1. GROWTH ASSESMENT DR Badi AlEnazi Consultant pediatric endocrinology and diabetolgist

2. Objectives: Phases of growth Growth measurement Growth chart Growth hormone Bone age Short stature Tall stature

3. Growth is a dynamic process influenced by many intrinsic and extrinsic factors that interplay to determine ultimate attained height

4. Careful tracking of childhood growth is a sensitive indicator of health and well- being, and therefore an essential component of sound pediatric care

5. Phases of Normal Growth In utero, growth affected by insulin and insulin-like growth factors 1 (IGF-1) and 2 (IGF-2). nutrition, At birth Normal weight 3 kg Normal length 50 cm Normal HC 35 cm

6. Phases of Normal Growth normal growth velocity for children until the pubertal growth spurt. First 12 months: 25 cm Second year: 12 cm Third year: approximately 8 cm Later childhood until puberty (5 to 10 years): growth averages 5 to 6 cm/year

7. Growth measurement below 2 years

8. Infantometer

11. Growth measurement (older children)

14. Measurement of growth Always measure Ht without shoes, and when plotting the patient in the growth curve, be accurate regarding the actual age of the child..

21. Skeletal Maturation bone age Skeletal maturation is assessed by examination of a “bone age”(BA) film, which is a radiograph of the left hand can assess the bone maturation of multiple ossification centers and compare it to standard male or female radiographs. The BA can then be compared to the patient’s chronologic age

23. Approach to short stature

24. Facts to be Elicited in the History (Etiology) Age of onset: Since when is the child not growing Previous growth records: School, home or physician records of previous heights and weights must be sought and charted on growth charts Antenatal history: Substance abuse, medication, infections (IUGR) −− Birth history: Birth weight/gestation age (IUGR) −−H/O birth asphyxia [multiple pituitary hormone deficiency (MPHD)] −− Breech delivery, neonatal hypoglycemia (GHD, MPHD) −− Prolonged neonatal hyperbilirubinemia (hypothyroidism) −−Developmental milestones (hypothyroidism, chromosomal/genetic cause)

25. Symptoms pertaining to illness −− Shortness of breath, cyanosis, cough, fever [heart disease, asthma, tuberculosis (TB)] −−Diarrhea, steatorrhea, abdominal pain (malabsorption) −−Headache, vomiting, visual problems (pituitary-hypothalamic mass) −− Constipation, lethargy, feeding difficulty (hypothyroidism) −− Polyuria, renal tubercular acidosis (RTA), chronic renal failure −−H/O hepatitis, distension abdomen, melena (chronic liver disease) −− Recurrent blood transfusions (thalassemia and other chronic anemia)

26. Dietary history: To elicit weaning practice, calorie and protein intake Drug history: Prolonged use of corticosteroids, amphetamine derivatives Family history of SS in first/second degree relatives Delay in puberty in one or both parent Social history: Child abuse, family discord, emotional deprivation (psychosocial dwarfism)

33. Differential features of familial and constitutional short stature Constitutional delay Familial short stature Feature Average Small (one or both) Parents' stature Delayed On time Parents' puberty SlowN Growth (puberty) DelayedN Bone age DelayedN Timing of puberty Normalshort Adult height

34. ENDOCRINE CAUSES OF GROWTH FAILURE GH deficiency. (congenital &acquired) GH deficiency. (congenital &acquired) GH resistance. GH resistance. Panhypopituitarism Panhypopituitarism Hypothyroidism. Hypothyroidism. Glucocorticoid excess Glucocorticoid excess Poor controlled DM Poor controlled DM Undiagnosed DI Undiagnosed DI Hypophosphatemic rickets Hypophosphatemic rickets CAH CAH

36. Cushing syndrome

39. PWS

40. growth hormone deficiency