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Flashcards in Growth in childhood Deck (30)
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1

What is commonly plotted in centile charts?

  • head circumference
  • weight
  • height/length
  • leg length
  • BMI
  • growth velocity

2

How is height velocity calculated and what are its units?

  • (height now - height last visit) / (age now-age last visit)
  • cm/yr

3

Describe the hormonal growth axis

  • Hypothalamus releases Somatostatin (-) or GHRH (+) 
  • Acts on somatotrophs of the anterior pituitary
  • Releases growth hormone
  • Acts on GH receptors to have its action and to stimulate IGF-1 production
  • IGF-1 acts on IGF-1 receptor to have its action

4

In what manner is GH released?

Pulsatile

5

What influences GH secretion?

  • Nutrition
  • Sleep
  • Exercise
  • Stress

6

What kind of hormone is GH?

Single chain polypeptide

 

7

What is infant growth dependent on?

  • Nutritionally dependent
  • GH dependent for 9-12 months

8

What is childhood growth dependent on?

  • Less dependent on nutrition
  • GH/IGF-1 axis main driver of growth

9

Explain this height velocity graph

  • Growth is highest in the antenatal phase
  • Decreases during infancy into childhood
  • Spikes again during puberty (driven by GH and sex steroids)
  • girls puberty is earlier than boys
  • Decreases again to a standstill after puberty

10

What happens to the bones when we stop growing?

  • The bones mature and epiphyses fuse at the end of puberty. 
  • The final part of growth occurs in the spine
  • The final epiphyses to fuse are in the pelvis. 

11

What is the use of centiles?

  • Centiles are not a “normal range”

  • Most children set out on a centile by about 2 years and grow on the same centile during childhood.

  • Pattern of growth is more important than position on the centiles.

  • A child who falls significantly in centile position is not growing normally, whatever their height.

12

What are some causes of short stature?

  • Genetic (main one)
  • Pubertal and growth delay

  • IUGR/SGA

  • Dysmorphic syndromes

  • Endocrine disorders

  • Chronic paediatric disease

  • Psychosocial depravation

13

What can be the consequence of IUGR on growth?

  • Not all children with intrauterine growth restriction catch up completely.
  • Growth will be normal in childhood but they have “lost” some height in the antenatal period.

14

What endocrine problems can cause short stature?

  • hypothyroidism
  • growth hormone deficiency
  • steroid excess

15

What syndromes can casue short stature?

  • Turner syndrome  XO

  • Down syndrome T21

  • skeletal dysplasias

16

Why do significant childhood illnesses cause short stature?

Significant illnesses can interfere with growth because of:

  • Inflammation
  • Poor nutrition
  • The effects of drugs such as steroids.

17

Give some examples of chronic paediatric diseases that cause short stature

  • Asthma

  • Sickle cell

  • Juvenile chronic arthritis

  • Inflammatory bowel disease

    –Crohns disease

    –Coeliac disease

  • Cystic fibrosis

  • Renal failure

  • Congenital heart disease

18

What are the causes of tall stature?

  • tall parents
  • early puberty
  • syndromes eg Marfans
  • growth hormone excess

19

What are the negative impacts of obesity?

Emotional:

  • Stigmatism
  • Bullying
  • Low self-esteem

School absence

Health:

  • High cholesterol
  • High bp
  • Diabetes
  • Bone and joint issues
  • Breathing difficulties

 

20

What conditions does obesity pre-dispose you to?

  • Type 2 diabetes
  • Orthopaedic problems

  • Polycystic ovarian disease

  • Cardiovascular risk

  • Psychological problems

  • Cancer

  • Respiratory difficulties

21

How is obesity assessed in children?

Position on the BMI centile for their age

22

What syndromes are associated with obesity?

  • Cushings
  • Prader-willi
  • Lawrence-moon-biedl

23

What are the genetics of weight?

Polygenic inheritance

Weight is highly heritable

 

24

List examples of monogenic obesity syndromes

  • Leptin deficiency

  • Leptin receptor deficiency

  • POMC deficiency

  • PC-1 deficiency

  • MC4R deficiency

25

Why is childhood obesity on the rise?

  • Decreased exercise/ increased calorie consumptiont
  • Association with increased TV watching
  • Consumption of soft drinks
  • Parental obesity

26

What are 'limit' ages in child development?

Upper age by which a development milestone should be achieved

 

27

Why is growth measured?

  • poor growth in infancy is associated with high childhood morbidity and mortality.

  • Growth is best indicator of health

  • Demonstration of normality of growth by age and stage of puberty

  • Identify disorders of growth

  • Assess obesity

28

What is the difference between height velocity and cumulative growth?

  • Height velocity = how fast a child is growing in cm/yr
  • Cumulative growth = total growth at any given point

29

What milestone is a 2 year old child expected to reach?

Join 2-3 words when talking

Know some body parts

ID objects in a picture

 

30

What milestone would a child be expected to reach at 12 months?

Pulls to stand

May walk alone breifly

Put blocks in a cup

Say 1-2 words