073015 1100 during bbtogrowth slides
TRANSCRIPT
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Building Blocks to Growth
Elizabeth Hanson, MD
John C. Lee, PhD
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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
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How do we measure growth?
• Weight
• Height/Length
• Head Circumference
• Body-Mass Index
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Growth Charts
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Growth Charts
15 month old boy 12.5 kg 82 cm
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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
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What do we need to grow?
Energy Growth
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Energy
Intake
Growth
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How growth goes wrong…
Child Not Growing
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How growth goes wrong…
Child Not Growing
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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
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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?
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Case 1 is most consistent with:
A. Malnutrition
B. Acquired Hypothyroidism
C. Genetic Syndrome
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Case 2 is most consistent with:
A. Malnutrition
B. Acquired Hypothyroidism
C. Genetic Syndrome
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Case 3 is most consistent with:
A. Malnutrition
B. Acquired Hypothyroidism
C. Genetic Syndrome
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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)
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Orotic Aciduria • What is the biochemical defect?
• HINT: Orotate and Orotidine are elevated
http://online.vitalsource.com/books/9780470912096/outline/10.13.1.1
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What are the biochemical defects?
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What is the clinical treatment?
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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