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INTRODUCTION

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ACTH Adrenocorticotropin hormone
ALS Acid labile subunit
cAMP Cyclic adenosine monophosphate
CPHD Combined pituitary hormone deficiency
EGF Epidermal growth factor
EGF-R Epidermal growth factor receptor
FGF Fibroblast growth factor
FGF-R Fibroblast growth factor receptor
GH Growth hormone
GHBP Growth hormone–binding protein
GHRH Growth hormone–releasing hormone
GHSR Growth hormone secretagogue receptor
GnRH Gonadotropin-releasing hormone
hCG Human chorionic gonadotropin
hCS Human chorionic somatomammotropin
HDL High-density lipoprotein
HESX1 Hesx1 homeodomain
hGH Human growth hormone
IGF-I Insulin-like growth factor I
IGF-II Insulin-like growth factor II
IGFBP Insulin-like growth factor–binding protein
IGHD Isolated growth hormone deficiency
IUGR Intrauterine growth retardation or restriction
JAK-STAT Janus kinase-signal transducers and activators of transcription
LDL Low-density lipoprotein
LH Luteinizing hormone
LS Lower segment
MC4R Melanocortin 4 receptor
NSD1 Nuclear receptor–binding SET domain protein 1
Pit-1 Pituitary transcription factor 1
Prop-1 Prophet of Pit-1 homeobox 1
PTH Parathyroid hormone
PTPN11 Protein tyrosine phosphatase nonreceptor 11
RTA Renal tubular acidosis
SGA Small-for-gestational age
SHOX Short stature homeobox
SOD Septo-optic dysplasia
SRIF Somatostatin
TBG Thyroxine-binding globulin
TRH Thyrotropin-releasing hormone
TSH Thyrotropin
US Upper segment

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Assessment of growth in stature is an essential part of the pediatric examination. Growth is an important index of physical and mental health and of the quality of the child’s psychosocial environment; chronic problems in any of these areas may be reflected in a decreased growth rate which may be a critical clue as to the age of onset of the condition. We shall consider influences on normal growth, the normal growth pattern, the measurement of growth, and conditions that lead to disorders of growth.

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NORMAL GROWTH

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INTRAUTERINE GROWTH

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The growth of a fetus begins with a single fertilized cell and ends with differentiation into more than 200 cell types, length increasing by 5000-fold, surface area by 6 × 106-fold, and weight by 6 × 1012-fold. This all to leads to an approximately 7 lb newborn. Overall, the growth of the fetus is dependent on the availability of adequate oxygen and nutrition delivered by the placenta and is orchestrated by a group of growth factors, all overseen by a basic genetic plan. Genetic factors are more important early in gestation, whereas the maternal environment attains more importance late in gestation.

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The classic definition of small-for-gestational age (SGA), is a birth weight two standard deviations (SDs) below the mean or below the 5th percentile for birth weight, or birth weight below 2500 g for a term infant in the United States. The term intrauterine growth retardation or intrauterine growth restriction (IUGR) is not synonymous with SGA, because IUGR refers to decreased intrauterine growth velocity noted on ultrasound. Statistics and charts showing various percentiles of weight for gestational age are available to determine which premature infants are SGA and what weights are appropriate for gestational age (AGA). About 20% of ...

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