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Flashcards in Growth in childhood Deck (56)
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Factors which can adversely affect growth in height

nutrition, hormone problems, genetic diseases.


How long is the average term baby and how much do they weigh

50cm long and 3.3kg weight


What are centile charts commonly used for

height, weight, head circumference and BMI are the commonest


What must be done to ensure accurate height and weight are measured

The equipment should be accurate and maintained properly

Position the child properly to get an accurate height (read the instructions on the growth chart)

Make sure you get rid of things which interfere with measuring- shoes off, hair out of the way, clothes off to weigh.

Calculate the age and plot correctly on the chart.


Differentiate height velocity vs. what is shown on centile

The centile charts we use are for cumulative height – how tall the child is now, (the total of all the growth they have done up to now, from conception).

Height velocity is how fast a child is growing in cm per year, usually this is calculated over a whole year. Most short children are growing at a completely normal speed.


As well as centiles and height velocity, what else is useful information in assessing child growth

the height of family members- parents and siblings.


How do each of the following affect growth from conception into childhood

1. Events before birth
2. Think about
3. Genetic factors
4. Think about

1. Events before birth- poor fetal growth, low birth weight, prematurity

2. Medical issues in childhood- malnutrition, chronic disease, endocrine problems including growth hormone deficiency

3. Genetic factors- the height of the family and any inherited disorders of growth.

4. Randomness. Not every child of the same parents will be the same adult height, and tall parents can occasionally have a short child. There are multiple genes which determine adult height, and these are randomly distributed at conception.


What is the fastest phase of growth after birth (incl. puberty etc)

the first 2 years of life


When is there most fluctuation around a centile position for height during childhood, and when is does this normally fix

First 2 years of life. Children can move up and down through the centiles at this phase of growth.

Most children will move to a centile position by 2 to 3 years of age and then continue on this centile position through childhood.


T/f it is common for children to move around centiles throughout childhood. If you suspect a growth problem, how long would you need to monitor the child for

F Normal children grow fast enough to keep on the same centile and movement up or down is unusual.

Monitor for at least a year


When is there fast growth in childhood and what does this depend on

There is a phase of fast growth at puberty- the pubertal growth spurt. The timing of this depends on the age at which the child enters puberty.


When and why does growth stop

The skeleton matures as the child grows, the epiphyses fuse at the end of puberty, and growth stops.


T/f if a child is on the bottom of the centile chart they probably have a problem

F.... If a child is growing fast enough to continue to grow on the same centile they are not likely to have a problem even if they are at the bottom of the centile chart.


What can cause a child to fall behind in height during puberty

Timing of puberty can impact on height- children who are late in developing can fall behind in height.


Outline the key hormonal regulator of growth in children

i. where is it released from
ii. control of its release
iii. which factors mediate its release

Growth hormone (GH) is the most important hormonal factor in growth.

GH secretion is controlled by the hypothalamus, which secretes growth hormone releasing hormone (GHRH) which stimulates secretion and somatostatin which suppresses secretion.


Outline the pattern of GH release

H is released by the pituitary as pulses most of which occur overnight.


How does GH have its growth effects

GH has some growth effect itself and also stimulates the release of IGF1 (insulin like growth factor !).


How does IGF1 travel in the body

IGF 1 circulates bound to a number of binding proteins and stimulates growth in all the tissues of the body


Outline the negative feedback control of growth hormone release

IFG1 negatively feeds back to reduce GH release

And to increase somatostatin release from hypothalamus


Which factors influence the pulsatile secretion of the GH

Nutrition, health, age, puberty, psychological factors, exercise, sleep


Causes of abnormal growth

Poor nutrition, chronic disease, endocrine, genetic factors, psychoigcal distress and neglect


Examples of genetic and endocrine causes of short stautre

Endocrine causes- GH deficiency, thyroid hormone deficiency

Genetic disorders affecting bone growth (eg achondroplasia, Turner syndrome, Down syndrome, PWS).


Causes of tall stature

Sydromes- Marfan and Soto

GH pituitary tumour

Precocious puberty (pubertal growth spurt occurs very early and so children with this can present with tall stature. However growth stops early as well so they can then be short as adults.)


When is GH treatment beneficial and not beneficial

BENEFICIAL: Children with confirmed GH deficiency/other disorders of growth

NOT BENEFICIAL: children who do not have anything wrong with them but are just short (“short normal children”)... tiny imporvement not worth time, effort and expense


Define obesity in adults vs children

For adults BMI of over 25 kg/m2 is overweight and over 30 kg/m2 is obese.

Children have lower BMI than adults and this changes with age so these figures do not apply, and obesity is assessed on the BMI centile position.


T/f rate of obesity is increasing and will continue to go up at same rate

F Rates of obesity and overweight have increased but may not continue to go up at the same rate for the future


When is obesity seen as desirable feature

some cultures where overweight has traditionally been seen as a desirable feature indicating wealth and high status


T/F obesity is always associated with poverty

In some areas of the world obesity is a feature of poverty and in others associated with affluence.


Why can some ethnicities develop obesity related ompications at a lower BMI than others

Some ethnic groups have less “tolerance” of obesity and are more likely to get complications like type 2 diabetes at a lower BMI


What are the complications of obesity

Overweight and obesity makes you more likely to get a range of disorders including type 2 diabetes, cardiovascular disease, some cancers, orthopaedic problems, PCOS, psychological issues, respiratory difficulty .