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Flashcards in Growth and Growth Disturbances Deck (49):

What is the most common cause of short stature in children?

familial short stature


What is the definition of short stature?

height below the 3rd percentile


What is the difference bw growth and stature?

growth = velocity
stature = height


What is the period of fastest growth in children?



What are the 5 stages of growth?

1) intrauterine/neonatal
2) infancy
3) toddler
4) childhood
5) adolescence


What is the most influential factor in intrauterine/neonatal growth?

maternal factors (obesity)


What is toddler aged and what is growth like during this time?

1) 12-36 months
2) fairly constant rate of about 3.9 inches/yr


What happens to a childs growth after age 3?

After age 3, kids follow a percentile channel that tracts toward genetic potential


When do growth spurts occur for girls and boys respectively during puberty?

1) girls - early in puberty
2) boys - late in puberty


On what two scales are an infant/toddler assessed on?

1) head circumference
2) weight for length


What is the first physical change in puberty for boys?

gonadal enlargement


What is the first physical change in puberty for girls?

thelarchy (breast development)


What does the American Academy of Pediatrics recommend for assessing length in infants/toddlers?

1) 3 times in the first 6 months of life
2) then every 3-4 months until 2 years of age
3) toddlers should be measured/weighed at least twice per year


What constitutes "normal" growth?

1) proportionality
2) values track after age 3
3) relative final height estimated and compared to AMPH


How does the growth chart add up as an index of overall health?

1) high sensitivity (you can tell if something is wrong)
2) low specificity (don't know what the diagnosis is)


What are the three phases of human growth?

1) infancy
2) childhood
3) puberty


What influences growth the most during infancy?

entirely dependent on nutrition


What is catch up and catch down growth?

1) occurs bw 1-3 years of life
2) represents a readjustment to the genetic blueprint for growth
3) often a cause for concern by parents
4) usually benign


What is AMPH (adjusted mid parental height) and what is its limitations?

1) purpose is to estimate a target adult height for a given child
2) it adjusts the stature chart for a child's parent's height
3) limitation - its just a guide - not a final height predictor


How do you calculate AMPH?

1) find MPH (mid parental height)
2) add 6.5 cm for boys and subtract 6.5 cm for girls


What is the standard deviation for AMPH?

+/- 4 inches (10cm)


Why are men generally tallers than women?

more pre-pubertal growth
higher maximum peak growth rate


How do you calculate growth velocity?

(visit 2 - visit 1) / (time interval) = growth velocity


What is the difference between growth and height?

growth is relative
height is cumulative


What are growth chart red flags?

1) rounded off plotting (points at even years)
2) crossing channels after age 3
3) proportionality (low height for weight)
4) height falling off before weight
5) "overweight, overtall for age" common in exogenous obesity


What are the practical applications of the bone age assessments?

1) bone age value can be used to correct actual height (young bone age gives you more time to grow and visa versa)
2) growth correlates more with bone age than chronologic age


When is a head MRI or CT recommended on a kid?

with proven GH deficiency


What is the typical order of secondary sexual development in boys?

1) pubic hair
2) gonadal enlargement
3) growth spurt
4) voice change
5) penile growth


What is the typical order of secondary sexual development in girls?

1) pubic hair
2) menarche
3) growth spurt
4) breast budding
5) acne


what are the clinical features of classic constitutional delay?

1) borderline short stature
2) marked bone age delay (1-4 years)
3) normal predicted adult height
4) family history of constitutional delay
5) delayed puberty (after 14 in boys, 13 in girls)
6) late growth spurt
7) eventual attainment of adult height


What characterizes familial short stature?

markedly short, but otherwise healthy
falls within normal genetic expectations


What characterizes growth delay/constitutional delay of growth and puberty (CDGP)

biological age delayed 2 years
decline in growth velocity at ages 2-3
family history


what is psychosocial short stature due to?

1) deprivation
2) psychosocial dwarfism


What characterizes short stature due to psychosocial deprivation?

1) lack of nurturing
2) often results in a failure to thrive
3) children generally recover with sufficient nourishment and attention


What characterizes short stature due to psychosocial dwarfism?

1) abnormal parent-child interaction leads to functional hypopituitarism
2) when removed from home may exhibit catch-up growth


What are systemic diseases that can affect growth?

1) chronic anemia
2) cardiac disease
3) immune system diseases
4) renal disease
5) cystic fibrosis


What are some nutritional diseases that can affect growth and development?

1) IBD and celiac disease
2) chronic liver disease (insulin like GF)
3) malnutrition
4) malabsorption


What is the primary cause of growth failure?



What is turner syndrome?

missing or abnormal X chromosome


What are the symptoms/consequences of turner syndrome?

1) short stature
2) delayed sexual development
3) infertility
4) cardiovascular disease
5) renal anomalies


What characterizes prader-willi syndrome?

1) itrauterine and early post natal growth retardation
2) hypotonia
3) poor linear growth
4) delayed sexual development
5) development delay
6) hyperphagia - obesity
7) behavior problems
8) sleep and respiratory difficulties


What is Kleinfelter syndrome?



What are the symptoms of kleinfelters?

1) tall stature
2) less muscular
3) decreased level of testosterone
4) gynecomastia during puberty
5) infertile


What are the symptoms of Noonan syndrome?

1) short stature
2) delayed puberty
3) webbed neck
4) developmental delay may occur
5) heart defects


How is noonan sydrome diagnosed?

diagnosed via clinical assessment


What are the symptoms of silver-russell syndrome?

1) intrauterine growth retardation
2) small triangular face
3) short stature
4) macrocephaly
5) skeletal asymmetry
6) genital anomalies


What is Marfan syndrome?

abnormality in fibrilin-1 gene


What 3 systems are affected by marfans?

1) skeletal
2) eyes
3) cardiovascular


What are the characteristics of marfans?

tall stature
long, thin limbs and fingers
subluxation of the lens of the eye