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Building Blocks to Growth
Elizabeth Hanson, MD
John C. Lee, PhD
Learning Objectives
By the end of this activity and associated preparatory materials, the student will be able to: • Plot height, weight, and head circumference on a
standard growth chart • Differentiate the pattern of growth failure caused
by inadequate caloric intake from other patterns of growth failure
• List the common reasons for disordered growth including genetic abnormalities, inadequate caloric intake, excess caloric demand from chronic disease, and endocrine abnormalities
How do we measure growth?
• Weight
• Height/Length
• Head Circumference
• Body-Mass Index
Growth Charts
Growth Charts
15 month old boy 12.5 kg 82 cm
What causes problems in these areas?
• Weight Calories
• Height/Length Hormones, Skeleton, Genetic
• Head Circumference Brain, Skull, Genetic
• Body-Mass Index: Ratio Kg/m2
- High in Excess Calories, Hormone Deficiency - Low in Insufficient Intake, Chronic disease - Normal in genetic syndromes with symmetric restriction
What do we need to grow?
Energy Growth
Energy
Intake
Growth
How growth goes wrong…
Child Not Growing
How growth goes wrong…
Child Not Growing
Growth Chart Activity
In your groups plot the growth points from your clinical cases on the growth charts provided and discuss the associated questions.
10 MIN
Cases Continued
Let’s look at the growth curves we plotted together. All demonstrate abnormal growth
Which one represents:
A) Malnutrition?
B) Acquired hypothyroidism?
C) Genetic syndrome?
Case 1 is most consistent with:
A. Malnutrition
B. Acquired Hypothyroidism
C. Genetic Syndrome
Case 2 is most consistent with:
A. Malnutrition
B. Acquired Hypothyroidism
C. Genetic Syndrome
Case 3 is most consistent with:
A. Malnutrition
B. Acquired Hypothyroidism
C. Genetic Syndrome
Case X: The Acute Visit
2 y.o. girl from Case X
CC: “Looks more pale than other kids”
Exam: • Pale; Sparse fine hair • Lung sounds are clear • Heart: systolic ejection murmur • Neuro: delayed developmental milestones
Lab tests: (LONG STORY SHORT……)
• Megaloblastic Anemia (Anemia with large RBC and abnormally nucleated WBC)
• Elevated urine orotic acid with detectable orotic acid crystals
• Elevated levels of orotate and orotidine in her serum
• (Growth Chart)
Orotic Aciduria • What is the biochemical defect?
• HINT: Orotate and Orotidine are elevated
http://online.vitalsource.com/books/9780470912096/outline/10.13.1.1
What are the biochemical defects?
What is the clinical treatment?
Summary
• Growth is an important indicator of health and well-being in children
• Weight, height/length, and head circumference (<3yrs) are monitored routinely at well child visits using a growth chart
• There are many causes for disordered growth including genetic abnormalities, inadequate caloric intake, and endocrine abnormalities
• The pattern of growth failure can help in determining the underlying cause – In the case of inadequate calories, weight falls first
followed by height/length and then head circumference
