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MD 3: Paeds > Growth problems > Flashcards

Flashcards in Growth problems Deck (7):

What are important points to obtain on history of child presenting with slow growth or short stature?

Growth History & Familial Patterns of growth

Intake history
-Breast feeding - frequency/duration, issues, exclusive vs partial, timing of solids
- Formula - type, amount, dilution method
- solids - when, what, range of foods
-Behavioural issues with feeding
-Milk consumption

Output history - bladder, bowels, vomiting

ROS - general and signs of puberty

FHx - digestive, hormonal, autoimmune issues, short stature

social hx - any child protection issues?


What are important points to obtain on examination of child presenting with slow growth or short stature?

Growth charts
-Slow growth (‘failure to thrive’) if child is <3rd percentile for weight or drops >= 2 percentiles height and head circumference are initially well preserved
-Further investigation required if child below the 25th percentile on growth velocity chart

Expected height
-Determine mid-parental height and plot on growth chart to compare expected growth
-Child’s height should be within one SD of the MPH (+/- 7.5-8cm)

Nutritional status

Signs of child abuse

Behaviour/parental interaction

Systems to exclude organic i.e. abdo, endocrine


What are red flags for children presenting with slow growth or short stature?

- Signs of abuse or neglect
- Poor carer understanding e.g. non-English speaking, intellectual disability
- Signs of family vulnerability e.g. drug and alcohol abuse, domestic violence, social isolation, no family support
- Signs of poor attachment
- Parental mental health issues
- Already/previously case managed by child protection services
- Did not attend or cancelled previous appointment/s
- Signs of dehydration
Signs of malnutrition or significant illness


What are DDx for slow growth/FTT?

Malabsorbtive diseases
Dentition/oral structural issues
Breast feeding/formula issues
Psychosocial factors, restrictive diet
Genetic and metabolic conditions


What are DDx for short stature?

a. Constitutional delay of growth & puberty
b. Familial short stature

a. Placental insufficiency
b. Russell-Silver syndrome

a. Bony dysplasia
b. Spinal irradiation

a. Malabsorption
b. Rickets
c. Malnutrition

Chronic illness

Iatrogenic - Corticosteroids

a. Turner syndrome
b. Down syndrome
c. Prader-Willi
d. Others

a. Hypothyroid
b. GH deficiency
c. Cushing syndrome
d. Pubertal delay/arrest


Features of constitutional delay of growth & puberty?

- Common normal variant
- Usually FHx of delayed puberty
- Growth slows around 2 years old fall in height percentile
- Growth is thereafter parallel to 3rd centile
- Prepubertal decline in growth exaggerated and onset of pubertal growth spurt is later than average
- Bone age is delayed height for bone age usually within normal mid-parental range
Final likely in keeping with family members


Features of familial short stature?

- Several adult family members are short
- Skeletal proportions & growth velocity normal
- Bone age equivalent to chronological age
May have constitutional delay in maturation