Paediatric-History taking & Physical examination of a children with short stature

Paediatric-History taking & Physical examination of a children with short statureCreated OnApril 28, 2020Last Updated OnApril 28, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of a children with short stature < All Topics Table of Contents History taking: Ask about patient’s info: Name, age, gender Ask about the chief complaint and relevant history of presenting illness Since when inadequate growth observed? Ask about systemic review of cardiac, pulmonary, renal, GIT, endocrine problems Ask about past medical history CVS, RS, Renal, GIT, endocrine disease + treatment given Ask about drug history Steroid use (mode of administration, duration, dosage) Ask about antenatal history Placental insufficiency (PIH, GDM) IUGR/ SGA Intrauterine infection Maternal smoking/ alcohol/ drug Ask about birth history Mode of delivery Birth weight Feeding issues? Neonatal complications? – NNJ/ neonatal hypoglycaemia/ micropenis NICU stay? Ask about developmental history Ask about immunization history Ask about feeding history Quality and quantity of food intake How is the appetite? How is the energy level? Active? How is the bowel habit? Any food allergy? Ask about family history Parental consanguinity History of familial diseases Height and age of puberty of parents and siblings Ask about social history Family’s financial status Stressor at home/ school Physical examination: Anthropometry Height, weight, head circumference < 2yo, measure length in lying position on a sliding board > 2yo, measure height in a standing position, and head in a Frankfurt position, using a stadiometer or portable anthropometer Lower segment (LS): distance from pubic symphysis to the floor) Upper segment (US): total height – LS Normal values of US:LS ratio: 1.7 @ birth, 1.3 @ 3yo, 1.0 @ 8yo, 0.9 @ 18yo If US:LS ratio increased: shorter lower limbs (skeletal dysplasia, hypothyroidism) If US:LS ratio decreased: short trunk (scoliosis, osteogenesis imperfect)/ short neck Arm span Distance between tips of middle fingers of both arms, outstretch at right angles to the body (measured across the back) Normal values (arm span – height): -3cm (0 – 7yo), 0cm (8 – 12yo), +4cm (boys) and +1cm (girls) at 14yo Short arm span: skeletal dysplasia, achondroplasia Large arm span: Marfan syndrome, Klinefelter’s syndrome If short arm span + high US:LS ratio: short limbs normal trunk/ normal limbs long trunk If short arm span + normal to low ratio: short trunk and limbs Growth velocity – serial measurements General examination Dysmorphic features (Turner or Noonan syndrome) General build – signs of malnutrition, muscle wasting, signs of neglect or child abuse Disproportionate short stature – achondroplasia Hypothyroidism: coarse face, dry skin, hair loss, macroglossia, reduced tone Cushing syndrome: buffalo hump, moon facies, abdominal striae, HTN Congenital GH deficiency: midline abnormalities Pubertal examination (Tanner staging) Delayed puberty: pituitary disorders, chronic illness Normal puberty: familial short stature Advanced puberty: precocious puberty Females SMR Stage Pubic hair Breasts 1 Preadolescent Preadolescent SMR Stage Pubic Hair Breasts 2 Sparse, light pigmented, straight, medial border of labia Breast and papilla elevated as small mound; diameter of areola increase SMR Stage Pubic hair Breasts 3 Darker, start to curl, more Breast and areola enlarged, no contour separation SMR Stage Pubic hair Breasts 4 Coarse, curly, abundant, but less than adult Areola and papilla form secondary mound SMR Stage Pubic hair Breasts 5 Adult feminine triangle Mature, nipple projects, areola part of breast contour Males SMR stage Pubic hair Penis Testis 1 None Preadolescent Preadolescent 2 Scanty, long, slightly pigmented Minimal enlargement Enlarged scrotum, pink SMR stage Pubic hair Penis Testis 3 Darker, curl, small amount Lengthens Larger SMR stage Pubic hair Penis Testis 4 Resemble adult type, but less quantity; coarse, curly Larger; glans and breadth increase Larger,...

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