fundamentals of growth and puberty Flashcards
what are the requirements for normal human growth?
Absence of chronic disease, emotional stability, secure family environment, adequate nutrition, hormones/growth factors, healthy growth plates
what is the ICP model and what dos it show?
ICP model – Infant Child Puberty Model
Human grows in 3 different ways depending on whether they are in infancy, childhood or puberty
Overall growth pattern is a sum of these 3 growths
during infancy, what is the most important factor of growth?
nutrition
what is the rate of growth at infancy?
25cm/year
what is the most important factor of growth during childhood?
GH-IGF axis – pituitary makes growth hormone which leads to the production of insulin like growth factor.
what is the rate of growth in childhood?
4-8cm/year
what is the most important factor of growth during puberty?
sex steroids: increase in growth hormone
what is the rate of growth during puberty?
12cm/year
why do we measure growth?
indicator of general health and well-being
why do we measure height and weight?
useful for identifying disorders affecting growth (such as Turner’s syndrome (lack an X chromosome) and growth hormone deficiency) - special growth charts for this.
More controversial; screening for tall stature – some diseases lead to tall stature and need to be screened for.
what are the elements of a well-functioning monitoring system?
- Calibrated equipment
- Correct measurement technique
- Systematically collected growth data
- Appropriate, up-to-date growth reference
- Screening rules for abnormal growth
- Referral criteria
- Adherence to guidelines
- Appropriate diagnostic work-up
how should babies be weighed?
without any clothes or nappy
how should children older than 2 years be weighed?
in vest and pants but no shoes or dolls/teddies in hand
how should children over 2’s length be measured?
use proper equipment; length board or mat. No nappy or footwear
when should length be measured?
after 2 years of age
how should you measure the length of a child under the age of 2?
board or mat – requires 2 measurers. 1 measurer holds head of child, and the other adjusts the sliding board to see where the legs end
what equipment do you use to measure height?
rigid ruler or stadiometer
how should height be measured?
o Ensure heels, bottom, back and head are touching the apparatus
o Measurer holds child over the mastoid processes to ensure contact is maintained with the stadiometer
o Don’t try to stretch up, measure on expiration
o No footwear
what are centiles?
describes the % of people below that line
why are there no centile lines between 0 and 2 weeks?
because some degree of weight loss is common after birth for healthy term infants. Birth weight gained back after 2nd week.
in what cases do children need further assessment of growth?
- Where weight or height or BMI is below the 0.4th centile, unless already fully investigated
- If the height centile is more than 3 centile spaces below the mid-parental centile.
- A drop-in height centile, position of more than 2 centile spaces (exclusion of measurement error).
how will advanced bone age present?
often tall stature and may have central precocious puberty (too soon).
how does delayed bone age present?
growth failure secondary to paediatric Cushing’s disease
define short stature
Defined as a length or height less than - 2SDS (mean height standard deviation score) = 2.3 centile for age and sex of appropriate reference population
