00:01
In this lecture we're going to discuss tracking growth in children,
and short stature, and how we handle that problem.
00:08
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.
00:24
When we're seeing these children,
we're frequently seeing them and recording their various parameters.
00:31
Early in life we do head circumference, weight, and height.
00:35
And then later on, we do mostly just the weight and the height
and we're calculating things like BMI.
00:42
So here?s two growth charts that we'll use.
00:44
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.
00:51
And we'll plot the height and weight of these children
to make sure things are going okay.
00:56
After or 2, there?s another set of growth charts that we'll use like these
which are really more prescribed by the CDC.
01:04
So we also track in addition to weight and height,
in the early childhood we'll track head circumference.
01:13
Here?s a hypothetical child you might see with an abnormal head circumference.
01:18
You can see why following overtime is important.
01:22
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.
01:32
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.
01:45
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.
01:57
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.
02:05
Following weight is critical and can give you clues about disordered eating,
from obesity to eating disorders and many different medical diseases as well.
02:17
So there are thousands of reasons why children might fail
to gain weight or gain weight too much.
02:23
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.
02:32
So for example,
here is a child who?s growing along in their growth curves.
02:38
You can see the top line, which is their height, has been going pretty well.
02:43
It's been tracking appropriately along about the 50th percentile.
02:48
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.
02:59
This sort of pattern is classic for a disease
where a child has increased metabolic demand.
03:05
For example, perhaps this child has just developed Crohn?s disease.
03:10
This child might have increased metabolic demand
and a decreased absorption of nutrients
causing the weight to start to fall off.
03:20
In general, children who have caloric insufficiency
will preserve their height at the expense of their weight early as things go.
03:30
But if they continue to starve
or continue to have increased metabolic demand,
the height will start to tail off later as well.