Growth and development Samir Najjar M D Professor

Growth and development Samir Najjar M. D Professor, Department of Pediatrics

Stages of growth and development • Intrauterine • Infancy • Childhood • Adolescence • Adulthood

Intrauterine Growth • Greatest length velocity at mid fetal life • Development of adipose tissue at 7 months • weight doubles in the last 2 months • Weight loss beyond 40 weeks

Constrains on intrauterine growth • Uterine size • Placenta • Size of the mother

Infancy • The era of changing growth rate

Childhood • The era of stable growth rate

Adolescence • The era of sex hormone induced shifting growth

What is short stature

CLASSIFICATION OF SHORT STATURE PATHOLOGIC NORMAL VARIANTS • Familiar short stature • Constitutional growth delay PROPORTIONATE PRENATAL DISPROPORTIONATE • Skeletal dysplasia • Rickets • Intrauterine growth retardation (IUGR) • Placental diseases • Infections • Teratogens • Dysmorphic syndromes • Chromosomal disorders POSTNATAL • Malnutrition • Chronic diseases • Gastrointestinal • Cardiopulmonary • Infections • Renal • Hematologic • Drugs • Psychosocial dwarfism • Endocrine disorder

CLASSIFICATION OF SHORT STATURE PATHOLOGIC NORMAL VARIANTS • Familiar short stature • Constitutional growth delay PROPORTIONATE PRENATAL DISPROPORTIONATE • Skeletal dysplasia • Rickets • Intrauterine growth retardation (IUGR) • Placental diseases • Infections • Teratogens • Dysmorphic syndromes • Chromosomal disorders POSTNATAL • Malnutrition • Chronic diseases • Gastrointestinal • Cardiopulmonary • Infections • Renal • Hematologic • Drugs • Psychosocial dwarfism • Endocrine disorder

CLASSIFICATION OF SHORT STATURE PATHOLOGIC NORMAL VARIANTS • Familiar short stature • Constitutional growth delay PROPORTIONATE PRENATAL DISPROPORTIONATE • Skeletal dysplasia • Rickets • Intrauterine growth retardation (IUGR) • Placental diseases • Infections • Teratogens • Dysmorphic syndromes • Chromosomal disorders POSTNATAL • Malnutrition • Chronic diseases • Gastrointestinal • Cardiopulmonary • Infections • Renal • Hematologic • Drugs • Psychosocial dwarfism • Endocrine disorder

CLASSIFICATION OF SHORT STATURE PATHOLOGIC NORMAL VARIANTS • Familiar short stature • Constitutional growth delay PROPORTIONATE PRENATAL DISPROPORTIONATE • Skeletal dysplasia • Rickets • Intrauterine growth retardation (IUGR) • Placental diseases • Infections • Teratogens • Dysmorphic syndromes • Chromosomal disorders POSTNATAL • Malnutrition • Chronic diseases • Gastrointestinal • Cardiopulmonary • Infections • Renal • Hematologic • Drugs • Psychosocial dwarfism • Endocrine disorder

CLASSIFICATION OF SHORT STATURE PATHOLOGIC NORMAL VARIANTS • Familiar short stature • Constitutional growth delay PROPORTIONATE PRENATAL DISPROPORTIONATE • Skeletal dysplasia • Rickets • Intrauterine growth retardation (IUGR) • Placental diseases • Infections • Teratogens • Dysmorphic syndromes • Chromosomal disorders POSTNATAL • Malnutrition • Chronic diseases • Gastrointestinal • Cardiopulmonary • Infections • Renal • Hematologic • Drugs • Psychosocial dwarfism • Endocrine disorder

Accepted indications for GH therapy • Childhood GH deficiency • Growth failure associated with chronic renal insufficiency • Turner syndrome • IUGR • Adults with GH deficiency