Human Growth Monitoring PDF

Growth Disorders Prof. Haydar El Hadi Babikir, M.B.BS, MD., CChN., FRCPCH Consultant Paediatric Neurologist Member of: (INCA); (BPNA); (SSNS)  DEFINITIONS Growth: Increase in cell size and number with a resultant increase in...

Growth Disorders Prof. Haydar El Hadi Babikir, M.B.BS, MD., CChN., FRCPCH Consultant Paediatric Neurologist Member of: (INCA); (BPNA); (SSNS)  DEFINITIONS Growth: Increase in cell size and number with a resultant increase in height or girth or both. Growth monitoring: Following the growth rate of a child in comparison to a standard by frequent periodic anthropometric measurements in order to assess growth adequacy. Anthropometry: Measurement of a person’s physical parameters and comparing them with a standard. Marcia Griffiths and Joy Del Rosso, Growth Monitoring and Promotion Of Healthy Young Child Growth, Nov 2007: Definitions, pg 5 Growth ANTHROPOMETRIC MEASUREMENTS 1.WEIGHT EQUIPMENT: Weighing scale Procedure:  Pretesting is essential.  Hung onto a stable support.  Ensure: Dial is at the eye-level.  The pointer of the scale adjusted to ‘0.’  Undressed the child [nude as possible].  Ensure feet are not in contact with the ground. Weighing scales  Is child short ?  Length is measured lying down and should be used for infants and children up to 24 months of age.  Height is measured standing and should be used for children 2 years and above. GROWTH MONITORING  Measuring height The heels, buttocks, shoulder blades and occiput should lightly touch the measuring device. The head is aligned so that the external eye angle– external ear canal is horizontal, this means that the eyes should be looking straight ahead.  Head Circumference A good measure of brain growth [especially in the first 2 years of life]. It is of great value in follow-up of low birth weight infants, and children with CNS abnormalities. Normal head circumference at birth is 34 – 36 cm  Head Circumference Head circumference increases by:  2 cm/month for the first 3 months,  Then by 1 cm/month from 3 – 6 months,  Then by 0.5c/month from 6 – 12 months.  (12 cm for 1st year of life) BODY MASS INDEX  BMI Interpretation BMI between at the 85th to 94th percentiles Considered overweight, Because of excess body fat or high lean body mass. BMI between the 5th percentile to 85th percentile The healthy weight range. BMI below the 5th percentile Underweight. Surface Area Surface Area  BONE AGE  X ray left hand wrist to tips of fingers  TW3 (Tanner Whitehouse) GP( Greulich-Pyle )ATLAS) GILSANZ and RATIB  WHY BONE AGE ? Skeletal maturity Correlates closely with SMR(sexual maturity rating) predict for remaining growth potential Helps in adult height prediction Body Composition Calipers are the instruments used to determine body fat There is a gradual increase in body fat with age Sport Books Publisher 25  Flexibility The range of motion about a joint or series of joints Factors affecting flexibility: Anatomical structure of joint (bony structure, muscles, ligaments, tendons) Exercise habits Stretching habits Age (natural decrease with age) Gender (women are generally more flexible) 26  What is the Standard Deviation in Statistics? The standard deviation (SD; Greek letter sigma σ or the Latin letter s) It quantify the amount of variation or dispersion of a set of data values. SD tells how measurements for a group are spread out from the average (mean), or expected value. A low SD that most of the numbers are very close to the average. A high SD means that the numbers are spread out. Standard Normal Deviation  How do you calculate the standard deviation? To calculate the standard deviation of those numbers: Work out the Mean (the simple average of the numbers) Then for each number: subtract the Mean and square the result. Then work out the mean of those squared differences. Take the square root of that and we are done! Standard Deviation  Percentile Is a measure used in statistics indicating the value below which a given percentage of observations in a group of observations fall. For example, the 20th percentile is the value (or score) below which 20% of the observations may be found. Each of the 100 equal groups into which a population can be divided according to the distribution of values of a particular variable. Each of the 99 intermediate values of a random variable that divide a frequency distribution into 100 groups. Growth Chart GROWTH CHART Birth to W  NORMAL GROWTH VELOCITY PRENATAL GROWTH : 1.2 -1.5 cm / week Infancy : 23 - 28 cm / year Childhood : 5 - 6.5 cm / year Puberty : 8.3 cm / year (girls), 9.5 cm / year (boys) Initial Screening Evaluation of Growth Failure  General tests CBC with differentials, renal profile, liver function test, ESR, Urinalysis, serum Ca, Ph,  Chromosomal analysis in every short girl  Endocrine tests  Thyroid function tests  Growth factors: IGF-1, IGFBP-3  Growth hormone stimulation tests if growth hormone deficiency is strongly suspected.  Imaging studies  Bone age : anteroposterior radiograph of left hand and wrist  CT / MRI brain ( if hypopituitarism is suspected)  Other investigations depends on clinical suspicion  Blood gas analysis  Radiograph of the spine APPLICATIONS SHORT STATURE  Short stature /Growth failure  Height below 3rd percentile (-2SD for age and gender)  Height significantly below genetic potentials (-2SD below mid- parental target).  Abnormally slow growth velocity  Evaluation Is the child short ? Plotted on an appropriate growth chart. Is velocity impaired ? Any dysmorphic features ? or Any disproportionate ?  CLINICAL PRESENTATION OF GROWTH HOTRMONE DEFICIENCY  Thesingle most important clinical manifestation of GHD is growth failure.  Congenital :  Breech presentation and perinatal asphyxia.  Hypoglycemia and prolonged jaundice.  The penis may be small.  Higher male : female ratio 3 : 1.  CLINICAL PRESENTATION  Acquired : - severe growth failure. - increase weight  GHD INVESTIGATIONS  Insulin-like growth factor-1 (IGF-I)  Insulin-like growth factor binding protein-3 (IGFBP-3)  Provocative growth hormone (GH) testing  MRI  GH stimulation test  Insulin, arginine, clonidine , glucagon.  GH peak after stimulation < 10 ng/ml  Clinical and auxology bone age GH stimulation IGF-I and IGFBP-3  GHD MANAGEMENT Treat underlying cause.  Psychological support for non-treatable causes. Indications For GH Treatment Paediatric GH deficiency. Turner syndrome. Small for gestational age. Chronic renal insufficiency. Idiopathic short stature. Prader–Willi syndrome. AIDS cachexia  GHD COMPLICATIONS Increased intracranial pressure. Impaired Glucose Tolerance Test. Joint & muscle pain. Carpal tunnel syndrome. Pancreatitis. Scoliosis. Increased risk of recurrence of neoplasm Tall Stature  Tall Stature  Tall Stature Height greater than two standard deviations above the mean for a population same sex, age, and race.  Height > 2 SD USA President Taft Telephone Crop  Tall Stature Aetiology Genetic – Familial tall stature – Familial rapid maturation( constitutional tall stature) Hormonal – GH excess – Hyperthyroid – Androgen/estrogen excess  Syndromes –Weaver, Sotos, Marfan, Kleinefelter.  Metabolic disorders obesity  Symptoms Increased fat Cardiovascular diseases, Obesity type 2 diabetes, obstructive sleep apnea, Complications certain types of cancer, osteoarthritis, depression] Excessive food, lack of Causes exercise, genetics Diagnostic method BMI > 30 kg/m2 Societal changes, Prevention personal choices Diet, exercise, Treatment medications, surgery Prognosis Reduce life expectancy Frequency 700 million / 12% (2015) Microcephaly  Microcephaly Microcephaly is a smaller than normal head HC =