Ravilya_Kaplan Pediatrics: Chapter 4 Growth

Front 1

what is short stature what is average stature

Back 1

"average" (50th percentile) plus or minus two standard
deviations (3rd-97th percentile). Measurements that fall below the 3rd percentile for
height are termed short stature.

Front 2

Risk Factors/Etiology. there are four basic patterns of proportional short stature:

Back 2

TRisk Factors/Etiology. here are four basic patterns of proportional short stature: pathologic
(postnatal onset), constitutional growth de

Front 3

Presentation. Pathologic short stature and constitutional short stature

Back 3

Presentation. Pathologic short stature and constitutional short stature both start out with the
patient in the normal range for height. Over time, the patient with pathologic short stature
starts falling off the height curve, crossing percentiles. In constitutional short stature, normal
final adult height is reached, but the growth spurt and puberty are delayed

Front 4

familial
short stature

Back 4

familial
short stature stay parallel to the growth curve. There is a strong family history of short
stature.

Front 5

Prenatal short stature

Back 5

Prenatal short stature also is parallel to the growth curve but is much more marked

Front 6

the single most important tool in evaluating disorders of
growth.

Back 6

growth chart is the single most important tool in evaluating disorders of
growth. As many points as possible should be plotted to see trends. Physical exam is helpful in
diagnosing syndromes and diseases associated with short stature.

Front 7

Any female being evaluated
for short stature should have a

Back 7

Any female being evaluated
for short stature should have a karyotype (Turner syndrome

Front 8

single, most important
diagnostic study in short statur is

Back 8

single, most important
diagnostic study is to obtain an x-ray of the left hand and wrist for bone age.

Front 9

Treatment.short statur

Back 9

Treatment. Correction of the underlying disease state may help improve height. Some patients
respond to human growth hormone.

Front 10

Differential Diagnosis.short statur

Back 10

Differential Diagnosis. Work-up for short stature.

Front 11

Tall Stature can be cause...

Back 11

Exogenous obesity can also cause
tall stature. Endocrine causes of tall stature include growth hormone excess (gigantism,
acromegaly), androgen excess (tall as children but short as adults), and hyperthyroidism

Front 12

Genetic syndromes and metabolic disorders responsible for tall stature include

Back 12

Genetic syndromes and metabolic disorders responsible for tall stature include homocystinuria,
cerebral gigantism, Beckwith-Wiedemann, Weaver-Smith, and Klinefelter syndromes.
Homocystinuria is autosomal recessive, with an incidence of 1:200,000. Patients have a
Marfanoid appearance with associated mental retardation or psychiatric illness.

Front 13

Cerebral
gigantism

Back 13

Cerebral
gigantism (Sotos syndrome) are large for gestational age, have mental retardation, and a mild
hydrocephalus.

Front 14

Evaluation of Growth
Growth velocity:

Back 14

Yearly increments of growth; should follow a growth curve

Front 15

Evaluation of Growth
Chronologie age (CA):

Back 15

Actual age

Front 16

Evaluation of Growth
Bone age (BA):

Back 16

X-ray of left hand and wrist

Front 17

Evaluation of Growth
I. Ideal.

Back 17

I. Ideal. CA = BA with normal growth velocity

Front 18

Evaluation of Growth
CA >BA

Back 18

with normal growth velocity: constitutional delay
with abnormal growth velocity: chronic systemic disease, endocrine disorders

Front 19

Evaluation of Growth CA = BA

Back 19

with normal growth velocity: genetic short stature
with abnormal growth velocity: genetic, chromosomal, syndrome

Front 20

Evaluation of Growth
CA< BA

Back 20

with normal growth velocity: obesity

with abnormal growth velocity: precocious puberty, congenital adrenal hyperplasia
(CAH), hyperthyroidism

Front 21

DISORDERS OF WEIGHT
Failure to Thrive
Definition.

Back 21

Definition. Failure to thrive is failure to gain weight or deceleration of weight growth.

Front 22

DISORDERS OF WEIGHT
Failure to Thrive
Risk Factors/Etiology.

Back 22

Risk Factors/Etiology. Failure to thrive can result from malnutrition (starvation, deprivation,
abuse), malabsorption (from infection, celiac disease, cystic fibrosis, disaccharidase deficiency,
protein-losing enteropathy), allergies, immune deficiency states, and chronic disease.

Front 23

DISORDERS OF WEIGHT
Failure to Thrive
Presentation.

Back 23

Presentation. Again growth charts are invaluable. In infants, birth weight is doubled by 4-5
months of age and tripled by 1 year. Patients may show little subcutaneous fat, muscle wasting,
rashes, poor tone, and weak cry.

Front 24

DISORDERS OF WEIGHT
Failure to Thrive

Diagnostic Tests
what .test should be considered

Back 24

Diagnostic Tests. Hospitalization for documentation of caloric intake and weight gain is sometimes
necessary. Complete blood counts, urinalysis, liver function tests, and serum protein
should be drawn. A sweat chloride test should be considered

Front 25

obesity
Definition.

Back 25

Obesity
Definition. Obesity is a generalized, excessive over-accumulation of fat. It may result from an
increase in number or size of adipocytes.


..

Front 26

obesity
Risk Factors/Etiology

Back 26

Parental obesity and family inactivity can predispose to obesity, Feeding
babies as a generic response to any crying can lead to obesit
Too much fruit juice in the first
year of life has been linked with subsequent obesity Some syndromes are related to obesity

Front 27

obesity

Back 27

Presentation. Tall stature may sometimes be seen. Boys may present with increased adipose tissue
in the mammary area mistaken for breast development.Abdominal striae are present. A
large pubic fat pad gives the appearance of micropenis. Puberty may come early. Associated
obesity of the proximal extremities is COlIJnWIl.

Front 28

obesity
Diagnostic Tests,

Back 28

Diagnostic Tests, Body mass index (EMl) >95% for age/sex or >30 in adolescents is used to
define obesity.

Front 29

obesity
Treatment.

Back 29

Treatment. Exercise and a balanced diet are the keystones to effectively managing obesity.

Front 30

obesityComplications.

Back 30

Complications. Obese infants and children are at increased risk for becoming obese adults.
This is related to more advanced age of onset and severity of obesity. Complications include
cardiovascular (hypertension, increased cholesterol), hyperinsulinism, slipped capital
femoral epiphysis, and sleep apnea.

Front 31

obesity dd

Back 31

Differential Diagnosis. This includes endocrine causes (Cushing, hypothyroidism, Prader..
Willi) and genetic causes (Turner, Laurence-Moon.. Biedl) ,