1. Yes, they can be applied to all children everywhere, regardless of ethnicity, socioeconomic status, and type of feeding (growth in early childhood is primarily driven by nutrition, environment, and healthcare).
2. WHO Reference 2007 for boys and girls (5–19 years).
3. Wasting/undernutrition rates in infancy will be substantially higher using the new WHO standards. With respect to overweight, use of the new WHO standards will result in a greater prevalence of overweight/obesity detection.
4. Six countries representing diverse geographic regions: Brazil, Ghana, India, Norway, Oman, and the United States.
5. Mid-Parental Height (MPH):
   • Boys: $\frac{\text{Maternal Height}+13\text{ cm}+\text{Paternal Height}}{2}$
   • Girls: $\frac{\text{Maternal Height}+(\text{Paternal Height}-13\text{ cm})}{2}$
   • Target range: $\text{MPH}\pm 5\text{ cm}$ (or $\pm 8.5\text{ cm}$ plotted at 18 years).

1. MPH: $\frac{150+(170-13)}{2}=\frac{150+157}{2}=153.5\text{ cm}$ (or calculated for boys/girls respectively; raw text note states: $153.5\text{–}166.5\text{ cm}$).
2. Target range: $\text{MPH}\pm 5\text{ cm}$ to $\pm 8\text{ cm}$ (approx $158.5\text{ to }174.5\text{ cm}$).
3. Height age: 10.5 years (age at which 142 cm is the 50th centile).
4. Weight age: 11 years (age at which 38 kg is the 50th centile).
5. Ideal height: ~138–140 cm (50th percentile for a 10-year-old girl).
6. Stunted: No (Height is between 50th and 75th centiles).
7. Wasted: No (Weight is appropriate/slightly above for height).

1. Interpretation: Increasing height centiles (crossing two percentile lines upwards, accelerated growth velocity) accompanied by decreasing weight centiles (weight loss).
2. Likely diagnosis: Hyperthyroidism (Thyrotoxicosis). It is not a normal pubertal spurt because there is significant concomitant weight loss.
3. Not familial: In familial tall/short stature, the growth velocity is normal and follows a constant centile channel; here the growth velocity is abnormally accelerated crossing percentiles.
4. Investigations: Free T3, Free T4, and Serum TSH.

1. Chart: Height velocity (growth velocity) chart.
2. Interpretation: Sudden sharp acceleration in growth velocity above the 97th centile at age 7–8 years, followed by rapid deceleration.
3. Normal Growth Velocity by Age:

Age Period	Gain in Height
0–12 months	25 cm/year
1–2 years (2nd year)	12 cm/year
2–3 years (3rd year)	8 cm/year
3–4 years (4th year)	7 cm/year
4 years to onset of puberty	5–6 cm/year
Pubertal spurt	8–10 cm/year (girls), 10–12 cm/year (boys)

4. Pathology: Endocrine/accelerated growth conditions, e.g., Precocious Puberty, Hyperthyroidism, Growth-hormone secreting tumor.

1. Patient A:
   • Diagnosis: Precocious puberty (or hyperthyroidism) successfully treated.
   • Interpretation: Normal growth velocity till 5 years, followed by sudden acceleration in growth velocity between 6–8 years (crossing percentiles upwards), which normalized back parallel to centiles after treatment.
2. Patient B:
   • Diagnosis: Familial Short Stature (Genetic Short Stature).
   • Basis of diagnosis:
     1. Short parents (target height is low/matches child's centile).
     2. Normal growth velocity parallel to and just below the 3rd centile.
     3. Chronological age = Bone age > Height age ($\text{CA}=\text{BA}>\text{HA}$).

1. Device: Prader Orchidometer. Used to assess testicular volume for pubertal staging.
2. Individual numbers: Testicular volume in milliliters ($\text{mL}$), ranging from $1\text{ mL}$ to $25\text{ mL}$.
   • Prepubertal: $1\text{–}3\text{ mL}$
   • Pubertal onset (Tanner Stage 2): $\ge 4\text{ mL}$
   • Adult: $15\text{–}25\text{ mL}$
3. Alternative: Simple ruler to measure testicular long-axis length:
   • $<2.5\text{ cm}$: Prepubertal (Tanner Stage 1)
   • $2.5\text{–}3.2\text{ cm}$: Pubertal onset (Stage 2)
   • $3.3\text{–}4.0\text{ cm}$: Stage 3
   • $4.1\text{–}4.5\text{ cm}$: Stage 4
   • $>4.5\text{ cm}$: Stage 5 (Adult)

• A $\to$ 3: Hypothyroidism (severe deceleration of growth velocity crossing percentiles downwards)
• B $\to$ 1: Constitutional delay of growth and puberty (growth parallel below 3rd centile with delayed pubertal spurt achieving normal adult height)
• C $\to$ 4: Turner syndrome (progressive loss of height centiles during childhood and absent pubertal growth spurt)
• D $\to$ 2: Familial short stature (growth parallel to 3rd centile, normal timing of puberty, adult height within target range)

Match: A-3, B-1, C-4, D-2.

A. Short Stature:

• 1 – C: $\text{CA}>\text{BA}=\text{HA}$ with normal GV $\to$ Constitutional Delay of Growth and Puberty
• 2 – A: $\text{CA}=\text{BA}>\text{HA}$ with normal GV $\to$ Familial Short Stature
• 3 – B: $\text{CA}>\text{BA}=\text{HA}$ with abnormal GV $\to$ Pathological / Systemic (e.g., Celiac disease, Hypothyroidism, PEM)

B. Tall Stature:

• 1 – A: $\text{CA}<\text{BA}=\text{HA}$ with normal GV $\to$ Simple / Exogenous Obesity
• 2 – B: $\text{CA}<\text{BA}=\text{HA}$ with abnormal GV $\to$ Precocious Puberty

1. CDC 2000 BMI-for-age percentile growth chart (2 to 20 years).
2. Tracking of BMI from early childhood into adolescence.
3. Adiposity rebound: The normal nadir (lowest point) and subsequent rise in BMI occurring around 5–6 years of age. An early adiposity rebound (e.g., before 5 years) is strongly associated with an increased risk of adolescent and adult obesity.
4. Difference: Child A shows early adiposity rebound (around 3–4 years of age) with BMI rising across percentiles, whereas Child B shows normal timing of adiposity rebound (around 6 years of age).
5. Classification at 16 years:
   • Child A: Obese / Overweight ($\text{BMI}\ge 95\text{th percentile}$).
   • Child B: Normal weight ($\text{BMI between 5th and 85th percentiles}$).

1. Interpretation:
   • Child A: Decelerated linear growth (falling height centiles) with overweight/increasing weight centiles.
   • Child B: Accelerated linear growth (tall stature) accompanying increasing overweight.
2. Condition in Child A: Corticosteroid excess / Endocrine obesity (e.g., Cushing syndrome, Hypothyroidism).
3. Causes for Child A:
   • Commonest: Iatrogenic / Exogenous corticosteroid therapy.
   • Other: Endogenous Cushing syndrome (Cushing disease, adrenal adenoma) or primary hypothyroidism.
4. Basis in Child B: Simple / Exogenous (nutritional) obesity (which typically stimulates linear growth and advance in bone age).
5. Weight-for-height plot in Child A: Markedly increased weight-to-height ratio ($>95\text{th percentile}$).

1. Steps in physical growth assessment:

   • Introduce self and make child comfortable.
   • Calculate exact decimal chronological age from birth date.
   • Obtain accurate weight (minimum clothing/underwear) and standing height using a calibrated stadiometer (Frankfurt horizontal plane).
   • Select appropriate growth chart (e.g., IAP 2015 / WHO charts).
   • Plot height-for-age, weight-for-age, and BMI-for-age.
   • Interpret percentiles for wasting, stunting, or overweight.

2. Mid-Parental / Expected Adult Height:

   • $\text{Mid-Parental Height (MPH)}=\frac{\text{Father’s height}+\text{Mother’s height}+13\text{ cm}}{2}=\frac{168+158+13}{2}=\frac{339}{2}=169.5\text{ cm}$
   • Target Range: $169.5\pm 5\text{ cm}$ ($164.5\text{–}174.5\text{ cm}$).

3. Evaluation Criteria:

   • Short Stature Evaluation: Indicated if height-for-age is $<3\text{rd percentile}$ (or $<-2\text{ SD}$) OR if projected adult height is $>5\text{ cm}$ below target height range.
   • Obesity Evaluation:
     • $\text{BMI}=\frac{\text{Weight (kg)}}{(\text{Height in m}{)}^2}$
     • Plot on BMI-for-age chart:
       • $5\text{th–}85\text{th percentile}$: Normal weight.
       • $85\text{th–}94\text{th percentile}$: Overweight / Risk of obesity.
       • $\ge 95\text{th percentile}$: Obesity (requires detailed evaluation).

1. Pattern 1: Constitutional Delay of Growth and Puberty (CDGP)

   • $\text{CA}>\text{BA}\approx \text{HA}$
   • Growth Velocity: Normal

2. Pattern 2: Acquired Growth Failure / Systemic Illness (e.g., Hypothyroidism, Celiac Disease, PEM)

   • $\text{CA}>\text{BA}\approx \text{HA}$
   • Growth Velocity: Subnormal / Decreased (abnormal)

3. Pattern 3: Familial Short Stature (Genetic Short Stature)

   • $\text{CA}\approx \text{BA}>\text{HA}$
   • Growth Velocity: Normal

4. Pattern 4: Endocrine Short Stature / Chromosomal (e.g., Turner Syndrome, Growth Hormone Deficiency)

   • $\text{CA}\approx \text{BA}>\text{HA}$ (or delayed BA)
   • Growth Velocity: Subnormal / Decreased (abnormal)

1. Inferior/mature pincer grasp (picking up a small object/pellet with thumb and index finger).
2. 9–12 months (mature neat pincer grasp at 10–12 months; crude pincer at 9 months).
3. Stranger anxiety / Waves "bye-bye" / Plays peek-a-boo.