Download growth and milstone disorder

GROWTH
ASSESMENT
DR Badi AlEnazi
Consultant pediatric endocrinology and diabetolgist
Objectives:







Phases of growth
Growth measurement
Growth chart
Growth hormone
Bone age
Short stature
Tall stature
Growth is a dynamic process influenced by
many intrinsic and extrinsic factors that
interplay to determine ultimate attained
height
Careful tracking of childhood growth is a
sensitive indicator of health and wellbeing, and therefore an essential
component of sound pediatric care
Phases of Normal Growth
In utero, growth affected by
 insulin and insulin-like growth factors 1
(IGF-1) and 2 (IGF-2). nutrition,
 At birth
 Normal weight 3 kg
 Normal length 50 cm
 Normal HC 35 cm

Phases of Normal Growth
normal growth velocity for children until the
pubertal growth spurt.
 First 12 months: 25 cm
 Second year: 12 cm
 Third year: approximately 8 cm
 Later childhood until puberty (5 to 10
years): growth averages 5 to 6 cm/year

Growth measurement
below 2 years
Infantometer
Growth measurement (older children)
Measurement of growth
Always measure Ht without shoes, and
when plotting the patient in the growth
curve, be accurate regarding the
actual age of the child..
Skeletal Maturation
bone age

Skeletal maturation is assessed by examination
of a “bone age”(BA) film, which is a radiograph
of the left hand

can assess the bone maturation of multiple
ossification centers and compare it to standard
male or female radiographs. The BA can then be
compared to the patient’s chronologic age
Approach to short stature
Approach to short stature
Facts to be Elicited in the History (Etiology)
• Age of onset: Since when is the child not growing
• Previous growth records: School, home or physician records of previous
heights
and weights must be sought and charted on growth charts
• Antenatal history: Substance abuse, medication, infections (IUGR)
−− Birth history: Birth weight/gestation age (IUGR)
−−H/O birth asphyxia [multiple pituitary hormone deficiency (MPHD)]
−− Breech delivery, neonatal hypoglycemia (GHD, MPHD)
−− Prolonged neonatal hyperbilirubinemia (hypothyroidism)
−−Developmental milestones (hypothyroidism, chromosomal/genetic cause)
• Symptoms pertaining to illness
−− Shortness of breath, cyanosis, cough, fever [heart disease, asthma,
tuberculosis
(TB)]
−−Diarrhea, steatorrhea, abdominal pain (malabsorption)
−−Headache, vomiting, visual problems (pituitary-hypothalamic mass)
−− Constipation, lethargy, feeding difficulty (hypothyroidism)
−− Polyuria, renal tubercular acidosis (RTA), chronic renal failure
−−H/O hepatitis, distension abdomen, melena (chronic liver disease)
−− Recurrent blood transfusions (thalassemia and other chronic anemia)
• Dietary history: To elicit weaning practice, calorie and
protein intake
• Drug history: Prolonged use of corticosteroids,
amphetamine derivatives
• Family history of SS in first/second degree relatives
• Delay in puberty in one or both parent
• Social history: Child abuse, family discord, emotional
deprivation (psychosocial dwarfism)
Differential features of familial and
constitutional short stature
Feature
Familial short
stature
Constitutional
delay
Parents' stature
)Small (one or both
Parents' puberty
On time
Average
Delayed
)Growth (puberty
N
N
N
short
Slow
Delayed
Delayed
Normal
Bone age
Timing of puberty
Adult height
ENDOCRINE CAUSES OF GROWTH FAILURE









GH deficiency. (congenital &acquired)
GH resistance.
Panhypopituitarism
Hypothyroidism.
Glucocorticoid excess
Poor controlled DM
Undiagnosed DI
Hypophosphatemic rickets
CAH
Cushing syndrome
PWS
growth hormone deficiency