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167 Cards in this Set
- Front
- Back
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For children, what is the most important indicator of health?
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Growth
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What are the biggest predictors of illness in children?
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Weight loss or gain
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If a child has a serious bacterial infection, they will have tachycardia outside of proportion to ____?
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Fever
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How long should respiratory and HR be counted for?
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1 minute
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Each degree of Farenheit increase in a child raises the HR ___ to ___ beats/minute
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8 to 10
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At what age should BP be taken on a child?
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>3
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What is the upper limit of HR in children?>
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160
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What does rosiola cause?
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Significant fever
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If you have trouble getting a BP on a child, what trick should you use?
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Raise the patients arm to make it louder
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What are the 3 rules in measuring a child's height?
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1. must be in the center of the scale
2. look at child's heels: they must be against the wall 3. head is eye level |
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If a child's measurement does not fit their growth curve, what should the nurse do first?
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Remeasure!
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The arm span of a child should be (< or >) the height span.
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<
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How old must a child be to start measuring BMI?
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2
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Accurate and reliable physical measurements are used to...
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1. monitor the growth of a patient
2 detect growth abnormalities 3. monitor nutritional status 4. track the effectiveness of medical or nutritional interventions |
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What do weight for age charts indicate?
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1. reflects body weight relative to age
2. influenced by recent changes in health or nutritional status 3. used in early infancy for monitoring weight and helping explain changes in weight-for-length and BMI-for-age in older children |
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True or False: Weight for age growth charts can be used to classify infants, children and adolescents as under or overweight?
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FALSE!!
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which growth chart is used to classify children as underweight, overweight or obese?
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BMI-for-age
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If a child presents with trunchal obesity and thin extremities, what should they be worked up for?
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Cushings
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Describe an abnormal channeling up?
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When the child has crossed more than 2 growth curves
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What percentage range of BMI does a child need to be in to be considered overweight?
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>85th and <95th
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What percentile on the weight for length/stature chart indicates obesity in children?
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>95th
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If a child is in the >95th percentile for BMI for age, what would they be diagnosed as?
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obese
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What ages is it common to have a drop in BMI with the lowest level of body fat?
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Ages 4-6
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If a child rebounds in their BMI before age 6, what can this be a sign of?
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Future fighting with weight
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What are the growth charts that can be used to determine if a patient is underweight and what percentile must they fall in?
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BMI-for-Age and Weight-for-length
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Short stature can be determined using which growth chart?
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Stature/length-for-age and under the 5th percentile
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Developmental problems can be assessed with which growth charts? What percentile would the patient fall in to be worked up for such problems?
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Head Circumference for age chart
must fall in the <5th percentile and the >95th percentile |
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BMI is a (screener/diagnostic tool)?
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Screener
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Which is worse mico or macrocephaly?
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Micro
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What is the ballard/dubowitz scale?
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Standards for intrauterine growth by gestational age
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Define SGA.
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Small for gestational age which is when the child is below the 10th percentile in weight, length or head circumference.
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How would a child be considered large for gestation age?
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THe chid's birth weight (or length or head circumference) lies above the 90th percentile for that gestational age
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True or False: early puberty does not tend to cause obesity?
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FALSE: it can cause obesity because growth slows down
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In examining if a child's growth or lack there of is abnormal, what should the HCP obtain from the parents?
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They must obtain the midparental height.
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How do you determine the midparental height?
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Girls: Father's height + mother's height - 5 inc/ 2
Boys: Father's height + mother's height + 5 inc/2 Target height: Midparental height= 2 SD (1 SD =2 inch) |
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What is the calculation for midparental height in cm?
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Girls: (Father's height -13cm) + mother's height/2
Boys: (Father's height + 13cm) + mother's height/ 2 |
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What is the predominant factor in growth from ages 0-2?
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Nutrition
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Growth Hormone plays the biggest factor in the growth of children of what age group?
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2-12
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Children ages 12 and up grow as a result of _____?
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Sex steroids/growth hormone
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What test should be done if a child has an abnormal temp of growth?
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Bone age on the left wrist
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True or false: a tall obese child may have hypothyroidism?
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False! would not be tall
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If the bone age is delayed by 2 or more years, what might the child have?
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constitutional growth delay
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What are terms of a constitutional growth delay?
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1. family history
2. the child is healthy, grwoing below but parallel to the 3rd percentile line 3. between 6-24 months, the linear grwoth and weight track downward to the 3rd percentile 4. delay onset of puberty and a growth spurt and usually end up with heights in the lower half of the normal range 5. Slow growth rate between 12-30 months |
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Give 4 examples of confounding factors in late childhood growth?
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-infrequent measurement opportunities
-normal prepubertal growth deceleration -Effects of medications for common disorder (ADHD, asthma, depression) -Normal variation in onset of puberty - |
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Growth charts are designed for children to start puberty at ___ for girls and ___ for boys.
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11 and 12.5
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Describe type I growth drop?
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Retardation of weight with near normal or slowly decelerating height and head circumference
Suggests undernutrition |
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Which pattern is described by near proportional retardation of weight and height with normal head circmference: constitutional growth delay, genetic short stature, endocrinopathies, structural dwarfs?
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Type 2
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Describe Type III patterns.
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Concomitant retardation of weight, height and head circumference.
-SGA -chromosomal aberrations -CNS abnormalities -Rarely familial |
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What is the normal US to LS in infants?
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1.7 to 1.8 to 1
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As a child approaches adolescence, their US to tLS ratio is ____ to ___
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0.9 to 1.0: 1
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In Marfan syndrome the Upper : lower segment ratio is ___?
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Low
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CNS and developmental problems have a tendency to make children go into puberty ____.
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Earlier
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What are 3 possible causes of deceleration of linear growth in a well-nourished child?
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1. Growth hormone deficiency
2. Hypothyroidism 3. Glucocorticoid excess (cushing's) |
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What is the cause if a child has an initial decline in weight follow by decreased height velocity?
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Malnutrition or systemic illness
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Dysmorphic features are often caused by ___?
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chromosomal abnormality
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Skeletal dysplasia or metabolic bone disease are often a result of ____?
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disproportionate features or skeletal abnormalities.
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True or false: primary growth disturbances include intrauterine growth retardation.
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Ture
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What are the 5 general causes of short stature?
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1. Normal patterns of growth
2. Primary growth distribution 3. systemic illness 4. genetic disorders 5. disproportionate short stature |
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what is one major symptom prader willi syndrome?
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They eat all the time. Break into the fridge
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What are the proper examination/test to conduct when w a child has decreased growth?
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1. Physical exam
2. Free T4 and TSH 3. ESR 4. Electrolytes, BUN creatinine, UA, LFT 5. Bone age of left hand and wrist |
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Which hormones are responsible for skeletal maturation?
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estrogen, thyroid hormone, androgen and growth hormone
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Bone age is generally more than __ years in advance of chronological age in long-standing precocious ___ because of the action of ___ hormones.
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2; puberty; sex
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How do you take the bone age?
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in the left hand and wrist a conventional xray is taken.
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What is the most common cause of accelerated growth?
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over-nutrition is the most common cause - weight affected more than height
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What are the differential diagnoses to accelerated growth?
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-Precocious puberty (adrenal or gonadal)
-Hyperthyroidism -genetic (familial) or syndrome (Kleinfelter or Marfan's) -GH excess |
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How is sexual maturity rated in males?
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-size of the testes
-length of the penis and width |
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Female sexual maturity is rated on which 2 features?
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1. breast development
2. pubic hair development |
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How is testicular size measured in boys?
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-Prader orchidometer
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What testicular size in boys is the first sign of puberty?
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> or = to 4mL
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What is the first sign of pubertal development in girls?
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Breast buds
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What is the official name for rating sexual maturity?
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Tanner stages
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85% of female have ____ as the first sign of puberty.
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thelarche
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What is Tanner 1 in girls?
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No breast buds
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If the breast bud diameter is </= areola width, the girl is in tanner __?
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2
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Describe tanner 3 in terms of female breast buds.
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breast diameter > areolar width
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Describe Tanner stage IV in girls.
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Mounding of areola above plane of the breast
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Adult breast are Tanner ___
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5
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Menarche occurs an average of ___ years ___ thelarche.
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2; after
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The peak height velocity of puberty in females is reached at ___ years immediately prior ___.
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2; menarche
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The long diameter of the penis must be ___cm to be considered the earliest sign of puberty.
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2.5
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What is tanner stage 2 in girls in terms of pubic hair?
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slightly pigmented over mons or labia
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If a girl has dark, course hair on the mons, what stage is she in?
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Tanner 3
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If a girl's pubic hair is adult in charactered and confined to the mons, which stage is this?
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Tanner 4
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Where is the pubic hair located in a girl with Tanner 5?
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spread to the medial thigh
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True or False: In males, the length of the penis growth before the width.
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True
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Describe Tanner stage 3 of the male genitalia.
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Phallus growth in length
Testes > 3cm, Volume 6mL-8mL |
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Which tanner stage in males corresponds to Testes >4cm and Volume 10-15mL.
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Tanner 4: Phallus growth in width
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Describe Tanner stage 5 of male genitalia.
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Adult testes >5cm
Volume >15mL |
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What is Tanner stage 1 for male sexual maturation?
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Testes, scrotum and penis about same size and proportion as early childhood
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If the skin of the male scrotum reddens and changes in texture, but little or no enlargement of the penis has occur (10.5-12.5), which tanner stage is the male in?
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Tanner 2
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Stage and describe when Males have enlargement of the penis.
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Tanner 3: first mailing in length; further growth of scrotum and testes
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When is the peak height velocity achieved in males?
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age 14, stage 4
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The peak height velocity in ___ occurs in stage 3.
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Girls
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The increase in statue in males is due to ___ produced by the ___, so the growth spurt in stature is preceded by an increase in the size of the ____.
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androgens; testes; testes
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Androgens cause the penis to ___ and ___
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Lengthen and widen
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True or False: Men quickly enter stage 3 tanner?
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FALSE: they take their time
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What stage of Tanner is descriptive of male pubic hair that is adult like but not spread to the thigh?
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Stage 4
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Girls must have enough ___ to make sex hormones.
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Cholesterol
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From What stage do girls tend to maintain their weight?
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Tanner 3
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Between the ages of 12-13, girls at the 5th percentile gain less than ___ lbs, while those at the 95th percentile gain more than __ lbs.
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8; 13
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Explain why girls have an increase in weight that peaks just prior to menarche.
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in early puberty their accumulation of total body fat, but during their peak height velocity they accelerate their accumulation of fat and lean body tissue
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Boys tend to decrease body fat after age ___.
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14
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If a child's BMI is increasing at a rate of 0.5 units/year during most of their second decade, what percentile are they likely in?
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5th
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With rapid bone growth, ___ ___ levels increase.
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alkaline phosphatase
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T or F: Alkaline phosphotase levels can be 50-100% above the normal range during rapid bone growth.
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Ture
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Pre-pubertal growth (> or <) post-pubertal growth?
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greater
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A child who as a delay in puberty has a tendency to be (taller/shorter)
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Taller
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What does serum alkaline phophatase levels indicate?
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Reflects growth/ turnover of bone
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What is the definition of delayed puberty?
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The absence or incomplete development of 2nd sexual characteristics by an age at which 95% of children of that sex and culture have initiatied sexual maturation
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What is the upper 95th % age range for development of secondary sex characteristics for boys and girls in the US?
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Boys: 14
girls: 12 |
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Define adrenarche.
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increased adrenal androgen secretion
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When and what occurs during adrenarche?
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-Occurs between ages 6-8
-transient growth spurt -some children develop0 axillary and pubic -no sexual development occurs |
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What are the 2 hormones that control gonadarche in boys and what do they specifically do?
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-LH stimulates testosterone production
-FSH stimulates sperm maturation |
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What do FSH and LH do in girls?
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-FSH stimulates estrogen and follicle formation
-LH stimulates the corpus luteum after ovulation |
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At what age in both boys and girls would adrenarche be considered precocious?
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Boys: before age 9
Girls: Before age 7 (white) before 6.5 (black) |
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What is the mean menarcheal age for white and black females?
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Black: 12.2
White: 12.9 |
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What disorder occurs when the endocrine organ (gonads) are not functioning and causes the pituitary to over produce the hormones?
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Hypergonadotropic hypogonadism: high LH and FSH
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What is hypogonadotropic hypogonadism?
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Low or normal LH and FSH is secondary to constitutional delay or a central gonadotropin deficiency
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List the requirements to have precocious puberty in girls?
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-any sign of puberty in a girl less than 8
-with increase to tanner 3 in 6-12 month period in 6-8 year old -menarche before age 10 -pubic hair -white: before age 7 -black: before age 6 |
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why would a girl who has menarche at age 10 be diagnosed with precocious puberty?
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Puberty in girls begins 2 years before menarche: age 8 = age cut off for girls
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What is one common cause of precocious puberty?
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Adrenal hyperplasia
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is precocious puberty in boys usually pathologic?
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Yes, 50 % of the time. It is more common in girls
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True or false; it is a red flag if menarche occurs without breast bud development in girls.
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TRUE
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What is contrasexual development?
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Feminization of boys and virilization of girls
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What are the red flags for pathologic pubertal development?
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1. penis enlarges without scrotal
2. extensive pubic hair growth 3. rapid growth in breast development through tanner 3 before age 8 4. elargement of penis without testies 5. documented growth acceleration in a 6-12 month period in a girl less than 8 or boy less than 9 6. any clitoral enlargement, voice deepening, or increase in muscle mass |
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What is incomplete precocious puberty?
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premature thelarche, adrenarche
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What is the most common variation in girls in relation to precocious puberty?
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premature thelarche, occurs in 1-4 years of age
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T or F: premature thelarche is benign if it is not associated with the onset of other pubertal events.
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TRUE
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How would precocious adrenarche show in children?
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Growth of axillary hair with odor stimulated by androgen. Also look for testicular enlargement in boys
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What is psuedo-precocious puberty?
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-some of the changes of puberty are present
-but appearance is isolated or out of normal sequence |
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What is isosexual puberty?
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-when the changes of puberty are consistent with the child's gender
-when they are discordant with gender they are heterosexual |
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What is gonadotropin independent ovarian disease?
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Decreased secretion of gonadotropin releaseing hormonal and prepubertal or lower level of LH and FSH
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What are the most common ovarian causes of gonadotropin independent ovarian disease?
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-follicular cysts of the ovary
-McCune Albright syndrom -Granulosa-theca cell tumors of the ovary |
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Describe gonadotropin independent testicular disease and the common causes.
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Increase in serum testosterone concentration with normal or low LH and FSH
-Leydig cell tumor -difference in testicular size -chronic gonadotropin secreting germ cell tumors -McCune Albright syndrome |
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What is the best way to test for precocious adrenarche?
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Smell the armpits!
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What could hypertension in children with rapid CPP suggest?
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congenital adrenal hyperplasia due to deficiency of 11 beta hydroxylase
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What are 6 indicators that there is adrogenic influence on precocious puberty?
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1. acne
2. facial or axillary hair 3. increased muscle bulk 4. extent of pubic hair 5. penile elongation 6. scrotal rugation increased with thinning |
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What do the presence of cafe au lait spots show for puberty?
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Possible neurofibromitosis or McCune Albright syndrome
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What should the HCP assess for in terms of thyroid function if a child has precocious puberty?
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Thyroid enlargement or presence of myxedema
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What findings help determine if precocious puberty is has estrogenic influence?
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-size of breast tissue
-must distinguish breast from soft smooth consistency of increased fat -reddish, les moist vaginal mucosa in prepubertal girl -pale moist appearance of pubertal vaginal mucosa, elongated clitoris -labia minor more visible as puberty progress |
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In clinical evaluation, what are the evidence of gonadotropic stimulation?
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-measure phallic and testicular dimension: testicle must be =
-without testicular enlargment, penis enlargment, adrenal pathology -testicular volume is greater than phallic size in normal puberty, CPP and Primary hypothyroidism |
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What are some examples of evidence of a mass involved with precocious puberty?
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-asymmetric testicular enlargemtn
-hepatomegaly -abdominal mass |
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What laboratory tests should be done during a work up for precocious puberty?
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-CBC
-erythrocyte sed rate -liver function test -TSH and free T4 -bone age of left wrist |
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What serum tests should be taken to help distinguish between primary and secondary hypogonadism
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random serum LH and FSH
-estradiol in girls and testosterone in males |
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A girl has delayed puberty if she has no menarche ___ years after breast development or no ___ by age 16.
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5; menses
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Over 50% of delayed puberty is due to ___ ___.
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constitutional delay: late bloomer
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What is the treatment for delayed puberty?
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testosterone for males and estrogen for females
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What is the most common cause of short stature?
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familial or due to constitutional growth delay
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When should a HCP worry about short stature in a child?
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-abnormally slow growth rate
-downward crossing of percentil channels on the growth chart after the age of 18 months -height below the 3rd percentile -height significantly below genetic potential by 2 SD |
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What are the symptoms of Turner's syndrome?
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-multiple nevi
-low posterior hairline -webbed neck -broad chest with wide spaced nipples -short fourth metacarpals -increased carrying angle of arms or CUBITUS VALGAS |
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What is cubitus valgas? when is it seen?
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increased carrying angle of arms often seen in turner's syndrome
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List the systemic illness that are associated with short stature.
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1. hypocaloric (malnutrition, GI, poorly controlled DM)
2. Metabolic (Renal, hepatic, cardiac, hematologic, respiratory, chronic infection) 3. Endocine (hypothyroidism, cushing's, GH deficiency |
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What are some common causes of structural overgrowth in infancy?
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-maternal diabetes
-cerebral gigantism -beckwith-wiedemann syndrome |
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What is the most common cause for LGA infants?
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Maternal diabetes
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What is Soto's syndrome? Describe the symptoms
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cerebral gigantism
-high forehead -frontal bossing -hypertelorism -prominent jaw -high arched palate -mental retardation -poor coordination |
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What are the symptoms of Beckwith-Wiedemann syndrome?
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-Macrosomia
-visceromegaly -macroglossia -omphalocele -prominent occiput -hypoglycemia with hyperinsulinism |
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Name 6 non-endocrine disorders that can cause structural overgrowth in childhood.
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1. familial
2. exogenous obesity 3. precocious puberty 4. marfan syndrome 5. homocystinuria 6. neurofibromatosis type 1 |
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What endocrine disorder can cause structural overgrowth?
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Growth hormone excess
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which hormones are in the upper range of normal for familial tall stature?
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GH secretion, serum IGF-1 and IFG binding protein-3
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True or false: exogenous obesity can cause short stature. explain.
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TRUE: bone age may be advanced and puberty starts early causing premature epiphyseal fusion
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What is acromegaly>?
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Disorder of GH excess in adulthood
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What is gigantism?
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Excessive linear growth that occurs with growth hormone excess when epiphyseal growth plates are open during childhood
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What endocrine disorder can cause structural overgrowth?
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Growth hormone excess
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which hormones are in the upper range of normal for familial tall stature?
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GH secretion, serum IGF-1 and IFG binding protein-3
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True or false: exogenous obesity can cause short stature. explain.
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TRUE: bone age may be advanced and puberty starts early causing premature epiphyseal fusion
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What is acromegaly>?
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Disorder of GH excess in adulthood
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What is gigantism?
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Excessive linear growth that occurs with growth hormone excess when epiphyseal growth plates are open during childhood
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