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 well-being, 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 measurementbelow 2 years
InfantometerInfantometer
Growth measurement (older children)
Measurement of growthMeasurement of growth
Always measure Ht without shoes, and Always measure Ht without shoes, and when plotting the patient in the growth when plotting the patient in the growth curve, be accurate regarding the curve, be accurate regarding the actual age of the child.. actual age of the child..
Skeletal Maturationbone 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 Differential features of familial and
constitutional short statureconstitutional short stature
FeatureFeature Familial short Familial short staturestature
Constitutional delayConstitutional delay
Parents' statureParents' stature Small (one or bothSmall (one or both)) AverageAverage Parents' pubertyParents' puberty On timeOn timeDelayedDelayed Growth (pubertyGrowth (puberty)) NNSlowSlow
Bone ageBone age NNDelayedDelayed Timing of pubertyTiming of puberty NNDelayedDelayed
Adult heightAdult height shortshortNormalNormal
ENDOCRINE CAUSES OF GROWTH FAILUREENDOCRINE CAUSES OF GROWTH FAILURE
GH deficiency. (congenital &acquired) GH deficiency. (congenital &acquired) GH resistance.GH resistance. PanhypopituitarismPanhypopituitarism Hypothyroidism.Hypothyroidism. Glucocorticoid excess Glucocorticoid excess Poor controlled DMPoor controlled DM Undiagnosed DIUndiagnosed DI Hypophosphatemic ricketsHypophosphatemic rickets CAHCAH
Cushing syndromeCushing syndrome
PWSPWS
growth hormone deficiencygrowth hormone deficiency