Paediatric - Growth

Front 1

factors affecting foetal growth

Back 1

1. birth order
   
2. heght of mother
3. weight gain duronh=g pregnacy
4. nutrition b4 n during preganncy
5. smoking and alchol by mother
6. genetics
7. matanal illness
8. intrautrine illnus of foetus

Front 2

intra utrine limitatting factors for growth retadation

n wt happen after birth

Back 2

1. space of utrus
   
2. shape of utrus (biconcave)
3. placental insuficiency

after birth - rapid growth growth catch up

Front 3

prenatal growth depending factors

Back 3

• matanal size and matanal nutrition
• genetics have little influence (execpyt for a few causes like achondroplasia)
• IGF1 and IGF II main growth factors
• indipendent of GF secretion
• thyroid and GF are not important in prenatal period
• testosteron has a place in male foetus "mini adolescence" in latter part of gestation

Front 4

post natal growth

Back 4

• quite rapid up to 2 years but not as great as prenatal
• many growth related disordes appers around this time
• genetc makeup and nutrition are major factors
• GH and thyroid are main hormones

• intrauterine - IGF
• infancy - nutrition depend
• children - thyroid and growth hormone deprnd
• pubertal - sex hormone depend
• 
  

Front 5

growth during infancy

Back 5

• nutrition depend
• upto 6m breast milk
• after some time growth rate will settle down to its genatic growth rate
• mini adolecence of males continue for 3-6 months
• this causes rapid growth in male babies

Front 6

how growth parameters change with time in infancy

Back 6

weight

• first 10 days 10% weight loss
• then 200g/week growth (roughly about 30g/day)
• 1st 4 months 30g/day
• 2nd 4 months 20g/day
• 3rd 4 months 10g/day

• 2x by 5 months
• 3x by 1 year
• 4x by 2 years

length

• at birth 48-50cm
• 50% increment by - 1 year

OFC

• at birth 33cm
• at birtth ofc > chest circumferance
• at 1yr ofc = chest circumferance
• at the end of 1 year growth of 12 cm
• 0-3 month -> 2cm/month
• 3-6 monh -> 1cm/month
• 6-12 month -> 0.5cm/month
  

Front 7

how growth parameters change with time in child hood

Back 7

• heright velocity = 20cm/year at birth
  
• 10-13 cm/year by 1 year
• 10-12 cm/year by 2 years
• 7.5cm - 10cm/year in 3rd year
• velocity settles at 5-6cm/year till puberty

body proportions change - legs grow faster

upper segment : lower segment

birth 1.7

2yrs 1.4

8yrs 1.0

males and femaoils grow similarly

Front 8

growth during adolocent

Back 8

• removel of suppresion of hypothalamo gonadothropin axis
• slow increase in sex hormones
• pubertal grwth occurs in trunk
• onset of puberty depend on the nutrition
• obesity ---> early puberty
• 2% adult height is achived in this growth spurt
• velocity 8-12cm/year
• male peak is at 14 yrs
• female peak is at 12 yrs
• early onset of puberty -> short

Front 9

measurement of length

Back 9

• back of heels
• calf
• buttock
• back of chest
• occipit
• frankfurt plane should be perpendicular to measuaring instrument

Front 10

uppersegment / lower segment messurement

Back 10

• demarcation is the upper boarder of the pubic symphasis
  
• stadiometer
  
• lowr segment messurement
  
• total hight - lowesegment = upper segment
  

Front 11

mid upper arm circumfrance

Back 11

• mid pint between acromium and olecranon process
  
• elbow felexed 90 degrees
  
• mark the mid point
  
• arm hanging freely and then messure the MUAC
  

Front 12

waist circumfarance

Back 12

• mark lower costal margine
  
• upper margine of illiac crest in the mid axillary line
  
• mid point between those 2 markings
  
• while in end of normal expiration
  
• not the level of umbilicus
  

Front 13

hip circumference

Back 13

• level maximum extension of the buttock seen from the lateral view

Front 14

arm span - height by age

Back 14

• birth to 7yrs = (-3cm)
• 8-12yrs = 0cm
  
• >12 years = +1 in girls / +4 in male

Front 15

factors affecting growth (post natal)

Back 15

1. genetics
2. nutrition
3. general state of health
4. hormonal state
5. syndromes
6. psychological / psychosocial
7. other

Front 16

chronic ilnuses give rise to growth retadation

Back 16

1. chronic liver disease
   
2. chronic renal disease
3. juvenile chronic artharitis
4. inflammatory bowel disease
5. severe asthma (disease n steroids)
6. chronic infections (broncheacstais
7. congenital heart disease

in acute malnutrition weight affect first. height do not affect unless the effect is longstanding

Front 17

homons affect growth

Back 17

1. gh
2. thyroid
3. insulin
4. sex hormones
5. corticosteroids

Front 18

common syndromes causing short stature

Back 18

1. downs
2. silver russell
3. turner
4. Noonan
5. fetal alcohol
6. prader willi

Front 19

common syndromes causing tall stature

Back 19

1. klinefelter
2. marfan
3. soto

Front 20

what is short stature

Back 20

• height below 3rd centile (-2SD) for chronological age = short stature
  

• at or just below 3rd centile is perfectly normal

• between -2SD and -3SD can be normal/ pathalogical. needs follow up
  

• <-3SD pathological

Front 21

short stature whome to investigate

Back 21

• even the cause is obvious - make sure
  
• very short with <-3SD
  
• tall parents
  
• deviation from normal growth curves
  

Front 22

invastigations in a short stature

Back 22

1. Hb
   
2. serum cratinin/ electrolyte / urine analysis
3. CXR / ECG/ Echo
4. Skull xray - lateral
5. bone age
6. karyotype
7. serum TSH / T4/T3
8. IGF 1 levels
9. GH provocative test

Front 23

genetic short stature

Back 23

• height -2sd
  
• goes with mid parantal height
  
• normal velocity
  
• bone age = chronological age
  
• sub normal adult height
  
• GH treatment not indicated
  

Front 24

constitutionally short

Back 24

• boys>girls
  
• " delayed growth"
  
• bone age < chronological age
  
• growth parameters (height age) are normal for particular bone age
  
• family hx of short stature in parents in childhood, delayed puberty and then get normal height
  
• treatment - reassurance
  

Front 25

hypothyroidism

Back 25

infentile body propotions

bone age <<chronological age and height age

abnormal velocity

Front 26

isolated GH deficiency

Back 26

normsl growth weight n length

subnormal growth velocity

present ~3yrs

< -3SD

normal skeletal propotions

interligance normal

skin folds > 50th percentile

homone replacemet