Growth & Growth Disorders

GROWTH ASSESSMENT / GROWTH DISORDERS

Measure Every Child

Weight :

birth 2, 4, 6, 8, 12, 16 weeks, 6-8 months, 1 year.

Length :

10 days and 3 monthly up to year 1.

Height :

Yearly from 18 months, school entry and routine checks at school.

Head Circumference :

36 hours, 10 days and 8 weeks and as indicated.


If there is any concern about growth, measurements should be taken more frequently.

Record child’s measurement and plot on growth charts

Measure real father and mother and calculate / plot mid parental centile [MPC] and target height range [TCR}

Is this child small/tall but appropriate for parental heights?

Yes Normal short/tall stature

Is child inappropriately short/tall for parental heights?

Yes Refer to Paed Endocrinologist

Is child growing at an inappropriate growth rate?

   


Possible Diagnosis

Short & Tall Stature

Small for chronological age

GROWTH DELAY

Abnormal karyo type

CHROMOSOME ABNORMALITIES
  • Turner Syndrome
  • Down’s Syndrome

Low brithweight, thin, dysmorphic, possible asymmetry

INTRAUTERINE GROWTH
RETARDATION (IUGR)
  • Including Russel Silver syndrome

Dysmorphic, cardiac problems

NOONAN SYNDROME

Abnormal hypopituitary function

ENDOCRINE DISORDERS
  • Growth hormone insufficiency
  • Panhypopituitarism
  • Hypothyroidism
  • Cushing's Syndrome
  • Premature sexual Maturation
  • Environmental growth failure

Dysmorphic

BONE DYSPLASIAS
  • Achondroplasia
  • Hypochondroplasia

Chronic ill health

CHRONIC DISEASES
  • Congenital heart disease
  • Renal failure
  • Coeliac/Crohn’s disease
  • Cystic Fibrosis
  • Asthma / eczema

Inappropriate tall stature

SYNDROMES
  • Marfan
  • Sotos
  • Klinefelter’s

ENDOCRINE
  • Precocious puberty


Genetic short/Tall  statureNORMAL GENETIC SHORT/TALL STATURE
All children who are considered short/tall should be assessed for their MPC and TCR (see page 5). If their height is within normal limits for their parents and they are growing at a normal rate, they are normal, whatever their position within the population standards.

There is no effective treatment for genetic short stature. The availability of biosynthetic growth hormone has allowed increased interest in the use of this substance for the treatment of children who are very short. This is still in the stage of clinical trials but available evidence suggests that final stature will not be altered significantly. While it is clear that even in children with normal growth hormone secretion, a short-term acceleration in growth may be achieved during growth hormone therapy, there is no certainty at this time that the long-term final height prognosis is altered. Further careful studies, extending over a number of years, will be necessary to show this. However, in the USA, there is a much more liberal treatment regimen for children with genetic short stature. Although this probably represents a very heterogeneous group of children, growth hormone is now licensed for use in this indication.

CONSTITUTIONAL DELAY/ADVANCEMENT OF GROWTH AND PUBERTY
Constitutional delay of growth in puberty (CGDP) frequently causes concern and seems to be more prevalent in boys than girls. It is often first noticed when the boy seems to have stopped growing, has younger siblings catching up or even being taller than him, or has classmates leaving hi behind. Growth delay of up to two years is not uncommon and a small number of children are delayed three, or even four years. Frequently one of the parents, an aunt or an uncle, brother or sister, will have had growth delay. A mother will often be able to establish that she was 15 or more years old at menarche instead of the more usual 12 to 14 years : it may be more difficult to establish a father’s pubertal delay owing to the lack of a fixed event such as menarche.

Once growth delay has been established any boy or girl can be absolutely reassured that puberty occurs in the end and that they will develop quite normally in every way. They can be reassured with a full demonstration of facts, figures, charts and predictions. Children find the information that they are simply taking after their mothers or fathers reassuring if not particularly welcome. What reassurance does not do is remove the very real physical handicap associated with being small and, worse, remaining pre-pubertal with a peer group of adolescents.

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