growth and development samir najjar m.d professor, department of pediatrics
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Growth and developmentGrowth and development
Samir Najjar M.D Samir Najjar M.D
Professor, Department of Professor, Department of PediatricsPediatrics
Stages of growth and Stages of growth and developmentdevelopment
• IntrauterineIntrauterine
• InfancyInfancy
• ChildhoodChildhood
• AdolescenceAdolescence
• AdulthoodAdulthood
Intrauterine GrowthIntrauterine Growth
• Greatest length velocity at mid fetal Greatest length velocity at mid fetal lifelife
• Development of adipose tissue at 7 Development of adipose tissue at 7 monthsmonths
• weight doubles in the last 2 monthsweight doubles in the last 2 months
• Weight loss beyond 40 weeksWeight loss beyond 40 weeks
Constrains on intrauterine Constrains on intrauterine growthgrowth
• Uterine sizeUterine size
• PlacentaPlacenta
• Size of the motherSize of the mother
Adolescence Adolescence
•The era of sex hormone The era of sex hormone induced shifting growthinduced shifting growth
POSTNATAL
•Malnutrition
•Chronic diseases
• Gastrointestinal
•Cardiopulmonary
•Infections
•Renal
•Hematologic
•Drugs
•Psychosocial dwarfism
•Endocrine disorder
PRENATAL
•Intrauterine growth retardation (IUGR)
•Placental diseases
•Infections
•Teratogens
•Dysmorphic syndromes
•Chromosomal disorders
PROPORTIONATE
DISPROPORTIONATE•Skeletal dysplasia•Rickets
SHORT STATURE
NORMAL VARIANTS
•Familiar short stature
•Constitutional growth delay
PATHOLOGIC
CLASSIFICATION OF SHORT STATURE
POSTNATAL
•Malnutrition
•Chronic diseases
• Gastrointestinal
•Cardiopulmonary
•Infections
•Renal
•Hematologic
•Drugs
•Psychosocial dwarfism
•Endocrine disorder
PRENATAL
•Intrauterine growth retardation (IUGR)
•Placental diseases
•Infections
•Teratogens
•Dysmorphic syndromes
•Chromosomal disorders
PROPORTIONATE
DISPROPORTIONATE•Skeletal dysplasia•Rickets
SHORT STATURE
NORMAL VARIANTS
•Familiar short stature
•Constitutional growth delay
PATHOLOGIC
CLASSIFICATION OF SHORT STATURE
POSTNATAL
•Malnutrition
•Chronic diseases
• Gastrointestinal
•Cardiopulmonary
•Infections
•Renal
•Hematologic
•Drugs
•Psychosocial dwarfism
•Endocrine disorder
PRENATAL
•Intrauterine growth retardation (IUGR)
•Placental diseases
•Infections
•Teratogens
•Dysmorphic syndromes
•Chromosomal disorders
PROPORTIONATE
DISPROPORTIONATE•Skeletal dysplasia•Rickets
SHORT STATURE
NORMAL VARIANTS
•Familiar short stature
•Constitutional growth delay
PATHOLOGIC
CLASSIFICATION OF SHORT STATURE
POSTNATAL
•Malnutrition
•Chronic diseases
• Gastrointestinal
•Cardiopulmonary
•Infections
•Renal
•Hematologic
•Drugs
•Psychosocial dwarfism
•Endocrine disorder
PRENATAL
•Intrauterine growth retardation (IUGR)
•Placental diseases
•Infections
•Teratogens
•Dysmorphic syndromes
•Chromosomal disorders
PROPORTIONATE
DISPROPORTIONATE•Skeletal dysplasia•Rickets
SHORT STATURE
NORMAL VARIANTS
•Familiar short stature
•Constitutional growth delay
PATHOLOGIC
CLASSIFICATION OF SHORT STATURE
POSTNATAL
•Malnutrition
•Chronic diseases
• Gastrointestinal
•Cardiopulmonary
•Infections
•Renal
•Hematologic
•Drugs
•Psychosocial dwarfism
•Endocrine disorder
PRENATAL
•Intrauterine growth retardation (IUGR)
•Placental diseases
•Infections
•Teratogens
•Dysmorphic syndromes
•Chromosomal disorders
PROPORTIONATE
DISPROPORTIONATE•Skeletal dysplasia•Rickets
SHORT STATURE
NORMAL VARIANTS
•Familiar short stature
•Constitutional growth delay
PATHOLOGIC
CLASSIFICATION OF SHORT STATURE
Accepted indications for GH Accepted indications for GH therapy therapy
• Childhood GH deficiencyChildhood GH deficiency
• Growth failure associated with Growth failure associated with chronic renal insufficiencychronic renal insufficiency
• Turner syndromeTurner syndrome
• IUGRIUGR
• Adults with GH deficiencyAdults with GH deficiency
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