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Stage 2: Human Deveopment > Infant Growth + Short Stature > Flashcards

Infant Growth + Short Stature Flashcards

1
Q

How does normal growth vary?

A

1) Wide variation in population
2) Wide variation in families
3) Different ethnic populations
4) Effects of deprivation - not enough food to get all nutrients for growth
- We have to distinguish normal variation in growth from pathological growth

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2
Q

What are the differences in normal growth between boys and girls?

A
  • Girls overtake boys at 12 years old bc girls start puberty earlier
  • Delayed puberty give boys 14cm more height than girls
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3
Q

What are the 3 phases of growth + what hormones/factors cause them?

A

1) Infancy - nutrition, insulin
2) Mid-childhood - growth hormone, thyroxine
3) Puberty - growth hormone, sex hormones (also stop growth)

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4
Q

When does growth hormone have no effect on growth?

A

Infancy - can have GH deficiency and be growing fine

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5
Q

What is needed for normal growth?

A

1) Health - is there pathology?
2) Food - is there a problem of nutrition? Are they getting enough and are they absorbing it?
3) Nurturing - are they bring abused/neglected? - children grow less
4) Hormones - at the right time and the right amounts
- Normal growth results from a complex interaction of all these factors

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6
Q

What is the definition of short stature?

A
  • A standing height < 0.4th centile (< 2.5 SD below the mean)
  • Child who falls outside mid-parental heigh range
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7
Q

How do you define decreased growth velocity?

A
  • Growth of < 4cm/year during mid-childhood (babies 20cm/year, v fast)
  • Decreased growth velocity < 25th centile for over 12 months, on growth velocity chart
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8
Q

What is faltering growth?

A
  • Dropping > 2 centile lines on a growth chart over a period of 12 months
  • In first 6 months this can be normal - changing centiles
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9
Q

What could a disproportionate appearance suggest and what would you do?

A
  • Possible skeletal dysplasia
  • Short and overweight - suggestive of endocrinopathy
  • Monitor the child over a period of 6 months
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10
Q

How do you assess growth?

A

1) History
2) Anthropometry
3) Examination
4) Investigations and assessment of skeletal maturity (bone age)
5) Adult height prediction

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11
Q

How can a systemic condition lead to growth problems?

A

All energy is used to manage condition, not for growth

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12
Q

How does sleeping affect growth?

A

GH is produced at night in pulses

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13
Q

What maternal factors can affect growth?

A

Maternal health, smoking

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14
Q

What do you want to include in the history to find out the cause of growth problems?

A
  • Nutrition and feeding
  • Nausea/vomiting/bowel habits
  • Sleeping
  • Delayed development/syndrome
  • PMH/systemic enquiry
  • Family history
  • Birth weight - IUGR, antenatal history
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15
Q

What are causes of short stature?

A

1) Familial
2) IUGR/SGA with poor catch up growth by 4 years old
3) Extreme prematurity < 28 weeks
4) Constitutional delay of growth and puberty
5) Nutritional/chronic illness
6) Chromosomal disorders/syndromes
7) Psychosocial deprivation
8) Endocrine causes
9) Disproportionate short stature/skeletal dysplasia
10) Idiopathic

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16
Q

How does extreme prematurity affect growth?

A

Approx 15% remain short during childhood and persists into adulthood

17
Q

What is constitutional delay of growth and puberty?

A
  • Healthy but just delayed
  • e.g. delayed bone age e.g. 6 year old bones in 8 year old
  • So will be short but continue growing after others have stopped e.g. at 18
  • Usually a familial history
18
Q

What chronic illnesses (affecting nutrition) can cause short stature?

A
  • IBD
  • Congenital heart malformations
  • CF
  • Coeliac disease
19
Q

What chromosomal disorders/syndromes can cause short stature?

A
  • PWS (Prader-Willi)
  • RSS (Russell-Silver)
  • TS (Turner syndrome)
  • Noonan’s
  • Pseudohypoparathyroidism
20
Q

What are endocrine causes of short stature?

A

1) Hypothyroidism - metabolism slows down
2) GH deficiency (with ectopic posterior pituitary?)
3) Glucocorticoid excess
4) Laron’s syndrome - GH insensitivity

21
Q

What do people with short stature due to endocrine causes look like and why?

A

Short and fat

- No where for weight to go if not growing e.g. GH deficiency

22
Q

What do people with short stature due to chronic inflammatory diseases e.g. IBD?

A

Short and thin

23
Q

What are the clinical features of coeliac disease?

A

1) Tiredness
2) Anaemia
3) Positive antibodies
4) Positive jejunal biopsy
5) Response to diet
6) Wasted bottom
7) Big tummy
8) If treat with gluten-free diet, height and weight improves and reached upper limit of mid-parental height

24
Q

What measurements would you do in someone with short stature?

A

1) Height
2) Weight
3) Parent’s heights
4) Mid parental height range
5) ± Head circumference
6) ± Sitting height
7) ± Subischial leg length

25
Q

How do you get the subischial leg length?

A

Subtract sitting height from standing height

26
Q

What are 1st line investigations for short stature?

A

1) FBC (good measure of disease)
2) Ferritin
3) U&E
4) CRP/ESR
5) TFT
6) Coeliac screen
7) IGF-1
8) Bone age
9) CGH array/karyotype

27
Q

Why do you do a CGH array/karyotype when investigating short stature?

A

To check for Turner’s syndrome

28
Q

What are 2nd line investigations for short stature?

A

1) GH provocation test ± additional pituitary function tests
2) MRI brain (pituitary)
3) Skeletal survey

29
Q

What is a GH provocation test?

A

Make them produce GH, stress hormone, created bodily stress

30
Q

Why would you do an MRI of the brain?

A

To check if there is a tumour esp. on pituitary gland

31
Q

When else can a skeletal survey show?

A

Any safeguarding issues

32
Q

How do you investigate for bone age?

A
  • Do an X ray of e.g. hand
  • Compare each bone with atlas of reference bone for age
  • Mainly phalanges
33
Q

How do you treat short stature?

A
  • Depends on the underlying cause

- GH will make most people grow

34
Q

What is treatment with GH licensed for?

A

1) GH deficiency
2) Turner’s syndrome
3) Prader Willi syndrome
4) SGA + poor catch up
5) Chronic renal failure
6) SHOX deficiency - also seen in Turner’s syndrome

Stage 2: Human Deveopment (34 decks)

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