In the diagnosis of growth disorders in children, it is important to determine the growth rate, accurately measure the child’s height and determine the relative height shortage compared to the height of the parents’ body. In addition, a medical history of past diseases and injuries plays a significant role. The smuggling tests include, for example, nutritional status assessment.
What is the diagnosis of growth disorders in children?
The following elements are the most important in diagnostics:
1. Accurate measurement of the child’s height – height measurement in younger children (under 18 months of age) is performed in the supine position using a liberometer. On the other hand, in older children, the measurement is made in a standing position using a Harpenden stadiometer or a height gauge. The subject’s head should be positioned so that the external auditory openings form a horizontal line with the lower edge of the eye sockets. Measure your body height three times and then calculate the mean value. Only taking measurements with the same equipment and at a similar time of the day allows the results to be comparable. An important term used in auxology is “height age”; the term is the age at which a child growing along the 50th percentile has the height of the subject being assessed. The easiest way to read the height age is from the percentile grid for a given gender.
2. Determination of the relative growth shortage in relation to the body height of the parents – in assessing the current height of the child, the so-called target height, calculated on the basis of the parents’ height, should be taken into account. A short-grown child is one whose height is lower by at least two percentile channels compared to the average growth position of the parents.
3. Assessment of the growth rate
A patient’s growth rate should be judged on the basis of two or more measurements taken at least 6 months apart. Growth rate within 1 standard deviation from the mean for sex and age is considered normal.
In practice, it can be assumed that the growth rate should be at least:
– 7 cm per year in children up to 3 years of age,
– 6 cm per year in the period from 3 to 5 years of age,
– 5 cm per year in the period from 4 to 10 years of age,
– 4 cm per year in girls over 10 years of age, and also in boys over 12 years of age (which are still before puberty).
4. Assessment of bone age and growth prognosis – in each child with a short stature, it is necessary to determine the bone age on the basis of a comparison of the radiograph of the non-dominant hand with the appropriate standards according to Greulich and Pyle.
The so-called predicted height can be determined from the child’s height and bone age, which is important in patients whose bone age does not match the calendar age.
5. Relevant data from the interview
The physical examination should include:
– an interview regarding the course of pregnancy: possible diseases, medications or stimulants used by the mother, duration of pregnancy, course of delivery, assessment of the child’s birth weight and length, Apgar score,
– data from the neonatal period: detected defects, the presence of hypoglycemia, prolonged jaundice, microgenitalism, edema – of the neck, backs of hands and feet,
– past diseases and injuries, used drugs, especially hormonal drugs (e.g. glucocorticosteroids – time, dose and route of administration),
– an interview regarding the growth and maturation of the patient’s parents and siblings (height measurements if possible), the presence of short stature in the family,
– drawing the patient’s growth curve on the basis of data from the health record book and the results of current body height measurements.
6. Physical examination
The physical examination should include an assessment of the following elements:
– symmetry of the body structure – the proportion of the length of the torso to the length of the limbs, the proportion of proximal and distal parts of the limbs, as well as the ratio of the face and the skull,
– nutritional status,
– external genitalia and the degree of sexual maturity according to the Tanner scale. Before starting endocrine diagnostics, the most common causes of growth deficiency, i.e. intestinal malabsorption, parasitic diseases, deficiency anemia, urinary tract infections, and chronic respiratory and circulatory diseases, should be excluded.
Providing the child with the necessary vitamins and minerals will help in the proper development of the child. For this, try, for example, the YANGO liquid multivitamin for children.
Also check:
Chart Grids – A Quick Reference
Growth grids for girls
Growth grids for boys
A detailed list of the reasons for the shortage of growth is presented in Table 13.1
Source: A. Cajdler-Łuba, S. Mikosiński, A. Sobieszczańska-Jabłońska, I. Nadel, I. Salata, A. Lewiński: “FUNCTIONAL DIAGNOSTICS OF HORMONAL DISORDERS WITH ELEMENTS OF DIFFERENTIAL DIAGNOSTICS; Czelej Publishing House