Paediatrics ESSAYS - Есета по Педиатрия на английски език

1. Growth and Puberty

Normal growth
• Can be divided into 2 phases:
o Pre-natal/ foetal growth:
▪ Maternal factors most important
o Postnatal growth:
▪ Infantile (birth → 2 yrs). Decelerating growth rate. Dependent on nutrition, insulin and
thyroxine.
▪ Childhood: slow steady growth velocity. Dependent on GH and thyroxine.
▪ Puberty: dependent on GH and sex hormones (testosterone/ oestrogen).

• Recording growth:
o UK-WHO growth charts for children aged 0-4.
▪ Ethno-specific growth charts
• Tall = Dutch, Afro-Caribbean
• Short = Gujurati, Urdu, Punjabi
o On the growth chart, plot:
▪ Head circumference:
• OFC (occipital-frontal circumference)
• 33-35cm at birth
• 1cm/ month for first year.
▪ Length/ height:
• Height at birth + 2cm a month
• 0-2yo: lying naked infant with head and feet held
• Head → HEEL.
• >2yo: wall mounted stadometer. Shoes and socks off. Eyes at ear level.
▪ Weight:
• Naked on scales
• Normal = 3.5kg at term
• <2.5kg = low birth weight
o <1.5kg = very low
o <1kg = extremely low
• Small for gestational age = <10
th centile.
o Weight gain:
▪ Normal to lose <10% of weight in 2 weeks after birth.
▪ X2 at 6mo; x3 at year.
▪ Normal rates of weight gain:
• 1
st 3 mo: 30g/ day
• 3-6 mo: 20g/day
• 6-12 mo: 15g/ day
o BEWARE of centile crossing: can indicate pathology
▪ E.g. head circumference → hydrocephalus?

o Plotting preterm infants:
▪ Use a separate low birth-weight chart for <32 weeks
▪ Pre-term section only has charts for WEIGHT and OFC.
▪ Use preterm sections of WHO chart for <37 weeks (≤36)
• Use up until EDD + 2 weeks
▪ >42 weeks, plot on with gestational correction (also do this if they are pre-term):
• Draw dot on actual age in weeks
• Then draw arrow backwards/ forwards to