Normal and Abnormal Growth Flashcards
How far apart are the centiles spaced on growth charts?
2/3 apart
What is plotted on the x axis of growth charts?
Time
How many measures are needed to compare the growth of a child on a growth chart?
At least two = can’t tell normal growth from a single measure
Why is a longitudinal view important when assessing the growth of a child?
Ensures the child is developing and growing over time as they should be
Are babies technically obese?
Yes = babies are born obese and lose weight over the first few years of life, before beginning to gain weight
What impact does birth weight have on future weight gain?
The heavier a baby is when its born, the earlier it will start to gain weight
When is a child considered to be showing normal growth?
Their measurements are within the normal range
Their rate of growth is within the normal range
Is child who is growing normally likely to have an underlying pathology?
No
How many viral infections do toddlers get a year?
12-15 = this is considered normal, and isn’t concerning if the child is growing normally
What does a secular trend of a growth chart refer to?
The change in growth charts over time
What effect has childhood obesity had on growth charts?
Has shifted the curve to the right and increased the tail of the graph
What did the WHO Multicentre Growth Reference Study measure?
How children should grow rather than how children are actually growing
What was the main impact of the WHO Multicentre Growth Reference Study?
Proved that one growth chart could be used for children of all races
What are the rules for measuring weight?
Babies must have no clothes or nappies on Only class III clinical scales in metric setting should be used
What are the rules for measuring head circumference?
Use narrow plastic tape
Measure three times and use the average
Measure at the widest point of the head
When should the length of a child be measured?
Before age 2 if there is concern = no nappy or shoes to be worn
Why does length measurement vary widely?
Depends on mood of the child and the style of measurer
When should height measurement begin?
From age 2
What are the rules for measuring height?
Use rigid rule with T piece
Ensure heels, bottom, back and head are touching apparatus with eyes and ears at 90 degrees
Measure on expiration
No shoes to be worn
What is the average age for onset of puberty?
Age 11 for girls
Boys are 6 months later on average
What is the secretion of GnRH like throughout life?
Stops in first few months after birth and doesn’t begin again until puberty
What is the first indication of puberty onset in boys?
Increase in testicular volume (increase to 4ml)
What is used to stage puberty?
Tanner staging = puberty begins at stage 2
What is the first indication of puberty onset in girls?
Breast development
What is true precocious puberty?
Normal pubertal development occurring abnormally early = <8 for girls, <9 for boys (more common in girls)
What is pubertal delay?
Absence of secondary sexual development = age 13 for girls, age 14 for boys (more common in boys)
What is thelarche?
Breast budding
What is adrenarche?
Body hair and odour
When do periods normally begin?
Two years post thelarche
When do pubertal growth spurts occur in girls?
Usually at the start of puberty (breast budding at stage 2 or 3)
When do boys have their pubertal growth spurt?
At the end of puberty (once testicular volume is 10-12ml)
What should be covered in the history of a child with concerns about growth?
ICE, birth, PMH, pubertal symptoms, parental heights and puberty
What will be examined in a child concerned about their growth?
Height, weight, height velocity, pubertal status
What are some blood tests done for investigating growth?
Gonadotrophins, growth factors (IGF1), testosterone/oestradiol, thyroid status, karyotyping (especially in girls, helpful for Turner’s syndrome)
What are some investigations done for growth?
Bloods, bone status, dynamic function tests
MRI of brain, USS of uterus (precocious puberty)
What are the classifications of short stature?
Genetic short stature = short parents
Constitutional growth delay = delayed bone age
Dysmorphic syndromes = Down’s/Turner syndrome
Endocrine disorders = pituitary/adrenal problems
Chronic diseases = coeliac
Psychosocial deprivation = multifactorial
What effect does a loving environment have on growth?
Children who are loved more grow quicker and better
What is the importance of growth?
Serves as a marker of heath = delayed or precocious growth may be indicative of other pathology
What are the consequences of poor growth?
Psychosocial aspects = bullying
Socioeconomic status = shorter adults earn less money
