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Post-natal growth abnormalities

Post-natal growth abnormalities. ©S Nussey/ b 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

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Post-natal growth abnormalities

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  1. Post-natal growth abnormalities ©S Nussey/bIOS

  2. Prevalence of growth problems • Approx 10% of children may present because of: • Excessive shortness • Excessive tallness • Fatness • Thinness

  3. 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

  4. 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

  5. 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 latedevelopers

  6. Post-natal growth is mainly controlled by somatotrophin

  7. Pattern of GH secretion

  8. How is growth measured?

  9. Auxology - the use of charts

  10. Auxology - the use of charts • Length/Height • Weight • Head circumference • Measures of development: • Pubertal status • Bone age

  11. Auxology - the use of charts Pre-term 20 weeks to EDD Pre-term to 52 weeks 12-24 months

  12. Height velocity plot demonstrates 3 phases of growth

  13. Tanner stages

  14. Bone age: Tanner & Whitehouse 2

  15. Short stature & dysmorphism If in doubt measure skeletal proportions and look for dysmorphic features

  16. Investigations of GH deficiency • GH stimulation tests: • Insulin • Glucagon • Clonidine • Arginine + GHRH • Basal IGF-1 and IGF-BP3 • Neuro-imaging • Skeletal survey

  17. Tall stature

  18. Marfan’s Klinefelter’s

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