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