Ebook Paediatrics and child health (3/E): Part 2

Part 2 book “Paediatrics and child health” has contents: Growth, endocrine and metabolic disorders, musculo skeletal disorders, renal and urinary tract disorders, dermatology and rashes, haematological disorders, emotional and behavioural problems,… and other contents.

252 / Part 3: An approach to problem-based paediatrics CHAPTER 13 Growth, endocrine and metabolic disorders Symptoms Short stature Plateauing in growth Weight and growth faltering Obesity The large head The small head 253 256 257 259 262 264 Disorders Constitutional short stature Maturational delay 266 266 I knew a little elfman once Down where the lilies blow I asked him why he was so small, And why he didn’t grow He slightly frowned, and with his eyes He looked me through and through: ‘I’m quite as big for me,’ he said, ‘As you are big for you.’ John Kendrick Bangs (1862–1922) Non-organic failure to thrive Intrauterine growth retardation Nutritional obesity Congenital hypothyroidism Thyroiditis Growth hormone deficiency Cushing’s syndrome/corticosteroid excess Turner’s syndrome Diabetes mellitus 266 267 267 269 269 271 272 272 273 COMPETENCES You must Know Be able to Appreciate • When a child’s growth is of concern • How to diagnose the common and important conditions responsible for poor growth in infants and children, and the principles of managing them • The causes of poor weight gain in young children and babies • How to advise a child who is suffering from obesity • The principles of managing diabetic ketoacidosis • Plot measures on a growth chart • Weigh and measure a baby and child accurately and correct for prematurity • Calculate BMI • Measure blood glucose using a home monitor • The stress and anxiety of having a child with weight faltering (FTT), especially if there are eating difficulties • The impact that diabetes has on the child and family • The principles involved in managing diabetes • The importance of good diabetic control to prevent complications Paediatrics and Child Health, Third Edition Mary Rudolf, Tim Lee, Malcolm Levene © 2011 Mary Rudolf, Tim Lee and Malcolm Levene Published 2011 by Blackwell Publishing Ltd Chapter 13: Growth, endocrine and metabolic disorders / 253 Symptoms and signs of growth, endocrine and metabolic disorders Finding your way around • Normal variant • Perinatal insult • Genetic syndrome • Neurodegenerative conditions (Craniostenosis) SMALL HEAD • Normal variation • Hydrocephalus • Subdural effusion or haematoma LARGE HEAD • Nutritional obesity • Endocrine causes • Genetic syndromes • Hypothalamic causes GROWTH, ENDOCRINE AND METABOLIC DISORDERS FALTERING GROWTH AND FAILURE TO THRIVE FALL-OFF IN GROWTH OBESITY SHORT STATURE PHYSIOLOGICAL CAUSES • Constitutional short stature • Maturational delay ENDOCRINE CAUSES • Hypothyroidism • Growth hormone deficiency • Corticosteroid excess (iatrogenic) • Constitutionally small baby • Psychosocial causes • Neglect • IUGR and genetic syndromes • Malabsorption • Gastro-oesophageal reflux • Chronic illness • Hypothyroidism • Cushing’s syndrome or disease • Growth hormone deficiency • Chronic illness • Psychosocial OTHER CAUSES • Chronic illness • Turner’s syndrome • Other genetic conditions • IUGR • Psychosocial causes Short stature Causes of short stature Physiological causes Normal variant (often familial, also known as ‘constitutional short stature’) Maturational delay (often familial) Pathological causes Endocrine • Hypothyroidism • Corticosteroid excess • Growth hormone deficiency Chronic illness • Inflammatory bowel disease, coeliac disease and chronic renal failure may be occult Genetic • Turner’s syndrome • Other genetic syndromes • Skeletal dysplasias Intrauterine growth retardation Psychosocial 254 / Part 3: An approach to problem-based paediatrics At birth, a baby’s weight and length are influenced mainly by intrauterine factors This does not correlate well with parental heights, but over the next year or two the baby’s growth adjusts, so that by the age of years most children have attained their genetically destined centile From then until the onset of puberty children usually grow steadily along their centile with little deviation During puberty it is normal for centiles to be crossed again until final height is achieved, which usually is located midway between the parental centiles Normal growth reflects a child’s well-being, and any deviation may be indicative of adverse physical or psychosocial factors Guidelines for concern about a child’s growth are shown in the Red Flag box Guidelines for concern beyond the age of years • The short or tall child Height or weight beyond the dotted lines on the growth chart (>99.6th or