MNJ08-001
In relation to growth charts:
- Will the standards be applicable to all children?
- What reference data should be used for children older than 5 years?
- How will these new standards change current estimates of overweight (for 8 years old) and undernutrition (infancy) in children?
- Which countries were involved in WHO MGRS study.
- What is mid-parental height and target centiles?
Answer
- Can be applied to all children everywhere, regardless of ethnicity, socioeconomic status and type of feeding
- Zz WHO Reference 2007 for boys and girls, 5-19 years
-
- Washng rates will be substantially higher using thenew WHOstandards Withrespect to overweight, use of the new WHO standards will resultin a greater prevalence
- . 6countries representing different regions of the world: Brazil,Ghana, India, Norway, Oman, and the United States.
- . Boys. [(maternal height + 13) + paternal height] /2 Gurls: [maternal height + (paternal height - 13)]/2 Chart these range at "18 years"= Target range
MNJ08-002
* 10 years old Rajini, weight 38 kg and height 142 cm. Mother is 150 cm, father is 170 cm. Record this data: Calculate
- MPH
- Target range
- Height age
- Weight age
- Ideal height
- Stunted
- Wasted
Answer
MPH: 166.5 cm
- Target range: 158.5 to 174.5
- Height age: 10 years
- Weight age: 10 years
- Ideal height: 140 cm
- Stunted: No
- Wasted: No
MNJ08-003
11-year-old female Aditi was brought with history of fever 2 days, caused by "viral pharyngitis". Her doctor after "routine" measurement of height and weight asked her to undergo certain tests:
- Interpret the chart.
- Likely diagnosis. Is this puberty?
- Why this is not familial?
- What investigations to confirm the clinical suspicion?
Answer
Pe eee ee acts Pes pee Increasing height centiles crossing two lines Decreasing weight centles.
- Hyperthyroidism.
- Not pubertal spurt as weight loss 1s there
- Not genetic causes as growth velocity has increased (in genetic GV = Normal)
- T,/T,/TSH.
MNJ08-004
*
- What does this chart show?
- How do you interpret the red lines?
- Give the normal values for this parameter at different age groups
- What type of pathology do you think this child suffered from (give 2 examples)?
Answer
Growth velocity chart
- Sudden increase in growth velocity at age 7-8 years
- Normal growth velocity (see the table below)
- Precocious puberty and hyperthyroidism
| Age period | Gain in height | |
|---|---|---|
| 0-12 months | 25cm | |
| 2nd year | 12cm | |
| 3rd—4th years | 7om | |
| >4 years—puberty | 5 cm/year | |
| 12-13 years | 10 cm/year |
MNJ08-005
*
- In patient A, female, now age 11 years, what 1s your diagnosis? How do you interpret her growth chart?
- Patient B, born with weight 2.3 kg and length 47 cm. His mother is 152 cm and father is 160 cm. Both do not have a skeletal dysplasia. What is your diagnosis? Give 3 points on which you base your diagnosis
Answer
- Child A was atnormal GV tll5 years age but sudden increase in GV at 6-8 years age but again normal GV indicate some pathological conditions like precocious puberty or hyperthyroidism at this age but treatment was taken so again come in normal values.
- Famulial short stature, short parents, low birth weight, normal growth velocity.
MNJ08-006
*
- Name this device and mention its use
- What do the individual numbers signify?
- What you use if this device is not available during examination of a child with early puberty? And how you interpret the results?
Answer
Orchodometer, it 1s useful to know the testicular volume
- i bee a Individual number are teshcular volume
- If orchidometer 1s not available, then we can use simple scale-rular <2.5 em stage prepubertal (Stage-I) 2.5-3.2 cm = Pubertal Stage-II
3.2–4 cm = Stage-III 4–4.5 cm = Stage-IV >4.5 cm = Stage-V
MNJ08-007
* Match
Agarwal growth chart for girls depicting typical growth patterns in familial short stature (—), constitutional delay of growth and puberty (—), Turner syndrome (—) and hypothyroidism (—)
112
- Construction growth delay
- Familial
- Hypothyroid
- Turner
Answer
A-3, B-1, C-4, D-2
MNJ08-008
* May 2013:
Match the following in a child with short stature
- CA > BA = HA A Familial 2. CA = BA > HAB Celiac disease
3 CA > BA = HA + abnormal GV C. Constitutional
Match the following in a child with tall stature
1 CA < BA = HA A. Obesity
- CA < BA = HA + abnormal GV B Precocious puberty
Answer
See the text at beginning of the chapter.
MNJ08-009
*
Study the growth patterns of child A and child B. Answer the following questions
- What condition can lead to the pattern seen in child A?
Child-A
| ture-f | s: B ige |
We | igl | nt- | for | -a | ge | p | er | ce | nti | le | s | ΛE | RE | COF | RD | # . | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| or 1 | Manoj I | Kum | ar Si | han | ma | 1 | 2 | 13 | 3 | 14 | 15 | 5 | 16 | 1 | 7 | 18 | 1 | 9 | 20 | ||||||||||
| Mot | her's Stat | ure _ | Fat | her's | s Sta | ature | _ | É | 1 | - | 1 | 1 | 11 | 1 | 17 | T | Т | Ŧ | ľ | cm | |||||||||
| - 1 | Date | - | ge | 1 | We | ight | 4 | S | tatu | re | Ŧ | E | BMI* | A | i E | (1) | A | RS | )= | 400 | 76 | ||||||||
| _ | + | _ | _ | + | _ | _ | + | _ | _ | - | H | ŧ | # | - | 95 | 190 | 74 | ||||||||||||
| # | # | İ | ŧ | 1 | - | ŧ | -90 | 185 | 70 | ||||||||||||||||||||
| + | + | _ | _ | + | _ | _ | _ | 1 | 2 | 1 | 4 | ŧ | H | ≡75! | 180 | 72 | |||||||||||||
| t | Ħ | Z | 7 | 4 | L | =50 | |||||||||||||||||||||||
| _ | A4 | Selection | 20.7 | L | H | Z | X, | A | J | 4 | ŧ | -25 | 175 | 68 | |||||||||||||||
| *To C | Calculate | Weig | m) x | 10 | ,000 | 1 | X | X | 1 | × | H | Ī | |||||||||||||||||
| in | ±cm: | _ | 3=4 | _ | _ | _ | 10 | ο± | 11: | 7 | 4 | 1 | 1 | 4 | 1 | Ħ | I | E | 10 | 165 | -00 | ||||||||
| 160 | Ħ | Ĭ | Ĭ | ŧ | Ĭ | ŧ | Ĭ | Ï | Ϊ | 1 | 4 | 7 | ⊅ | 160 | -64 | ||||||||||||||
| -62 | + | Ħ | ŧ | ŧ | 1 | 1 | 4 | X. | 4 | 1 | ŧ | -62 | |||||||||||||||||
| -60 | 155 | Ħ | + | Ħ | ŧ | ŧ | 4 | 1/ | 4 | Λ | X | X | / | ŧ | ŧ | 155 | 60 | ||||||||||||
| 100 | = 150- | ŧ | Ħ | ŧ | ŧ | 1 | 4 | 4 | 4) | 4 | 1 | 1 | / | # | ŧ | 150 | - 00 | ||||||||||||
| -58 | 145 | ŧ | Ħ | ŧ | F | Z | 2 | 7 | 4, | Z | 1 | 7 | 7 | E | = | Ŧ | Ŧ | ||||||||||||
| -56 | Ŧ | 1 | 1 | 1 | 7 | 1 | F | 1 | Ŧ | F | 105 | E | |||||||||||||||||
| -54 | 140 | ŧ | П | * | 7 | Z | 1 | 1 | X | Z | Z | F | Ŧ | ŧ | 230 | ||||||||||||||
| 20700-0 | 135 | ŧ | , | И, | Z, | 1 | 7 | 4 | K | / | = | 100 | 220 | ||||||||||||||||
| -52 | 130 | Ħ | 1 | ١, | Z, | / | Z | 1 | 1 | ŧ | Ė | ŧ | ŧ | 95 | 95 | 210 | |||||||||||||
| -50 | 1 | 4 | K | M | Τ | X | Z | 1 | ŧ | ŧ | ŧ | , | 1 | 200 | |||||||||||||||
| -48 | 1 | ŧ | 1 | 4 | / | Ă, | 4 | ŧ | ŧ | E | # | 1 | 290 | 30 | 190 | ||||||||||||||
| -46 | 120 | Ħ | 1 | 1 | 1 | 1 | ŧ | Ħ | # | Ė | / | 7 | # | 85 | 100 | ||||||||||||||
| -115: | 1 | K) | 1 | X | 1 | ŧ | Ħ | ŧ | 1 | H | ŧ | -75° | 80 | 180 | |||||||||||||||
| -44 | 110 | 1 | A | 1 | A | 4 | ŧ | ŧ | , | / | 7 | 4 | * | 75 | 170 | ||||||||||||||
| -42 | 1 | 4 | 1 | 1 | 1 | ŧ | ١, | / | 1 | 4 | Z | 504 | ±160 | ||||||||||||||||
| -40 | 105 | M | 1 | Ŧ | ł | Ŧ | 1 | 1 | J | 4 | ≥ 50! | ±150 | |||||||||||||||||
| 1100.00 | 100: | 1 | 4 | П | ŧ | F | ŧ | =, | / | 1 | 1 | 1 | 4 | >25 | 65 | £140 | |||||||||||||
| -38 | 95 | M | 14 | Ŧ | Ħ | ŧ | ŧ | ١, | 4 | 1 | 4 | 1 | n | , | 1 | 7 | + | = 10- | 60 | 130 | |||||||||
| -36 | =90 | 1 | ŧ | 1 | ŧ | # | 1 | 1 | 1 | 1 | 4 | - | - | 5 | _ | 120 | |||||||||||||
| -34 | _ | /// | Ŧ | П | / | F | Χ | V | 1 | 4 | 1 | 1 | 1, | Z | 7 | 1 | 110 | ||||||||||||
| -32 | - | ŧ | Ħ | / | F | Χ | X | 1 | 1 | 1 | 4 | 7 | 1 | 1 | = | ||||||||||||||
| -00 | 1 | ŧ | ١, | 1 | 7 | 1 | X | Ζ | 1 | 4 | Z | 7 | 0.000 | 100 | |||||||||||||||
| -30 | - | 1 | 4 | , | Z | 1 | 1 | 4 | 1 | 4 | K | 40 | = 90 | ||||||||||||||||
| -80 | 35 | ı | 1 | 2 | 4 | 1 | 4 | 2 | 1 | ŧ | 35 | 80 | |||||||||||||||||
| -70 | Ħ | ŧ | 1 | 2 | $ | Z | 4 | 4 | 1 | ŧ | ŧ | F-70 | |||||||||||||||||
| -60 | 30 | , | / | ŧ | Ш | K | H | 2 | 1 | 1 | $ | 7 | ŧ | Ė | ŧ | ŧ | 30 | 160 | |||||||||||
| = 25 | Ħ | Ł | 1 | 2 | 4 | 1 | 1 | 1 | Ė | ŧ | 25 | = | |||||||||||||||||
| -50 | = 20 | 1 | * | 1 | 1 | 1 | 1 | F | 20 | = 50 | |||||||||||||||||||
| -40 | = | 1 | 1 | F | E-40 | ||||||||||||||||||||||||
| -30 | 7 | 1 | П | F | 15 | 1 00 | |||||||||||||||||||||||
| lb | 10 kg |
A | GE | 0 | /E/ | R | S) | 10 kg |
lb | ||||||||||||||||||||
| IN | 2 3 | 1 1 | 1 | - | - | 0 | - | - | - | 1 | 1 | 1 | 111 | 1 | 1 | 18 | 9 | Ein |
SOURCE: Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion (2000). http://www.cdc.gov/growthcharts
Child-B
| ure | _ | vve | SIĈ | JII | 1-10 | or. | aç | je | P | er | ce | п | ie | S | HE | CO | RD | # | - | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| lano | ar : | Sh | arm | na | 1 | 2 | 1 | 3 | 14 | 1 | 15 | 16 | 3 | 17 | 18 | 1 | 9 | 20 | |||||||||||||||
| er's St | atur | _ | _ | r's | Statu | _ | _ | - | _ | Ė | Ė | Ë | A | GE | C | YE | ARS | 3)= | Ĥ | - | Ë | Ė | Ì | cm | -in- | ||||||||
| D | ate | + | ρ | ge | _ | H | We | ight | - | H | Sta | tun | e | ٠ | - | 3MI | _ | E | Ì | 1 | 1 | E | 190 | ||||||||||
| 1 | t | E | ŧ | 1 | + | ŧ | 99 | 25 | 74- | ||||||||||||||||||||||||
| + | _ | _ | H | + | ŧ | ŧ | 1 | 7 | F | 185 | 72- | ||||||||||||||||||||||
| + | H | t | ۰ | E | 1 | 7 | 4 | Ħ | =75 | 5= | 180 | ||||||||||||||||||||||
| E | 1 | 7 | 1 | 1 | - | ŧ | =50 | 0= | 175 | _70· | |||||||||||||||||||||||
| T. 0 | 181 | de la | 211 | - | 200 | - | 0.00 | E | 1 | / | 1 | 4 | 1 | E | -25 | 5- | 68- | ||||||||||||||||
| 10 C | alcula | n) + | n) > | (10 | ,00 | 9 | 7 | 1 | 7 | X | 1 | E | 170 | - 00 | |||||||||||||||||||
| in: | cn | - | _ | 3= | - 4 | - | 5- | E | _ | -7 | - | 8= | -10 | 1 | 11 | + | , | 1 | 4, | 1 | 1 | + | + | E | 10 | 165 | -66 | ||||||
| - | = | Ŧ | Ĭ | = | Ĭ | , | _ | Ϊ | Ι, | Ζ, | Ź, | 4 | Λ | 1 | 4, | H | 1 | E | -64- | ||||||||||||||
| 62 | 160 | 4 | E | 1 | E | 1 | 1 | Z | 1 | 7 | 1 | 1 | ŧ | Ħ | 160 | -62- | |||||||||||||||||
| 15 | 5 | F | 1 | ŧ | ŧ | 1 | 1 | X, | X | Z | 1 | 4, | 4 | 4 | H | ŧ | F | H | 155 | ||||||||||||||
| 60 | 150 | 1 | 1 | ŧ | E | 1 | E | Χ | 4 | X | 1 | Ź | 4 | 4 | ŧ | Н | 1 | E | 150 | 60 | |||||||||||||
| 58 | - | Ħ | # | # | ŧ | Ħ | 1 | + | ŧ | 4 | 4 | X | 1 | Ź | 4 | + | ŧ | Ħ | # | ŧ | Ħ | ,100 | - | ||||||||||
| F0. | 14 | - | E | 7 | - | F | , | 1 | 4 | 1 | 1 | Z | 1 | Ŧ | Н | ŧ | E | = | |||||||||||||||
| 56 | 140 | 5 | 1 | ŧ | Ь | 1 | 4 | 1 | Ł | Z | Z | 1 | ŧ | Ħ | # | E | 105 | 230 | |||||||||||||||
| 54 | - | - | E | 1 | 1 | Ø | 1 | 7 | 4, | 1 | / | 1 | ŧ | Ħ | # | ŧ | = | ||||||||||||||||
| 52 | 13 | 7 | E | ٠, | 1 | E | H | 1 | 1 | 7 | 9 | 4 | 1 | ŧ | ŧ | E | 100 | ||||||||||||||||
| 130 | 1 | Ħ | / | ŧ | ŧ | 1 | 4 | 1 | ۲, | 4 | 7 | 2 | 1 | ŧ | ŧ | ŧ | Ħ | ŧ | - 95 | 54 | 95 | 210 | |||||||||||
| 50 | 12 | 1 | E | Z | 4 | 1 | 1 | 4 | 1 | П | =90- | 200 | |||||||||||||||||||||
| 48 | - | 1 | ŧ | E | 1 | 4 | 4 | 1 | 1 | 1 | ŧ | Ħ | 1 | b | 290 | 0= | 190 | ||||||||||||||||
| 40 | 120 | )+ | / | # | ŧ | 1 | 7 | 4 | 43 | Z | # | # | ŧ | # | # | ŧ | 1 | 4 | 4 | ŧ | Ħ | _85: | 100 | ||||||||||
| 46 | 11 | 5 / | 1 | 1 | 1 | 7 | 4 | / | F | / | Ŧ | 1 | 1 | 1 | E | 180 | |||||||||||||||||
| 44 | 110 | 4 | K | 1 | Z | 1 | ŧ | 1 | 4 | И | 1 | Ł | >75 | ) | _75 | 170 | |||||||||||||||||
| 42 | - | N | 1 | 1 | Z | 1 | 1 | ŧ | 1 | 4 | X | Ħ | ŧ | 160 | |||||||||||||||||||
| £10: | 5 | E | 1 | 1 | Z | 7 | E | Ŧ | 1 | 4 | 1 | 4 | Þ | =50 | 05 | = 70∃ | 150 | ||||||||||||||||
| 40 | 100 | 5 | 1 | 1 | 7 | / | ŧ | # | ŧ | ŧ | 7 | X | 1 | ŧ | 1 | ŧ | 65 | 140 | |||||||||||||||
| 38 | + | H | / | 4 | 1 | E | 1 | = | 1 | F | 1 | Z | 1 | 4 | Ы | 1 | F | >2 | 5 | ||||||||||||||
| 95 | 7 | 1/ | 4 | ŧ | E | / | 1 | Ē | ₫ | 1 | 1 | 1 | , | 1 | Z | 1 | E | = 10 | )= | =60: | 130 | ||||||||||||
| 36 | =90 | )# | 1 | # | ŧ | ŧ | F | ŧ | # | ١, | 1 | 1 | 7 | 4 | 1 | 4 | 4 | Þ | - | 5= | =55: | E120 | |||||||||||
| 34 | -85 | , / | 1 | I | 1 | E | Ι, | 1 | X | Z | 1 | 4 | 1 | 4, | E | -50- | 110 | ||||||||||||||||
| 32 | -1/ | 1 | 1 | ٥ | 1 | X | Έ, | 1 | 1 | 1 | 1 | E | = | ||||||||||||||||||||
| =80 | )= | Ħ | ١, | 1 | ŧ | + | ŧ | 4 | 1 | X | Z | 1 | 7 | 1 | # | ŧ | Ħ | 7.25.25.25 | 100 | ||||||||||||||
| 30- | 1 | H | 1 | E | 1 | Z, | 1 | 4 | 7 | 4 | Z, | 7 | Н | Ŧ | E | 40 | 90 | ||||||||||||||||
| 80: | =35 | H | 1 | ŧ | E | 7 | 4 | 1 | 1 | 1 | 3 | 4 | Ħ | ŧ | E | 35 | 80 | ||||||||||||||||
| 70 | 1 | ŧ | ŧ | X | 1 | Z | 4 | 1 | 4 | 7 | 2 | ŧ | Ħ | # | ŧ | Ħ | 00 | E-70 | |||||||||||||||
| 177 | 1 3 | ) | 1 | ŧ | E | 1 | 4 | P | 1 | 4 | 2 | 1 | Ŧ | E | =30 | E | |||||||||||||||||
| 60 | =2 | 5 | # | ŧ | ١, | 1 | 2 | 7 | 1 | 1 | 3 | 4 | 1 | ŧ | 1 | ŧ | Ħ | ŧ | ŧ | Ħ | -25 | -70 -60 |
|||||||||||
| 50 | 1 | 8 | 1 | 2 | E | 1 | F | Ħ | F | -50 | |||||||||||||||||||||||
| 40 | =20 | 1 | 1 | $ | 2 | 1 | 1 | Ħ | =20 | 40 | |||||||||||||||||||||||
| 30 | =15 | 5 | E | # | # | 1 | F | F | F | П | F | =15 | 30 | ||||||||||||||||||||
| 30 | 10 | =10 | E 30 | ||||||||||||||||||||||||||||||
| lb: | kç | 1 | 1 | F | F | E | A | GE | C | YE | AR | SI | Ŧ | E | Ib |
Published May 30, 2000 (modified 11/21/00).
SOURCE: Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
SAFER HEALTHIER-PEOPLE
- Identify the chart
- What phenomenon is sought to be reflected in the sequential plot of values in this chart?
- What does the arrow indicate? What is the significance of this?
- What is difference between child A and child B?
- How will the child A and child B be classified at 16 years age in terms of their BMI?
- Interpret the findings in respect of child A and child B and enlist them.
- What is the commonest cause of the pattern seen in child A? Enlist 1 more condition which can result in a similar picture.
- What is the basis of pattern seen in child B?
- What will the weight-for-height plot show for child A.
Answer
- CDC 2000 BMI-for-age percentile plot
-
- Tracking of BMI from early childhood into adolescence
-
- Adiposity rebound; early rebound associated with obesity
-
- Earlier adiposity rebound in case of child A as compared to child B
-
- Overweight (child A); risk for overweight (child B)
MNJ08-010
* Growth assessment station:
This male child was born on 09 July 2000.
- Assess the height and weight parameters of the child.
- The fathers height is 168 cm and the mothers height is 158 cm. What is the child's expected adult height?
- Does the child require evaluation for short stature or obesity? You are required to enumerate the steps of calculation.
Answer
No model answer in source material.
MNJ08-011
-
Write relation of bone age, height age and chronological age and growth velocity. w.r.t. each of the example.
-
a What are he doing in image A?
-
b What is his possible development age?
-
c What is important social milestone at this age?
- Identify EACH of the growth patterns.
Answer
No model answer in source material.