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

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

3. 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

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

6. 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

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

16. These charts will be familiar

21. infant
puberty
mid-childhood

23. Genetic range ± 10cm
Genetic range ± 8cm

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

25. MPH

26. Look at rate of growth – Rhythm of growth
Height velocity

27. Height Velocity

28. Decimal age Date 16th June 2004 – 2004.458
DOB 25th Dec 1997 –
Age years

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

33. 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

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

38. “FaiIure to thrive” – Is there something wrong?

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

40. 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!

41. Thrive Lines

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

43. Thrive Lines

44. 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

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

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

52. Questions ?