In this lecture we're going to discuss tracking growth in children,
and short stature, and how we handle that problem.
So we do as a result of primary care,
frequent checks of children during their life at 0, 2, 4, 6, 9, and 12 months
and then on through childhood after that.
When we're seeing these children,
we're frequently seeing them and recording their various parameters.
Early in life we do head circumference, weight, and height.
And then later on, we do mostly just the weight and the height
and we're calculating things like BMI.
So here?s two growth charts that we'll use.
We usually use the WHO or World Health Organization Charts until the age of 2,
and there?s one for boys and one for girls.
And we'll plot the height and weight of these children
to make sure things are going okay.
After or 2, there?s another set of growth charts that we'll use like these
which are really more prescribed by the CDC.
So we also track in addition to weight and height,
in the early childhood we'll track head circumference.
Here?s a hypothetical child you might see with an abnormal head circumference.
You can see why following overtime is important.
In this child, this child was doing very well
in terms of their appropriately growing head circumference
until about the age of 9 months
when the head circumference really started expanding.
This child perhaps has a new onset hydrocephalus
or increased pressure of the cerebrospinal fluid in the brain
which is causing the head circumference to gradually expand
more than you would like.
By tracking it, we get a sense of where this child is intentionally going
and then going from there when it changes as per what we would expect.
So in this case, we might be concerned about this child
and perceive with more tests because we've been tracking
their growth and development.
Following weight is critical and can give you clues about disordered eating,
from obesity to eating disorders and many different medical diseases as well.
So there are thousands of reasons why children might fail
to gain weight or gain weight too much.
And the age at which children start to either fall off
or go up on their growth curves
is critical to understanding exactly what the problem is.
So for example,
here is a child who?s growing along in their growth curves.
You can see the top line, which is their height, has been going pretty well.
It's been tracking appropriately along about the 50th percentile.
In this child, they were perhaps 75th percentile weight which is fine
until an age, right here you can see it,
where the weight really started tailing off.
This sort of pattern is classic for a disease
where a child has increased metabolic demand.
For example, perhaps this child has just developed Crohn?s disease.
This child might have increased metabolic demand
and a decreased absorption of nutrients
causing the weight to start to fall off.
In general, children who have caloric insufficiency
will preserve their height at the expense of their weight early as things go.
But if they continue to starve
or continue to have increased metabolic demand,
the height will start to tail off later as well.