Flashcards in Child Growth Deck (18)
Why measure growth
- Poor growth in infancy is associated with high childhood morbidity and mortality.
- Growth is best indicator of health
- Demonstration of normality of growth by age and stage of puberty
- Identify disorders of growth
- Assess obesity
What is a centile chart
Way of expressing variation in the population
Are centiles a normal range
Centiles are not a “normal range”
- you can be taller or shorter than the centile lines and still be completely normal and healthy. E.g is you have very tall parents, you would have genes for tall height.
At what age do most children set out on a centile
Most children set out on a centile by about 2 years and grow on the same centile during childhood - see diagram of the centile graph
What do you look at when looking at centile charts
Pattern of growth is more important than position on the centiles.
- Most very tall or very short people are healthy and grow in a normal pattern.
A child who falls significantly in their centile position is not growing normally, whatever their height.
When does growth stop
At the end of puberty
What is height velocity
[Height velocity calculation:
height now - height last visit]/[age now - age last visit]
Interval approx 6 months
Expressed in cm/year
Describe the speed of growth of a child after birth
Very fast growth at the beginning post-natal, falls off until puberty. At puberty you get the puberty growth spurt
Describe the endocrinology of growth
GH is stimulated to be released from the anterior pituitary by GHRH. Somatostatin inhibits the secretion of GH. GH then acts on GH receptors which stimulates the production of IGF-1.
Both GH and IGF-1 have their own actions. IGF-1 binds to IGF-1 receptors on growth plates causing you to grow.
Note: Somatotroph cells of AP secrete GH and GH is a single chain polypeptide so as treatment has to be given IV. Growth is influenced by nutrition, sleep, exercise, stress
What are the phases of growth
Describe antenatal growth
The most rapid phase and crucial for achieving potential
Maternal health and the placenta are important factor for antenatal growth
Epigenetic changes due to poor antenatal environment
List some chronic paediatric diseases which can affect growth?
Juvenile chronic arthritis
Inflammatory bowel disease
Congenital heart disease
What are the causes of tall stature?
Syndromes e.g. Marfans
Growth hormone excess - gigantism
Why is getting fat bad?
With increasing weight there is increasing risk of death
Describe the growth of bone in children?
The bones mature and epiphyses fuse at the end of puberty.
The final part of growth occurs in the spine and the final epiphyses to fuse are in the pelvis.
What are the causes of short stature?
- Pubertal and growth delay
- IUGR (intrauterine growth restriction - when you're born tiny and never really grow and catch up to the normal)/SGA
- Dysmorphic syndromes (Downs)
- Endocrine disorders (hypothyroidism)
- Chronic paediatric disease (If you have lots of inflammatory cytokines this triggers a pathway that blocks the effect of GH)
- Psychosocial depravation (neglect = causes changes in GH pulsitility)
What is the cause of most short children?
Normal growth pattern
Most short children have a normal growth pattern and do not have any medical problem.
They are usually the children of short parents