1 / 67

Pediatrics Seminar

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.

bruno
Download Presentation

Pediatrics Seminar

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


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

  2. 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.

  3. 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.

  4. 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.

  5. Case Scenario: • P/E: • Growth Parameters: • Height: 120 cm. • Weight: 23 Kg. • Head Circumference: 52 cm.

  6. Stature

  7. Weight

  8. H.C.

  9. Wt-for-Ht.

  10. 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.

  11. Case Scenario: • P/E: • Breast: • Tanner I. • Wide spaced nipples are evident. • Pubic Hair: • Tanner I.

  12. 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.

  13. 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.

  14. An approach to short stature Preseted by: Fahd Alareashi

  15. Short Stature Outlines

  16. Short Stature Outlines

  17. Short Stature: • A child whose height is below the 3rd percentile for age and sex.

  18. 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.

  19. Short Stature Outlines

  20. Short Stature Outlines

  21. Growth Charts

  22. 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.

  23. Different Types of Growth Charts: Male Growth Charts Weight-for-Age Height-for-Age Weight-for-Height HC-for-Age

  24. Different Types of Growth Charts: Female Growth Charts Weight-for-Age Height-for-Age Weight-for-Height HC-for-Age

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

  26. Short stature with normal growth rate and delayed growth spurt with eventual achievement of normal adult stature. • “ CONSTITUTIONAL GROWTH DELAY “ Stature

  27. Normal growth rate. • Short stature in childhood. • Short stature in adults. • “ Familial Short Stature“ Stature

  28. “ Acquired Pathologic Short Stature“ Stature

  29. 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.

  30. 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

  31. CAUSES of:short stature

  32. Short Stature Outlines

  33. Short Stature Outlines

  34. Causes:

  35. Causes:

  36. Causes: • Most common. • Normal Growth Velocity. • Non Pathologic.

  37. Causes: Familial Short Stature Constitutional Growth Delay

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

  39. 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.

  40. Causes:

  41. Causes:

  42. Causes: Prenatal “ Primordial “ Postnatal

  43. Causes: Prenatal “ Primordial “ • All parameters are affected; Height, weight, & head circumference. • IUGR. • Chromosomal: Down syndrome, Turner syndrome. • Skeletal dysplasia. Proportionate

  44. 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

  45. Causes: Postnatal • Achondroplasia. • Rickets. • Hypothyroidism. Disproportionate

  46. Short Stature Outlines

  47. Short Stature Outlines

  48. Approach & Assessment of:short stature

  49. Assessment History Taking

  50. 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.

More Related