Normal Growth and Physical Development PDF

NORMAL GROWTH AND PHYSICAL DEVELOPMENT Leah Tattum MD FRCPC General Pediatrician [email protected] DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none Steps taken to review and mitigate potential...

NORMAL GROWTH AND PHYSICAL DEVELOPMENT Leah Tattum MD FRCPC General Pediatrician [email protected] DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none Steps taken to review and mitigate potential bias None potential conflict of interest has not been properly disclosed or managed should contact the course director or Foundations/Clerkship Director. Before we start this lecture... This meeting may be recorded. You may be asked to participate in polls. Don’t forget to evaluate the session! Objectives 1. List factors affecting growth in childhood and adolescence 2. Be able to recognize normal rates of growth 3. Develop an approach to assess growth. 4. Describe an approach to children with short stature. Objective 1 List factors affecting growth in childhood and adolescence. Question  What is the most important factor affecting growth in children? a) Nutrition b) Genetics c) Chronic Disease d) Growth Hormone e) There is no one factor…It is a combination of genetics, nutrition, environmental and hormonal factors. What are the factors involved in growth? GENES  Growth potential: Height, weight, head circumference have genetic association within families.  Ethnicity: growth potential of different ethnic groups is different.  Sex differences: boys and girls have separate growth charts, prepubertal growth spurt is earlier in girls  Genetic disorders,syndromes:  Chromosomal abnormalities :T21, XO  Gene mutations: Achondroplasia Early life: Intrauterine Factors Maternal nutritional Maternal deficiency Infections (TORCH) Rh incompatibility Smoking, EtOH Gestational Diabetes Placental Fetal Placental insufficiency Health, Genes, Hormones: INSULIN!! Not Growth Hormone/Thyroid or Estrogens ENVIRONMENT NUTRITION  Parental  Healthy diet characteristics incorporating principles of  Physical Canada’s food guide surroundings  Food insecurity  Living standards,  Cultural factors: socioeconomic  Methods of child factors rearing and infant  Social factors feeding MEDICAL ISSUES  Any chronic disease  Hormones  GHdeficiency, hypothyroidism, hypopituitarism,steroid excess  GI and Metabolism  Infection diseases  Medications  Steroids  ADHD stimulant medications Phases of growth  Intrauterine  Infancy  Childhood  Adolescence  Adulthood Phases of growth: Key pearls  Growth is an indicator of general health  Fetal Growth – Insulin  1st year of life = Nutrition is primary factor.  After 2nd year of life = Hormonal and Genetic factors important subsequently. GROWTH HORMONE: Appetite and hunger IGF-1 induces cell division, Increases fat mobilization, Bone and protein synthesis and bone Decreases body fat tissue growth elongation Summary  Many factors that regulate growth with complex interactions between them in all the different phases of growth. Chronic Hormones Disease Early Life Environment Genes Growth Nutrition Objective 2 Be able to recognize normal rates of growth. Question  What is a normal rate at which children grow? a) It depends on their age b) 10-13 cm/year c) 8-10 cm/year d) 5-6 cm/year e) 6-9 cm/year Tempo of growth: Linear but changing Age Growth Velocity Intrauterine Peak at 2nd trimester 0-12 months 18-25 cm/year 12-24 months 10-13 cm/year 24-36 months 7.5-10 cm/year Childhood 5-6 cm/year Adolescence 6-9 cm/year Puberty Growth Spurt 8-10 cm/year Post-puberty +/- 5 cm Adulthood Epiphyseal fusion Average Growth velocity in children  Newborn to age 3y – follow the curve  Fastest 0-6 months, then slower  Age 3y -adolescence:  >5 cm/yr = normal  14 yrs Girls < 8 yrs > 13 yrs Summary  Children have different growth velocities at different age ranges  Largest periods of growth: birth-age 2y and puberty  Age 3y – adolescence = >5 cm/yr Objective 3 Develop an approach to assess growth.  Question  Which is the best way to measure growth? a) b) c) d)  ‘s of assessing growth 1. Accurate measurements 2. Get the right growth chart 3. Plot correctly!  Communicate with families about growth charts Accurate Measurement of Growth  Consistent accurate technique is important  no shoes, light clothes, standing or lying straight  Infants:  Measuring board with fixed plate and sliding plate  Toddlers and older:  stadiometer Height in Infants Height in toddlers and older children Head Circumference measurement Getting the right growth charts  2010: WHO Charts for Canada  Separate charts for boys and girls  Birth‐24 months: Weight, Length, HC, Weight for Length charts  2‐19 years: Weight, Height, BMI charts  You will a chance to use these growth charts during clinical skills* http://www.cpeg-gcep.net/content/who-growth-charts-canada WHO charts for Canada: HC WHO charts for Canada: Height & Weight WHO charts for Canada: BMI Key points to interpretation  Look at percentile in relation to parents’ height  3% children fall below 3rd percentile.  Growth Velocity vs. Absolute height  Not all short children need growth evaluation  Children growing on the curves may not be growing at their genetic potential. When do we worry?  HtF Growth Slow 6-36 mo; Normal Velocity then normal Family Hx FSS delayed growth Bone Age = Chronological age < Chronological age Puberty Onset Normal Delayed Final Ht Short Near normal NOTE: Both have normal birth weight and growth velocity.(past 36 mo in cdgp) #3. If Proportionate, SLOW growth velocity?  NUTRITION*  Chronic disease  Environment (Deprivation syndromes)  Drugs that affect IGF-1:  methylphenidate, steroids  ENDOCRINE  Hypopituitarism  Growth Hormone deficiency  Hypothyroidism  Cortisol excess In general, endocrine disorders are associated with…….  Decline in growth velocity with preservation of weight  e.g. Hypothyroidism, Cushing’s, GHD  Crossing of percentiles  Delayed bone age  >F Growth Slow 6-36 mo; Normal Velocity then normal Family Hx FSS delayed growth Bone Age = Chronological age < Chronological age Puberty Onset Normal Delayed Final Ht Short Near normal NOTE: Both have normal birth weight and growth velocity.(past 36 mo in cdgp) Key Messages 1. Many factors regulate growth with complex interactions between them in all the different phases of growth. 2. Children have different growth velocities at different age ranges  Largest periods of growth: birth‐age 2y and puberty  Age 3y – adolescence = >5 cm/year Key Messages o Best practices for height measurement: ❑ Infants: Measuring board with fixed plate and sliding plate ❑ Toddlers and older: stadiometer ❑ WHO growth charts for Canada  Approaching a child with short stature: Ask 4 questions  Prenatal vs Postnatal  Proportionate vs Disproportionate  Growth velocity Normal vs slow  Bone age Normal vs Delayed Objectives 1. List factors affecting growth in childhood and adolescence 2. Be able to recognize normal rates of growth 3. Develop an approach to assess growth. 4. Describe an approach to children with short stature. For your reference Please Evaluate this Session Now Your feedback is valuable to the MD Program and to your teachers as we strive to continually improve your learning experience. Thank you. 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