Sunday, 3 January 2016

Test Your Paediatrics Knowledge: Growth

Which of the following statements about a child with short stature is correct?

a. The bone age is delayed in a child with constitutional growth delay
b. Height crosses a major percentile line on the child’s growth chart
c. Weight is more affected than height in a child with an endocrine deficiency
d. Karyotyping is part of the routine investigation of all children with short stature
e. Growth hormone replacement is helpful in a child with familial growth delay

The correct answer is A.
Children with constitutional growth delay (CGD), the most common cause of short stature and pubertal delay, typically have retarded linear growth within the first 3 years of life. In this variant of normal growth, linear growth velocity and weight gain slows beginning as young as age 3-6 months, resulting in downward crossing of growth percentiles, which often continues until age 2-3 years. At that time, growth resumes at a normal rate, and these children grow either along the lower growth percentiles or beneath the curve but parallel to it for the remainder of the prepubertal years.

CGD is a global delay in development that affects every organ system. Delays in growth and sexual development are quantified by skeletal age, which is determined from bone age radiographic studies of the left hand and wrist. Growth and development are appropriate for an individual's biologic age (skeletal age) rather than for their chronologic age. Timing and tempo of growth and development are delayed in accordance with the biologic state of maturity.

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