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

Infancy Infancy

•The era of changing growth The era of changing growth raterate

Childhood Childhood

•The era of stable growth rateThe era of stable growth rate

Adolescence Adolescence

•The era of sex hormone The era of sex hormone induced shifting growthinduced shifting growth

What is short statureWhat is 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

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