SM_149b: Growth: Disease Specific Impact in Children

Question 1

Organic pediatric malnutrition has ___

Answer 1

Organic pediatric malnutrition has an underlying medical cause

Question 2

____ should always be corrected when assessing growth

Answer 2

Children born <37 weeks premature until 24 months should always be corrected when assessing growth

Question 3

Disturbances in ___ may be the first indication of an underlying disease state

Answer 3

Disturbances in growth may be the first indication of an underlying disease state

Question 4

Describe the different growth curves

Answer 4

Growth curves

• CDC
• WHO: breast fed infants
• Premaature infants: 40 weeks - gestational age at birth (corrected = chronological age - adjustment for prematurityZ)

Question 5

Describe daily weight gain in children

Answer 5

Daily weight gain in children

• 20-30 grams in first 3-4 months
• 15-20 grams in first year
• 5-10 grams at 12 months to 2 years

Question 6

Describe height of children

Answer 6

Height of children

Girls = [(father height - 5 in) + mother height] / 2

Boys = [father height + (mother height + 5 in)] / 2

Question 7

BMI is not applicable if ____

Answer 7

BMI is not applicable if age < 2 years

• Weight / length: assesses weight compared to height, indicator of acute malnutrition
• Length / heigh for age: indicator of chronic malnutrition and stunting

Question 8

___ is the last growth parameter to decrease

Answer 8

Head circumference is the last growth parameter to decrease

Question 9

Non-organic pediatric malnutrition has ___

Answer 9

Non-organic pediatric malnutrition has psychosocial origin leading to poor intake

Question 10

Failure to thrive / growth faltering is ____ < 3 months and ____ > 3 months

Answer 10

Failure to thrive / growth faltering is acute < 3 months and chronic > 3 months

Question 11

Describe anthropometry of children

Answer 11

Anthropometry of children

Question 12

Describe appropriate growth charts

Answer 12

Appropriate growth charts

• WHO growth curve for children < 2 years of age
• BMI used for children > 2 years of age
• Weight / length < 2 years

Question 13

Weight/length can indicate ____

Answer 13

Weight/length can indicate acute malnutrition

Question 14

Length/height for age include ____ or ____

Answer 14

Length/height for age include chronic malnutrition or stunting

Question 15

This is ____

Answer 15

This is normal weight

Question 16

This is ___

Answer 16

This is obese

Question 17

Failure to thrive or growth faltering is based on ____

Answer 17

Failure to thrive or growth faltering is based on established growth standards for age-sex

• Weight for age or weight/length < 5%
• Weight may cross more than 2 major percentiles
• Decrease in > 2 SD on growth charts over 3-6 months

Question 18

Failure to thrive / growth faltering can occur due to ____, ____, ____, and ____

Answer 18

Failure to thrive / growth faltering can occur due to insufficient intake, losing calories, increased caloric demand, and inability to utilize calories appropriately

• Losing calories: vomiting / diarrhea, malabsorption
• Increased caloric demand: complex heart disease, liver disease, and pulmonary disease
• Inability to utilize calories appropriately: mitochondrial disease, chromosomal abnormality

Question 19

Failure to thrive / growth faltering can occur in ___, ___, ___, and ___

Answer 19

Failure to thrive / growth faltering can occur in cystic fibrosis, IBD, celiac disease, and for social reasons such as poor maternal interaction with child and improper mixing of formula

Question 20

Cystic fibrosis may present with ____, ____, and ____ and is a cause of ____

Answer 20

Cystic fibrosis may present with respiratory infections, poor weight gain, and fat malabsorption and is a cause of growth failure

• CFTR mutations
• Sweat Cl > 60 mmol/L on two separate occasions
• Immunoreactive trypsinogen concentration

Question 21

Describe GI manifestations of cystic fibrosis

Answer 21

Cystic fibrosis GI manifestations

• Pancreatic insufficiency (∆F508) 90%
• Pancreatitis / pancreatic sufficiency: fat malabsorption (fat soluble vitamins A, D, E, and K)
• Meconium ileus / perforation leading to intestinal resection / short bowel syndrome
• Distal intestinal obstructive syndrome - severe constipation that may require intensive therapy

Question 22

Describe functions of the pancreas

Answer 22

Pancreas functions

• Secretes alkaline fluid that neutralizes gastric acid
• Secretions have increased viscosity, blocking ducts of exocrine glands i.e. pancreas
• Contains multiple digestive enzymes to help with absorption

Question 23

Goal for growth in a patient with cystic fibrosis is ____

Answer 23

Goal for growth in a patient with cystic fibrosis is > 50th percentile for weight/length and BMI

• Pancreatic enzyme replacement therapy is used to treat

Question 24

Inflammatory bowel disease presents with ____, ____, ____, ____, and ____

Answer 24

Inflammatory bowel disease presents with abdominal pain, diarrhea, rectal bleeding, weight loss, and growth failure in pediatric populations

Question 25

Growth failure / faltering is defined as ____, ____, or ____

Answer 25

Growth failure / faltering is defined as height < 5th percentile, decrease in height velocity below the 5th percentile, and fall off the growth curve

(higher incidence at diangosis in Crohn’s than ulcerative colitis)

Question 26

Growth failure / faltering in IBD results from ____, ____, and ____

Answer 26

Growth failure / faltering in IBD results from inadequate caloric intake, malabsorption, and increased energy expenditure from chronic inflammation

• Inadequate caloric intake: gastritis, esophagitis, fear of worsening symptoms
• Increased energy expenditure from chronic inflammation: pro-inflammatory cytokines, decreased IGF-1, and exogenous steroids

Question 27

____ with IBD have greater risk of growth failure

Answer 27

Boys with IBD have greater risk of growth failure

(treat all with remicade and humira)

Question 28

____ is an immune-mediated disorder that is triggered by gluten allergy in genetically susceptible persons after the introduction of solid food

Answer 28

Celiac disease is an immune-mediated disorder that is triggered by gluten allergy in genetically susceptible persons after the introduction of solid food

Question 29

Celiac disease presents with ____, ____, ____, and ____

Answer 29

Celiac disease presents with abdominal pain, diarrhea, constipation, and growth faltering

• Diagnosis: various IgA assays

Question 30

Someone with scalloping and nodularity on endoscopy may have growth faltering due to ___

Answer 30

Someone with scalloping and nodularity on endoscopy may have growth faltering due to celiac disease

Question 31

Celiac crisis in children presents with ____, ____, and ____ and often occurs after use of ____

Answer 31

Celiac crisis in children presents with severe diarrhea, hypoproteinemia, and electrolyte abnormalities and often occurs after use of corticosteroids

Question 32

Describe non-organic growth faltering

Answer 32

Non-organic growth faltering

• Post-partum depression
• Economic reasons: improperly prepared formula
• Young mother with lack of social support
• Maternal-child bonding issues: colicky infant
• Inpatient monitoring of weight gain sometimes necessary