Biometric Measurements and Normal Growth Parameters in a Child
Nirmal Raj Gopinathan in Clinical Orthopedic Examination of a Child, 2021
The first thing a clinician commonly looks for in any child is his/her height, weight, and body span. Examination of a child should ideally start with measurements of the head and chest circumferences, weight, height, and arm span. In a child, these parameters can either be recorded by the clinician or by the staff nurse when the child is in the waiting area. Measurement of a child’s height and arm span can act as the first indicator of an underlying etiology, which might lead to a short stature. The head circumference is measured using a measuring tape. An accurate measurement can be obtained by placing the tape around the head at its greatest circumference, starting from the occipital protuberance to the midforehead. This measurement can then be plotted on specific growth charts. A child with a head circumference >95th percentile or <5th percentile for the child’s age should be evaluated further.
Lysinuric protein intolerance
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop in Atlas of Inherited Metabolic Diseases, 2020
Most infants present with anorexia, vomiting and finally full-blown failure to thrive (Figures 32.2, 32.3, and 32.4) [3]. There may be alopecia. Subcutaneous fat is diminished or absent, and the skin folds loose. Diarrhea may suggest a malabsorption syndrome. Skin lesions may resemble those of kwashiorkor or acrodermatitis, and zinc deficiency (Figures 32.2 and 32.3). A dry scaly rash is sometimes seen, as well as sores on the sides of the mouth [16]. Dystrophic nails may contribute to the picture of acrodermatitis enteropathica (Figure 32.4). A five-year-old boy with chronic diarrhea and pitting edema of the lower extremities was thought to have celiac disease because villous atrophy was found on intestinal biopsy [16]. There was no improvement with a gluten-free diet. There is usually some hepatomegaly and muscular hypotonia. The spleen may be palpable. Body weight is reduced, and linear growth falls off. Of 20 Finnish patients [6], 16 had heights that were 2–6 SDs below the mean. Head circumference is normal. Skeletal maturation is usually delayed. Anemia is the rule, leukopenia common, and serum ferritin highly elevated. Increased plasma concentrations of cholesterol and triglycerides are frequently increased [17]. As in protein-deficient malnutrition (Kwashiorkor), there is fatty degeneration, and inflammation of the liver.
Sex Chromosome Anomalies
Merlin G. Butler, F. John Meaney in Genetics of Developmental Disabilities, 2019
Follow up of 47,XXX girls detected in newborn surveys into early adolescence or young adulthood demonstrated the absence of a specific clinical phenotype (76). Of these girls, 80% were 15 years or older. Most reported good health, although about 25% had episodes of recurrent nonorganic abdominal pain as teenagers. 47,XXX girls are tall adolescents and adults with final heights generally at or above the 90th centile (171cm). Subjects are generally underweight for height and cluster near the 60–70th centiles (59–62 kg), resulting in a tall thin appearance. Head circumference is generally reduced to the 25–35th centiles (53–54 cm), a trend that had been noted since birth. Motor milestones were delayed and the poor coordination and awkwardness seen in childhood persisted. Few 47,XXX girls participated in sports in school or in athletic activities as young adults. Menarche was established in all subjects between the ages of 11½ and 13½ years and they had regular periods. Nine out of 37 (24%) had become pregnant. Chromosome analysis of seven of the resulting fetuses showed all with normal chromosomes.
Medical devices and the pediatric population – a head-to-toe approach
Published in Expert Review of Medical Devices, 2019
Joy H. Samuels-Reid, Judith U. Cope
The head is large relative to the body in infants and young children. The skull is thinner and more flexible. This requires different types of considerations for the pediatric population and age-appropriate medical devices. Head circumference is a significant metric in assessing growth and development of the neonate and infant and is measured across the frontal-occipital prominence, the area of greatest diameter. While head circumference is an indicator for growth and development in the pediatric population, it is not in adults. It is tracked on growth charts during pediatric exams from birth through the first few years. Newborns have greater brain weights in proportion to body weight. The anterior and posterior fontanelles close at different times: the anterior fontanelle is the last to close between 1 to 3 years (the median time is about 13.8 months) and the posterior closes 2–3 months after birth. Depressed fontanelles may indicate dehydration, while bulging fontanelles may indicate swelling in the brain [6]. Early closure of fontanelles may lead to microcephaly, misshapen head and delay in closure may signal hydrocephalus. Cranial sutures close at different rates. It is important that use of devices take into consideration the status of cranial sutures and the stage of growth and development of the skull. If sutures close prematurely, they result in craniosynostosis [7]. Devices such as cranial helmets are often used to correct positional head deformity such as plagiocephaly.
Botulinum Toxin Type A in the Spasticity of Cerebral Palsy Related to Congenital Zika Syndrome: An Observational Study
Published in Developmental Neurorehabilitation, 2022
Giulia Armani-Franceschi, Cleber Luz, Pedro H. Lucena, Danilo d’Afonseca, Henrique Sales, Alessandra L. Carvalho, Isadora C. Siqueira, Karine Silva, Sandra Portuense, Larissa Monteiro, Igor D. Bandeira, Ailton Melo, Rita Lucena
Between August and December 2018, 34 children (18 (53%) female and 16 (47%) male) with spasticity due to cerebral palsy as a secondary condition of CZS were subjected to BoNT-A administration. Sample characteristics are presented in Tables 1 and Tables 2. The age, weight, head circumference at birth and at time of assessment, and growth in head circumference were normally distributed. Age varied from 24 to 38 months (32.06 ± 3.07 months). Mean head circumference at birth was 29.64 cm (± 1.91 cm). Head circumference data at birth was missing in the medical record for two of the 34 participants. Mean head circumference at time of assessment was 41.25 cm (± 3.08 cm). Mean growth in head circumference since birth was 11.6 cm (± 3.12 cm). Participants’ mean weight was 11.70 kg (± 2.18 kg).
Acute presentation of papillary glioneuronal tumor due to intra-tumoral hemorrhage in a toddler: an odd presentation of a rare pathology
Published in British Journal of Neurosurgery, 2023
Amin Tavallaii, Ehsan Keykhosravi, Hamid Rezaee
A two years old male toddler was transferred to our center from a small town in the province with history of sudden onset left hemiparesis and lowering of consciousness since morning of admission day. There were no history of seizure attack or trauma. Patient was admitted to our center with Glasgow Coma Scale (GCS) of 13, agitated and without appropriate cooperation. Vital signs were within normal range and no abnormality was seen in initial laboratory testing which was performed in referring hospital. Physical examination revealed left hemiparesis with muscle forces of 2/5 and 3/5 in left upper and lower limbs respectively in the Medical Research Council (MRC) scale. Muscle spasticity or hyperreflexia was not present but left plantar reflex was upward. All cranial nerves examinations were intact as far as patient cooperation allowed. Head circumference was within normal range. Fundoscopic examination was not possible and not performed due to patient agitation. Because, there were no history of seizure and patient hemiparesis did not improve over time, a possibility of post ictal tod’s paralysis was unlikely.