Post-natal growth abnormalities

©S Nussey/IOS

Prevalence of growth problems

• Approx 10% of children may present

because of: – Excessive shortness

– Excessive tallness

– Fatness

– Thinness

We live in a ‘heightist’ society

• The majority will have short stature

• Only a few will have an underlying organic cause

• The majority will only require explanation, support and reassurance

Importance of parental influence

• Before birth, the size of the baby is mainly related to

that of the mother

• By the age of 2 y the influence of both parents is evident

• To calculate predicted height add parental heights in cm,

divide by two and add 7cm for a boy or subtract 7cm for

a girl

• If one parent is excessively tall or short, ask why

Importance of ‘physiological age’

• Chronological age may be misleading:– Early (20%), normal (60%) & late (20%) developers

• Compared to average peers:– Early developers go into puberty earlier, grow faster and stop

growth earlier

– Later developers have delayed puberty, grow slower and for longer time

• At 14 years of age there can be a 15 cm difference between the early and late developers

Post-natal growth is mainly controlled by somatotrophin

Pattern of GH secretion

How is growth measured?

Auxology - the use of charts

Auxology - the use of

charts

•Length/Height

•Weight

•Head circumference

•Measures of development:

•Pubertal status

•Bone age

Auxology - the use of charts

Pre-term 20 weeks to EDD Pre-term to 52 weeks 12-24 months

Height velocity plot demonstrates 3 phases of growth

Tanner stages

Bone age: Tanner & Whitehouse 2

Short stature & dysmorphism

If in doubt measure skeletal proportions and lookfor dysmorphic features

Investigations of GH deficiency

• GH stimulation tests: – Insulin– Glucagon– Clonidine– Arginine + GHRH

• Basal IGF-1 and IGF-BP3• Neuro-imaging• Skeletal survey

Tall stature

Marfan’s Klinefelter’s