Short Stature in Children Lecture

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Questions and Answers

What is 'failure to thrive' commonly associated with in terms of growth metrics?

It is commonly associated with greater impairment in weight gain than linear growth.

How does 'failure to thrive' affect the weight-for-height ratio?

It results in a reduced weight-for-height ratio.

What major growth metric is less impaired compared to weight gain in cases of 'failure to thrive'?

Linear growth is less impaired compared to weight gain.

In assessing children's growth, why might weight gain be prioritized over linear growth?

Weight gain is prioritized because it shows greater impairment in cases of 'failure to thrive'. Signup and view all the answers

What does a low weight-for-height ratio imply for a child experiencing 'failure to thrive'?

It implies that the child's weight is disproportionately low compared to their height. Signup and view all the answers

What implications does 'failure to thrive' have on a child's overall health assessment?

It indicates potential nutritional deficiencies and a need for comprehensive evaluation. Signup and view all the answers

What can be a critical outcome of emphasizing linear growth over weight gain in pediatric assessments?

It may lead to overlooking serious nutritional deficiencies affecting the child's health. Signup and view all the answers

What is the significance of measuring height in children?

Measuring height helps assess growth patterns and identify potential health issues. Signup and view all the answers

When is height considered pathological?

Height is considered pathological if it falls below a specific centile. Signup and view all the answers

List one potential cause for height abnormalities in children.

Celiac disease can cause height abnormalities due to nutrient malabsorption. Signup and view all the answers

What tests are helpful in evaluating growth disorders?

Thyroid function tests and IGF levels are important in evaluating growth disorders. Signup and view all the answers

How can bone age be determined in children?

Bone age can be assessed using an X-ray of the left hand. Signup and view all the answers

What does a low IGF level indicate?

A low IGF level may indicate growth hormone deficiency. Signup and view all the answers

What is the recommended action if a child has low growth hormone levels?

Growth hormone (GH) therapy may be administered if levels are low. Signup and view all the answers

What does disproportionate growth involve?

Disproportionate growth involves the growth of one limb or body part more than others. Signup and view all the answers

What role does fasting play in growth assessment?

Morning fasting can be crucial for accurate IGF and other hormone level measurements. Signup and view all the answers

What does Mid Parental Height (MPH) indicate regarding a child's growth potential?

MPH is a predictive measure of a child's potential adult height based on the heights of their parents. Signup and view all the answers

How is Height Age (HA) different from Chronological Age?

Height Age (HA) reflects a child's growth status rather than their actual age, indicating how their height compares to peers. Signup and view all the answers

What does Bone Age (BA) measure, and why is it used?

Bone Age (BA) measures the maturity of a child's bones to assess growth and development in relation to their chronological age. Signup and view all the answers

Explain why a child's chronological age is important in growth assessment.

Chronological age provides a baseline for comparison with normative growth patterns and helps identify atypical growth. Signup and view all the answers

What are the three levels of appropriate investigations in assessing growth?

The three levels of investigations include clinical evaluation, laboratory tests, and imaging studies. Signup and view all the answers

How can nutrition impact a child's growth patterns?

Nutrition plays a critical role in a child's growth by providing essential nutrients necessary for bone development and overall health. Signup and view all the answers

What are potential indicators of a child's growth issues when comparing HA and BA?

A discrepancy where Height Age is significantly lower than Bone Age can indicate growth hormone deficiencies or other disorders. Signup and view all the answers

Why is the evaluation of Mid Parental Height (MPH) crucial in pediatric growth assessments?

Evaluating MPH helps to set realistic growth expectations and identify potential growth issues early on. Signup and view all the answers

In what way does Bone Age (BA) correlate with growth hormone activity?

Bone Age (BA) often reflects the effects of growth hormone; advanced BA may indicate excessive hormone activity, while delayed BA can suggest a deficiency. Signup and view all the answers

What role does a clinical evaluation play in understanding a child's growth patterns?

Clinical evaluation provides initial insights through a physical examination, growth charts, and developmental history to assess growth adequacy. Signup and view all the answers

What are some endocrine causes of growth issues mentioned in the content?

Growth Hormone deficiency, hypothyroidism, and Cushing syndrome. Signup and view all the answers

How is the height of a child at 4 years calculated based on their birth height?

The height at 4 years is calculated as height at birth multiplied by 2, resulting in 100 cm. Signup and view all the answers

What formula is used to estimate a child's height between the ages of 2 to 12 years?

The formula is age (years) multiplied by 6 plus 77. Signup and view all the answers

At what height should a child be expected to measure by the age of 13 if they were 50 cm at birth?

The expected height at 13 years would be 150 cm. Signup and view all the answers

What is the length of a child at birth and its significance in assessing growth?

The length at birth is 50 cm and serves as a baseline for future growth assessments. Signup and view all the answers

If a child is experiencing emotional deprivation, what impact could that have on their growth?

Emotional deprivation may hinder growth due to potential stress-related hormonal imbalances. Signup and view all the answers

What is the primary purpose of growth charts in assessing short stature?

Growth charts provide reference points to compare a child's height to their peers. Signup and view all the answers

How can deviations from normal height percentiles indicate potential growth issues?

Deviations from the normal range can indicate underlying growth issues that may require further evaluation. Signup and view all the answers

List two key components of the initial investigations for short stature.

A comprehensive history and a physical examination are key components. Signup and view all the answers

Why is regular monitoring important for children with short stature?

Regular monitoring is crucial to identify early signs of atypical growth patterns. Signup and view all the answers

What might necessitate additional blood tests or imaging studies in a child with short stature?

Additional tests may be necessary based on specific clinical findings and suspected diagnoses. Signup and view all the answers

What role does nutritional support play in the management of short stature?

Nutritional support is essential to address any deficiencies that may affect growth. Signup and view all the answers

What is one possible treatment for confirmed growth hormone deficiency in children?

Growth hormone therapy may be advisable for children with confirmed deficiencies. Signup and view all the answers

How does understanding the underlying cause of short stature affect management strategies?

Management strategies are tailored to address the specific underlying cause of short stature. Signup and view all the answers

What is the relationship between follow-up care and the effectiveness of treatment for short stature?

Proper monitoring and follow-up care are essential to ensure effective treatment and optimal growth. Signup and view all the answers

What factors may influence the decision to conduct genetic testing in the evaluation of short stature?

Genetic testing may be considered based on clinical findings and family history related to growth issues. Signup and view all the answers

Why are growth charts essential in the assessment of short stature in children?

Growth charts help track a child's height over time, allowing for the identification of growth patterns and deviations from expected growth trajectories. Signup and view all the answers

What key factors should be considered when evaluating a child's growth using growth charts?

Factors include the child's age, sex, genetic potential, and historical growth patterns to ensure a comprehensive assessment. Signup and view all the answers

List the three primary levels of investigation that should be undertaken when assessing short stature.

The primary levels include a detailed medical history, a thorough physical examination, and specific diagnostic tests like blood tests and X-rays. Signup and view all the answers

How does chronic illness impact the investigations for short stature?

Chronic illness can lead to nutritional deficiencies and hinder growth, necessitating specific tests to evaluate underlying conditions related to the illness. Signup and view all the answers

What role do blood tests play in the management of short stature?

Blood tests measure hormone levels, aiding in the diagnosis of endocrine disorders that may affect growth, such as growth hormone deficiency. Signup and view all the answers

In the management of short stature due to endocrine disorders, what is a common treatment approach?

Growth hormone therapy is commonly administered, involving regular injections tailored to the child’s specific needs. Signup and view all the answers

Why is family history important when assessing short stature?

A thorough family history can highlight patterns of short stature that may indicate genetic factors, guiding further investigation. Signup and view all the answers

Describe how psychosocial stress can affect growth in children.

Psychosocial stressors can negatively influence a child's emotional and physical wellbeing, potentially leading to inhibited growth and development. Signup and view all the answers

What potential dietary assessments are crucial when investigating short stature?

Evaluating dietary intake for nutritional deficiencies such as protein and calories is vital, as these can directly impact growth. Signup and view all the answers

How can X-rays assist in the investigation for short stature?

X-rays are used to assess bone age, providing insights into skeletal development and whether it aligns appropriately with chronological age. Signup and view all the answers

Study Notes

Short Stature Lecture Notes

The lecture is about short stature in children
Dr. Azad A Haleem AL.Mezori and Dr. Nareen A. Abdulrahman are the presenters.
The presenters are associated with the University of Duhok, Faculty of Medical Science, School of Medicine, and the Pediatrics Department.
The objectives include defining short stature, mentioning types, outlining diagnostic principles, identifying causes and outlining management strategies.
Kurdish language may be used for clarification.

Growth

Growth is an increase in physical size of the whole body, or its parts.
It is a quantitative change in the child's body.
Growth is measured in Kg, pounds, meters, inches, etc.

Development

Development is a progressive increase in skill and capacity of function.
It is a qualitative change in the child's functioning.
Development is measured through observation.

Factors Affecting Growth

Birth size (UGR) influences growth.
Nutrition (Celiac, Malnutrition) affects growth.
General well-being impacts growth.
Psychosocial factors affect growth.
Endocrine factors affect growth.

Short Stature Causes

Normal Variants (Familial Short Stature, Constitutional Delay)
Proportionate Pathological: Prenatal (SGA), TORCH, Genetic, Metabolic.
Disproportionate Pathological: Increased U/L ratio (Skeletal Dysplasias), Decreased U/L ratio (Short trunk MPSs, Scoliosis, Short neck), Psychosocial, Endocrine causes (GH deficiency/resistance, Hypothyroidism, Cushing syndrome).

Normal Growth

Length at birth: 50 cm
Length at 1 year: 75 cm
Height at 4 years: height at birth x 2 (100 cm)
Height at 13 years: height at birth x 3 (150 cm)
From 2-12 years: age (yr) x 6 + 77

Measuring Height

Supine length (<2 years): use box and board, with movable footboard
Erect height (>2 years): head held horizontally, applied pressure to mastoid processes.

Assessment of a Child with Short Stature

Accurate height measurement.
Height plotted on appropriate growth charts.

Important Definitions

Chronological age: Actual age of the child.
Height age: Age at which child is at 50th centile.
Bone age: Indicator of skeletal maturation.
Target MPH: F + M / 2 + 6.5 (boys) and F + M/ 2 - 6.5 (girls).

Guidelines for Referral

UK guidelines rely on single measurement at school entry (5 years) without data on sensitivity and specificity.

Body Proportions

Lower segment (LS): Measurement from symphysis pubis to floor.
Upper segment (US): Subtracted from height.
U/L ratio: Birth = 1.7, 3 years =1.3, >7 years = 1
Proportionate: Involves trunk and lower extremities, vs Disproportionate -one or the other is more affected.

Clinical Evaluation Questions

Ask about parental height and measure height separately.
Apply assessment criteria for constitutional short stature.
Evaluate if below the centile for height.
Investigate for causes including: UTI, GSE, RFT, Celiac, CXRCTB, Thyroid Function Tests, x-ray to find bone age.

Provocative Tests (GH Stimulation Tests)

Random sampling insufficient for GH deficiency diagnosis; stimulation tests are needed.
Limited number of tests used after overnight fast.
Insulin tolerance test (ITT): induces hypoglycemia (dangerous).
Glucagon test: 100 microgrammes/kg BW IM (max.1 mg)
L-dopa test: Not dependable.
Arginine test: 0.5 g/kg BW, Slow IV infusion (max,30g)
Clonidine test: 0.1 - 0.15 mg/kg BW orally.

IGF-1 and IGFBP-3 Measurement

IGFBP-3 and IGF-1 represent stable and integrated GH production.
Combination of IGF-1 and IGFBP-3 measurements superior in diagnosing GH-related disorders.

Interpretation of Results

Normal IGF-1 and IGBP-3 levels indicate normal GH levels.
Low IGF-1 and IGBP-3 may be due to GH deficiency or resistance.
If GH remains low after stimulation, it suggests GH deficiency (hypopituitarism).
High GH suggests resistance (primary IGF-1 deficiency/Laron syndrome).

Approach to Short Stature (Heevi Hospital)

Height measurement (CDC 3rd centile)
Family chart (MPH)
Bone Age evaluation (Greulich and Pyle method).
BA < HA < CA: Pathological short stature.
Level 1 Investigations: general, level 2: TFT, provocative tests (GH stimulation tests) & IGF.

Management

Counselling of parents.
Dietary advice (e.g., malnutrition, celiac disease).
GH injections.
Limb lengthening procedures (skeletal displasias).
Levothyroxine (hypothyroidism)

Growth Hormone Therapy

Dosage customized to each child.
23-39 micrograms/kg/day for growth hormone deficiency.
45-50 micrograms/kg/day for Turner syndrome and chronic renal insufficiency.
35 micrograms/kg/day for growth disturbance in children born SGA.

Predicted Treatment Outcome

Gain in final height, varying 3-11 cm, for growth hormone deficiency, Turner syndrome (5 cm), chronic renal insufficiency (3-9 cm).
Continuous GH treatment normalizes final height in short SGA children without persistent catch-up growth.

Discontinuation of Treatment

Discontinue if final height reached.
Patient decides they are tall enough.
Growth velocity increases less than 50% baseline.
Final height is approached with growth velocity less than 2cm total in 1 year.
Bone age > 14 years (girls) and 16 years (boys).
Problems with adherence to treatment.

Follow-up

Follow-up needed due to risk of primary hypothyroidism/adrenal insufficiency.

Side Effects

Pseudotumor cerebri.
Hyperglycemia.
Acute pancreatitis.
Liver abnormalities.
Gynecomastia.

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Description

This lecture focuses on short stature in children, presented by Dr. Azad A Haleem AL.Mezori and Dr. Nareen A. Abdulrahman from the University of Duhok. It covers definitions, types, diagnostic principles, causes, and management strategies related to short stature. The session aims to provide a comprehensive understanding for medical students and practitioners in pediatrics.