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PEDIATRICS SEMINAR PRESETED BY: FAHD ALAREASHI & ??????????

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Presentation on theme: "PEDIATRICS SEMINAR PRESETED BY: FAHD ALAREASHI & ??????????"— Presentation transcript:

1 PEDIATRICS SEMINAR PRESETED BY: FAHD ALAREASHI & ??????????

2 CASE SCENARIO: A 10-year-old girl presents to the clinic with her parents. Her parents report that she is the shortest in her class. However, they have become concerned because her 8-year-old sister is now the same height as she is. The patient has not yet attained menarche and her mother reports no breast development. She has been well with no chronic medical problems, no hospitalizations, and no surgeries.

3 CASE SCENARIO: She lives with her mother, father, and sister. She is currently in the fifth year elementary school and she always scores grade A. Her mother is 173 cm (5'8") and weighs 68 kg (150 pounds). She had menarche at age 12. The patient's father is 185 cm (6'1") and weighs 95 kg (210 pounds). There is no family history of any medical problems.

4 CASE SCENARIO: On further history, you find that your patient was 43 cm (17 inches) long at term (average is 49.5 cm, 19.5 inches). P/E: General: Conscious. Looks girl. No apparent distress. Vital signs: Temperature: 37◦ C. Pulse: 90 bpm. BP: 100/60 mmHg. RR: 18 breaths/min.

5 CASE SCENARIO: P/E: Growth Parameters: Height: 120 cm. Weight: 23 Kg. Head Circumference: 52 cm.

6 Stature

7 Weight

8 H.C.

9 Wt-for-Ht.

10 CASE SCENARIO: P/E: Head & Neck: Neck is supple and webbed. Low posterior hair line. Chest: Heart: Normal S1 & S2, No additional sound. Lungs are clear. Abdomen: Soft. No masses.

11 CASE SCENARIO: P/E: Breast: Tanner I. Wide spaced nipples are evident. Pubic Hair: Tanner I.

12 CASE SCENARIO: INVESTIGATIONS: Her growth chart is reviewed which demonstrates: an average growth velocity: 3cm/year. Bone age: 8 years & 6 months. CBC: normal. ESR: normal. TFT's: normal. UA: normal. Serum electrolytes: normal.

13 CASE SCENARIO: INVESTIGATIONS: Chromosomal analysis: 45 XO. ► Diagnosis of Turner Syndrome is made. She is referred for a renal ultrasound, cardiology evaluation, and a hearing screen. She is also seen by the pediatric endocrinologist and is started on growth hormone.

14 AN APPROACH TO SHORT STATURE PRESETED BY: FAHD ALAREASHI

15 SHORT STATURE Outlines

16 SHORT STATURE Outlines

17 SHORT STATURE: A child whose height is below the 3 rd percentile for age and sex.

18 GROWTH FAILURE: Slow growth rate regardless of the stature. Ultimately, a slow growth rate leads to short stature. A Growth Chart is used to show: A child's current height. Growth Velocity : how fast the child is growing.

19 SHORT STATURE Outlines

20 SHORT STATURE Outlines

21 GROWTH CHARTS

22 GROWTH CHARTS: Growth charts are a standard part of any checkup. They show health care providers how kids are growing compared with other kids of the same age and gender.

23 DIFFERENT TYPES OF GROWTH CHARTS: Weight-for-AgeHeight-for-Age HC-for-Age MALE GROWTH CHARTS Weight-for-Height

24 FEMALEGROWTHCHARTS DIFFERENT TYPES OF GROWTH CHARTS: Weight-for-AgeHeight-for-Age HC-for-Age Weight-for-Height

25 GROWTH CHARTS: Assessment: Short Stature: Height < 3 rd percentile. Growth Failure: Height crossing 2 major percentiles. Low growth velocity: Rate < 25 th percentile.

26 Stature Short stature with normal growth rate and delayed growth spurt with eventual achievement of normal adult stature. “ CONSTITUTIONAL GROWTH DELAY “

27 Stature Normal growth rate. Short stature in childhood. Short stature in adults. “ Familial Short Stature “

28 Stature “ Acquired Pathologic Short Stature “

29 SPECIAL TYPES OF GROWTH Turner syndrome, Achondroplasia, Down syndrome

30 MID-PARENTAL HEIGHT: Children are usually in a percentile between their parents' height. The Expected Height of the child as adult lies between ± 5 cm from the Mid-parental age: Girls: = 2 Boys: = [Mother’s Height + Father’s Height + 13] [Mother’s Height + Father’s Height - 13] 2

31 CAUSES OF: SHORT STATURE

32 SHORT STATURE Outlines

33 SHORT STATURE Outlines

34 CAUSES:

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42 Prenatal “ Primordial “ Postnatal

43 CAUSES: Prenatal “ Primordial “ IUGR. Chromosomal: Down syndrome, Turner syndrome. Skeletal dysplasia. All parameters are affected; Height, weight, & head circumference. Proportionate

44 CAUSES: Postnatal Endocrine: GH deficiency. Hypopituitarism. Cushing syndrome. Chronic Diseases: Cyanotic congenital heart diseases. Celiac diseases, IBD, cystic fibrosis. Chronic infections. Chronic renal failure. Psychosocial neglect: Height > Weight “Short & Fat” Weight > Height “Short & Skinny” Weight & Height are decreased Proportionate

45 CAUSES: Postnatal Achondroplasia. Rickets. Hypothyroidism. Disproportionate

46 SHORT STATURE Outlines

47 SHORT STATURE Outlines

48 APPROACH & ASSESSMENT OF: SHORT STATURE

49 ASSESSMENT History Taking

50 HISTORY: Antenatal History: IUGR? Any complications: pre-eclampsia, hypertension, anemia, maternal history of smoking, alcohol & infections, drugs? Delivery: Gestational age? Mode of delivery? APGAR score. Complications? Hypoglycemia.

51 HISTORY: Nutritional History? Symptoms suggesting systemic chronic diseases: Dyspnea? Sweating with feeding? Recurrent respiratory infection? Chronic diarrhea? Fatigue, cold intolerance? “hypothyroidism” Recent weight gain, acne, mood swing? “Cushing”

52 HISTORY: Syndromes? Down syndrome, Turner syndrome?... Family History? Short stature? Chronic illnesses. Neglect? Starvation?

53 HISTORY: Drug History? Corticosteroids? Insulin? Development History? Delayed? Systemic Review: A complete review of systems needs to be undertaken in order to help exclude an undiagnosed syndrome or chronic medical condition

54 ASSESSMENT Physical Examination

55 PHYSICAL EXAMINATION: Vital Signs. Anthropometric Measurements: Height: Plotted on growth chart. Height velocity growth chart in the 6 – 12 months. Nutritional Assessment: Mid arm circumference. Weight for age and weight for height.

56 PHYSICAL EXAMINATION: Vital Signs. Anthropometric Measurements: Proportionate / Disproportionate: Upper / lower segment ratio. Arm span minus Height.

57 PHYSICAL EXAMINATION: Vital Signs. Anthropometric Measurements: Calculate Mid-parental Age: Girls: = 2 Boys: = [Mother’s Height + Father’s Height + 13] [Mother’s Height + Father’s Height - 13] 2

58 PHYSICAL EXAMINATION: Dysmorphic Features? Down Syndrome? Turner Syndrome? Single palmar crease, webbed neck, low hairline,.. Moon face “Cushing”? Puberty Assessment (Tanner Staging): Examinations for systemic illnesses.

59 ASSESSMENT Investigations

60 INVESTIGATIONS: Bone age. Wrist X-ray for rickets: Skeletal survey for skeletal dysplasia: a series of X-rays of all the bones in the body, or at least the axial skeleton and the large cortical bones. Karyotyping.

61 INVESTIGATIONS: Ca, P, Alkaline phosphatase. LFTs, RFTs. ESR. Sweat chloride test for cystic fibrosis.

62 INVESTIGATIONS: Endocrinal studies: T4, TSH, GH: Basal level. Level after pituitary stimulation: exercises, clonidin or arginin.

63 SHORT STATURE Outlines

64 SHORT STATURE Outlines

65 MANAGEMENT

66 MANAGEMENT: Non-pathological short stature: No treatment is required. Pathologic short stature: Manage the underlying cause. Growth Hormone GH: GH Therapy if the following criteria are met: GH shown to be deficient by 2 different stimulation tests. Patient is short, insufficent growth velocity, <3rd percentile. Bone age x-rays show unfused epiphyses Turner syndrome, Noonan syndrome, chronic renal failure.

67 THE END….


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