1. Post-natal growth abnormalities ©S Nussey/  IOS

2. Prevalence of growth problems Approx 10% of children may present because of: –Excessive shortness –Excessive tallness –Fatness –Thinness

3. We live in a ‘heightist’ society The majority will have short stature Only a few will have an underlying organic cause The majority will only require explanation, support and reassurance

4. Importance of parental influence Before birth, the size of the baby is mainly related to that of the mother By the age of 2 y the influence of both parents is evident To calculate predicted height add parental heights in cm, divide by two and add 7cm for a boy or subtract 7cm for a girl If one parent is excessively tall or short, ask why

5. Importance of ‘physiological age’ Chronological age may be misleading: –Early (20%), normal (60%) & late (20%) developers Compared to average peers: –Early developers go into puberty earlier, grow faster and stop growth earlier –Later developers have delayed puberty, grow slower and for longer time At 14 years of age there can be a 15 cm difference between the early and late developers

6. Post-natal growth is mainly controlled by somatotrophin

8. Pattern of GH secretion

13. How is growth measured?

14. Auxology - the use of charts

15. Length/Height Weight Head circumference Measures of development: Pubertal status Bone age

16. Auxology - the use of charts Pre-term 20 weeks to EDD Pre-term to 52 weeks 12-24 months

18. Height velocity plot demonstrates 3 phases of growth

19. Tanner stages

20. Bone age: Tanner & Whitehouse 2

21. Short stature & dysmorphism If in doubt measure skeletal proportions and look for dysmorphic features

23. Investigations of GH deficiency GH stimulation tests: –Insulin –Glucagon –Clonidine –Arginine + GHRH Basal IGF-1 and IGF-BP3 Neuro-imaging Skeletal survey

25. Tall stature

26. Marfan’s Klinefelter’s