In addition, it is important to make sure that puberty does actually occur and progress normally, as delayed puberty and absent puberty are difficult to initially distinguish. A child with presumed constitutional delay of growth must continue to be followed, because if puberty comes earlier or occurs at a faster tempo than expected, the child may not achieve the expected adult height. ![]() For example, a girl with Turner syndrome could have a delayed bone age due to lack of estrogen production, but her predicted height based on bone age is still likely to be low for the family.Īnother caveat is the timing of puberty. If the predicted height based on the bone age is still below the height expected for the family, further work-up is still indicated. However, there are several caveats to the diagnosis of constitutional delay of growth. If the bone age and pubertal stage are delayed, the child would be expected to have a later puberty than average and catch up in height by growing longer than average. If a child's height is below what is expected for the midparental height, the growth velocity is normal, and there are no signs of other disease, the next step is to assess the child's degree of pubertal development and obtain a bone age. Assessing the child's BMI or weight for height is also important, as insufficient calorie intake or calorie loss from issues such as malabsorption will also cause poor growth. An abnormal growth velocity requires further work-up into endocrine (hypothyroidism, growth hormone deficiency, sex steroid deficiency, cortisol excess, etc.) and non-endocrine causes (cardiac, renal, hepatic, gastroenterologic, hematologic or other disease) of growth delay. If the child has been growing at a normal growth velocity over time, pathologic causes of short stature are less likely. Plotting growth points and BMIĪnother important step is to plot previous growth points. If the child is within the range of their mid-parental height, the child likely has familial short stature (assuming the parents did not have medical issues limiting their growth). The next step is to obtain the parental heights and calculate a mid-parental height (taking the average of the parent's heights in inches and adding on 2.5 inches for a boy and subtracting 2.5 inches for a girl). The first step to take when seeing a short child is to carefully measure them and be certain their height is plotted accurately on the correct age and sex growth chart. While constitutional delay of growth, or being a "late bloomer" is a common cause of short stature, it should be considered a diagnosis of exclusion, first requiring ruling out other causes of short stature. CARP bone age was only 0.2 +/- 0.2 years more advanced than chronological age and the difference was not significant. Results: RUS bone age was 1.04 +/- 0.2 years more advanced than chronological age (P 0.0001). Height corresponded to 1 +/- 0.1 Z scores. In clearly pathological children, such as those with endocrinopathies, they do not apply.From a healthcare professional: If a child's bone age is delayed, are they always a late bloomer? The radius, ulna and short bones (RUS) and the carpal (CARP) bone age were assessed. The equations probably apply to girls complaining of tall stature and boys or girls complaining of shortness and needing reassurance as to normality. It is not clear which system is preferable. These have about the same accuracy as the equations based on initial classification by chronological age, but allowance for bone age retardation is less. An alternative system of equations which are based on initial classification by bone age rather than chronological age is given. One-third of the amount that midparent height differs from mean midparent height is added or subtracted. Prediction can be somewhat imporved by allowing for midparent height. Girls ages 4 to 11 are predicted to within plus or minus 6 cm premenarcheal girls aged 12 and 13 to within plus or minus 5 and plus or minus 4 cm, respectively and postmenarcheal girls aged 12 and 13 to within plus or minus 4 and plus or minus 3 cm, respectively. Boys aged 4 to 12 are predicted in 95% of instances to within plus or minus 7 cm of true height, and at ages 13 and 14 to within plus or minus 6 cm. The bone age used is the revised version of the Tanner-Whitehouse standards, omitting the score for carpal bones (RUS age, TW 2 system). ![]() These are based on longitudinal data from 116 boys and 95 girls of the Harpenden Growth Study and the London group of the International Children's Centre longitudinal study. There is a separate equation for each half year of chronological age and for pre- and postmenarcheal girls at ages 11 to 14. Multiple regression equations for predicting the adult height of boys and girls from height and bone age at ages 4 and upwards are presented.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |