Evaluation of Worrisome Growth

Question 1

What parameters define worrisome growth for height?

Answer 1

2nd percentile (roughly 2 SD below average for age and gender) or 3.5 inches shorter than mid-parental height

Question 2

Kids usually grow about ________ cm in the first year of life.

Answer 2

25

Question 3

From year one to four, kids grow about ______ cm/year.

Answer 3

10

Question 4

Arguably the most important metric in evaluating a child’s growth is _____________.

Answer 4

a history of past points; for instance, you could have a kid who’s at the 2nd percentile, but that is less worrisome if he or she has been at the 2nd percentile for their entire life (as opposed to if they were at the 15th percentile during their last visit)

Question 5

Delayed bone ages predict _____________.

Answer 5

greater eventual height

Question 6

How can bone age help in the evaluation of growth?

Answer 6

Bone age that is younger than actual age is indicative of future growth, while bone age older than actual age predicts less future growth.

Question 7

When does the fall in growth in familial short stature occur?

Answer 7

Usually between 6 months and 18 months; decreases in growth after “the first couple years of life” is worrisome for other causes of short stature

Question 8

Constitutional growth delay is familiarly called _____________.

Answer 8

being a late bloomer –falling off the growth curve before 2-3 years of age, then paralleling it until puberty when some height is then regained

Question 9

Constitutional growth delay is a ____________ trait.

Answer 9

polygenic (60% - 80% will have a family member with short stature)

Question 10

The term “failure to thrive” should only be used for _-_______________.

Answer 10

kids younger than 2 years

Question 11

What is nutritional growth retardation?

Answer 11

Linear growth stunting from poor weight gain in children over 2 years

Question 12

Hormonal causes of worrisome growth generally affect ____________.

Answer 12

height (not weight)

Question 13

Many features of ____________ that are present in adults are not present in kids. Often the only sign is poor growth.

Answer 13

hypothyroidism

Question 14

Congenital growth hormone deficiency results in _________________.

Answer 14

• holoprosencephaly
• cleft lip
• septo-optic dysplasia
• optic nerve hypoplasia
• empty sella syndrome

Question 15

_____________ can present on a spectrum, with a range of severity.

Answer 15

Growth hormone deficiency

Question 16

What can cause acquired growth hormone deficiency?

Answer 16

Trauma
Infection
Hypophysitis
Neoplasm
Radiation

Question 17

Face immature for age, increased truncal fat, and prominent frontal bossing are suggestive of ____________________.

Answer 17

growth hormone deficiency

Question 18

Why is it important to pay attention to a child’s growth?

Answer 18

Because deficient growth may be the first sign of an underlying illness and a missed diagnosis may result in permanently limited growth

Question 19

What percent of kids will fall within 3.5 inches of the mid-parental height prediction?

Answer 19

97%

Question 20

What should be offered to parents of children with constitutional growth delay?

Answer 20

Generally just reassurance, but you can give testosterone to boys or estrogen to girls to delay puberty (so that the bones can continue to grow)

Question 21

The most common cause of failure to thrive is ________________.

Answer 21

psychosocial factors

Question 22

What defines failure to thrive?

Answer 22

Falling across two major percentile lines before age two or falling to less than 3rd percentile before age two

Question 23

What two things stimulate growth hormone?

Answer 23

Clonidine and arginine

Question 24

What is Noonan syndrome?

Answer 24

Abnormal post-GH-receptor signaling

Question 25

What is true of kids born SGA?

Answer 25

Most catch up before age two

Question 26

GH is FDA-approved for SGA kids who have ______________.

Answer 26

not caught up to normal by age two

Question 27

Giving GH to those who are not GH deficient ______________.

Answer 27

does not produce dramatic results

Question 28

Side effects of GH include _______________.

Answer 28

SCFE, pseudotumor cerebri, and unknown long-term risks