Growth Problems

Constitutional delay
Failure to thrive
Familial short stature
Obesity
Turner syndrome

  • Describe how the endocrine system contributes to pubertal development and vertical (linear) growth
  • Describe the physiology of pre- and post-natal growth
  • Describe the normal pattern of growth velocity in the fetus, infants, children, and adolescents
  • Differentiate abnormal growth from normal growth variants
  • Describe the physiological and psychological consequences of obesity and malnutrition

Overview & Foundational Knowledge

Nwosu BU & Lee MM. Evaluation of short and tall stature in children. American Family Physician 2008; 78(5): 597-604.

Evaluation and investigation of abnormal linear growth with calculations of mid-parental height and body proportions.

Jaffe AC. Failure to thrive: Current clinical concepts. Pediatrics in Review 2011; 32: 100-108.

Excellent review article on failure to thrive.

Goldstein MA, Dechant EJ & Beresin EV. Eating disorders. Pediatrics in Review 2011; 32(12): 508- 520.

Review article about important history and physical findings in eating disorders as well as the complications and management of anorexia bulimia.

Bradford NF. Overweight and obesity in children and adolescents. Primary Care. Clinics in Office Practice 2009; 36: 319-339.

Definitions, etiology and management of obesity but uses older Centre for Disease Control (CDC) charts.

Clinical Resources

A Health’s Professional’s Guide to using the new WHO growth charts (rather than the old CDC growth charts).

https://www.dietitians.ca/Downloads/Public/tcg-position-paper.aspx

Dieticians of Canada website.This article is a great guide for how to properly assess growth measurements in pediatrics. It includes definitions for classifying normal and abnormal growth; of note, uses the WHO growth charts (which are not necessarily used at all Canadian institutions – see link below)

http://www.cpeg-gcep.net/content/who-growth-charts-canada

The Canadian Pediatric Endocrine Group (CPEG) believes that it is optimal to have a single set of growth charts nationally and have therefore officially endorsed the 2014 revision to the WHO growth charts for Canada with a preference for the use of set 2 (see link).

Virtual Patients or Cases

Allen DB & Cuttler L. Short stature in childhood – Challenges and choices. NEJM 2013; 368: 1220-1228.

This article works through a case and highlights the distinguishing features of familial short stature and constitutional delay – the two most common causes of short stature in children.

Growth Problems

https://www.pedscases.com/possible-growth-delay-15-year-old-male

Podcasts on failure to thrive and pediatric obesity.

Clinical Presentations