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Normal growth

Normal growth. Rafat Mosalli MBBS FRCPC FAAP 5Th Year Medical students. Lecture and session roles. Punctuality Dress code Body hygiene Preparation participation. objectives. What is normal child growth? How do we assess for growth? Why growth chart is important?

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Normal growth

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  1. Normal growth Rafat Mosalli MBBS FRCPC FAAP 5Th Year Medical students

  2. Lecture and session roles • Punctuality • Dress code • Body hygiene • Preparation • participation

  3. objectives What is normal child growth? How do we assess for growth? Why growth chart is important? What is the normal growth rate ? What is the importance of : Upper: lower segment ratio(U:L) and Bone age What is abnormal growth?

  4. Normal growth Facts It is dynamic process. It is not only gaining Height! Appropriate wight,hight,HC for age. Normal growth pattern: between the 3rd and the 97th percentiles Very important to measure each visit and exam (make it routine!)

  5. Growth Measurements Weight: appropriate scale and naked Length: stature of a supine child(<2y) Height: stature of standing child(>2y) HC (head &brain growth) : Occipitofrontal Circumference average of 3 measurements Growth velocity: annual linear growth rate

  6. Growth assessment Plotting Wt,Ht,HC in serial measurement on the growth chart. Longitudinally along a time line (pattern)  to assess growth rate Growth rate in Boys differ from female!

  7. Growth spurt and peak Ht velocityGirls always earlier Pubertal growth: 11 years in boys Vs 9 years for girls Peak Ht Velocity • In Female 11.5 Vs Male 13.5y • Female stop growing by 14y Vs 17y in Male

  8. Growth charts Importance Objective ,continuous assessment Comparison and follow up Detect growth deviation Detect disproportionate growth - It is based on population size!

  9. Rules of thumb for Growth rate (1) Weight: -Wt loss for the first few days: 5-10% of BWT -Return of BWT at 7-10 days of age -Double BWT by 5-6m -Triple BWT by 1 y -Quadruple by 2y -Daily Wt gain: 20-30g /d (first 4m) 15-20g/d (first year) -Annual Wt gain is 2kg between 2y-Puberty

  10. Rules of thumb for Growth rate (2) Average Height: Length at birth 50cm at birth,75cm at 1y At age 3 y is 90cm At age 4y is 100 cm (double Birth length) Annual Ht increase: 5-7cm (4y-puberty)

  11. Rules of thumb for Growth rate (3) Head circumference At Birth 35 cm Increase 1cm/mo for first yr = 47cm the first 3m of life is the highest (2cm/m ) For the rest of life only 10 cm

  12. Upper: lower segment ratio(U:L) A ratio of Upper length (Distance from the top of the head to the top of the pubis)to the lower length distance from the top of the pubis to bottom of the feet) It vary with age: the younger the higher. At birth 1.7:1  At 10 y 1:1 Importance? causes of disproportionate short stature?

  13. Teeth First teeth at 5-8m:central mandibualr incisor Permanent teeth appear at 5-7y:first molar Not helpful to assess rate of growth

  14. Bone age (BA) • A measure of somatic maturity and growth potential • radiographs of the hand &wrist compared with a standards one. • Result compared with Chronological age(CA) • Diagnostic key in evaluating short stature.  Genetic (BA=CA)  Constitutional (BA<CA)

  15. Mid Parental height • Best predictor of eventual expected adult height. Girls (father Ht-13)+(Mother Ht ) 2 Boy (mother Ht+13)+(father Ht) 2 -Give an average of (+/- 5cm) of expected potential adult Ht

  16. Abnormal growth 1-Height: Short stature Tall stature 2-Weight: Failure to Thrive(FTT) Overweight(110-120% of BMI) Obesity (>120% of BMI) (3)HC: Microcephaly vs Macrocephaly

  17. Short stature Causes • Genetic • Constitutional (late bloomer) • Chronic diseases • Syndromes • Endocrine • Psychological • Intrauterine (SGA,IUGR

  18. Short stature Causes

  19. Evaluating short stature 1-History is the most important? family Hx, parent puberty 2-Examination Dysmorphology, Weight, HC ,U/L ratio, Mid parental Height) 3-Investigations 4- Bone age

  20. We Talked about What is normal child growth? How do we assess for growth? Why growth chart is important? What is the normal growth rate ? What is the importance of : Upper: lower segment ratio(U:L) and Bone age What is abnormal growth?

  21. Remember ! Growth is dynamic process. To measure growth parameters and plot it every visit (growth rate) Rule of thumb for growth rate. Large shifts in growth and large discrepancy in percentiles warrant an immediate attention and investigations!

  22. Remember in Short stature -Bone age is diagnostic key in Short stature • FH is key • FTT suggest organic ,malnutrition causes Vs overweight endocrine cause • Constitutional delay is not uncommon &need Fu/4-6m and usually no treatment • Endocrine causes is rare

  23. References • Nelson essential • Questions? drmosalli@hotmail.com

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