growth evaluation

Question 1

When should height and weight be measured

Answer 1

birth, 2-4 days, 1, 2, 4, 6, 9, 12, 15, 18, 24 months and every year thereafter through age 21

Question 2

1. Define “worrisome growth.”

Answer 2

1. height: short stature (heigh below -2 SD for age and gender or below 2 SD of the midparental target height), Dwarfism (height below -3SD for age), Midget (dwarf with normal body proportions). 2. growth velocity: abnormally slow linear growth velocty dropping across two major centile lines on growth chart

Question 3

Calculate genetic height potential for boys and girls

Answer 3

Boys: (mom heigh + 5in + dad height)/2. Girls: (dad height - 5in + mom height)/2

Question 4

Skeletal maturation and height

Answer 4

There is a direct correlation between the degree of skeletal maturation and the time of epiphyseal closure. The greater the bone age delay, the longer the time before epiphyseal fusion ceases growth

Question 5

Body proportions over time

Answer 5

Upper to lower body ratio starts at 1.7 at birth and falls to 1.0 by 10 years of age.

Question 6

Arm span over time and average male/female arm span

Answer 6

Arm span is shorter than height in boys before 10 – 11 years and girls before 10 to 14 years after which arm span exceeds height. Avg adult male has arm span 5.2 cm > ht and adult female 1.2 cm >ht

Question 7

Define constitutional growth delay

Answer 7

Characterized by growth deceleration during first 2 years of life followed by normal growth paralleling lower percentile curve throughout prepubertal years

Question 8

Final height in constitutional growth delay

Answer 8

Generally end up along lower end of normal height range for families. Skeletal maturation is delayed but catch up growth is achieved by late puberty and fusion of growth plates is delayed.

Question 9

Constitutional growth delay family history

Answer 9

Polygenic trait- positive family in 60-80% of pts

Question 10

Treatment of constitutional growth delay

Answer 10

Can treat boys with testosterone if bone age ≥11-1/2 years to avoid compromising final height. Can treat girls with estrogen (less common)

Question 11

Define familial short stature

Answer 11

Children who have normal growth velocity and height that are within normal limits for parent’s heights. Initially will have decrease in growth rate between 6 and 18 months of age. Some families may have tubular bone alterations

Question 12

Define failure to thrive

Answer 12

Infants/young children with deceleration of weight gain to a point <3%. Fall in weight across 2 or more major percentiles.

Question 13

Most common causes of failure to thrive

Answer 13

poor nutrition and psychosocial factors

Question 14

Which condition does failure to thrive look like on a growth chart?

Answer 14

constitutional growth delay

Question 15

Define nutritional growth retardation

Answer 15

Linear growth stunting from poor weight gain in children over 2 years of age. May be secondary to systemic illnesses such as celiac dz, IBD, stimulant meds.

Question 16

What condition does nutritional growth retardation look like on growth chart

Answer 16

constitutional growth delay and constitutional thinness

Question 17

Define children born small for gestational age

Answer 17

Less than -2 SD for birth weight or length (less than 2.3 percentile)

Question 18

Etiologies of children born small for gestational age

Answer 18

1. Maternal – infection, nutritional deficiencies, uterine abnormalities, smoking, alcohol, drugs. 2. Placental – Previa, abruption, infarcts, structural, multiple gestation. 3. Fetal – Chromosomal abnormalities, metabolic, infections,
   malformations1. Maternal – infection, nutritional deficiencies, uterine abnormalities, smoking, alcohol, drugs. 2. Placental – Previa, abruption, infarcts, structural, multiple gestation. 3. Fetal – Chromosomal abnormalities, metabolic, infections,
   malformations

Question 19

Which growth curves are used to classify infants as small for gestational age

Answer 19

Usher and McLean growth curves-

Question 20

Catch up growth in infants born small for gestational age

Answer 20

Most healthy infants born SGA achieve catch-up in height by age 2 years. Most catch up growth is achieved within 6 months of birth. 10-15% will remain short as adults. Final height may be compromised by early puberty

Question 21

Pathophys of SGA

Answer 21

Fetal response to prolonged nutritional deficiencies late in gestation may be to prematurely reset to a slow growth rate with a degree of resistance to GH, IGF-1, and insulin

Question 22

Treatment for SGA children

Answer 22

growth hormone is approved for SGA children who fail to have catch up growth by 2 years. May increase final heigh by avg of 3 inches

Question 23

Hormonal causes of worrisome growth

Answer 23

Usually weight is spared. Hypothyroidism, GH/ IGF-1 abnormalities, cushing syndrome, rickets

Question 24

hypothyroidism in children vs adults

Answer 24

Many clinical features that are seen in hypothyroid adults are lacking in children

Question 25

Causes of congenital GH deficiency

Answer 25

Hypothalamic-pituitary malformations: holoprosencephaly, isolated cleft lip or palate, septo-optic-dysplasia, optic nerve hypoplasia, empty sella syndrome

Question 26

Causes of acquired GH deficiency

Answer 26

trauma, CNS infection, hypophysitis, CNS tumors, Cranial irradiation

Question 27

GH deficiency growth chart

Answer 27

abnormal growth velocity

Question 28

Clinical sx and signs of GH deficiency

Answer 28

decreased muscle, increased subq fat around trunk, immature face for age, prominent forehead, depressed midface, small phallus in males, midline facial defects, prolonged jaundice or hypoglycemia in newborn period

Question 29

Evaluation for GH deficiency

Answer 29

1. bone age. 2. low IGF-1 (note will be low in underweight children regardless of GH status). 3. Stimulating tests- clonidine, arginine, glucagon, L-dopa. Never draw random GH level

Question 30

What causes short stature in Turner syndrome

Answer 30

Haploinsufficiency of SHOX genes cause skeletal and growth abnormalities

Question 31

What causes short stature in Prader Willi syndrome

Answer 31

GH deficiency

Question 32

What causes short stature in Noonan syndrome

Answer 32

abnormal GH post-receptor signaling

Question 33

Stature in Turner syndrome

Answer 33

Virtualy all girls with turner syndrome have short stature. Final heigh is about 20cm less than target height, if untreated. Weight is low to normal

Question 34

Treatment of Turner syndrome

Answer 34

Growth hormone improves growth and final adult height. Early treatment is important

Question 35

Describe skeletal abnormalities in Turner syndrome

Answer 35

short stature, increased carrying angle of forearms, short neck, micro or retrognathia.

Question 36

Describe lymphatic abnormalities in Turner syndrome

Answer 36

low hairline, webbed neck, lymphedema

Question 37

Describe cardiac, renal, reproductive, endocrine and neuro abnormalities in Turner syndrome

Answer 37

cardiac: bicuspid aortic valve, coarctation. Renal: horeshoe kidney. Repro: ovarian insufficiency. Endocrine: hypothyroid, celiac dz. Neuro: non verbal learning disability. Also otitis media and hearing loss

Question 38

Evaluation of worrisome growth

Answer 38

1. bone age (left hand and wrist). 2. screening labs: metabolic panel, CBC, UA, karyotype in girls, TSH, IGF-1. 3. If nutritional: check ESR, tissue transglutaminase Ab and IgA

Question 39

FDA approved uses of recombinant human GH

Answer 39

GH deficiency, chronic renal insufficiency, adult GH deficiency, Turner syndrome, Prader Willi syndrome, small for gestational age, idiopathic short stature, SHOX deficiency, Noonan syndrome

Question 40

Potential side effects of GH

Answer 40

slipped capital femoral epiphysis, pseudo tumor cerebri