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
-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
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?
-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
-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)
Signs of child abuse
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?
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
Iatrogenic - Corticosteroids
a. Turner syndrome
b. Down syndrome
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