Pediatrics Seminar

1. Pediatrics Seminar Preseted by: Fahd Alareashi & ??????????

2. Case Scenario: • A 10-year-old girl presents to the clinic with her parents. • Her parents report that she is the shortest in her class. • However, they have become concerned because her 8-year-old sister is now the same height as she is. • The patient has not yet attained menarche and her mother reports no breast development. • She has been well with no chronic medical problems, no hospitalizations, and no surgeries.

3. Case Scenario: • She lives with her mother, father, and sister . • She is currently in the fifth year elementary school and she always scores grade A. • Her mother is 173 cm (5'8") and weighs 68 kg (150 pounds). She had menarche at age 12. • The patient's father is 185 cm (6'1") and weighs 95 kg (210 pounds). • There is no family history of any medical problems.

4. Case Scenario: • On further history, you find that your patient was 43 cm (17 inches) long at term (average is 49.5 cm, 19.5 inches). • P/E: • General: • Conscious. • Looks girl. • No apparent distress. • Vital signs: • Temperature: 37◦ C. • Pulse: 90 bpm. • BP: 100/60 mmHg. • RR: 18 breaths/min.

5. Case Scenario: • P/E: • Growth Parameters: • Height: 120 cm. • Weight: 23 Kg. • Head Circumference: 52 cm.

6. Stature

7. Weight

8. H.C.

9. Wt-for-Ht.

10. Case Scenario: • P/E: • Head & Neck: • Neck is supple and webbed. • Low posterior hair line. • Chest: • Heart: Normal S1 & S2, No additional sound. • Lungs are clear. • Abdomen: • Soft. • No masses.

11. Case Scenario: • P/E: • Breast: • Tanner I. • Wide spaced nipples are evident. • Pubic Hair: • Tanner I.

12. Case Scenario: • INVESTIGATIONS: • Her growth chart is reviewed which demonstrates: • an average growth velocity: 3cm/year. • Bone age: • 8 years & 6 months. • CBC: normal. • ESR: normal. • TFT's: normal. • UA: normal. • Serum electrolytes: normal.

13. Case Scenario: • INVESTIGATIONS: • Chromosomal analysis: • 45 XO. • ► Diagnosis of Turner Syndrome is made. • She is referred for a renal ultrasound, cardiology evaluation, and a hearing screen. • She is also seen by the pediatric endocrinologist and is started on growth hormone.

14. An approach to short stature Preseted by: Fahd Alareashi

15. Short Stature Outlines

16. Short Stature Outlines

17. Short Stature: • A child whose height is below the 3rd percentile for age and sex.

18. Growth Failure: • Slow growth rate regardless of the stature. • Ultimately, a slow growth rate leads to short stature. • A Growth Chart is used to show: • A child's current height. • Growth Velocity : how fast the child is growing.

19. Short Stature Outlines

20. Short Stature Outlines

21. Growth Charts

22. Growth Charts: • Growth charts are a standard part of any checkup. • They show health care providers how kids are growing compared with other kids of the same age and gender.

23. Different Types of Growth Charts: Male Growth Charts Weight-for-Age Height-for-Age Weight-for-Height HC-for-Age

24. Different Types of Growth Charts: Female Growth Charts Weight-for-Age Height-for-Age Weight-for-Height HC-for-Age

25. Growth Charts: • Assessment: • Short Stature: Height < 3rd percentile. • Growth Failure: • Height crossing 2 major percentiles. • Low growth velocity: Rate < 25th percentile.

26. Short stature with normal growth rate and delayed growth spurt with eventual achievement of normal adult stature. • “ CONSTITUTIONAL GROWTH DELAY “ Stature

27. Normal growth rate. • Short stature in childhood. • Short stature in adults. • “ Familial Short Stature“ Stature

28. “ Acquired Pathologic Short Stature“ Stature

29. SPECIAL Types of Growth Turner syndrome, Achondroplasia, Down syndrome • special growth charts available for these conditions. • These children grow along percentiles specific to their condition.

30. Mid-Parental Height: • Children are usually in a percentile between their parents' height. • The Expected Height of the child as adult lies between ± 5 cm from the Mid-parental age: Girls: = [Mother’s Height + Father’s Height - 13] 2 Boys: = [Mother’s Height + Father’s Height + 13] 2

31. CAUSES of:short stature

32. Short Stature Outlines

33. Short Stature Outlines

34. Causes:

35. Causes:

36. Causes: • Most common. • Normal Growth Velocity. • Non Pathologic.

37. Causes: Familial Short Stature Constitutional Growth Delay

38. Causes: Familial Short Stature • Short parents. • Born short. • Bone age (X-ray): Chronological age. • Puberty occurs at time. • No treatment is indicated.

39. Causes: Constitutional Growth Delay • Bone age is delayed. • Puberty is delayed. • Hx. of delayed puberty in parents. • Normal adult height. • May require short term therapy with androgens/estrogens.

40. Causes:

41. Causes:

42. Causes: Prenatal “ Primordial “ Postnatal

43. Causes: Prenatal “ Primordial “ • All parameters are affected; Height, weight, & head circumference. • IUGR. • Chromosomal: Down syndrome, Turner syndrome. • Skeletal dysplasia. Proportionate

44. Causes: Postnatal • Endocrine: • GH deficiency. • Hypopituitarism. • Cushing syndrome. • Chronic Diseases: • Cyanotic congenital heart diseases. • Celiac diseases, IBD, cystic fibrosis. • Chronic infections. • Chronic renal failure. • Psychosocial neglect: Height > Weight “Short & Fat” Weight > Height “Short & Skinny” Weight & Height are decreased Proportionate

45. Causes: Postnatal • Achondroplasia. • Rickets. • Hypothyroidism. Disproportionate

46. Short Stature Outlines

47. Short Stature Outlines

48. Approach & Assessment of:short stature

49. Assessment History Taking

50. History: • Antenatal History: • IUGR? • Any complications: pre-eclampsia, hypertension, anemia, maternal history of smoking, alcohol & infections, drugs? • Delivery: • Gestational age? • Mode of delivery? • APGAR score. • Complications? • Hypoglycemia.