normal growth rafat mosalli mbbs frcpc faap rafat mosalli mbbs frcpc faap 5th year medical students
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Normal growthNormal growth
Rafat Mosalli Rafat Mosalli MBBS FRCPC FAAPMBBS FRCPC FAAP
5Th5Th Year Medical students Year Medical students
Lecture and session roles
PunctualityPunctuality Dress codeDress code Body hygieneBody hygiene PreparationPreparation participationparticipation
objectivesobjectives
What is normal child growth?What is normal child growth? How do we assess for growth?How do we assess for growth? Why growth chart is important?Why growth chart is important? What is the normal growth rate ?What is the normal growth rate ? What is the importance of :What is the importance of :
Upper: lower segment ratio(U:L) and Bone Upper: lower segment ratio(U:L) and Bone ageage
What is abnormal growth?What is abnormal growth?
Normal growth FactsNormal growth Facts
It is dynamic process.It is dynamic process. It is not only gaining Height!It is not only gaining Height! Appropriate Appropriate wight,hight,HCwight,hight,HC for age. for age. Normal growth pattern: between the 3Normal growth pattern: between the 3rdrd
and the 97and the 97thth percentiles percentiles Very important to measure each visit and Very important to measure each visit and
exam (make it exam (make it routine!)routine!)
Growth MeasurementsGrowth Measurements
Weight: Weight: appropriate scale and nakedappropriate scale and naked LengthLength: stature of a supine child(<2y): stature of a supine child(<2y) HeightHeight: stature of standing child(>2y): stature of standing child(>2y) HC HC ((head &brain growth) head &brain growth) : Occipitofrontal : Occipitofrontal
CircumferenceCircumference average of 3 measurementsaverage of 3 measurements Growth velocityGrowth velocity: annual linear growth rate: annual linear growth rate
Growth assessmentGrowth assessment
Plotting Wt,Ht,HC in serial measurement Plotting Wt,Ht,HC in serial measurement on the growth chart.on the growth chart.
Longitudinally along a time line (pattern)Longitudinally along a time line (pattern)
to assess growth rateto assess growth rate
Growth rate in Growth rate in Boys differ from female!Boys differ from female!
Growth spurt and peak Ht velocityGirls always earlier
Pubertal growth:Pubertal growth:
11 years in boys Vs 9 years for girls11 years in boys Vs 9 years for girls
Peak Ht VelocityPeak Ht Velocity In Female 11.5 Vs Male 13.5yIn Female 11.5 Vs Male 13.5y
Female stop growing by 14y Vs 17y in Female stop growing by 14y Vs 17y in MaleMale
Growth chartsGrowth charts
ImportanceImportance Objective ,continuous assessmentObjective ,continuous assessment Comparison and follow upComparison and follow up Detect growth deviationDetect growth deviation Detect disproportionate growthDetect disproportionate growth
- It is based on population size!- It is based on population size!
Rules of thumb for Growth rateRules of thumb for Growth rate
((1) Weight1) Weight::
-Wt loss for the first few days: 5-10% of BWT-Wt loss for the first few days: 5-10% of BWT
-Return of BWT at -Return of BWT at 7-10 days7-10 days of age of age
-Double BWT by 5-6-Double BWT by 5-6mm
-Triple BWT by -Triple BWT by 1 y1 y
-Quadruple by -Quadruple by 2y2y
-Daily Wt gain:-Daily Wt gain:
20-30g20-30g /d (first /d (first 4m4m))
15-20g15-20g/d (/d (first yearfirst year))
--AnnualAnnual Wt gain is 2kg between Wt gain is 2kg between 2y-Puberty2y-Puberty
Rules of thumb for Growth rateRules of thumb for Growth rate
((2) Average Height:2) Average Height: Length Length at birthat birth 50cm at birth,75cm at 1y 50cm at birth,75cm at 1y At age At age 3 y3 y is 90cm is 90cm At age At age 4y4y is 100 cm (double Birth length) is 100 cm (double Birth length) AnnualAnnual Ht increase: 5-7cm (4y-puberty) Ht increase: 5-7cm (4y-puberty)
Rules of thumb for Growth rateRules of thumb for Growth rate
((3) Head circumference3) Head circumference At At BirthBirth 35 cm 35 cm Increase 1cm/mo for Increase 1cm/mo for first yrfirst yr = 47cm = 47cm
the first 3m of life is the highest (2cm/m )the first 3m of life is the highest (2cm/m )
For the rest of life only 10 cm For the rest of life only 10 cm
Upper: lower segment ratio(U:L)Upper: lower segment ratio(U:L)
A ratio of A ratio of Upper lengthUpper length (Distance from the (Distance from the top of the head to the top of the pubis)to top of the head to the top of the pubis)to the the lower lengthlower length distance from the top of distance from the top of the pubis to bottom of the feet)the pubis to bottom of the feet)
It vary with age: the younger the higher.It vary with age: the younger the higher. At birth 1.7:1 At birth 1.7:1 At 10 y 1:1 At 10 y 1:1 Importance?Importance?
causes of disproportionate short stature?causes of disproportionate short stature?
TeethTeeth
First teeth at 5-8m:central mandibualr First teeth at 5-8m:central mandibualr incisorincisor
Permanent teeth appear at 5-7y:first molarPermanent teeth appear at 5-7y:first molar Not helpful to assess rate of growthNot helpful to assess rate of growth
Bone age (BA)
A measure of somatic maturity and growth A measure of somatic maturity and growth potentialpotential
radiographs of the hand &wrist compared with a radiographs of the hand &wrist compared with a standards one.standards one.
Result compared with Chronological age(CA)Result compared with Chronological age(CA) Diagnostic key in evaluating short stature.Diagnostic key in evaluating short stature. Genetic (BA=CA)Genetic (BA=CA)
Constitutional (BA<CA)Constitutional (BA<CA)
Mid Parental height
Best predictor of eventual expected adult Best predictor of eventual expected adult height.height.
Girls Girls (father Ht-13)+(Mother Ht )(father Ht-13)+(Mother Ht ) 22 Boy Boy (mother Ht+13)+(father Ht)(mother Ht+13)+(father Ht) 22-Give an average of -Give an average of (+/- 5cm(+/- 5cm) of expected ) of expected
potential adult Htpotential adult Ht
Abnormal growthAbnormal growth
1-Height:1-Height: Short statureShort stature Tall statureTall stature2-Weight:2-Weight: Failure to Thrive(FTT)Failure to Thrive(FTT) Overweight(110-120% of BMI)Overweight(110-120% of BMI) Obesity (>120% of BMI)Obesity (>120% of BMI)(3)HC:(3)HC: Microcephaly vs MacrocephalyMicrocephaly vs Macrocephaly
Short stature Causes
GeneticGenetic Constitutional Constitutional (late bloomer)(late bloomer) Chronic diseasesChronic diseases SyndromesSyndromes EndocrineEndocrine PsychologicalPsychological Intrauterine (SGA,IUGRIntrauterine (SGA,IUGR
Short stature Causes
Evaluating short stature
1-History1-History is the most important? is the most important?
family Hx, parent pubertyfamily Hx, parent puberty
2-Examination2-Examination
Dysmorphology, Dysmorphology, WeightWeight, HC ,U/L ratio, Mid , HC ,U/L ratio, Mid parental Height)parental Height)
3-3-InvestigationsInvestigations
4- 4- Bone ageBone age
We Talked aboutWe Talked about
What is normal child growth?What is normal child growth? How do we assess for growth?How do we assess for growth? Why growth chart is important?Why growth chart is important? What is the normal growth rate ?What is the normal growth rate ? What is the importance of :What is the importance of :
Upper: lower segment ratio(U:L) and Bone Upper: lower segment ratio(U:L) and Bone ageage
What is abnormal growth?What is abnormal growth?
Remember !Remember !
Growth is dynamic process.Growth is dynamic process. To measure growth parameters and plot it To measure growth parameters and plot it
every visit (growth rate)every visit (growth rate) Rule of thumb for growth rate.Rule of thumb for growth rate. Large shifts in growth and large Large shifts in growth and large
discrepancy in discrepancy in percentilespercentiles warrant an warrant an immediate attention and investigations!immediate attention and investigations!
Remember in Short stature
-Bone age is diagnostic key in Short stature-Bone age is diagnostic key in Short stature- FH is keyFH is key- FTT suggest organic ,malnutrition causes FTT suggest organic ,malnutrition causes
VsVs overweight overweight endocrine causeendocrine cause- Constitutional delay is not uncommon Constitutional delay is not uncommon
&need Fu/4-6m and usually no treatment&need Fu/4-6m and usually no treatment- Endocrine causes is rareEndocrine causes is rare
