2.pertumbuhan normal

8/11/2019 2.Pertumbuhan Normal

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GROWTH &

GROWTH DISORDERSOLEH

Dr. H. Hakimi SpAK

Dr. H Charles Darwin Siregar SpADr. Melda Deliana SpAK

Dr. Siska Mayasari Lubis SpA

Pediatric Endocrinology USU/ADAM

MALIK HOSPITAL


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Aim

Understand stature and growth

Growth assessment through growthchart

Able to refer child with growth problems


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Control of Growth


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HYPOTHALAMUS

PITUITARY

Liver

TARGET

TISSUE

IGF-1

GH-R

IGF-R

IGFBP

GHBP

GH-R

GH

GH RH SOMATOSTATIN+ -

PARACRINE

AUTOCRINE

ENDOCRINE

IGF-1

IGFBP


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PREREQUISITE

KNOWLEDGEGrowth Chart

A chart that reflects the height and weight ofa certain population which is specific for

race, age, and sex. The curves represent the approximate

normal growth patterns of the targetedpopulation

Most normal children growth patterns areparallel to one of the lines in the curve

Weight assessment is important indetermining etiologies of some growthfailures


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PREREQUISITE

KNOWLEDGE

Heights of normal group of children tend

to follow a normal distribution

average height is at the 50th percentile Height less than 2SD (3rd percentile) or

more than 2SD (97thpercentile)

considered abnormal


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Growth Chart

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Age (years)

Height

(cm)

97

50

3


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PREREQUISITE

KNOWLEDGE

Height velocityis increase of height between2 measurements (preferably 6 monthsinterval)

Chronological ageage according to birthdate.

Height ageis the appropriate age for the

height observed. Obtained by drawing ahorizontal line from the observed height tocross the 50thpercentile of the growth chart.

At that cutoff point draw a vertical line to seethe age.


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PREREQUISITE

KNOWLEDGE

Potential genetic height: The range of

adult height that should be achieved the

child regarding to the biological parentsfinal height.

Boys = (Fh+ 13) + Mh 8.5 cm

2

Girls = (Fh- 13) + Mh 8.5 cm

2


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Growth Chart

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Age (years)

Height

(cm)

97

50

3

HACA

Potential Genetic Height


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PREREQUISITE

KNOWLEDGE

Bone Age: is the apparentage of the epiphysealcenters on roentgenograms

as compared with normals.Bone age reflects thebiological functioning of thebody. Usually approximates

height age. Useful in predicting final

height (if bone age >6 yearsold)

Methods GP, TWH, RWT


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Infant Childhood Puberty

Cm/

year

GH Sex steroid

Growth Velocity Curve


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Anthropometrics

General

Height

Weight

Head circumference

Body proportion

Sitting height

Arm span


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Genetic factors

Catch-up & catch downduring the infantphase of growth

Strong correlation between childs height(older than 2 years) with mid parental heightshows PGH. If child height less than 2.5SD of MPH high probability of growth

disorders Potential genetic height

constitutional delay of growth & puberty has afamily history of delayed puberty and/or

growth


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Potential Genetic

Height

CanalizationCatch-down

INFANT PERIOD

0 1 2 3

year


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PREREQUISITTE

KNOWLEDGE Define

Normal growth

Abnormal growth

Normal growth is indicated by heights thatfall within 2 standard deviation of themean and form a curve that parallels the3rd, 50th, or 97thpercentile on the growth

chart

Abnormal growth is growth curve thatdoes not parallel the 3rd, 50th, or 97thpercentile on the growth chart


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PREREQUISITTE

KNOWLEDGE Difference of Growth

Size

Catch up growth

Growth is a process of changes in

anthropometrics measurements with time

Size indicates height and weight at a point

of time. For height it is identical to stature.

Normalization of growth after a period ofabnormal growth


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Growth parameters

0-2 years

Length increases 50% during 1styear &

another 50% of the 1styear growth during2ndyear

At 2 years old is + 50% of final height

Weight doubles birth weight at 45

months of age and triples birth weight at 1

year


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Growth parameters

Prepubertal years

Height increase 68 cm per year.

Slight acceleration at 6-8 years old (mid childspurt)

normal slowing of growth just before puberty

Enters puberty with + 85% of final height

Weight doubles birth weight at 45

months of age and triples birth weight at 1

year


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Growth parameters

Pubertal years

Accelerated growth = growth spurt

Weight


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Rules of Fives for normal growth

rates in childrenBirth 1yr 4yr 8yr 12yr

Length (cm) 50 75 100 125 150

Growth velocity 25 8 6 6

(cm/yr)


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Catch-up Growth Occurs

Rapidly Catch-up weight gain in wasted children

occurs 20 times the normal rate

Catch-up height in stunted childrenoccurs 3 times the normal growth rate

A child who is both wasted and stunted

will gain weight rapidly until his weightof height is appropriate, then growth will

slow


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SHORT STATURE

YES

PATHOLOGIC

NORMAL GROWTH VELOCITY?

NO

NORMAL

VARIANT

BODY PROPORTION? DYSMORPHISM

W/H INDEX?


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SHORT STATURE

PATHOLOGIC

PROPORTIONAL

W/H

ENDOKRIN

GH DEFICIENCYHYPOTHYROID

CORTISOL EXCESS

PSEUDOHYPOPARATHYR

OID

W/H

MALNUTRITION

CHRONIC INFECTION

CHRONIC DISEASE

(ORGANIC)

PSYCHOSOCIAL

IUGR

DYSMORPHIC

DYSPROPORTIONATE


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SHORT STATURE

NORMAL VARIANT

FAMILIAL SS CONSTITUTIONAL DELAY OFGROWTH AND PUBERTY

BA = CA

FINAL HEIGHT < 3RDPERCENTILE

APPROPRIATE WITHPGH

BA < CA

FINAL HEIGHT =NORMAL

APPROPRIATE WITH PGH

POSITIVE FAMILY HISTORYOF CDGP


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Growth Chart

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Age (years)

Height

(cm)

Familial Short StatureGrowth Chart

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Age (years)

Height

(cm)

ConstitutionalDelay of Growth & Puberty


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Stature and Growth

Which child needs more attention?


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GROWTH CHART

STATURE

Patient 1 ()

Patient 2 (

)GROWTH

NORMAL (

)

ABNORMAL ( )CATCH UP ( )


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2.pertumbuhan normal

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