pediatrics seminar
Download
Skip this Video
Download Presentation
Pediatrics Seminar

Loading in 2 Seconds...

play fullscreen
1 / 67

Pediatrics Seminar - PowerPoint PPT Presentation


  • 108 Views
  • Uploaded on

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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Pediatrics Seminar' - bruno


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
pediatrics seminar

Pediatrics Seminar

Preseted by: Fahd Alareashi & ??????????

case scenario
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.
case scenario1
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.
case scenario2
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.
case scenario3
Case Scenario:
  • P/E:
      • Growth Parameters:
              • Height: 120 cm.
              • Weight: 23 Kg.
              • Head Circumference: 52 cm.
case scenario4
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.
case scenario5
Case Scenario:
  • P/E:
      • Breast:
              • Tanner I.
              • Wide spaced nipples are evident.
      • Pubic Hair:
              • Tanner I.
case scenario6
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.
case scenario7
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.
an approach to short stature

An approach to short stature

Preseted by: Fahd Alareashi

short stature2
Short Stature:
  • A child whose height is below the 3rd percentile for age and sex.
growth failure
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.
growth charts1
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.
different types of growth charts
Different Types of Growth Charts:

Male

Growth

Charts

Weight-for-Age

Height-for-Age

Weight-for-Height

HC-for-Age

different types of growth charts1
Different Types of Growth Charts:

Female

Growth

Charts

Weight-for-Age

Height-for-Age

Weight-for-Height

HC-for-Age

growth charts2
Growth Charts:
  • Assessment:
                  • Short Stature: Height < 3rd percentile.
                  • Growth Failure:
                  • Height crossing 2 major percentiles.
                  • Low growth velocity: Rate < 25th percentile.
slide26

Short stature with normal growth rate and delayed growth spurt with eventual achievement of normal adult stature.

  • “ CONSTITUTIONAL GROWTH DELAY “

Stature

slide27

Normal growth rate.

  • Short stature in childhood.
  • Short stature in adults.
  • “ Familial Short Stature“

Stature

special types of growth
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.
mid parental height
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

causes2
Causes:
  • Most common.
  • Normal Growth Velocity.
  • Non Pathologic.
causes3
Causes:

Familial Short Stature

Constitutional Growth Delay

causes4
Causes:

Familial Short Stature

  • Short parents.
  • Born short.
  • Bone age (X-ray): Chronological age.
  • Puberty occurs at time.
  • No treatment is indicated.
causes5
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.
causes8
Causes:

Prenatal “ Primordial “

Postnatal

causes9
Causes:

Prenatal “ Primordial “

  • All parameters are affected; Height, weight, & head circumference.
  • IUGR.
  • Chromosomal: Down syndrome, Turner syndrome.
  • Skeletal dysplasia.

Proportionate

causes10
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

causes11
Causes:

Postnatal

  • Achondroplasia.
  • Rickets.
  • Hypothyroidism.

Disproportionate

a ssessment
Assessment

History Taking

history
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.
history1
History:
  • Nutritional History?
  • Symptoms suggesting systemic chronic diseases:
            • Dyspnea?
            • Sweating with feeding?
            • Recurrent respiratory infection?
            • Chronic diarrhea?
            • Fatigue, cold intolerance? “hypothyroidism”
            • Recent weight gain, acne, mood swing? “Cushing”
history2
History:
  • Syndromes?
            • Down syndrome, Turner syndrome?...
  • Family History?
            • Short stature?
            • Chronic illnesses.
            • Neglect? Starvation?
history3
History:
  • Drug History?
            • Corticosteroids?
            • Insulin?
  • Development History?
            • Delayed?
  • Systemic Review:
            • A complete review of systems needs to be undertaken in order to help exclude an undiagnosed syndrome or chronic medical condition
a ssessment1
Assessment

Physical Examination

physical examination
Physical Examination:
  • Vital Signs.
  • Anthropometric Measurements:
          • Height:
                • Plotted on growth chart.
                • Height velocity growth chart in the 6 – 12 months.
          • Nutritional Assessment:
                • Mid arm circumference.
                • Weight for age and weight for height.
physical examination1
Physical Examination:
  • Vital Signs.
  • Anthropometric Measurements:
          • Proportionate / Disproportionate:
                • Upper / lower segment ratio.
                • Arm span minus Height.
physical examination2
Physical Examination:
  • Vital Signs.
  • Anthropometric Measurements:
          • Calculate Mid-parental Age:

Girls:

=

[Mother’s Height + Father’s Height - 13]

2

Boys:

=

[Mother’s Height + Father’s Height + 13]

2

physical examination3
Physical Examination:
  • Dysmorphic Features?
              • Down Syndrome? Turner Syndrome?
              • Single palmar crease, webbed neck, low hairline,..
              • Moon face “Cushing”?
  • Puberty Assessment (Tanner Staging):
  • Examinations for systemic illnesses.
a ssessment2
Assessment

Investigations

investigations
Investigations:
  • Bone age.
  • Wrist X-ray for rickets:
  • Skeletal survey for skeletal dysplasia:
            • a series of X-rays of all the bones in the body, or at least the axial skeleton and the large cortical bones.
  • Karyotyping.
investigations1
Investigations:
  • Ca, P, Alkaline phosphatase.
  • LFTs, RFTs.
  • ESR.
  • Sweat chloride test for cystic fibrosis.
investigations2
Investigations:
  • Endocrinal studies:
        • T4, TSH,
        • GH:
            • Basal level.
            • Level after pituitary stimulation: exercises, clonidin or arginin.
management1
Management:
  • Non-pathological short stature:
          • No treatment is required.
  • Pathologic short stature:
          • Manage the underlying cause.
          • Growth Hormone GH:
            • GH Therapy if the following criteria are met:
              • GH shown to be deficient by 2 different stimulation tests.
              • Patient is short, insufficent growth velocity, <3rd percentile.
              • Bone age x-rays show unfused epiphyses
              • Turner syndrome, Noonan syndrome, chronic renal failure.
ad