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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 .

Skeleton.High in Excess Calories.Low in Insufficient Intake. Skull.Normal in genetic syndromes with symmetric restriction . Genetic • Head Circumference  Brain. Chronic disease .What causes problems in these areas? • Weight  Calories • Height/Length  Hormones. Genetic • Body-Mass Index: Ratio Kg/m2 . Hormone Deficiency .

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 .

All demonstrate abnormal growth Which one represents: A) Malnutrition? B) Acquired hypothyroidism? C) Genetic syndrome? .Cases Continued Let’s look at the growth curves we plotted together.

Genetic Syndrome .Case 1 is most consistent with: A. Acquired Hypothyroidism C. Malnutrition B.

Genetic Syndrome . Acquired Hypothyroidism C.Case 2 is most consistent with: A. Malnutrition B.

Malnutrition B. Genetic Syndrome .Case 3 is most consistent with: A. Acquired Hypothyroidism C.

o.Case X: The Acute Visit 2 y. 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) . girl from Case X CC: “Looks more pale than other kids” Exam: • Pale.

13.1.vitalsource.1 .Orotic Aciduria • What is the biochemical defect? • HINT: Orotate and Orotidine are elevated

What are the biochemical defects? .


What is the clinical treatment? .


Summary • Growth is an important indicator of health and wellbeing 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. weight falls first followed by height/length and then head circumference . inadequate caloric intake. and endocrine abnormalities • The pattern of growth failure can help in determining the underlying cause – In the case of inadequate calories.