Reproduction 5 - Child Growth & Development Flashcards
1
Q
What do centile charts measure?
A
- Height
- Weight
- Head circumference (measures brain development)
- BMI
2
Q
How are centile charts used?
A
- Plot the age against height
- 50% of children shorter than 50th centile, and 25% shorter than 25th centile
- Different for boys and girls
3
Q
How are children measured accurately?
A
- Equipment should be accurate and maintained properly
- Position the child properly
- Make sure you take shoes off and hair out of the way
- Calculate age and plot correctly
- Measured lying down before the child is old enough to stand
4
Q
How is child height monitored?
A
- Centile charts look at cumulative height
- Height velocity is how fast a child is growing in cm per year (height now-height last visit / age now-age last visit)
- Consider growth of parents and siblings
5
Q
List influences of normal child growth
A
- Events before birth- poor fetal growth, low birth weight, prematurity
- Medical issues in childhood- malnutrition, chronic disease, endocrine problems including growth hormone deficiency
- Genetic factors- the height of the family and any inherited disorders of growth.
- Randomness. (Not every child of the same parents will be the same adult height, and tall parents can occasionally have a short child. There are multiple genes which determine adult height, and these are randomly distributed at conception.)
6
Q
How do children grow?
A
- Fastest phase in the first 2 years (first year 23-25cm)
- Most children move to a centile position at this age and then stick with it
- Movement up or down centiles is then unusual (pattern is the most important thing)
- Phase of fast growth at puberty - pubertal growth spurt
- Timing of this depends on the age at which the child enters puberty
- Skeleton matures as the child grows. At the end of puberty, the epiphyses fuse and growth stops
- Late puberty can result in falling behind in height
- In childhood nutrition has less impact
7
Q
Describe the hormonal control of growth and growth hormone secretion
A
- GH is the more important hormonal factor
- Controlled by GNRH from the hypothalamus, and somatostatin which suppresses it
- Released as pulses mostly overnight
- GH has growth effect itself and also stimulates release of IGF1 (insulin like growth factor 1)
- IGF1 stimulates growth in all tissues of the body, and exerts negative feedback
- Influenced by nutrition, sleep, exercise and stress
8
Q
List causes of short stature
A
- Pubertal and growth delay
- IUGR/SGA
- Chronic disease (causing inflammation)
- Endocrine causes - GH deficiency, thyroid hormone deficiency, steroid excess
- Genetic disorders (achondroplasia, turner, downs syndrome)
- Psychological distress and neglect
- If a normal pattern, there may not be a medical problem - eg. short parents)
9
Q
List causes of tall stature
A
- Marfan or Soto sydrome
- Tall parents
- GH excess from a pituitary tumour (rare)
- Children with precocious puberty will be tall children, but short adults as growth stops early
10
Q
How are short children treated?
A
- If confirmed GH deficiency they will receive treatment
- Treatment for other bone growth disorders
- However, short normal children receive no treatment as it is not worth the time and expense
11
Q
How is obesity defined?
A
- For adults BMI of over 25 kg/m2 is overweight and over 30 kg/m2 is obese.
- Children have lower BMI than adults and this changes with age so these figures do not apply, therefore obesity is assessed on the BMI centile position.
12
Q
Describe incidence of obesity worldwide
A
- Rates of obesity and overweight have increased but may not continue to go up at the same rate for the future
- There are some nations who have a much higher rate of obesity than others. In some areas of the world obesity is a feature of poverty and in others associated with affluence.
- Some ethnic groups have less “tolerance” of obesity and are more likely to get complications like type 2 diabetes at a lower BMI
- 2/3 adults, 1/4 2-10 year olds, 1/3 11-15 year olds
13
Q
What are the complications of obesity?
A
- Barker hypothesis (risk of death higher in very underweight or very overweight individuals)
- Type 2 diabetes
- PCOS
- Cardiovascular disease (high cholesterol, high blood pressure)
- Breathing difficulties
- Bone and joint problems
- Some cancers
- Orpthopaedic problems
- Emotional and behavioural (stigmatism, bullying, low self-esteem)
14
Q
Why does obesity happen?
A
- Balance of food versus energy expenditure
- Hunger is regulated by the hypothalamus (eg. leptin, POMC, PC-1, MC4R). Small number of people have gene mutations affecting these hormones/ receptors.
- Some gene variants (eg. FTO gene) affect eating behaviour and appetite, and can make an individual eat in a way more likely to gain weight)
15
Q
Describe history taken in children
A
- Antenatal – illnesses/infections; medications; drugs; environmental exposures
- Birth – Prematurity, Prolonged/complicated labour
- Postnatal – illnesses/infections; Trauma
- Consanguinity – increases chances of chromosomal or autosomal recessive conditions
- Developmental milestones from parent
16
Q
Describe examinations taken to monitor child development
A
- Growth parameters (height, weight and head circumference)
- Dysmorphic features
- Neurological examination and skin
- Systems examination to identify associations, syndromes
- Standardised developmental assessment – Schedule of growing skills II, bailey developmental scale, denver
17
Q
How are abnormalities in child development monitored?
A
Depends on suspected cause but may include
- Cytogenetic studies
- Metabolic screen (thyroid, renal, liver and bone profiles)
- Blood ammonia and lactate
- Urine and blood organic and amino acids
- Creatine kinase
- Imaging – CT, MRI
- EEG
- Nerve and muscle biopsy
- Referral to other members of the MDT
18
Q
What is cerebral palsy?
A
- Disorder of movement and posture arising from a non-progressive lesion of the brain acquired before the age of 2 years.
- Affecting corticospinal pathways - flexor contraction overcomes extensor movement
- Incidence 1-2 per 1000 live births
- Most causes (~80%) are antenatal
- Presentation may evolve and vary with age
19
Q
List associated problems with cerebral palsy
A
- Learning difficulties
- Epilepsy
- Visual impairment
- Hearing loss
- Feeding difficulties
- Poor growth
- Respiratory problems.
20
Q
How are children with cerebral palsy managed?
A
- Minimise spasticity and manage associated problems
- Dietitian
- Specialist health visitor (advice for parents, advocate)
- Paediatritian (Assessment, diagnosis, medial management
- Psychologist (monitor cognitive function, behavioural testing, educational advice)
- Speech and language therapist (feeding, language and speech development)
- Physiotherapist (balance and mobillity)
- Occupational therapist (hand eye coordination, housing adaptations)
21
Q
What is autism spectrum disorder?
A
- Prevalence is 3-6 per 1000 live births
- Boys>girls
- Usually presents between 2 – 4 years of age
- Features include impaired social interaction; speech and language disorder; and imposition of routines with ritualistic and repetitive behaviour.
22
Q
What are the comorbidities of autism?
A
- Learning and attention difficulties
- Epilepsy
23
Q
How is autism managed?
A
Intensive support for the child and family
24
Q
List diagnositc criteria for attention deficit hyperactivity disorder
A
- Inattention
- Hyperactivity
- Impulsivity
- Lasting > 6 months
- Commencing < 7 years and inconsistent with the child’s developmental level
- These features should be present in more than one setting, and cause significant social or school impairment.
25
Q
What are children with ADHD at risk of?
A
- Conduct disorder
- Anxiety disorder
- Aggression (increased incidence of criminal behaviour)
- Increased risk of substance abuse
- Antisocial personality
