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Flashcards in growth evaluation Deck (40):
1

When should height and weight be measured

birth, 2-4 days, 1, 2, 4, 6, 9, 12, 15, 18, 24 months and every year thereafter through age 21

2

1. Define “worrisome growth."

1. height: short stature (heigh below -2 SD for age and gender or below 2 SD of the midparental target height), Dwarfism (height below -3SD for age), Midget (dwarf with normal body proportions). 2. growth velocity: abnormally slow linear growth velocty dropping across two major centile lines on growth chart

3

Calculate genetic height potential for boys and girls

Boys: (mom heigh + 5in + dad height)/2. Girls: (dad height - 5in + mom height)/2

4

Skeletal maturation and height

There is a direct correlation between the degree of skeletal maturation and the time of epiphyseal closure. The greater the bone age delay, the longer the time before epiphyseal fusion ceases growth

5

Body proportions over time

Upper to lower body ratio starts at 1.7 at birth and falls to 1.0 by 10 years of age.

6

Arm span over time and average male/female arm span

Arm span is shorter than height in boys before 10 – 11 years and girls before 10 to 14 years after which arm span exceeds height. Avg adult male has arm span 5.2 cm > ht and adult female 1.2 cm >ht

7

Define constitutional growth delay

Characterized by growth deceleration during first 2 years of life followed by normal growth paralleling lower percentile curve throughout prepubertal years

8

Final height in constitutional growth delay

Generally end up along lower end of normal height range for families. Skeletal maturation is delayed but catch up growth is achieved by late puberty and fusion of growth plates is delayed.

9

Constitutional growth delay family history

Polygenic trait- positive family in 60-80% of pts

10

Treatment of constitutional growth delay

Can treat boys with testosterone if bone age ≥11-1/2 years to avoid compromising final height. Can treat girls with estrogen (less common)

11

Define familial short stature

Children who have normal growth velocity and height that are within normal limits for parent’s heights. Initially will have decrease in growth rate between 6 and 18 months of age. Some families may have tubular bone alterations

12

Define failure to thrive

Infants/young children with deceleration of weight gain to a point <3%. Fall in weight across 2 or more major percentiles.

13

Most common causes of failure to thrive

poor nutrition and psychosocial factors

14

Which condition does failure to thrive look like on a growth chart?

constitutional growth delay

15

Define nutritional growth retardation

Linear growth stunting from poor weight gain in children over 2 years of age. May be secondary to systemic illnesses such as celiac dz, IBD, stimulant meds.

16

What condition does nutritional growth retardation look like on growth chart

constitutional growth delay and constitutional thinness

17

Define children born small for gestational age

Less than -2 SD for birth weight or length (less than 2.3 percentile)

18

Etiologies of children born small for gestational age

1. Maternal – infection, nutritional deficiencies, uterine abnormalities, smoking, alcohol, drugs. 2. Placental – Previa, abruption, infarcts, structural, multiple gestation. 3. Fetal – Chromosomal abnormalities, metabolic, infections,
malformations1. Maternal – infection, nutritional deficiencies, uterine abnormalities, smoking, alcohol, drugs. 2. Placental – Previa, abruption, infarcts, structural, multiple gestation. 3. Fetal – Chromosomal abnormalities, metabolic, infections,
malformations

19

Which growth curves are used to classify infants as small for gestational age

Usher and McLean growth curves-

20

Catch up growth in infants born small for gestational age

Most healthy infants born SGA achieve catch-up in height by age 2 years. Most catch up growth is achieved within 6 months of birth. 10-15% will remain short as adults. Final height may be compromised by early puberty

21

Pathophys of SGA

Fetal response to prolonged nutritional deficiencies late in gestation may be to prematurely reset to a slow growth rate with a degree of resistance to GH, IGF-1, and insulin

22

Treatment for SGA children

growth hormone is approved for SGA children who fail to have catch up growth by 2 years. May increase final heigh by avg of 3 inches

23

Hormonal causes of worrisome growth

Usually weight is spared. Hypothyroidism, GH/ IGF-1 abnormalities, cushing syndrome, rickets

24

hypothyroidism in children vs adults

Many clinical features that are seen in hypothyroid adults are lacking in children

25

Causes of congenital GH deficiency

Hypothalamic-pituitary malformations: holoprosencephaly, isolated cleft lip or palate, septo-optic-dysplasia, optic nerve hypoplasia, empty sella syndrome

26

Causes of acquired GH deficiency

trauma, CNS infection, hypophysitis, CNS tumors, Cranial irradiation

27

GH deficiency growth chart

abnormal growth velocity

28

Clinical sx and signs of GH deficiency

decreased muscle, increased subq fat around trunk, immature face for age, prominent forehead, depressed midface, small phallus in males, midline facial defects, prolonged jaundice or hypoglycemia in newborn period

29

Evaluation for GH deficiency

1. bone age. 2. low IGF-1 (note will be low in underweight children regardless of GH status). 3. Stimulating tests- clonidine, arginine, glucagon, L-dopa. Never draw random GH level

30

What causes short stature in Turner syndrome

Haploinsufficiency of SHOX genes cause skeletal and growth abnormalities

31

What causes short stature in Prader Willi syndrome

GH deficiency

32

What causes short stature in Noonan syndrome

abnormal GH post-receptor signaling

33

Stature in Turner syndrome

Virtualy all girls with turner syndrome have short stature. Final heigh is about 20cm less than target height, if untreated. Weight is low to normal

34

Treatment of Turner syndrome

Growth hormone improves growth and final adult height. Early treatment is important

35

Describe skeletal abnormalities in Turner syndrome

short stature, increased carrying angle of forearms, short neck, micro or retrognathia.

36

Describe lymphatic abnormalities in Turner syndrome

low hairline, webbed neck, lymphedema

37

Describe cardiac, renal, reproductive, endocrine and neuro abnormalities in Turner syndrome

cardiac: bicuspid aortic valve, coarctation. Renal: horeshoe kidney. Repro: ovarian insufficiency. Endocrine: hypothyroid, celiac dz. Neuro: non verbal learning disability. Also otitis media and hearing loss

38

Evaluation of worrisome growth

1. bone age (left hand and wrist). 2. screening labs: metabolic panel, CBC, UA, karyotype in girls, TSH, IGF-1. 3. If nutritional: check ESR, tissue transglutaminase Ab and IgA

39

FDA approved uses of recombinant human GH

GH deficiency, chronic renal insufficiency, adult GH deficiency, Turner syndrome, Prader Willi syndrome, small for gestational age, idiopathic short stature, SHOX deficiency, Noonan syndrome

40

Potential side effects of GH

slipped capital femoral epiphysis, pseudo tumor cerebri