Growth Disorders

Question 1

What methods do we use to assess growth?

Answer 1

• Height/length and weight
• Growth charting
• Midparental height & target centiles
• Growth velocity
• Bone age
• Pubertal Assessment i.e. Tanner’s Stages

Question 2

How is growth charted?

Answer 2

Age vs height graphs with pre-drawn centiles.
You want to see a child is growing within the centiles and at a normal velocity (i.e. not crossing centiles)

There are also condition-specific charts for illnesses that affect growth such as Turner’s syndrome of Down’s Syndrome

Question 3

What are the parts of Tanner’s pubertal assessment?

Answer 3

Breast size 1-5
Genital Development 1-5
Pubic Hair 1-5
Axillary Hair 1-3
Testicular volume 2-20ml

The hairs are examples of secondary sexual characteristics (i.e. brought on by androgens not sex steroids)

Question 4

Describe a pattern of normal growth from birth to 20?

Answer 4

• High height gain at birth decreasing through infancy
• Plateu/steadily decreasing height gain during childhood
• Huge growth spurt during puberty (girls before boys)

Question 5

What factors are important when considering growth patterns?

Answer 5

• Race
• Gender
• Parental Heights
• early/late onset puberty
• Poor health
• Socio-economic factors (e.g. poor nutrition)
• Psycho-social deprivation (Can profoundly stunt growth)

Question 6

What are the earliest signs of puberty & when does it start?

Answer 6

Breast budding in girls and testicular enlargement in boys.

Normal puberty occurs at 8-13 in girls and 9-14 in boys

Question 7

How does obesity affect growth and puberty?

Answer 7

Obese children tend to hit puberty earlier, so growing taller earlier.
But will stop growing earlier and so end up the same height as non-obese children

Question 8

What are the indications for referal (in reference to growth)?

Answer 8

• Off centiles in height
• Crossing centiles (abnormal velocity)
• Chronic disease stunting growth
• Obvious dysmorphic features
• Early/late puberty

Question 9

What can cause childhood obesity?

Answer 9

• Simple obesity
• Drugs e.g. insulin or steroids, antithyroid drugs
• Syndromes e.g. Downs, Praeder Willi
• Endocrine disorders e.g. hypothyroidism
• Hypothalamic damage (loss of appetite control)

Question 10

How do you treat childhood obesity?

Answer 10

Diet
Exercise
Psychological Input

Question 11

What are the normal non-pathological causes for a short stature?

Answer 11

• Familial (your families just short)
• SGA (small for gestational age)
• Constitutional delay in growth and puberty (CDGP)

Question 12

What is CDGP?

Answer 12

Mainly occurs in boys so look for a family history from brothers/dad

Its where you go through puberty a year or two late and have a bone-age delay. Perfectly normal and not worrying.

Question 13

What are the non-normal causes of a short stature?

Answer 13

• Undernutrition
• Chronic illness
• psychosocial
• Hormonal (hypothyroidism or GH deficiency)
• Syndromes (turner or Prader-Willi)

Question 14

What could cause delayed puberty? (mainly in boys)

Answer 14

• CDGP
• Gonadal Dysgenesis (e.g. Turner 45X or Klinefelter 47XXY
• Chronic disease
• Impaired HPG axis
• Cryptorchidism (no testes) or Testicular irradiation (cancer patient)

Question 15

What are the types of early puberty? (mainly girls)

Answer 15

• Infantile or premature thelarche (breast buds), the rest of puberty occurs at the normal age
• Exaggerated adrenarche
• Precocious pseudopuberty (Early adrenarche)
• Premature Menarche
• True Central Prococious Puberty

Question 16

What is true central precocious puberty?

Answer 16

Early sex hormone production

It may be idiopathic or possibly a brain tumour

Question 17

How do you treat true central precocious puberty?

Answer 17

GnRH analogue

Question 18

How would we approach a child born with ambiguous genitalia?

Answer 18

Firstly dont guess the gender

• Examine for gonads/ internal organs
• US for internal sexual organs
• Karyotyping

Important to exclude congenital adrenal hyperplasia as it can cause adrenal crisis

Question 19

What are the types of hypothyroisism in kids?

Answer 19

Congenital - screen new borns and treat within 2 weeks

Acquired - Commonly Autoimmune Thyroiditis. Look for a FH of thyroid or autoimmune disorders

Question 20

Causes of congenital hypothyroidism

Answer 20

Underdeveloped thyroid:

• atyreosis: absence/malfunction
• Hypoplastic: underdeveloped
• ectopic: in wrong place

Dyshormonogenic: errors in metabolism

Question 21

Definition of obese AND overweight

Answer 21

BMI over 97.5th centile is OBESE or SD>2

BMI over 85th centile is OVERWEIGHT or SD>1.04

Question 22

How to assess for obesity

Answer 22

• Weight
• Height
• BMI
• Waist circumference
• skin folds
• History and examination
• Complications

Question 23

List a few complications of diabetes?

Answer 23

• Gallstones—pancreatitis
• FLD
• Metabolic syndrome
• Reproductive syndrome
• GORD..

Question 24

What are the steps to be taken when diabetes is suspected in childhood

Answer 24

1-	THINK steps:
•	Thirsty
•	Thin 
•	Tired 
•	Using toilet more 

2- Test: finger prick test for Glucose >11mmol
3- Telephone: call GP asap

Question 25

What are common symptoms which could present in children with diabetes under 5

Answer 25

- Heavier than usual nappy - Blurred vision - Candiasis - Constipation - Skin infections - Change in behaviour

Question 26

Symptoms of DKA

Answer 26

- N&V - Abdominal pain - Sweet smelling breath - Drowsiness - Rapid, deep sighing - COMA

Question 27

Investigation of DKA

Answer 27

-TEST IMMEDIATELY: finger prick test If over 11mmol/l then it is diabetes If less then must be other ``` -NOT: Returned urine sample Fasting blood glucose Oral glucose tolerance test Wait for test results ```

Question 28

what are the pathological causes of short height

Answer 28

- IUGR: intra-uterine growth rate - Malnutrition - Hormonal: hypothyroidism - Iatrogenic (steroids) - Psychological - Chronic illness ( coeliac, IBD) - Syndromes: Turner syndrome, Praeder Willi syndrome, Noonan’s syndrome, Achondroplasia