Childhood Growth – Normal or Abnormal Dr Neil Wright – Consultant Paediatrician, Sheffield Children’s Hospital

Will cover: Measuring & monitoring growth Assessing normal growth Centile charts Assessing normal growth Parental height & genetic potential Growth velocity Patterns of normal growth

Why does poor growth cause concern? Concern that there may be something wrong! Illness, neglect, deprivation? Growth is a barometer of a child’s physical and emotional wellbeing Concern about effects on child. Social & Economic Bullying Income Marriage prospects

What is normal Growth? Growth is a dynamic process Single measurements of limited value Serial measurements & growth velocity

Growth is not just weight gain! Too often emphasis is on weight alone! Assessing growth involves considering a variety of factors including parental heights, social inequalities & ethnic background

Disproportion can give clues to diagnosis. Short limbs  hypochondroplasia Short back & long legs  delayed puberty

These charts will be familiar

infant puberty mid-childhood

Genetic range ± 10cm Genetic range ± 8cm

Mum 156 cm & Dad 186cm (156 + 186 / 2) - 7 MPH = 164 cm (50%) Range 164 ± 8 cm

MPH

Look at rate of growth – Rhythm of growth Height velocity

Height Velocity

Decimal age Date 16th June 2004 – 2004.458 DOB 25th Dec 1997 – 1997.981 Age 6.47 years

Velocity Age 5 yr 105cm Age 6.2 yr 111cm Velocity 5 cm/year

Normal puberty Breast buds first sign in girls Testicular enlargement first sign in boys Delay in girls > 13 years Delay in boys > 14 years Early in girls < 8 years Early in boys < 9 years

Common problems Poor growth – “failure to thrive” Psychososocial deprivation Stretch marks & overweight Early puberty Late puberty

“FaiIure to thrive” – Is there something wrong?

Factors that affect birth weight Maternal size & weight Parity Gestational diabetes Smoking Paternal size

What happens after birth? Often only weight is measured A third show catch-up growth A third maintain birth weight centile A third show catch-down growth!

Thrive Lines

Thrive lines – help differentiate pathology from normal “catch-down growth ? pathological

Thrive Lines

Don’t neglect common sense Vomiting Dysmorphic features Diarrhoea Poor Social circumstances Actual weight loss Weight > 2 major centiles below height May still suggest concern

Causes short stature Constitutionally small - small parents Ideopathic short stature usually small birth Psychosocial Delayed puberty Chronic disease Endocrine causes – Striae ? Cushings

Obesity drives Growth Nutritional obesity – tall & fat Endocrine problem – short & fat Often early developement

Questions ?