1. 兒童生長評估
小兒科 蔡孟哲

2. Outlines Growth curve Growth mechanisms Growth evaluation
Height, weight, BMI and head girth
Growth mechanisms
Growth evaluation

3. Normal height curve (M)

4. Normal height curve (F)

5. Growth measurement

6. Height velocity 0-1 year: 25 cm/yr 1-2 year: 10 cm/yr
Puberty: cm (total)
M: 7-13 cm/yr
F: 6-12 cm/yr

7. Normal weight curve (M)

8. Normal weight curve (F)

9. Weight gain Rule of thumb 3 kg  birth 4.5 kg  1 m/o 6 kg  3 m/o
9 kg  1 y/o
12 kg  2 y/o
15 kg  3.5 y/o
18 kg  5 y/o
2.5 kg/yr  >5 y/o

10. Child growth
Infancy childhood transition
Infancy childhood transition

11. Body mass index
Overweight
At risk for overweight

12. Adiposity rebound
Obesity (Silver Spring) 2009;17:1310

13. Head circumference

14. Growth factors GROWTH Intrauterine Endocrine Chromosome Nutrition Gene
Disease
Stress

15. Growth hormone axis
Ant.

16. Hormonal action IGF-1 MelinePlus Protein synthesis Gluconeogenesis
Cartilage growth
Protein synthesis
Lipolysis
MelinePlus

17. Etiology Genetic Chromosomal Hormonal Nutritional Intrauterine
Russell-Silver syndrome, Prader-Willi syndrome
Chromosomal
Down syndrome, Turner syndrome
Hormonal
GH deficiency, hypothyroidism
Nutritional
Intrauterine
Medication
Steroid, chemotherapy
Systemic illness
Renal disease, congenital heart disease, achalasia
Psychological

18. Structural Evaluation
詳盡的病史
生長發育紀錄 (生長曲線表及生長速率)，過去病史，用藥紀錄，營養狀況，家人的生長紀錄
身體檢查
包括：身高、體重、頭圍、外觀畸形、全身理學檢查、心雜音及其他內臟器官狀況等
父母親身高
Target height (TH): Mid-parental height +/- 6.5cm
Final height: TH +/- 5-7 cm
實驗室檢查
Screening test for height: Hb, T4, TSH, IGF-1, chromosome (female), Bone age
Screening test for weight: Albumin, blood gas, TG, CHOL, dry blood MS

20. Bone Age

21. Height Estimation Projectile Greulich and Pyle Tanner-Whitehouse
Dependent on ethnic-specific growth chart
Greulich and Pyle
97% FH at 14 y/o for girl and at 16 y/o for boy
Tanner-Whitehouse
Complicated calculation

22. Growth Stimulation Test
Methods:
Clonidine test
L-DOPA test
Insulin-tolerance test
Glucagon test
Arginine test
Interpretation:
At least 2 consistent tests
GH < 7 ng/ml
來源:兒童生長協會衛教手冊: 生長激素的不足與治療

23. Clinical Scenario (1)
A 6-y/o boy was found to have cryptorchidism and short stature. Otherwise, he is healthy.
His height <3rd %; weight = 10th %; HV = 3.4 cm/yr
Father’s height = 50th %; mother’s height 25th %; Unremarkable family history
Lab data:
T ug/dl; TSH 2.29 uU/ml; IGF ng/ml; Cs 14.3 ug/dl
Bone age:
3 y/o
What ‘s your thought and management about his problem?

24. Clinical Scenario (2) Stimulation test: after thyroxine supplement
Clonidine test: GH 1.1  4.4  2.3 ng/mL
L-DOPA test: GH  7.0  4.8 ng/mL; Cs  ug/dL
Diagnosis:
Combined pituitary hormone deficiency
Brain MRI:
Ectopic pituitary bright spot
Source:Yahoo Picturs

25. Thanks for your attention
The End
Thanks for your attention