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