Tanner 2 female pubic
Initial scarcely pigmented straight hair
along medial border of labia
Tanner 3 female pubic
sparse dark visibly pigmented curly pubic hair on labia
Tanner 4 female pubic
hair coarse and curly
abundant but less than adult
Tanner 5 female pubic
lateral spreading
type and triangle spread of adult hair to medial surface of thighs
Tanner 6 female pubic
further extension laterally, upward, or dispersed.
Tanner 1 testes
testes, scrotum, and penis are the same size and shape as in the young child
Tanner 2 testes
enlargement of scrotum and testes
skin of scrotum becomes redder, thinner, and wrinkled.
Penis no larger.
Tanner 3 testes
Enlargement of the penis, especially in length
further enlargement of testes, descent of scrotum
Tanner 4 testes
continued enlargement of penis and sculpturing of the glans.
inc. pigmentation of scrotum
Tanner 5 testes
Scrotum ample
penis reaching nearly to bottom of scrotum
Tanner 1 male pubic
preadolescent
no growth of hair
Tanner 2 male pubic
slightly pigmenting longer straight hair often still downy.
usually at the base of penis, sometimes on scrotum
Tanner 3 male pubic
dark pigmented curly pubic hair around base of penis
Tanner 4 male pubic
Pubic hair definitely adult in type but not in extent
no further than inguinal fold
Tanner 5 male pubic
adult distribution
hair spread to medial surface of thighs but not upward
Tanner 6 male pubic
hair spread along linea alba
turner syndrome
absence of one of X chromosomes
- short stature: 5-10 percentile
klinefelter syndrome
1/1000 male birth
- defect found in puberty
frontal baldness absent fewer chest hairs breast development female type pubic hair small testicular size poor beard growth narrow shoulders hide hips long arms and legs
Marfan syndrome
1/5000 births
tall slender
loose joints
heart/aortic issues
