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Growth Assessment
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Julia Driggers, Kanak Verma, Vi Goh
Puberty refers to the physical changes that occur during adolescence, including growth in stature and development of secondary sexual characteristics. The latter occurs in a series of events that also follows a predictable pattern, with some individual variation in sequence and timing of onset (between 8 and 13 years in girls and 9.5 and 14 years in boys). Sexual maturation can happen gradually or with several changes at once. Tanner staging is a sexual maturity rating system used to define physical measures of sexual development, including breast changes in females, genital changes in males, and pubic hair changes in both females and males. Tanner staging is commonly used to define the pre- or peri-pubertal stage of a child at a single point in time (Appendix B). In boys, the first change is testicular development followed by penile growth and pubic hair development. In girls, the first change is breast development followed by the appearance of pubic hair which is then followed by menarche.
Biometric Measurements and Normal Growth Parameters in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Prateek Behera, Nirmal Raj Gopinathan
An assessment of the child’s sexual maturity during evaluation is an essential component of the clinical examination pertaining to certain disorders. While it is essential for a detailed examination of patients who are admitted for evaluation of their condition, it might be omitted when examining in the outpatient department. The universally accepted method is the one described by Tanner and Marshall, which is also called the sexual maturity rating (SMR). Tanner staging is based on the gradual and often sequential changes in the external genitalia in males, breasts in females, and pubic hair in both males and females. In females, the development of breasts (thelarche) occurs around 8–12 years of age and is the first pubertal change. This is followed by the appearance of pubic hairs (pubarche). In males, puberty starts when the testicular volume becomes more than 4 ml (estimated with an orchidometer), and pubic hairs start to appear usually between 9 and 14 years of age. In both males and females, five SMR ratings have been defined from 1 to 5 (Figure 2.1). While SMR provides some idea about a child’s chronological age, many decisions in adolescent pediatric orthopedics are based on the child’s bone age, which is estimated using radiographs. Tanner staging has been used by investigators in decision-making for the management (of various pathologies),2,3 but there is criticism too. Assigning a Tanner stage to a child has large interobserver and intraobserver variability,4 and it should hence be used judiciously for this purpose.
Personalized Nutrition in Children with Crohn Disease
Published in Nilanjana Maulik, Personalized Nutrition as Medical Therapy for High-Risk Diseases, 2020
General nutritional management principles should include full nutritional assessment and anthropometry at the time of diagnosis in all children with CD. Anthropometry of current status should be augmented with all available information about historical growth patterns and trajectory. Parental height measurement and calculation of mid-parental height may guide assessment of adequacy of the child’s current height. Estimation of bone age and assessment of Tanner staging are also relevant.
Different Characteristics of Pre-Pubertal and Post-Pubertal Idiopathic Intracranial Hypertension: A Narrative Review
Published in Neuro-Ophthalmology, 2023
Hannah S. Lyons, Sophie L. P. Mollan, Grant T. Liu, Richard Bowman, Mark Thaller, Alexandra J. Sinclair, Susan P. Mollan
There is a clear distinction between the pre- and post-puberty phenotype of primary pseudotumour cerebri. The literature has shown that post-pubertal children are phenotypically similar to adult IIH and that obesity or recent weight gain in post-pubertal IIH is a risk factor of their disease. Yet studies investigating childhood IIH typically combine the paediatric population with the adolescent population in the analysis. Paediatric studies also include those children where a secondary aetiology is identified, and this could confound results and outcomes as compared to studies describing exclusively primary pseudotumour cerebri. Direct use of Tanner staging, as recommended by one group,38 would help improve cohort classification. By defining the puberty period, it would allow a more accurate comparison of which children are phenotypically similar to adults with the disease.
Biochemical measures of ovarian function in female survivors of retinoblastoma treated with intra-arterial melphalan: an initial report
Published in Ophthalmic Genetics, 2022
Priya H. Marathe, Ira J. Dunkel, Jasmine H. Francis, Zoltan Antal, Y. Pierre Gobin, David H. Abramson, Danielle N. Friedman
This is a single-institutional, retrospective, IRB-approved study of female retinoblastoma survivors treated at a tertiary cancer center. Eligible participants included biological females treated for retinoblastoma with melphalan-based OAC between 2006 and 2019 with attained age ≥10 years and at least one set of gonadotropins (follicle stimulating hormone [FSH] and luteinizing hormone [LH]) available for review in the electronic medical record. Patients who received alkylating agents systemically, such as individuals treated with chemotherapy-based autologous stem cell transplantation, were excluded, as myeloablative chemotherapy is a known independent risk factor for ovarian dysfunction (6). Data on treatment exposures, gonadotropins, menstrual regularity, and Tanner staging were abstracted from the medical record. Ovarian dysfunction was defined as FSH and LH values both >12 IU/mL (7). Symptoms of ovarian dysfunction were defined as menstrual irregularity, hot flashes, and emotional lability.
Daughters of polycystic ovary syndrome pregnancies and androgen levels in puberty: a Meta-analysis
Published in Gynecological Endocrinology, 2022
Georgios Valsamakis, Odyssefs Violetis, Christos Chatzakis, Olga Triantafyllidou, Makarios Eleftheriades, Irene Lambrinoudaki, George Mastorakos, Nikos F. Vlahos
The current meta-analysis was designed to assess the androgens levels in peripubertal daughters of PCOS mothers compared to daughters of mothers without PCOS. In order to exclude the effect of peripubertal period in reproductive system of female progenies, we divided the population into two subgroups defined by the stage of puberty according to Tanner staging system. Thus, the first subgroup included prepubertal girls (Tanner I) whereas the second comprises pubertal girls (Tanner II-V). The analysis demonstrated that pubertal daughters of PCOS mothers present significantly higher total testosterone, higher 17a-hydroxyprogesterone (17-OHP) and lower SHBG levels when compared to daughters born to mothers without PCOS. However, the study concluded that in prepubertal stage only SHBG levels were statistically different between the comparing groups with offspring of PCOS mothers exhibiting higher concentrations. With regard to androstenenedione (Δ4Α), the estimated difference (95% CI) contained the neutral value in both subgroups. Unfortunately, we did not find studies examining DHEAS levels which could follow our analysis design.