Growth In Childhood

Question 1

List some things which can be measured in children as a marker of their growth

Answer 1

Head circumference 
Weight
Height/length
Leg length 
BMI
Growth velocity

Question 2

What does cumulative mean?

Answer 2

Plotting something continually over time

Question 3

What is the equation for height velocity?

Answer 3

Height now - height of last visit / age now - age of last visit

Question 4

How often is height velocity calculated?

Answer 4

Every 6 months

Question 5

What is the unit of height velocity?

Answer 5

Cm/yr

Question 6

Describe the production of the hormone which controls growth

Answer 6

Hypothalamus - GHRH
Anterior pituitary - GH
GH binds to GH receptor in liver and produces IGF-1

Question 7

Where does IGF-1 act?

Answer 7

Via the IGF-1 receptor on osteoblasts of growth plate/epiphyses of bones

Question 8

Which cells exist in the growth plate?

Answer 8

Osteoblasts

Question 9

What kind effect does IGF-1 have on the bones?

Answer 9

Autocrine and paracrine effect

Question 10

When is the most rapid phase of growth?

Answer 10

Antenatal (in the womb)

Question 11

Name some important factors for fetal growth

Answer 11

Maternal health
Placenta
IGF-2 (reason for big babies)

Question 12

Which parent does IGF-2 come from

Answer 12

The father - it’s paternally imprinted

Question 13

What is important for growth in the first year?

Answer 13

Nutrition!

Question 14

What is important for growth after the first year?

Answer 14

GH

Question 15

What are the axes of the growth chart?

Answer 15

Height

Age

Question 16

If you saw a plateau on an infant’s growth chart, what would it suggest?

Answer 16

GH deficiency

Question 17

What drives the growth of children between infancy and adolescence?

Answer 17

GH
IGF-1
(Nutrition has less of an impact)

Question 18

What drives growth at puberty?

Answer 18

Sex steroids

GH

Question 19

What do the sex steroids do to bones at the end of puberty?

Answer 19

They fuse epiphyseal growth plates

Question 20

Compare male and female puberty and growth spurt

Answer 20

Girls hit puberty earlier so their growth spurt is earlier than boys

Boys - 13-14cm higher than males

Question 21

Which bones fuse first at the end of puberty?

Answer 21

Feet>Long bones

Question 22

Where does the final part of growth occur?

Answer 22

Spine

Question 23

Which epiphyses are the last to fuse?

Answer 23

The ones in the pelvis

Question 24

What is most important about where you are on a centile?

Answer 24

The pattern of growth is more important than the position on a centile

Question 25

What would be a marker of growth abnormality?

Answer 25

If a child falls from a centile position / cross centiles

Question 26

List the causes of short stature

Answer 26

``` Genetics IUGR/SGA Endocrine disorders (GH deficiency) Pubertal/growth delay Dysmorphic syndromes (Down's) Chronic paediatric diseases Psychosocial deprivation ```

Question 27

List specific endocrine causes of short stature

Answer 27

Hypothyroidism GH deficiency Steroid excess

Question 28

List three genetic causes of growth stature despite having normal growth hormone levels

Answer 28

Turner syndrome Down syndrome Skeletal dysplasia

Question 29

What is important to know before plotting a growth chart?

Answer 29

``` Birth history Weight Parental heights Medical history Previous measurements ```

Question 30

How can you adjust to genetic differences in height?

Answer 30

Work out mid parental centile

Question 31

List three things about illness which can interfere with growth?

Answer 31

Inflammation, poor nutrition and effects of drugs e.g. steroids can interfere with growth

Question 32

List some blood tests you'd do if a child seemed to be growing slowly

Answer 32

``` FBC CRP Serum iron LFT Kidney function tests TFTs Coeliac screen IGF1 ```

Question 33

List some examinations done if a child appears to be growing slowly

Answer 33

Bone age MRI of pituitary Pituitary function testing

Question 34

List some chronic paediatric diseases which may cause growth abnormalities and explain how these interfere with growth

Answer 34

``` Asthma Sickle cell Juvenile chronic arthritis IBD (Crohn's, coeliac) CF Renal failure Congenital heart failure ``` Inflammation interferes with intracellular IGF-1 production

Question 35

List four causes of tall stature

Answer 35

Excess growth hormone Marfan syndrome (connective tissue disorder) Early puberty Tall parents

Question 36

List some complications of obesity

Answer 36

``` T2DM Orthopaedic problems Polycystic ovarian disease CV risk Psychological problems Cancer Respiratory difficulties ```

Question 37

Name some syndromes associated with obesity

Answer 37

Cushings Prader Willi Lawrence-Moon-Biedl

Question 38

List some genetic causes of obesity

Answer 38

``` Leptin deficiency Leptin receptor deficiency POMC deficiency PC-1 deficiency MC4R deficiency ```

Question 39

Discuss the Berka hypothesis

Answer 39

The more underweight you are as a child, the most likely you are to become obese as a child

Question 40

What is the genetics of obesity?

Answer 40

It's polygenic, highly inheritable