This document provides information on defining and interpreting growth parameters in children, including low birth weight, prematurity, weight formulas, normal heights and head circumferences at different ages, mid-parental height calculation, and causes of growth retardation. It also discusses evaluating a child with short stature, including anthropometry, bone age assessment, differential diagnosis, and initial investigations. Key areas of focus are auxology, growth monitoring, growth curves, and evaluating the cause of short stature or growth failure in a child.
This document provides an overview of the approach to evaluating and managing short stature in children. It defines short stature and outlines normal growth patterns. Common causes of short stature include familial short stature, constitutional delay of growth, prenatal issues, malnutrition, chronic illness, and endocrine disorders. A thorough history, physical exam including growth measurements and Tanner staging, and screening lab tests can provide clues to identify underlying causes. Further testing may include bone age, thyroid function, genetics, celiac serology, and growth hormone stimulation if initial workup is normal. Management depends on the specific cause but may include diet, supplements, growth hormone therapy, or surgery.
Short stature is defined as height below the 3rd percentile or more than 2 standard deviations below the median height for age and sex. Approximately 3% of children are short, with half having normal variants like familial or constitutional short stature. Investigations include blood tests, bone age, growth hormone stimulation tests, and karyotyping. Management depends on the underlying cause and may include dietary changes, medication like levothyroxine or growth hormone, or surgical procedures. Common causes of proportionate short stature include familial short stature, constitutional delay of growth, and certain genetic or medical conditions.
This document discusses short stature, including its definition, classification, diagnostic approach, and management. Short stature is defined as a height more than two standard deviations below the mean for age. The diagnostic approach involves assessing midparental height, growth velocity, bone age, and screening for underlying causes via medical history, physical exam, and laboratory tests. Causes of short stature include familial/constitutional factors in 95% of cases as well as endocrine, nutritional, genetic, and other medical conditions. Management depends on the underlying etiology but may involve counseling, dietary/lifestyle changes, pharmacological treatment such as growth hormone therapy, and treatment of any identified medical conditions.
This document provides an overview of evaluating and managing short stature in children. It discusses evaluating a child's growth pattern, examining family history and performing physical exams. Key factors that can cause short stature are discussed, including familial, constitutional growth delay, chronic diseases, psychosocial, chromosomal, genetic syndromes and endocrine disorders. Investigations discussed include growth charts, bone age assessments, blood tests and other tests depending on symptoms. Management depends on the underlying cause, such as counseling for familial short stature, disease management for chronic illnesses, growth hormone therapy for deficiencies.
This document discusses short stature in children, defining it as height below 2 standard deviations for age and gender. It outlines factors that can affect height, including nutrition, hormones, and intrauterine growth. Short stature is classified as dysmorphic, proportionate, or disproportionate. Evaluation involves medical history, physical exam, auxiliary tests like bone age and growth hormone stimulation, and considering familial, constitutional, nutritional, endocrine, and genetic causes. Management depends on the underlying etiology and may include counseling, dietary changes, surgery, hormone replacement, or growth hormone therapy.
A child presenting with short stature should have their height, weight, growth velocity, parental heights, dysmorphic features, pubertal development, bone age, and appropriate investigations assessed. Key factors include determining if growth is proportionate or disproportionate, calculating mid-parental height and target height for comparison, and evaluating bone age to distinguish constitutional growth delay from other causes. A thorough history, physical exam, and targeted laboratory tests can help identify underlying causes like genetic syndromes, malnutrition, endocrine disorders, or chronic illnesses.
Family seeks medical attention for their short child. The document discusses evaluation of short stature including criteria for pathological short stature, factors regulating growth, assessment of growth including height measurements and bone age, common causes of short stature like constitutional delay of growth and puberty, primary growth hormone deficiency, and hypothyroidism. Evaluation of a short child involves history, physical exam, laboratory tests, and assessing height, parental heights, and bone age.
This document provides an overview of the approach to evaluating and managing short stature in children. It defines short stature and outlines normal growth patterns. Common causes of short stature include familial short stature, constitutional delay of growth, prenatal issues, malnutrition, chronic illness, and endocrine disorders. A thorough history, physical exam including growth measurements and Tanner staging, and screening lab tests can provide clues to identify underlying causes. Further testing may include bone age, thyroid function, genetics, celiac serology, and growth hormone stimulation if initial workup is normal. Management depends on the specific cause but may include diet, supplements, growth hormone therapy, or surgery.
Short stature is defined as height below the 3rd percentile or more than 2 standard deviations below the median height for age and sex. Approximately 3% of children are short, with half having normal variants like familial or constitutional short stature. Investigations include blood tests, bone age, growth hormone stimulation tests, and karyotyping. Management depends on the underlying cause and may include dietary changes, medication like levothyroxine or growth hormone, or surgical procedures. Common causes of proportionate short stature include familial short stature, constitutional delay of growth, and certain genetic or medical conditions.
This document discusses short stature, including its definition, classification, diagnostic approach, and management. Short stature is defined as a height more than two standard deviations below the mean for age. The diagnostic approach involves assessing midparental height, growth velocity, bone age, and screening for underlying causes via medical history, physical exam, and laboratory tests. Causes of short stature include familial/constitutional factors in 95% of cases as well as endocrine, nutritional, genetic, and other medical conditions. Management depends on the underlying etiology but may involve counseling, dietary/lifestyle changes, pharmacological treatment such as growth hormone therapy, and treatment of any identified medical conditions.
This document provides an overview of evaluating and managing short stature in children. It discusses evaluating a child's growth pattern, examining family history and performing physical exams. Key factors that can cause short stature are discussed, including familial, constitutional growth delay, chronic diseases, psychosocial, chromosomal, genetic syndromes and endocrine disorders. Investigations discussed include growth charts, bone age assessments, blood tests and other tests depending on symptoms. Management depends on the underlying cause, such as counseling for familial short stature, disease management for chronic illnesses, growth hormone therapy for deficiencies.
This document discusses short stature in children, defining it as height below 2 standard deviations for age and gender. It outlines factors that can affect height, including nutrition, hormones, and intrauterine growth. Short stature is classified as dysmorphic, proportionate, or disproportionate. Evaluation involves medical history, physical exam, auxiliary tests like bone age and growth hormone stimulation, and considering familial, constitutional, nutritional, endocrine, and genetic causes. Management depends on the underlying etiology and may include counseling, dietary changes, surgery, hormone replacement, or growth hormone therapy.
A child presenting with short stature should have their height, weight, growth velocity, parental heights, dysmorphic features, pubertal development, bone age, and appropriate investigations assessed. Key factors include determining if growth is proportionate or disproportionate, calculating mid-parental height and target height for comparison, and evaluating bone age to distinguish constitutional growth delay from other causes. A thorough history, physical exam, and targeted laboratory tests can help identify underlying causes like genetic syndromes, malnutrition, endocrine disorders, or chronic illnesses.
Family seeks medical attention for their short child. The document discusses evaluation of short stature including criteria for pathological short stature, factors regulating growth, assessment of growth including height measurements and bone age, common causes of short stature like constitutional delay of growth and puberty, primary growth hormone deficiency, and hypothyroidism. Evaluation of a short child involves history, physical exam, laboratory tests, and assessing height, parental heights, and bone age.
This document provides guidance on evaluating and managing short stature in children. It discusses evaluating a short child by taking a history including birth details, illnesses, nutrition, and parental heights. Physical examination involves measuring height, weight, body proportions, and examining parents. Growth charts are used to assess if a child's height is below standard deviations. Potential causes of short stature discussed include familial, constitutional growth delay, chronic diseases, psychosocial, chromosomal, genetic syndromes, and endocrine disorders. Initial investigations include blood tests and bone age x-ray. Advanced tests may include skeletal survey, karyotype, growth hormone stimulation. Management depends on the identified cause and may include counseling, disease treatment, hormone therapy.
Basic approach on short stature in childrenAzad Haleem
This document provides an overview of short stature, including definitions, types, diagnostic principles, causes, and management. It defines short stature as height below the 3rd percentile and discusses types such as familial short stature. Diagnosis involves accurate height measurements, bone age assessment, mid-parental height comparison, and medical investigations. Causes include growth hormone deficiency, Turner syndrome, and small size at birth. Management consists of dietary counseling, growth hormone injections, and limb lengthening procedures depending on the underlying cause.
Short stature indication of growth hormone therapyAftab Siddiqui
Short stature is defined as height more than two standard deviations below the mean for age and sex. The document outlines steps to evaluate a short child, including obtaining a medical history, physical exam assessing body proportions, calculating mid-parental height and projected height, and evaluating growth velocity and bone age. Bone age assessment methods such as Greulich and Pyle or Tanner and Whitehouse are described. Differential diagnosis for short stature includes normal variants, disproportionate skeletal dysplasias, and endocrine disorders like growth hormone deficiency. The workup may include basic labs, thyroid and pituitary function tests, genetics testing, and provocative growth hormone stimulation tests.
- Growth is the increase in size of organs and body, and is assessed through physical anthropometry such as weight, height, head circumference, and mid-upper arm circumference.
- Periodic growth assessment allows for early detection of growth faltering which can indicate undernutrition, infection, or disease.
- Factors like genetics, nutrition, hormones, environment, and socioeconomic status can influence growth.
- Growth charts are used to evaluate if a child's growth is normal based on weight for age, height for age, and BMI for age.
- Deviations from normal growth patterns on charts may indicate malnutrition or underlying health conditions.
Approach to Short Stature
Dr Raheel Ahmed
FCPS in Paediatric Medicine
Children Hospital, Chanka Medical College, Larkana
Topics
Definition.
Etiology
Measurements.
Examination.
Investigations.
Management.
Take home message.
Who is short child?
Short stature is defined as height that is two standard deviations below the mean height for age and sex (less than the third percentile).
OR
more than two standard deviations below the mid-parental height.
Etiology
Proportionate Short Stature
1) Normal Variants:
i) Familial
ii) Constitutional Growth Delay
2) Prenatal Causes:
i) Intra-uterine Growth Restriction-
Placental causes, Infections, Teratogens
ii) Intra-uterine Infections
iii) Genetic Disorders (Chromosomal
& Metabolic Disorders)
Postnatal Causes:
i) Undernutrition
ii) Chronic Systemic Illness
- Cardiopulmonary: CHD, Chronic Asthma,
Cystic Fibrosis
- Renal: RTA, CRF, Steroid dependent
Nephrotic Syndrome
- GI and Hepatic: Malabsorption, IBD, chronic
liver disease
- Chronic Severe Infections
- Hematological : Thalassemia, Sickle cell
anemia
iii) Psychosocial Short Stature
(emotional deprivation)
iv) Endocrine Causes:
- Growth Hormone Deficiency/ insensitivity
- Hypothyroidism
- hypopituitrism
- Diabetes Mellitus
- Cushing Syndrome
- Pseudohypoparathyroidism
- Precocious/ delayed puberty
Disproportionate Short Stature
1) With Short Limbs:
Achondroplasia,
Hypochondroplasia,
Chondrodysplasia punctata,
Chondroectodermal Dysplasia,
Diastrophic dysplasia,
Metaphyseal Chondrodysplasia
Osteogenesis Imperfecta,
Refractory Rickets
2) With Short Trunk:
Spondyloepiphyseal dysplasia,
Mucolipidosis
Mucopolysaccharidosis
Mid Parental Height
TCR
Calculated by MPH +-10
How to measure upper and lowersegments?
You should measure the upper segment( US ) then by using the total height you will obtain LS.
Upper segment is the sitting height.
Disproportionate short statue with short LS:-
Achondroplesia
Osteogenesis imperfecta.
Refractory rickets.
Disproportionate short stature with short US:-
Spondyloepiphysial dysplasia.
Mucopolysaccharidosis.
Growth velocity
0-1 year : 25cm/year
1-2 year: 12cm/year
2-3 year: 8cm/year
3-4 year: 7cm/year
4-9 year : 5-6 cm/year
As a rule any growth rate <4.5cm/year between 2-12 year is pathological.
USG AND DOPPLER IN DIAGNOSIS AND MANAGEMENT OF IUGRshiv lasune
This document discusses the use of ultrasound and Doppler in the diagnosis and management of intrauterine growth restriction (IUGR). It defines small for gestational age (SGA) as a fetus below the 10th percentile and describes how Doppler of the umbilical artery can help identify fetuses with IUGR, monitor disease progression, and predict outcomes. Doppler of other fetal vessels like the middle cerebral artery and ductus venosus can further evaluate the fetus and help guide management decisions. Together, Doppler studies provide both diagnostic and prognostic information useful in the care of growth restricted fetuses.
This document discusses the evaluation and differential diagnosis of short stature in children. It defines short stature as a height more than 2 standard deviations below the mean for age and sex. The evaluation involves taking a history, performing a physical exam, assessing growth parameters, growth velocity, midparental height, bone age, and indications for further investigations. Common causes discussed are familial short stature, constitutional short stature, and pathological short stature. Treatment options mentioned include growth hormone, oxandrolone, IGF-1, and aromatase inhibitors.
This document discusses the evaluation and differential diagnosis of short stature in children. It defines short stature as a height more than 2 standard deviations below the mean for age and sex. The evaluation involves taking a history, performing a physical exam, assessing growth parameters, growth velocity, midparental height, bone age, and indications for further investigations. Common causes discussed are familial short stature, constitutional short stature, and pathological short stature. Treatment options mentioned include growth hormone, oxandrolone, IGF-1, and aromatase inhibitors.
1) Short stature can be caused by disease, disability, or social stigma and requires evaluation.
2) A child is considered short if their height is below the 3rd percentile or more than 2 standard deviations below the median height for their age and sex.
3) Approximately half of children with short stature have a physiological/familial cause, while the other half have a pathological cause like malnutrition, chronic illness, hormonal deficiencies, or genetic syndromes.
4) Evaluation of a child with short stature involves taking a thorough history, performing anthropometric measurements and growth chart analysis, conducting a physical exam, and ordering initial lab tests and bone age assessment.
This document provides an overview of growth disorders including short and tall stature. It discusses the evaluation and causes of short stature such as growth hormone deficiency, Turner syndrome, and Prader-Willi syndrome. For growth hormone deficiency, it outlines the diagnostic process including stimulation tests and treatment with growth hormone. For tall stature, it reviews genetic, hormonal, and syndromic causes such as familial tall stature, precocious puberty, and Marfan syndrome.
Down syndrome is a genetic condition caused by trisomy of chromosome 21. It occurs in about 1 in 660 births. Key features in newborns include slanted eyes, small ears, loose skin on the back of the neck, and poor muscle tone. Individuals with Down syndrome often have health issues such as heart defects, hearing or vision problems, gastrointestinal abnormalities, thyroid disorders, and psychiatric conditions. Lifelong healthcare involves screening and management of associated medical problems with a focus on development, education, independence, and quality of life.
Failure to thrive (FTT) is defined as a lack of appropriate weight gain or a persistent weight loss from a child's normal growth curve. It can be classified as organic, caused by medical issues, or non-organic, caused by psychosocial factors. A thorough history, physical exam, and lab tests are needed to determine the etiology and develop an appropriate treatment plan focused on nutritional rehabilitation and addressing the underlying cause. Prognosis depends on the etiology, with FTT in the first year generally having a poorer outcome. Prevention efforts include exclusive breastfeeding, parental education, and early detection and intervention.
- Growth refers to an increase in physical size while development is a progressive increase in skills and functional capacity.
- Growth failure is a common presentation to pediatricians and most cases have physiological causes rather than pathological ones.
- Growth is regulated by nutrition, hormones like growth hormone and IGF-1, and sex steroids. Final height is determined 60-80% by genetics.
- Physiological causes of short stature include familial short stature and constitutional delay of growth and puberty while pathological causes can be endocrine disorders, malnutrition, or genetic conditions.
The document discusses growth hormone (GH) deficiency. It notes that GH is produced by the pituitary and regulates growth. GH secretion peaks during puberty then declines with age. Causes of GH deficiency include genetic factors, tumors, injuries and infections. Clinical features include short stature, delayed development, and body proportions differences. Evaluation involves assessing growth rates and examinations. Treatment is usually GH injections, aimed at restoring normal growth rates. Response is monitored through height velocity measurements.
This document discusses the case of Sandeep, a 4 year 10 month old boy who presents with short stature. His history and examinations are otherwise normal. The document outlines the process of evaluating and diagnosing short stature, including using growth charts, taking a thorough history and physical, and ordering basic screening tests. It discusses following up the case over several years and making a diagnosis of idiopathic short stature once common causes are ruled out. The document emphasizes the importance of thorough evaluation, communication with parents, and timely treatment to optimize outcomes for children with short stature.
Short stature can be defined as height more than 2 standard deviations below the mean for age. It is important to evaluate the cause of short stature through accurate height and growth velocity measurements, comparison to population and familial heights, assessment of body proportions, sexual maturity, and bone age. A thorough history and physical exam can provide clues to underlying conditions like endocrine, genetic, nutritional, or chronic diseases that may be causing pathological short stature.
Approximately 3% of children are short, with half being physiologically short due to familial or constitutional factors, and half being pathologically short. Common causes of pathological short stature include genetic disorders, chronic illnesses, malnutrition, and endocrine disorders such as growth hormone deficiency or hypothyroidism. A thorough evaluation includes medical history, physical examination, assessment of growth parameters, bone age, and laboratory tests to identify the underlying cause.
This document provides guidance on evaluating and managing short stature in children. It discusses evaluating a short child by taking a history including birth details, illnesses, nutrition, and parental heights. Physical examination involves measuring height, weight, body proportions, and examining parents. Growth charts are used to assess if a child's height is below standard deviations. Potential causes of short stature discussed include familial, constitutional growth delay, chronic diseases, psychosocial, chromosomal, genetic syndromes, and endocrine disorders. Initial investigations include blood tests and bone age x-ray. Advanced tests may include skeletal survey, karyotype, growth hormone stimulation. Management depends on the identified cause and may include counseling, disease treatment, hormone therapy.
Basic approach on short stature in childrenAzad Haleem
This document provides an overview of short stature, including definitions, types, diagnostic principles, causes, and management. It defines short stature as height below the 3rd percentile and discusses types such as familial short stature. Diagnosis involves accurate height measurements, bone age assessment, mid-parental height comparison, and medical investigations. Causes include growth hormone deficiency, Turner syndrome, and small size at birth. Management consists of dietary counseling, growth hormone injections, and limb lengthening procedures depending on the underlying cause.
Short stature indication of growth hormone therapyAftab Siddiqui
Short stature is defined as height more than two standard deviations below the mean for age and sex. The document outlines steps to evaluate a short child, including obtaining a medical history, physical exam assessing body proportions, calculating mid-parental height and projected height, and evaluating growth velocity and bone age. Bone age assessment methods such as Greulich and Pyle or Tanner and Whitehouse are described. Differential diagnosis for short stature includes normal variants, disproportionate skeletal dysplasias, and endocrine disorders like growth hormone deficiency. The workup may include basic labs, thyroid and pituitary function tests, genetics testing, and provocative growth hormone stimulation tests.
- Growth is the increase in size of organs and body, and is assessed through physical anthropometry such as weight, height, head circumference, and mid-upper arm circumference.
- Periodic growth assessment allows for early detection of growth faltering which can indicate undernutrition, infection, or disease.
- Factors like genetics, nutrition, hormones, environment, and socioeconomic status can influence growth.
- Growth charts are used to evaluate if a child's growth is normal based on weight for age, height for age, and BMI for age.
- Deviations from normal growth patterns on charts may indicate malnutrition or underlying health conditions.
Approach to Short Stature
Dr Raheel Ahmed
FCPS in Paediatric Medicine
Children Hospital, Chanka Medical College, Larkana
Topics
Definition.
Etiology
Measurements.
Examination.
Investigations.
Management.
Take home message.
Who is short child?
Short stature is defined as height that is two standard deviations below the mean height for age and sex (less than the third percentile).
OR
more than two standard deviations below the mid-parental height.
Etiology
Proportionate Short Stature
1) Normal Variants:
i) Familial
ii) Constitutional Growth Delay
2) Prenatal Causes:
i) Intra-uterine Growth Restriction-
Placental causes, Infections, Teratogens
ii) Intra-uterine Infections
iii) Genetic Disorders (Chromosomal
& Metabolic Disorders)
Postnatal Causes:
i) Undernutrition
ii) Chronic Systemic Illness
- Cardiopulmonary: CHD, Chronic Asthma,
Cystic Fibrosis
- Renal: RTA, CRF, Steroid dependent
Nephrotic Syndrome
- GI and Hepatic: Malabsorption, IBD, chronic
liver disease
- Chronic Severe Infections
- Hematological : Thalassemia, Sickle cell
anemia
iii) Psychosocial Short Stature
(emotional deprivation)
iv) Endocrine Causes:
- Growth Hormone Deficiency/ insensitivity
- Hypothyroidism
- hypopituitrism
- Diabetes Mellitus
- Cushing Syndrome
- Pseudohypoparathyroidism
- Precocious/ delayed puberty
Disproportionate Short Stature
1) With Short Limbs:
Achondroplasia,
Hypochondroplasia,
Chondrodysplasia punctata,
Chondroectodermal Dysplasia,
Diastrophic dysplasia,
Metaphyseal Chondrodysplasia
Osteogenesis Imperfecta,
Refractory Rickets
2) With Short Trunk:
Spondyloepiphyseal dysplasia,
Mucolipidosis
Mucopolysaccharidosis
Mid Parental Height
TCR
Calculated by MPH +-10
How to measure upper and lowersegments?
You should measure the upper segment( US ) then by using the total height you will obtain LS.
Upper segment is the sitting height.
Disproportionate short statue with short LS:-
Achondroplesia
Osteogenesis imperfecta.
Refractory rickets.
Disproportionate short stature with short US:-
Spondyloepiphysial dysplasia.
Mucopolysaccharidosis.
Growth velocity
0-1 year : 25cm/year
1-2 year: 12cm/year
2-3 year: 8cm/year
3-4 year: 7cm/year
4-9 year : 5-6 cm/year
As a rule any growth rate <4.5cm/year between 2-12 year is pathological.
USG AND DOPPLER IN DIAGNOSIS AND MANAGEMENT OF IUGRshiv lasune
This document discusses the use of ultrasound and Doppler in the diagnosis and management of intrauterine growth restriction (IUGR). It defines small for gestational age (SGA) as a fetus below the 10th percentile and describes how Doppler of the umbilical artery can help identify fetuses with IUGR, monitor disease progression, and predict outcomes. Doppler of other fetal vessels like the middle cerebral artery and ductus venosus can further evaluate the fetus and help guide management decisions. Together, Doppler studies provide both diagnostic and prognostic information useful in the care of growth restricted fetuses.
This document discusses the evaluation and differential diagnosis of short stature in children. It defines short stature as a height more than 2 standard deviations below the mean for age and sex. The evaluation involves taking a history, performing a physical exam, assessing growth parameters, growth velocity, midparental height, bone age, and indications for further investigations. Common causes discussed are familial short stature, constitutional short stature, and pathological short stature. Treatment options mentioned include growth hormone, oxandrolone, IGF-1, and aromatase inhibitors.
This document discusses the evaluation and differential diagnosis of short stature in children. It defines short stature as a height more than 2 standard deviations below the mean for age and sex. The evaluation involves taking a history, performing a physical exam, assessing growth parameters, growth velocity, midparental height, bone age, and indications for further investigations. Common causes discussed are familial short stature, constitutional short stature, and pathological short stature. Treatment options mentioned include growth hormone, oxandrolone, IGF-1, and aromatase inhibitors.
1) Short stature can be caused by disease, disability, or social stigma and requires evaluation.
2) A child is considered short if their height is below the 3rd percentile or more than 2 standard deviations below the median height for their age and sex.
3) Approximately half of children with short stature have a physiological/familial cause, while the other half have a pathological cause like malnutrition, chronic illness, hormonal deficiencies, or genetic syndromes.
4) Evaluation of a child with short stature involves taking a thorough history, performing anthropometric measurements and growth chart analysis, conducting a physical exam, and ordering initial lab tests and bone age assessment.
This document provides an overview of growth disorders including short and tall stature. It discusses the evaluation and causes of short stature such as growth hormone deficiency, Turner syndrome, and Prader-Willi syndrome. For growth hormone deficiency, it outlines the diagnostic process including stimulation tests and treatment with growth hormone. For tall stature, it reviews genetic, hormonal, and syndromic causes such as familial tall stature, precocious puberty, and Marfan syndrome.
Down syndrome is a genetic condition caused by trisomy of chromosome 21. It occurs in about 1 in 660 births. Key features in newborns include slanted eyes, small ears, loose skin on the back of the neck, and poor muscle tone. Individuals with Down syndrome often have health issues such as heart defects, hearing or vision problems, gastrointestinal abnormalities, thyroid disorders, and psychiatric conditions. Lifelong healthcare involves screening and management of associated medical problems with a focus on development, education, independence, and quality of life.
Failure to thrive (FTT) is defined as a lack of appropriate weight gain or a persistent weight loss from a child's normal growth curve. It can be classified as organic, caused by medical issues, or non-organic, caused by psychosocial factors. A thorough history, physical exam, and lab tests are needed to determine the etiology and develop an appropriate treatment plan focused on nutritional rehabilitation and addressing the underlying cause. Prognosis depends on the etiology, with FTT in the first year generally having a poorer outcome. Prevention efforts include exclusive breastfeeding, parental education, and early detection and intervention.
- Growth refers to an increase in physical size while development is a progressive increase in skills and functional capacity.
- Growth failure is a common presentation to pediatricians and most cases have physiological causes rather than pathological ones.
- Growth is regulated by nutrition, hormones like growth hormone and IGF-1, and sex steroids. Final height is determined 60-80% by genetics.
- Physiological causes of short stature include familial short stature and constitutional delay of growth and puberty while pathological causes can be endocrine disorders, malnutrition, or genetic conditions.
The document discusses growth hormone (GH) deficiency. It notes that GH is produced by the pituitary and regulates growth. GH secretion peaks during puberty then declines with age. Causes of GH deficiency include genetic factors, tumors, injuries and infections. Clinical features include short stature, delayed development, and body proportions differences. Evaluation involves assessing growth rates and examinations. Treatment is usually GH injections, aimed at restoring normal growth rates. Response is monitored through height velocity measurements.
This document discusses the case of Sandeep, a 4 year 10 month old boy who presents with short stature. His history and examinations are otherwise normal. The document outlines the process of evaluating and diagnosing short stature, including using growth charts, taking a thorough history and physical, and ordering basic screening tests. It discusses following up the case over several years and making a diagnosis of idiopathic short stature once common causes are ruled out. The document emphasizes the importance of thorough evaluation, communication with parents, and timely treatment to optimize outcomes for children with short stature.
Short stature can be defined as height more than 2 standard deviations below the mean for age. It is important to evaluate the cause of short stature through accurate height and growth velocity measurements, comparison to population and familial heights, assessment of body proportions, sexual maturity, and bone age. A thorough history and physical exam can provide clues to underlying conditions like endocrine, genetic, nutritional, or chronic diseases that may be causing pathological short stature.
Approximately 3% of children are short, with half being physiologically short due to familial or constitutional factors, and half being pathologically short. Common causes of pathological short stature include genetic disorders, chronic illnesses, malnutrition, and endocrine disorders such as growth hormone deficiency or hypothyroidism. A thorough evaluation includes medical history, physical examination, assessment of growth parameters, bone age, and laboratory tests to identify the underlying cause.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
5. Weight - formula
3 – 12 months = age in months + 9
2
1 – 6 years = age (yr) x 2 + 8
7 – 12 years = age (yr) x 7 – 5
2
6. Weight gain
Newborn
10% of birth weight is lost initially
Regain birth weight by 10 days
200 gm / week – 1st three months (30g/day)
150 gm / week – 2nd three months (20g/day)
100 gm / week – next 6 months (15g/day)
7.
8. Normal – Height
At birth – 50 cm
3 months – 60 cm
9 months – 70 cm
1 year – 75 cm
2 years – 90 cm
4 ½ years – 100 cm
Till 10 years – 5 cm / year
9.
10. Weight/ Height
A value below 90.5% indicates malnutrition
Value >120% indicates over wt or obesity
15. Arm span
Tips of middle fingers when the arms are
stretched out
It is equal to height at 10 yrs
In earlier years it is 1-2cms less than ht/length
After 12yrs it is 1-2cm>height
17. Head Circumference
• Brain growth is rapid during infancy and it is unaffected by
mild to moderate degree of malnutrition
• Should not be measured with in 24 hrs after birth
• Boney land marks – superior orbital ridge (ant), occipital
protuberance (post)
18. Normal head circumference
Birth – 35 cm
3 months – 40 cm
12 months – 45 cm
2 years – 48 cm
12 years – 52 cm
2 cm / month in 1st 3 months
1 cm / month in next 3 months
0.5 cm / month in 6 months
19. Chest circumference
At the level of nipple in a plane at right angle to the spine. Measured
the mid respiration
At birth HC is more than CC (by about 2.5cm)
By 6 to 12 months HC=CC
At 1st yr CC > HC (larger by 2.5cm).
At 5yrs CC >HC (by 5cm)
In PEM CC may continue to be less than HC
20. Mid arm circumference
Age independent criteria
Mid point between acromian process and olecranon
1 – 5 years : Arm Circumference fairly constant
>13.5 cm - Normal
12.5 – 13.5 cm : moderate malnutrition
<12.5 cm : severe malnutrition
21. MAC - Shakir’s Tape
It is a plastic tape with colored zone –
green, yellow & red
eindicateseverema12.5cm
Yellow indicates moderate malnutrition
(12.5-13.5cm)
reendica13.5cm
23. Length / Height
• < 2 years – recumbent length using infantometer
• > 2 years – standing height – Stadeometer
Formula : 2 – 12 yrs = age in years x 6 + 77 (in cm)
• In girls at 2yrs - half of adult height is attained.
• In boys at 2 ½ yrs - half of adult height is attained
24. • What are the common causes of growth retardation in a child
Dept of Pediatrics, AFMC
26. • Can you apply the term Failure to thrive for this patient
• Descriptive term for < 5 yr
• Organic or Non organic(80%)
27. • How do you define short stature
• Ht below 3rd centile or more than 2 standard deviations below the
mean ht for that age and sex according to population standard
28. Salient Points in History
• Well till 5 - 6 yrs of age
• Behavior changes
• Constipation
• Puffiness of face and swelling hands and feet
• Dry skin
• 2 yrs younger sister is taller than her
• History of delayed dentition
Dept of Pediatrics, AFMC
29. • What are the common dentition problems in children
• Delayed eruption
- Hypothyroidism
- Hypoparathyroidism
- familial
- Idiopathic
• Early Exfoliation
- Histiocytosis
- Leukemia
- cyclic neutropenia
31. • How do we differentiate between Familial and Constitutional delay in
growth?
Dept of Pediatrics, AFMC
32. Feature Constitutional Familial
Height Short Short
Height Velocity Normal Normal
Family history Delayed puberty short stature
Bone Age < CA Normal
Puberty Delayed Normal
Final Ht Normal Low
(normal TH)
Dept of Pediatrics, AFMC
33. Anthropometry
• Weight- 22.9 kg (52% of 50th centile)
• Height- 113 cm (<3rd centile)
• US/LS = 1.1
• Arm span- 112 cms
• Weight for height – 19 kg
• Height age corresponds – 6 yrs
• Weight age corresponds – 8 yrs
• Wt age > Ht age
• MPH – 149.5 cm
33
Dept of Pediatrics, AFMC
37. • What are the conclusions derived from US LS ratio
• Decreased US LS ratio
- spondyloepiphyseal dysplasias
- vertebral anomalies
• Increased US LS ratio
- rickets
- Congenital hypothyroidism
- achondroplasia
38. • How do we calculate Mid Parental Height
• Boys – mothers ht + father’s ht
------------------------------ + 6.5
2
Girls – mother’s ht + father’s ht
------------------------------ - 6.5
2
39. • What is the interpretation of wt for ht in children with short stature
• Decreased wt for ht
- malnutrition, chronic illnesses
• Increased wt for ht with short stature
- Endocrinopathies
- Syndromes
- Skeletal dysplasias
40. • How do we plot target ht on the growth chart
52. Causes of short stature in renal disease
• Poor nutrition
• Metabolic acidosis
• Osteodystrophy (rickets)
• Anemia
• Decreased IGF level
• Hypothyroidism
• Proteinuria
53. Who is Short?
• If child is below 3rd percentile
• But target height is also below 3rd percentile
• HEREDITORY SHORT STATURE
• REASSURANCE
54. Who is Short ?
• If child above 3rd percentile with target height
percentile above it
• Observe after initial screening
• Quarterly height measurement for height velocity
• It should be > 4 cm/year
55. Who is Short ?
• If child below 3rd percentile with target height
percentile above it
• height velocity < 4 cm/year
• Then he/she is short
56. What Next ?
Look at the child
• Whether upper body and lower body is proportionate or
disproportionate
• Disproportionate
• Skeletal Causes
• Proportionate
• Systemic or Endocrinal causes
57. Upper/Lower Ratio
• Normal
• 1.7 at Birth ,1.3 by 4 year, 1.0 by 7 years
• Increased Ratio
• Skeletal Dysplasia
• Turner’s Syndrome
• Cretinism
• X-Linked Hypophosphatemic Rickets
• Decreased Ratio
• Mucopolysaccharidosis
• Spondylo-epiphyseal dysplasia
58.
59.
60. What Next ?
Again look at the child
• Whether child is mentally retarded
or normal
• If Mentally Retarded
• Chromosomal Abnormality
• Genetic Syndrome’s
• Cretinism
61. Then ?
Calculate BMI
• If Low : Systemic Illness
: Anorexia Nervosa
• If Normal : Endocrinal
DICTIM: All obese children are taller than counterparts,
and if Short indicate endocrinal disease
64. Bone Age Estimation
• X-Ray left hand with wrist
• Scoring system of each of 20 individual hand bones
(Tanner-Whitehouse Method, TW2), a technique that has
been adapted for computerized assessment
• BA is a better predictor pubertal milestones than CA
65.
66. Possibilities
• BA = HA = CA
• Normally growing child
• BA = HA < CA
• Delayed Growth (Constitutional)
• BA = CA < HA
• Hereditory Short Stature
• Intrinsic Short Stature (Genetic)
• BA < HA < CA
• Delayed/Attenuated Growth (Pathological)
67. Dysmorphic Features
• Epicanthal fold
• Hypertelorism
• Auricular Malformation
• Facial Asymmetry
• Teeth Dysplasia
• Webbing of Neck
• Polydactyly
• Abnormal Crease of Palm
• Nail abnormality
70. Intrinsic Short Stature
• Single Gene Defects
• Down’s Syndrome
• Turner’s Syndrome
• Mucopolysaccharidosis
• Polygenetic or Unknown
• Prader Willi Syndrome
• Noonan’s Syndrome
• Progeria
• Silver Russell Syndrome
71. Idiopathic Short Stature
• Short Stature otherwise Healthy child
• Exclusion of Other causes
• Bone age within 2 SD of CA
• Normal GH Response to test
• For Treatment
• HA < 2.25 SD for age and sex
• Open Epiphyses
• Unable to achieve normal height with current Height
velocity
72. Further Evaluation
• Referral to Endocrinologist
• T3, T4, TSH
• IGF-1, IGF-BP3
• GH Stimulation
• Cortisol Evaluation
if Cushing’s syndrome is suspected
73. Diagnosis of growth failure
IGF 1 & BP3
IGF deficiency
ruled out
Normal
GH testing
Low
Increased basal
and stimulated
GH insensitivity
Peak < 10
Pit/ Hypothalamic
Peak 10 - 40
Functional
75. Follow Up
• 6-12 monthly
• Clinical evaluation
• Assessment of side effects
• IGF-1 levels
• Lipid Profile
• Fasting B Glucose
• BMD if initial was abnormal
76. SIDE EFFECTS
• Malignancy
• Benign Intracranial Hypertension
• Slipped Epiphysial Disc
• Fluid Retention
• Increase in naevi
• Gynaecomastia
• IGT & DM (Aggravation of Retinopathy)
• Predisposition of hypothyroidism & ACTH
deficiency
77. Confirmation of GHD: IGF-I
• Polypeptide, synthesized by liver and also locally in peripheral tissue
• Locally synthesized IGF-I – 20% of serum level
• Mediates growth promoting actions of GH
• Single sample for estimation
• Assay – difficult as extraction step is required
Williams text book of Endocrinology, 10th Ed
78. Factors affecting IGF-I levels
• Age
• Nutrition
• Genetic factors, ethnicity
• GH
• Insulin, cortisol, thyroxine, estrogen, androgen
• Catabolic state
• IGFBP
Williams text book of Endocrinology, 10th Ed
79. Indications and Goals of GHD Rx
• Patients with proven GHD - treated with GH as soon as possible
• Primary objectives of the therapy of GHD are:
- Normalization of height during childhood
- Attainment of normal adult height and genetic potential!!
80. GH Dosing
• O.025-0.035mg/kg daily subcutaneously in the evening
• 0.17 – 0.35 mg/kg/week (Summary statement, GH Research
Society 2000)
• Few studies – 0.3 mg/kg/wk better result than 0.17 mg/kg/wk (GH-IGF Res
1998)
81. Duration of GH therapy
• Improvements in linear growth have been almost the sole indication for the
use of GH in pediatric practice.
• Treatment is initiated as soon as possible once
• GH should be continued until the attainment of final height.
• Final Ht - slowing of growth to an annualized HV of <1 cm/yr or fusion of the
long bone epiphyses.
• Ideally – life long