Normal and Abnormal Growth

Question 1

How far apart are the centiles spaced on growth charts?

Answer 1

2/3 apart

Question 2

What is plotted on the x axis of growth charts?

Answer 2

Time

Question 3

How many measures are needed to compare the growth of a child on a growth chart?

Answer 3

At least two = can’t tell normal growth from a single measure

Question 4

Why is a longitudinal view important when assessing the growth of a child?

Answer 4

Ensures the child is developing and growing over time as they should be

Question 5

Are babies technically obese?

Answer 5

Yes = babies are born obese and lose weight over the first few years of life, before beginning to gain weight

Question 6

What impact does birth weight have on future weight gain?

Answer 6

The heavier a baby is when its born, the earlier it will start to gain weight

Question 7

When is a child considered to be showing normal growth?

Answer 7

Their measurements are within the normal range

Their rate of growth is within the normal range

Question 8

Is child who is growing normally likely to have an underlying pathology?

Answer 8

No

Question 9

How many viral infections do toddlers get a year?

Answer 9

12-15 = this is considered normal, and isn’t concerning if the child is growing normally

Question 10

What does a secular trend of a growth chart refer to?

Answer 10

The change in growth charts over time

Question 11

What effect has childhood obesity had on growth charts?

Answer 11

Has shifted the curve to the right and increased the tail of the graph

Question 12

What did the WHO Multicentre Growth Reference Study measure?

Answer 12

How children should grow rather than how children are actually growing

Question 13

What was the main impact of the WHO Multicentre Growth Reference Study?

Answer 13

Proved that one growth chart could be used for children of all races

Question 14

What are the rules for measuring weight?

Answer 14

Babies must have no clothes or nappies on
Only class III clinical scales in metric setting should be used

Question 15

What are the rules for measuring head circumference?

Answer 15

Use narrow plastic tape
Measure three times and use the average
Measure at the widest point of the head

Question 16

When should the length of a child be measured?

Answer 16

Before age 2 if there is concern = no nappy or shoes to be worn

Question 17

Why does length measurement vary widely?

Answer 17

Depends on mood of the child and the style of measurer

Question 18

When should height measurement begin?

Answer 18

From age 2

Question 19

What are the rules for measuring height?

Answer 19

Use rigid rule with T piece
Ensure heels, bottom, back and head are touching apparatus with eyes and ears at 90 degrees
Measure on expiration
No shoes to be worn

Question 20

What is the average age for onset of puberty?

Answer 20

Age 11 for girls

Boys are 6 months later on average

Question 21

What is the secretion of GnRH like throughout life?

Answer 21

Stops in first few months after birth and doesn’t begin again until puberty

Question 22

What is the first indication of puberty onset in boys?

Answer 22

Increase in testicular volume (increase to 4ml)

Question 23

What is used to stage puberty?

Answer 23

Tanner staging = puberty begins at stage 2

Question 24

What is the first indication of puberty onset in girls?

Answer 24

Breast development

Question 25

What is true precocious puberty?

Answer 25

Normal pubertal development occurring abnormally early = <8 for girls, <9 for boys (more common in girls)

Question 26

What is pubertal delay?

Answer 26

Absence of secondary sexual development = age 13 for girls, age 14 for boys (more common in boys)

Question 27

What is thelarche?

Answer 27

Breast budding

Question 28

What is adrenarche?

Answer 28

Body hair and odour

Question 29

When do periods normally begin?

Answer 29

Two years post thelarche

Question 30

When do pubertal growth spurts occur in girls?

Answer 30

Usually at the start of puberty (breast budding at stage 2 or 3)

Question 31

When do boys have their pubertal growth spurt?

Answer 31

At the end of puberty (once testicular volume is 10-12ml)

Question 32

What should be covered in the history of a child with concerns about growth?

Answer 32

ICE, birth, PMH, pubertal symptoms, parental heights and puberty

Question 33

What will be examined in a child concerned about their growth?

Answer 33

Height, weight, height velocity, pubertal status

Question 34

What are some blood tests done for investigating growth?

Answer 34

Gonadotrophins, growth factors (IGF1), testosterone/oestradiol, thyroid status, karyotyping (especially in girls, helpful for Turner’s syndrome)

Question 35

What are some investigations done for growth?

Answer 35

Bloods, bone status, dynamic function tests

MRI of brain, USS of uterus (precocious puberty)

Question 36

What are the classifications of short stature?

Answer 36

Genetic short stature = short parents
Constitutional growth delay = delayed bone age
Dysmorphic syndromes = Down’s/Turner syndrome
Endocrine disorders = pituitary/adrenal problems
Chronic diseases = coeliac
Psychosocial deprivation = multifactorial

Question 37

What effect does a loving environment have on growth?

Answer 37

Children who are loved more grow quicker and better

Question 38

What is the importance of growth?

Answer 38

Serves as a marker of heath = delayed or precocious growth may be indicative of other pathology

Question 39

What are the consequences of poor growth?

Answer 39

Psychosocial aspects = bullying

Socioeconomic status = shorter adults earn less money