{"id":156,"date":"2014-03-17T02:46:44","date_gmt":"2014-03-17T02:46:44","guid":{"rendered":"https:\/\/www.pupdoc.ca\/?page_id=156"},"modified":"2026-01-03T14:01:22","modified_gmt":"2026-01-03T14:01:22","slug":"growth-problems","status":"publish","type":"page","link":"https:\/\/www.pupdoc.ca\/en\/growth-problems\/","title":{"rendered":"Growth Challenges"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; inner_shadow=&#8221;on&#8221; fullwidth=&#8221;on&#8221; _builder_version=&#8221;4.16&#8243; background_color=&#8221;#961622&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_fullwidth_header title=&#8221;Growth Problems&#8221; text_orientation=&#8221;center&#8221; _builder_version=&#8221;4.16&#8243; background_color=&#8221;rgba(255, 255, 255, 0)&#8221; global_colors_info=&#8221;{}&#8221; button_one_text_size__hover_enabled=&#8221;off&#8221; button_one_text_size__hover=&#8221;null&#8221; button_two_text_size__hover_enabled=&#8221;off&#8221; button_two_text_size__hover=&#8221;null&#8221; button_one_text_color__hover_enabled=&#8221;off&#8221; button_one_text_color__hover=&#8221;null&#8221; button_two_text_color__hover_enabled=&#8221;off&#8221; button_two_text_color__hover=&#8221;null&#8221; button_one_border_width__hover_enabled=&#8221;off&#8221; button_one_border_width__hover=&#8221;null&#8221; button_two_border_width__hover_enabled=&#8221;off&#8221; button_two_border_width__hover=&#8221;null&#8221; button_one_border_color__hover_enabled=&#8221;off&#8221; button_one_border_color__hover=&#8221;null&#8221; button_two_border_color__hover_enabled=&#8221;off&#8221; button_two_border_color__hover=&#8221;null&#8221; button_one_border_radius__hover_enabled=&#8221;off&#8221; button_one_border_radius__hover=&#8221;null&#8221; button_two_border_radius__hover_enabled=&#8221;off&#8221; button_two_border_radius__hover=&#8221;null&#8221; button_one_letter_spacing__hover_enabled=&#8221;off&#8221; button_one_letter_spacing__hover=&#8221;null&#8221; button_two_letter_spacing__hover_enabled=&#8221;off&#8221; button_two_letter_spacing__hover=&#8221;null&#8221; button_one_bg_color__hover_enabled=&#8221;off&#8221; button_one_bg_color__hover=&#8221;null&#8221; button_two_bg_color__hover_enabled=&#8221;off&#8221; button_two_bg_color__hover=&#8221;null&#8221;][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; inner_shadow=&#8221;on&#8221; _builder_version=&#8221;4.16&#8243; background_color=&#8221;#ffffff&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_tabs module_class=&#8221;key-conditions&#8221; _builder_version=&#8221;4.27.4&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; hover_enabled=&#8221;0&#8243; z_index_tablet=&#8221;500&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;][et_pb_tab title=&#8221;Key Conditions&#8221; _builder_version=&#8221;4.27.4&#8243; body_font=&#8221;||||&#8221; tab_font=&#8221;||||&#8221; global_colors_info=&#8221;{}&#8221;]Constitutional delay<br \/>\nFailure to thrive<br \/>\nFamilial short stature<br \/>\nObesity<br \/>\nTurner syndrome<br \/>\n[\/et_pb_tab][et_pb_tab title=&#8221;Foundational Knowledge&#8221; _builder_version=&#8221;4.27.4&#8243; body_font=&#8221;||||&#8221; tab_font=&#8221;||||&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<ul>\n<li>Describe how the endocrine system contributes to pubertal development and vertical (linear) growth<\/li>\n<li>Describe the physiology of pre- and post-natal growth<\/li>\n<li>Describe the normal pattern of growth velocity in the fetus, infants, children, and adolescents<\/li>\n<li>Differentiate abnormal growth from normal growth variants<\/li>\n<li>Describe the physiological and psychological consequences of obesity and malnutrition<\/li>\n<\/ul>\n<p>[\/et_pb_tab][et_pb_tab title=&#8221;Resources&#8221; _builder_version=&#8221;4.27.4&#8243; body_font=&#8221;||||&#8221; tab_font=&#8221;||||&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<div class='et-learn-more clearfix'>\n\t\t\t\t\t<h3 class='heading-more'>Overview &amp; Foundational Knowledge<span class='et_learnmore_arrow'><span><\/span><\/span><\/h3>\n\t\t\t\t\t<div class='learn-more-content'><table>\n<tbody>\n<tr>\n<td><strong>Nwosu BU &amp; Lee MM.  Evaluation of short and tall stature in children.  American Family Physician 2008; 78(5): 597-604.<\/strong><\/p>\n<p><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18788236\/\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/pubmed.ncbi.nlm.nih.gov\/18788236\/<\/a><\/p>\n<p><em>Evaluation and investigation of abnormal linear growth with calculations of mid-parental height and body proportions.<\/em><\/td>\n<\/tr>\n<tr>\n<td><strong>Jaffe AC. Failure to thrive: Current clinical concepts. Pediatrics in Review 2011; 32: 100-108.<\/strong><\/p>\n<p><a href=\"https:\/\/doi.org\/10.1542\/pir.32-3-100\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/doi.org\/10.1542\/pir.32-3-100<\/a><\/p>\n<p><em>Excellent review article on failure to thrive.<\/em><\/td>\n<\/tr>\n<tr>\n<td><strong>Goldstein MA, Dechant EJ &amp; Beresin EV.  Eating disorders.  Pediatrics in Review 2011; 32(12): 508- 520.<\/strong><\/p>\n<p><a href=\"https:\/\/doi.org\/10.1542\/pir.32-12-508\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/doi.org\/10.1542\/pir.32-12-508<\/a><\/p>\n<p><em>Review article about important history and physical findings in eating disorders as well as the complications and management of anorexia bulimia.<\/em><\/td>\n<\/tr>\n<tr>\n<td><strong>Bradford NF. Overweight and obesity in children and adolescents.  Primary Care. Clinics in Office Practice 2009; 36: 319-339.<\/strong><\/p>\n<p><a href=\"https:\/\/doi.org\/10.1016\/j.pop.2009.01.002\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/doi.org\/10.1016\/j.pop.2009.01.002<\/a><\/p>\n<p><em>Definitions, etiology and management of obesity but uses older Centre for Disease Control (CDC) charts.<\/em><\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n\t\t\t\t<\/div><\/p>\n<div class='et-learn-more clearfix'>\n\t\t\t\t\t<h3 class='heading-more'>Clinical Resources<span class='et_learnmore_arrow'><span><\/span><\/span><\/h3>\n\t\t\t\t\t<div class='learn-more-content'><table>\n<tbody>\n<tr>\n<td><strong>A Health\u2019s Professional\u2019s Guide to using the new WHO growth charts (rather than the old CDC growth charts).<\/strong><\/p>\n<p><a href=\"https:\/\/www.dietitians.ca\/DietitiansOfCanada\/media\/Documents\/WHO%20Growth%20Charts\/2014-A-Health-Professionals-Guide-to-Using-the-Charts.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.dietitians.ca\/DietitiansOfCanada\/media\/Documents\/WHO%20Growth%20Charts\/2014-A-Health-Professionals-Guide-to-Using-the-Charts.pdf<\/a><\/p>\n<p><em>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 \u2013 see link below)<\/em><\/td>\n<\/tr>\n<tr>\n<td><strong>National growth charts from the Canadian Pediatric Endocrine Group (CPEG)<\/strong><\/p>\n<p><a href=\"http:\/\/www.cpeg-gcep.net\/content\/who-growth-charts-canada\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/www.cpeg-gcep.net\/content\/who-growth-charts-canada<\/a><\/p>\n<p><em>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).<\/em><\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n\t\t\t\t<\/div>\n<div class='et-learn-more clearfix'>\n\t\t\t\t\t<h3 class='heading-more'>Virtual Patients or Cases<span class='et_learnmore_arrow'><span><\/span><\/span><\/h3>\n\t\t\t\t\t<div class='learn-more-content'><table>\n<tbody>\n<tr>\n<td><strong>Allen DB &amp; Cuttler L. Short stature in childhood \u2013 Challenges and choices. NEJM 2013; 368: 1220-1228.<\/strong><\/p>\n<p><a href=\"https:\/\/doi.org\/10.1056\/nejmcp1213178\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/doi.org\/10.1056\/nejmcp1213178<\/a><\/p>\n<p><em>This article works through a case and highlights the distinguishing features of familial short stature and constitutional delay \u2013 the two most common causes of short stature in children.<\/em><\/td>\n<\/tr>\n<tr>\n<td><strong>Growth Problems<\/strong><\/p>\n<p><a href=\"https:\/\/www.pedscases.com\/possible-growth-delay-15-year-old-male\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.pedscases.com\/possible-growth-delay-15-year-old-male<\/a><\/p>\n<p><em>Podcasts on failure to thrive and pediatric obesity.<\/em><\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n\t\t\t\t<\/div>\n<div class='et-learn-more clearfix'>\n\t\t\t\t\t<h3 class='heading-more'>Cards<span class='et_learnmore_arrow'><span><\/span><\/span><\/h3>\n\t\t\t\t\t<div class='learn-more-content'><table>\n<tbody>\n<tr>\n<td><strong>Failure to Thrive: Low Weight<\/strong><\/p>\n<p><a href=\"https:\/\/cards.ucalgary.ca\/deck\/366\" target=\"_blank\" rel=\"noopener noreferrer\">Failure to Thrive: Low Weight<\/a><\/p>\n<p><em>Canuc-Paeds physician authored, replayable cases<\/em><\/td>\n<\/tr>\n<tr>\n<td><strong>Short Stature &#8211; Diagnosis<\/strong><\/p>\n<p><a href=\"https:\/\/cards.ucalgary.ca\/deck\/345\" target=\"_blank\" rel=\"noopener noreferrer\">Short Stature &#8211; Diagnosis<\/a><\/p>\n<p><em>Canuc-Paeds physician authored, replayable cases<\/em><\/td>\n<\/tr>\n<tr>\n<td><strong>Short Stature &#8211; Investigations<\/strong><\/p>\n<p><a href=\"https:\/\/cards.ucalgary.ca\/deck\/346\" target=\"_blank\" rel=\"noopener noreferrer\">Short Stature &#8211; Investigations<\/a><\/p>\n<p><em>Canuc-Paeds physician authored, replayable cases<\/em><\/td>\n<\/tr>\n<tr>\n<td><strong>Short Stature &#8211; Management<\/strong><\/p>\n<p><a href=\"https:\/\/cards.ucalgary.ca\/deck\/347\" target=\"_blank\" rel=\"noopener noreferrer\">Short Stature &#8211; Management<\/a><\/p>\n<p><em>Canuc-Paeds physician authored, replayable cases<\/em><\/td>\n<\/tr>\n<tr>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n\t\t\t\t<\/div>[\/et_pb_tab][\/et_pb_tabs][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; 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button_one_border_width__hover_enabled=&#8221;off&#8221; button_two_border_width__hover_enabled=&#8221;off&#8221; button_one_border_color__hover_enabled=&#8221;off&#8221; button_two_border_color__hover_enabled=&#8221;off&#8221; button_one_border_radius__hover_enabled=&#8221;off&#8221; button_two_border_radius__hover_enabled=&#8221;off&#8221; button_one_letter_spacing__hover_enabled=&#8221;off&#8221; button_two_letter_spacing__hover_enabled=&#8221;off&#8221; button_one_bg_color__hover_enabled=&#8221;off&#8221; button_two_bg_color__hover_enabled=&#8221;off&#8221;][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; background_color=&#8221;#ffffff&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row column_structure=&#8221;1_3,1_3,1_3&#8243; _builder_version=&#8221;4.16&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; custom_margin=&#8221;||0px|&#8221; custom_margin_tablet=&#8221;&#8221; custom_margin_phone=&#8221;&#8221; custom_margin_last_edited=&#8221;on|tablet&#8221; custom_padding=&#8221;||0px|&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_3&#8243; _builder_version=&#8221;4.16&#8243; background_position=&#8221;top_left&#8221; custom_padding=&#8221;||0px|&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;&#8221; custom_padding_last_edited=&#8221;on|desktop&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text module_class=&#8221;menu-clinical-line-height&#8221; _builder_version=&#8221;4.16&#8243; text_line_height=&#8221;1.4em&#8221; custom_margin=&#8221;||0px|&#8221; custom_margin_tablet=&#8221;&#8221; custom_margin_phone=&#8221;&#8221; custom_margin_last_edited=&#8221;on|desktop&#8221; custom_padding=&#8221;||0px|&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;&#8221; custom_padding_last_edited=&#8221;on|phone&#8221; border_style=&#8221;solid&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><a href=\"https:\/\/www.pupdoc.ca\/abdominal-pain-abdominal-mass\/\">Abdominal Pain &amp; Abdominal Mass<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/acutely-ill-child\/\">Acutely Ill Child<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/adolescent-health-issues\/\">Adolescent Health Issues<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/altered-loc\/\">Altered Level of Consciousness<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/bruising-bleeding\/\">Bruising \/ Bleeding<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/dehydration\/\">Dehydration<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/development-behavioural-learning-problems\/\">Development \/ Behavioural \/ Learning Problems<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/diarrhea\/\">Diarrhea<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/edema\/\">Edema<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/eye-issues\/\">Eye Issues<\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_3&#8243; _builder_version=&#8221;4.16&#8243; background_position=&#8221;top_left&#8221; custom_padding=&#8221;||0px|&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text module_class=&#8221;menu-clinical-line-height&#8221; _builder_version=&#8221;4.16&#8243; text_line_height=&#8221;1.4em&#8221; custom_margin=&#8221;||0px|&#8221; custom_padding=&#8221;||0px|&#8221; custom_css_main_element=&#8221;margin-bottom: 0px !important;&#8221; border_style=&#8221;solid&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><a href=\"https:\/\/www.pupdoc.ca\/fever\/\">Fever<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/genitourinary-complaints\/\">Genitourinary Complaints<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/growth-problems\/\"><strong>Growth Problems<\/strong><\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/headache\/\">Headache<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/inadequately-explained-injury\/\">Inadequately explained injury<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/limp-extremity-pain\/\">Limp \/ Extremity Pain<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/lymphadenopathy\/\">Lymphadenopathy<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/mental-health-concerns\/\">Mental Health Concerns<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/murmur\/\">Murmur<\/a><br \/><a href=\"https:\/\/www.pupdoc.ca\/neonatal-jaundice\/\">Neonatal Jaundice<\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_3&#8243; 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