Growth and development Samir Najjar M.D Professor, Department of Pediatrics

Stages of growth and development Intrauterine Intrauterine Infancy Infancy Childhood Childhood Adolescence Adolescence Adulthood Adulthood

Intrauterine Growth Greatest length velocity at mid fetal life Greatest length velocity at mid fetal life Development of adipose tissue at 7 months Development of adipose tissue at 7 months weight doubles in the last 2 months weight doubles in the last 2 months Weight loss beyond 40 weeks Weight loss beyond 40 weeks

Constrains on intrauterine growth Uterine size Uterine size Placenta Placenta Size of the mother Size of the mother

Infancy The era of changing growth rate The era of changing growth rate

Childhood The era of stable growth rate The era of stable growth rate

Adolescence The era of sex hormone induced shifting growth The era of sex hormone induced shifting growth

What is short stature

POSTNATAL Malnutrition Chronic diseases Gastrointestinal Cardiopulmonary Infections Renal Hematologic Drugs Psychosocial dwarfism Endocrine disorder PRENATAL Intrauterine growth retardation (IUGR) Placental diseases Infections Teratogens Dysmorphic syndromes Chromosomal disorders PROPORTIONATE DISPROPORTIONATE Skeletal dysplasia Rickets SHORT STATURE NORMAL VARIANTS Familiar short stature Constitutional growth delay PATHOLOGIC CLASSIFICATION OF SHORT STATURE

POSTNATAL Malnutrition Chronic diseases Gastrointestinal Cardiopulmonary Infections Renal Hematologic Drugs Psychosocial dwarfism Endocrine disorder PRENATAL Intrauterine growth retardation (IUGR) Placental diseases Infections Teratogens Dysmorphic syndromes Chromosomal disorders PROPORTIONATE DISPROPORTIONATE Skeletal dysplasia Rickets SHORT STATURE NORMAL VARIANTS Familiar short stature Constitutional growth delay PATHOLOGIC CLASSIFICATION OF SHORT STATURE

POSTNATAL Malnutrition Chronic diseases Gastrointestinal Cardiopulmonary Infections Renal Hematologic Drugs Psychosocial dwarfism Endocrine disorder PRENATAL Intrauterine growth retardation (IUGR) Placental diseases Infections Teratogens Dysmorphic syndromes Chromosomal disorders PROPORTIONATE DISPROPORTIONATE Skeletal dysplasia Rickets SHORT STATURE NORMAL VARIANTS Familiar short stature Constitutional growth delay PATHOLOGIC CLASSIFICATION OF SHORT STATURE

POSTNATAL Malnutrition Chronic diseases Gastrointestinal Cardiopulmonary Infections Renal Hematologic Drugs Psychosocial dwarfism Endocrine disorder PRENATAL Intrauterine growth retardation (IUGR) Placental diseases Infections Teratogens Dysmorphic syndromes Chromosomal disorders PROPORTIONATE DISPROPORTIONATE Skeletal dysplasia Rickets SHORT STATURE NORMAL VARIANTS Familiar short stature Constitutional growth delay PATHOLOGIC CLASSIFICATION OF SHORT STATURE

POSTNATAL Malnutrition Chronic diseases Gastrointestinal Cardiopulmonary Infections Renal Hematologic Drugs Psychosocial dwarfism Endocrine disorder PRENATAL Intrauterine growth retardation (IUGR) Placental diseases Infections Teratogens Dysmorphic syndromes Chromosomal disorders PROPORTIONATE DISPROPORTIONATE Skeletal dysplasia Rickets SHORT STATURE NORMAL VARIANTS Familiar short stature Constitutional growth delay PATHOLOGIC CLASSIFICATION OF SHORT STATURE

Accepted indications for GH therapy Childhood GH deficiency Childhood GH deficiency Growth failure associated with chronic renal insufficiency Growth failure associated with chronic renal insufficiency Turner syndrome Turner syndrome IUGR IUGR Adults with GH deficiency Adults with GH deficiency