Scenario 22: Puberty Flashcards
How do we construct a growth chart?
Define the reference population, decide whether longitudinal or cross-sectional. Use centiles.
Why do we need new growth charts?
‘Secular trend’, the obesity epidemic, based on worldwide data not just UK, based on breast-fed infant population, describe optimal rather than average growth
How do growth rates before puberty relate to the timing of puberty?
Faster developers or overweight children often hit puberty earlier, slower developers or underweight children later
What is the best measure of the tempo of growth?
The bone age viewed by an x-ray of the left hand and wrist. View the growth plate where GH and IGF1 and other transcription factors act. Uses skeletal maturity scoring system
What are the Tanner stages?
Stages of breast development, pubic and axillary hair, penis and scrotum development, testicular volume
What is the Prader Orchidometer?
The string of beads used to size the testes to assess their development
How can we predict the adult height of a child?
Plot parental target height. Plot height of parent of same sex as child on chart and opposite sex (+12.5cm for mother of boy, -12.5cm for father of girl) target height is the mid point between the 2 parents
When may ‘crossing centiles’ be normal?
In infants- to catch up or catch down growth
In puberty- early or delayed developers
What are some key points relating to short stature?
Birth weight, nutrition and feeding in infancy, other physical abnormalities, developmental history, evidence of recent growth failure
How does family history relate to short stature?
Ethnic origin, parental stature, parental nutrition, parental disproportion, pubertal development of parents
What may cause a low birth weight?
Prematurity, chromosomal/genetic abnormalities, inter-uterine infection, other toxins (e.g. foetal alcohol syndrome)
What are the features of Silver-Russel syndrome?
Prenatal growth failure, no post-natal catch up growth, skeletal abnormalities (limb asymmetry, incurved 5th finger), small triangular face, normal HC
What are some severe syndromes causing short stature?
Seckel, Delange, Rubinstein-Taybi, Smith-Lemli-Opitz
What are some moderate syndromes causing short stature?
Williams, Prader-Willi, Noonans
What would a marked delay in bone age signal?
Hormone deficiency, delayed puberty
What would a moderate delay in bone age signal?
Chronic disease, psychosocial issues,
What would a normal delay in bone age signal?
IUGR syndromes, bone dysplasias
What would an advancment in bone age signal?
Obesity, sexual prcocity, sex hormone excess
How does acquired hypothyroidism present?
Somewhat overweight, elevated TSH, small thyroid, short stature
What are the symptoms of coeliacs disease in children?
Short, thin, tired, anaemic, positive antibodies, negative jejunal biopsy, response to diet
What may cause a short spine in children?
Spinal anomlay, scoliosis, SED, irradiation, haemoglobinopathy
What may cause short legs in children?
Hypothyroid, rickets, skeletal dysplasia, turner syndrome
What may cause long legs in children?
Klinefelter’s syndrome, delayed puberty
What are the signs of Turner syndrome?
Short stature, abnormal upper/lower segment ratio, high palate, small jaw, cubitus valgus, short metacarpals, webbing, oedema,
What can Turner syndrome cause?
Gonadal failure and infertility, cardiovascular abnormalities, renal abnormalities, pigmented naevi, hashimotos thyroiditis, hypothyroidism, hypertension, deafness
How can we treat delayed puberty?
Low dose testosterone in boys, or oestrogen in girls
What may cause a tall stature?
Genetics, thyrotoxicosis, precocious puberty, congenital adrenal hyperplasia, Klinefelter’s, fragile X-syndrome, Marfan’s syndrome
How can we treat growth hormone deficiency?
Subcutaneous injection of synthetic growth hormone once daily in evening until reach adult height
What is the first external sign of puberty in boys and girls?
Breast budding in girls, testes enlargement in boys. Pubic hair not generally regarded as pubertal onset.
What is the definition of precocious puberty?
Any secondary sex characteristic appearing before 8 years (girls) or 9 years (boys)
Why does facial hair grow at a different rate to pubic or axillary hair in puberty?
Axillary or pubic hair only requires a low level of androgens to stimulate growth in both sexes. Facial hair required a high level of androgens and is male-related.
What occurs in the 0-2 year stage of child development?
Attachment, maturation of sensory, perceptual and motor functions and understand objects through senses.
What occurs in the 2-6 year stage of child development?
Locomotion, fantasy play, language development, sex role identification and group play
What occurs in the 6-12 year stage of child development?
Friendship, skill learning, self-evaluation, team play, understand cause and effect and conversation
What occurs in the 12-18 year stage of child development?
Physical maturation, emotional development, peer group and sexual relationships, understand abstract thinking
What are the 5 stages of language development?
Preverbal communication, phonological development, semantic development, syntax and grammar development, pragmatics development
According to Piaget what are the 4 main stages of cognitive development?
- Sensorimotor- Initial reflexes via sensory motor schema. Child interacts with environment and manipulates objects. Understanding of object permanence.
- Pre-operational- Internal representation of concrete objects and situations. Child uses symbolic schemes like language. Ego centric. Reasoning dominated by perception
- Concentrate operations- Reasoning involves more than one salient feature (conservation) Logical reasoning can only be applied to objects that are real or can be seen.
- Formal operation- Can think logically about potential events or abstract ideas. Can test hypotheses about hypothetical events
How does attachment develop according to Bowlby?
Process of proximity seeking identified attachment figure in situations of distress or alarm for purpose of survival
How does the progesterone only contraceptive prevent fertilisation?
Thickens cervical mucus, variable effect on ovulation
How does the combined contraceptive pill prevent fertilisation?
Suppress FSH release, stabilises endometrium, potentiates action of progesterones, suppresses LH, thickens cervical mucus, produces unreceptive endometrium, affects secretion and peristalsis within fallopian tube
