Children: Developmental Disorders

GROWTH AND PUBERTY PROBLEMS

Short stature

This is considered to be a psychosocial and physical handicap if the definitive height is in:

• males <162.6 cm (5′ 4″)

• females <152.4 cm (5′ 0″)

General causes to consider:

• constitutional delay in maturing—late growth spurt

• familial short stature of a genetically small family

• organic causes (e.g. coeliac disease, Crohn disease)

Treatment (specialist supervision)

• Recombinant growth hormone (somatropin)

Criteria

• Height below 1st percentile

• Growth velocity <25th percentile for bone age

• Bone age <13.5 yrs ♀; <15.5 yrs ♂

Tall stature

Where the estimated mature height is above the 97th percentile for:

• males >193.1 cm (6′ 4″)

• females >182.9 cm (6′)

Reassurance, counselling and education may alleviate the family’s concerns. If treatment appropriate, refer to an endocrinologist (after the appearance of the first pubertal change). Treatment includes high-dose oestrogen in girls and testosterone in boys.

Growing pains (benign nocturnal limb pain)

Features

• Typical age 3–12 yrs

• Positive family history

• Pain wakes child

• Poorly localised in leg—knee, shin, calf

• Usually lasts 20–30 mins, (maybe hours) regardless of Rx

• Normal examination

• No pain or disability next morning

Management

• Reassurance

• Resolves spont. in time

• Consider heat pack and simple analgesics

• Massage is helpful

• Check ESR if in doubt

Normal puberty

Onset 9–14 yrs:

• males average age 11–12 yrs (mean 11 yrs)

• females 8–13 yrs (mean 11 yrs); mean age of menarche 12.5 yrs

Delayed puberty

This is the absence of pubertal development in:

• girls >13 yrs

• boys >14 yrs

If familial or constitutional (delayed growth and bone age), no investigation. If in doubt order a bone age X-ray. Manage according to findings (e.g. chronic asthma) or refer to a paediatric endocrinologist. Treatments include testosterone in boys and oestradiol in girls.

Precocious puberty

This is the appearance of true puberty in:

• girls <8 yrs

• boys <9 yrs

Investigations If concerned include FSH and LH, gonadal steroid (testosterone or oestradiol), bone age and MRI of brain if ↑ FSH or LH.

Management

• If evolving slowly—no treatment

• If concerned, refer to paediatric endocrinologist

Premature thelarche

This is isolated breast development in girls < 8 yrs without other pubertal signs. It is benign and observe with reassurance.