3) Growth Charts

The normal distribution of most biological variables follows a gaussian

curve. A standard centile chart gives a range of growth curves with
limits of 2 SD from the mean. These correspond to the 3rd and 97th
centiles. By definition these limits will encompass about 94% of the
population, but must be remembered 6% of normal children are outside
the limits. Serial measurements are far more valuable than single
measurements to assess the pattern of the child's growth.
Abnormal growth:Deciding whether growth is abnormal in an individual child requires:estimation of growth velocity.
Reference to standard growth charts and familiarity with normal
and abnormal growth patterns.
Consideration of genetic and environmental contributory factors,
e.g. parental height, ethnic group, nutrition, emotional status,
general physical health.

If the above indicate that growth may be abnormal and cause is not
obvious from history and examination, the following may help to
determine the cause:weight, skin fold thickness.
Sitting height.
Occipito-frontal circumference.
Pubertal staging.
Investigation:
CBC, ESR.
U & E, Creatinine, Calcium, Phosphate.
Alkaline phosphatase, Iron.
Skull X-Ray.
Bone age for skeletal maturity.
Thyroid function test.

Basal gonadotrophines.
Karyotype in all short girls.
Screening for suspected growth hormone deficiency.
Jejunal biopsy.
Approach to short stature
History: - How it was noticed.
- Onset & any illness or psychological abnormality.
- Associated symptoms as (chronic diarrhea, cyanosis,
recurrent chest infection, bronchial asthma, recurrent
urinary tract infection.)
- Nutritional history (diet & appetite).
- Past history :1) Prenatal ( maternal illness, D.M, HTN, Antepartum
haemorrhage, TORCH infection, Drugs).
2) Natal (birth weight, height, head circumference).
3) Postnatal ( intracranial radiation, birth defect).
- Drugs as steroids
- Family history (similar illness, puberty, consanguinity)
- Social history (matrenal deprivation, eating habits).
- Developmental history.
Examination:1) General
looks ill or well, general built, hygiene, dysmorphic
feature, vital sign.
2) Growth parameter
weight and height.
Head circumference (if < 5 years)
Apply on two charts (weight for height, & weight for age).
Height velocity chart (normal in familial & constitutional)
mid parental height.
Arm span.
Upper and lower segment (sitting and standing )
Puberty staging.
Skin fold thickness (in nutritional state)
3) Systemic examination.

Investigation:* CBC, Urine analysis, Thyroid function test.

* Bone age (bone age = chronological age in familial, delay in
constitutional, retarted in organic)
* Chromosomal analysis.
Indication for referral a short stature child:1)
> 3 SD below median.
2)
> 2 SD below median with poor height velocity for 6
months to 1 year.
3)
Flattening of height for age > 2 centile line.
4)
Short in comparison with parents & sibling.

Short Stature

Physiologic

Pathological

Familial Dispropotion
&
Constitutional
Skeletal dysplasia
Rickets
(vit.D res.)
Bone disorder's

Propotionat

Prenatal
IUGR
DM,HTN
TORCH
Teratogenic
Chromosomal
Turnar Syn.
Mucopolysac.
Acondroplasia
Noonan S.
Pradar Well S.

Postnatal
Endocrine(GHD)
Psycosocial
Malnutrition
Cealiac D.
Cystic Fib.
Falot Tetr.
Chro.Aneamia
Chro.Renal F.

NORMAL GROWATH CHART

CONSTITUTIONAL SHORT STATURE

FAMILIAL SHORT STATURE

PATHOLOGICAL GROWTH FAILURE

ACUTE GASTROENTERITIS