7. Assessment of Growth Sem 5 Lecture.pdf

ASSESSMENT OF GROWTH Semester 5 MUMC Growth Defined as increase in dimension that is size and number Growth starts from fetal life Determinants of growth – 4 phases Factors that affect Growth - Sex - Racial - Genetics - Environment - Nutrition - Diseases - Hormones Ref : Illustrated Textbook...

ASSESSMENT OF GROWTH Semester 5 MUMC Growth Defined as increase in dimension that is size and number Growth starts from fetal life Determinants of growth – 4 phases Factors that affect Growth - Sex - Racial - Genetics - Environment - Nutrition - Diseases - Hormones Ref : Illustrated Textbook of Paediatrics Tom Lissauer, Will Carroll, Elsevier, 6th Ed, 2021 PURPOSE OF GROWTH MONITORING Purpose : a. Guide healthy and appropriate growth b. Identify abnormal growth patterns that may suggest underlying disease. c. Facilitate early diagnosis and early referral d. Assess response to nutrition / intervention advise e. Monitor recovery from illness HOW TO ASSESS GROWTH How to assess growth ? ➢Anthropometry – weight , height / length , head circumference ➢Measure adiposity Body mass index , weight to length ratio, Triceps and subscapular skin folds ➢Body proportions – Upper segment : Lower segment ratio Arm span to height ratio ➢Sexual maturity – Tanner staging ➢Bone age ➢Dental age ANTHROPOMETRY – Weight ◦ Beam scale or ◦ electronic weighing machine ◦ Minimum clothing ◦ Accuracy up to 0.1 kg for older children ◦ Up to 0.01 kg for smaller children ANTHROPOMETRY – Height / Length • < 2 years: infantometer to measure recumbent length • > 2 years: stadiometer to measure standing height • Average height info : → At birth: 50 cms. → At 1 year: 75 cms. → 2- 12 years: Age(yrs) x 6 +77 = Ht in cms • Length is 0.7cm longer than height ANTHROPOMETRY – Head circumference ◦ Most prominent point on occiput and supraorbital ridge ◦ Using non-stretchable tape ◦ Represents growth of the brain ◦ Measure 3x ◦ Select the largest measurement to the nearest 1mm ▪ Microcephaly is defined as head circumference < 3 SD for sex and age ▪ Cranisynostosis: premature closure of sutures . ANTHROPOMETRY – Mid arm circumference(MAC) ◦ Between 1-5 years of age : MAC remains constant Normal : > 13.5 cm Moderate malnutrition : 12.5 – 13.5 cm Severe malnutrition : < 12.5 cm How to record ? ➢should be measured on left arm ➢Midway between olecranon and acromion ➢Use a non stretchable tape. ANTHROPOMETRY – Mid arm circumference(MAC) How to record ? ➢should be measured on left arm ➢Midway between olecranon and acromion ➢Use a non stretchable tape. Body Mass Index ◦ Formula : Height in square metres / weight in kilograms ◦ Age and Gender-specific body mass index centile ◦ To assess if underweight or overweight ◦ Overweight : BMI between 90th to < 97th percentile ◦ Severely overweight : BMI ≥ 97th percentile Skin fold thickness – measures adiposity • Various skinfold thicknesses eg Ø triceps skinfold thickness Ø subscapular skinfold thickness Ø biceps skinfold thickness • Herpendine calipers Not routinely done Arm span to height ratio ◦ Distance between the tips of the middle fingers with both arms spread apart. ◦ Fixed ratio across all ages ◦ If ratio > 1.05 : 1 , suggest Marfan ANTHROPOMETRY – others Upper segment : lower segment ratio 1. Lower Segment - distance from the upper border of pubic symphysis to heel. 2. Upper Segment - Height/length minus Lower segment 3. Normal Upper segment (US): Lower segment (LS) ratio At birth : 1.7:1 3 years old : 1.3:1 7 years & later : 1 : 1 ANTHROPOMETRY – Upper segment : lower segment ratio 4. Higher ratio suggests short limb dwarfism eg achrondroplasia or bone disorders such as rickets Sexual maturity - Puberty ▪ Normal age range : Girls : 8 – 13 years Boys : 9 – 14 years ▪ First signs of pubertal maturation ○ breast budding in girls ○ increase in testicular volume in boys > 4 ml ▪ Tanner staging of puberty Orchidometer Stages of puberty – Tanner Stage Female - breast development Male – genital stage G1 B1 B2 B4 B3 G3 G2 B5 Pubic Hair changes – Female and male PH1 PH2 PH3 PH4 PH5 G4 G5 Skeletal maturity ◦Bone age ◦Hand and wrist radiography Dental age U L HOW TO MONITOR GROWTH Growth Charts ◦ Most important tool in assessment of growth of individual child ◦ First designed by David Morley ◦ It is a visual display of physical growth ◦ Mainly for longitudinal follow up Uses of growth charts: ▪ Growth monitoring ▪ Diagnostic tool ▪ Planning and policy making ▪ Educational tool ▪ Tool for action ▪ Evaluation Types of Growth Charts ◦WHO Growth charts ◦CDC Growth Charts 2000 WHO growth charts ◦ The standards describe the growth of children living in six countries (including the United States) in environments believed to support optimal growth. ◦ use the growth of breastfed infants as the norm for growth. ◦ 0 – 5 years of age ◦ Range is expressed as a Z-score between -3.0 and +3.0 ◦ This corresponds to 2 and 98 percentile ◦ Recommended for children up to aged 2 years, regardless of type of feeding. CDC Growth Charts 2000 • Centers for Disease Control and Prevention , USA • Charts extend to 20 years of age • 3rd and 97th percentiles available • All Racial and Ethnic Groups Combined Types of Growth Charts Available Birth to 36 months Weight-for-length - Boys and Girls Length-for-age Weight-for age Head circumference-for-age 2 to 20 years Stature-for-age -Boys and Girls Weigh-for-age Weight-for-height Birth To 36 monthsLength and Weight for Age – Boys Birth To 36 months – Length and Weight For Age - Girls 2 To 20 years – Height and weight for age Girls Birth To 36 months Head Circumference for age and weight for length – Boys Reference Population: Standard Normal Curve 50th Percentile 5th Probably pathological 3rd - 3 SD 95th 97th + 3 SD Probably pathological Types of abnormal growth patterns ? ◦Weight faltering ( Failure to thrive ) ◦Height faltering ( Stunted growth ) ◦Excessive weight gain ◦Excessive height gain. Case scenario 1 ABC is a 10-month-old boy born at term. Breast fed initially He is noted to have feeding difficulties and shortness of breathing since 3 months of age Examination and 2D echo confirmed that he has VSD. His serial weights and lengths are shown as below : Age Birth 1 month Weight (kg) 3.2 3.7 Length (cm) 50 3 month 6 month 5.5 6.3 60 67 9 month 10 month 7 7 71 72 Possible diagnosis ? Possible diagnosis ? VSD in failure with faltering growth Or Failure to thrive Case scenario 2 TS is a 6 years old girl. Her mother noticed that she has not been growing and appears to be the shortest in her class. On examination, she appears to be normal looking . Possible diagnosis ? Possible diagnosis ? Growth Hormone Deficiency SPECIAL GROUPS Fenton Growth chart for preterm babies – boys and girls •Begin at 22 weeks and end at 50 weeks. Down Syndrome Turner syndrome Learning Objectives 1.Recall the common anthropometric measurements and growth charts. 2.Plot and interpret anthropometric measurements on growth charts. 3.Evaluate a child with growth failure using the history and physical examination. References: 1. Illustrated Textbook of Paediatrics Tom Lissauer, Will Carroll, Elsevier, 6th Ed, 2021 2. WHO Child Growth Standards. World Health Organization. Geneva: 2006. Available from: https://www.who.int/childgrowth/en/ 3. Growth Charts - Clinical Growth Charts (cdc.gov) 4. Growth Assessment and Monitoring during Childhood, Yap et al, Ann Acad Med Singapore 2018: 47: 149-55 THE END