Abnormal growth

Abnormal growth

Reassure

  • Normal growth rate along centile predicted by parental height
  • Age appropriate pubertal stage
  • No symptoms of raised intracranial pressure
  • No symptoms of diabetes insipidus
  • No risk factors for a brain tumour
  • Normal neurological examination

Action

Reassure

Review / Observe

  • Growth rate slower than normal (height and/or weight falling away from centiles or small for family height) Or
  • Growth rate slower than normal AND pubertal stage inappropriate for age

Action

If isolated growth problem, refer to paediatrician for assessment
If growth and pubertal problem, refer for specialist paediatric endocrinologist for assessment

Scan

  • Growth rate slower than normal (height or weight falling away from centiles or small for family height)
  • Symptoms of raised intracranial pressure
  • Symptoms of diabetes insipidus
  • Abnormal neurological examination

Action

Scan

Diagnostic Pitfalls

  • Delayed diagnosis associated with not considering a CNS cause of growth failure with vomiting

Examination/assessment

  • Determine how long patient/parents/carers have had concerns about growth
  • Ask specifically about eating patterns and behavior
  • Plot height and weight on growth chart and compare with previous measurements
  • Plot head circumference in children under two
  • Measure and plot parental heights and calculate predicted height
  • Ask specifically about associated symptoms and risk factors:
    • Personal or family history of a brain tumour
    • Leukaemia
    • Sarcoma and early onset breast or bowel cancer prior therapeutic CNS irritation
    • Neurofibromatosis types 1 and 2
    • Tuberous Sclerosis
    • Li Fraumeni Syndrome
    • Family history of colorectal polyposis
    • Gorlins Syndrome
    • Other familial genetic syndromes
  • Determine pubertal status
  • Neurological examination (include assessment of vision (including acuity), gait and coordination)
  • Full visual assessment – especially looking for loss of upward gaze

Worrying features

  • Symptoms of new onset of excessive fluid intake and the need to pass urine so frequently that it disturbs sleep