Normal and Abnormal Growth

Question 1

what is the middle line on a growth curve?

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

number of standard deviations from the mean

= (x - mean)/SD

Question 4

if 100 people are measured, how many are within 1 SD from the middle line?

Answer 4

68

Question 5

if 100 people are measured, how many are within 2SD from the midline?

Answer 5

95

Question 6

how can a growth chart be used to determine normal growth?

Answer 6

child should stay on the same centile line for both height and weight as they grow

Question 7

how does growth rate change over time?

Answer 7

increased rate up until around 1
rate decreased until around 11-12 where it spikes
rate then decreases to zero by late adolescence

Question 8

how does weight change over time?

Answer 8

born with lots of “puppy fat”
decreases until around 5 where child is at their thinnest
weight then rebounds and begins to increase again
if more overweight at 5 yrs when weight is at its lowest, weight rebounds faster and weight increase after 5 is more rapid

Question 9

what defines normal growth in children?

Answer 9

their measurements are within normal range compared with children of same age
their rate of growth is within the normal range compared to children of their age

Question 10

how has growth in children changed over past 30 years?

Answer 10

increase in height and weight

Question 11

what determines growth in children?

Answer 11

80-90% genetics

10-20% environment

Question 12

how should children’s weight be measured?

Answer 12

babies = no clothes or nappy
children >2 = vest and pants, no shoes, dolls or teddies in hands
only class III clinical electronic scales in metric setting used

Question 13

how is head circumference measured?

Answer 13

at widest point

using narrow plastic disposable paper tape

Question 14

how is length measured?

Answer 14

<2 years if concerned
length board/mat
without nappy or footwear
- can vary depending on mood of child etc

Question 15

when/how should height be measured?

Answer 15

from 2 y/o
using rigid rule with T piece or stadiometer
measure on expiration with shoes removed

Question 16

how is growth plotted on a chart?

Answer 16

use dot

age in weeks for first 6-12 months

Question 17

how are centile lines used?

Answer 17

if the point is exactly on the line or within 1/4 of a space of the centile line the child is described as being on the centile line
if not they are describes as being between centile lines

Question 18

a change in how many centile spaces is considered abnormal?

Answer 18

2

• centile space = space between 2 centile lines
• can cross a centile line

Question 19

at what age does a female enter puberty?

Answer 19

11 (average)

- boys usually 6 months later

Question 20

what are gonadotrophins?

Answer 20

FSH and LH

Question 21

what is precocious puberty?

Answer 21

early onset of puberty

• <8 in girls
• <9 in boys

Question 22

when is puberty delayed?

Answer 22

absence of secondary sexual development in
- girls = 13
- boys = 14
more common in boys

Question 23

what is the average height difference between adult males and females?

Answer 23

12. 5-14 cm
    - boys have delayed PHV
    - boys PHV > girls
    - boys taller in pre-puberty

Question 24

what causes onset of puberty?

Answer 24

hypothalamic stimulation of anterior pituitary to produce gonadotrophins is on during pregnancy for development of genital etc
switched off at birth
switched on again around 11 causing onset of puberty
being overweight can cause earlier onset

Question 25

what can be used to determine stages of male puberty?

Answer 25

testicular volume

pubic hair

Question 26

what can be used to determine stages of female puberty?

Answer 26

breast size
axillary hair
pubic hair
menstruation

Question 27

what are the 3 stages of puberty in females?

Answer 27

thelarche - breast budding
adrenarche - body hair and odour
menarche - peroids start (usually 2 yrs posy thelarche)

Question 28

important aspects of history in potentially abnormal growth?

Answer 28

ICE - does it bother child?
birth
PMH
pubertal symptoms
FH
- parental heights
- parental puberty

Question 29

what is mid parental height?

Answer 29

measurement used to predict which height a child should achieve by adulthood
plot mother and fathers heights on separate graphs and join with a line
where this line crosses the centile line is the mid-parental centile
compare mid-parental centile to the childs height on a separate “adult height predictor graph”
child should be within 2 centile spaces of mid-parental centile

Question 30

what investigations are performed in potential growth problem?

Answer 30

bloods
- gonadotrophins
- groath factors (IGF-1)
- testosterone/oestradiol
- thyroid
- karyotype
- other pathology
bone age (wrist X ray)
dynamic function tests
MRI brain
uterus US

Question 31

what are the 6 classifications of short stature?

Answer 31

genetic short stature
constitutional growth delay
dysmorphic syndromes
endocrine disorders
chronic diseases
psychosocial deprivation