LECTURE No. 12. Anatomical and physiological features of the endocrine system in children. Sexual development. Semiotics of defeat

1. Anatomical and physiological features of the endocrine system in children. sexual development

The pituitary gland is the most important endocrine gland that produces a number of tropic protein hormones. Associated with the hypothalamic region of the CNS.

Carries out a regulatory influence on the function of all endocrine glands and unites the entire endocrine system into a single whole.

pituitary hormones:

1) ACTH (adrenocorticotropic hormone).

Affects the adrenal cortex, stimulates the synthesis and secretion of glucocorticoids;

2) TSH (thyroid-stimulating hormone). Stimulates the growth and function of the thyroid gland, increases its secretory function, the accumulation of iodine by the gland, the synthesis and release of its hormones;

3) STH (somatotropic hormone) - growth hormone. Increases protein synthesis and reduces the breakdown of amino acids, causes nitrogen retention in the body, increases glycemia, causes retention of phosphorus, sodium, potassium, calcium, while increasing fat breakdown, all this leads to accelerated growth;

4) gonadotropic hormones. Stimulate the function of the gonads.

There are three gonadotropic hormones; LH (luteinizing hormone) in women stimulates the release of estrogen and promotes the formation of the corpus luteum, in men it stimulates testosterone production, testicular growth and controls the process of spermatogenesis; FSH (follicle-stimulating hormone) in women stimulates the development of follicles, ovaries, estrogens, in men - androgen secretion, spermatogenesis and the growth of seminiferous tubules; prolactin, is involved in the formation of milk and the maintenance of lactation;

5) vasopressin is an antidiuretic hormone. Causes water retention in the body by its reabsorption from the distal tubules of the kidneys;

6) oxytocin. Causes contraction of smooth muscles, stimulates lactation, increases diuresis.

In children, STH in high concentrations occurs in newborns and during sleep. ACTH and TSH in newborns are also elevated, then sharply reduced. The concentration of LH and FSH in early childhood is low and increases during puberty.

The thyroid gland produces the following hormones: thyroxine, triiodothyronine, thyrocalcitonin. These hormones have an exceptionally profound effect on the child's body. Their action determines normal growth, maturation of the skeleton (bone age), differentiation of the brain and intellectual development, normal development of skin structures and its appendages, increased oxygen consumption by tissues, and acceleration of the use of carbohydrates and amino acids in tissues. These hormones are universal stimulants of metabolism, growth and development.

The parathyroid glands secrete parathyroid hormone, which plays an important role in the regulation of calcium metabolism. The maximum activity of the parathyroid glands refers to the perinatal period and to the first or second year of life of children. These are periods of maximum intensity of osteogenesis and intensity of phosphorus-calcium metabolism.

The adrenal glands produce corticosteroid hormones (glucocorticoids), mineralocorticoids, androgens, catecholamines (epinephrine, norepinephrine, dopamine).

Glucocorticoids have anti-inflammatory, desensitizing, antitoxic properties. Mineralocorticoids affect salt metabolism.

Catecholamines act on vascular tone, heart activity, nervous system, metabolism of carbohydrates and fats, endocrine glands.

The pancreas secretes insulin, glucagon, and somatostatin. Insulin lowers blood glucose levels and regulates carbohydrate metabolism. Somatostatin inhibits the secretion of growth hormone and TSH, the pituitary gland, insulin and glucagon. In newborns, insulin release increases in the first days of life and depends little on blood glucose levels.

The sex glands perform endocrine and reproductive functions. The male and female gonads release the corresponding hormones into the blood, which regulate the development of the reproductive system, determine the appearance of secondary sexual characteristics in males and females. In addition, sex hormones have an anabolic effect, play an important role in the regulation of protein metabolism, the formation of the skeletal system, and hematopoiesis.

Sexual development of children is divided into three periods:

1) prepubertal - up to 6-7 years, the time of hormonal rest;

2) prepubertal - from 6 to 9 years in girls and from 7 to 10–11 years in boys, the hypothalamic-pituitary-gonadal system is activated;

3) puberty - from 9-10 to 14-15 in girls, when the growth of the mammary glands, hair growth of the pubis and armpits, changes in the shape of the buttocks and pelvis, the appearance of menstruation occur, and from 11-12 to 16-17 in boys, when genital growth, male-type hair growth, voice breaking, spermatogenesis, ejaculation appear.

2. Methodology for the study of the endocrine glands and semiotics of growth disorders and puberty

When examining children for the presence of endocrine pathology, first of all, attention is paid to deviations in somatic and sexual development. Very often, with various endocrine diseases, there are both growth retardation and puberty, and premature physical and puberty. It is necessary to find out if the relatives had endocrine pathology (diabetes mellitus, obesity, dwarfism, etc.). Determine the weight and length of the child's body and compare with standard tables.

Pay attention to the condition of the skin (dryness, increased pigmentation, striae, features of the distribution of subcutaneous fat, the nature of hair growth). Assess the condition of teeth, nails, hair. Next, an objective examination of all organs and systems is carried out, as in a normal examination. Palpation assesses the size and consistency of the thyroid gland. When examining the genital area in boys, it is necessary to carefully examine the testicles (density, size, the presence of both testicles in the scrotum), the scrotum (pigmentation), the penis (size, age compliance), determine the condition of the mammary glands (gynecomastia), note secondary hair growth, find out the time changes in the timbre of the voice, etc.

In girls, it is necessary to examine the mammary glands, the clitoris (if there is an increase), large and small labia, determine the secondary hair growth, the time of the onset of menstruation.

Special research methods:

1) X-ray examination of the skull (allows you to assess the state of the pituitary gland by the size of the Turkish saddle), X-ray examination of the hands (allows you to determine bone age, is used for growth retardation and physical development);

2) determination of hormones and their metabolites in the blood and urine (allows you to evaluate the work of all endocrine glands of the body);

3) ultrasound examination (allows for the diagnosis of the thyroid, pancreas, adrenal glands and gonads in persons of both sexes and mammary glands);

4) computed tomography (used in the study of the pituitary and hypothalamic region, adrenal glands, pancreas);

5) cytogenetic studies - sex chromatin, karyotype (used to diagnose genetic diseases, hermaphroditism and other disorders of sexual development);

6) examination of blood and urine (for the presence of a-amylase, alkaline phosphatase, calcium, potassium, chlorine, cholesterol, glucose, ketone bodies, etc.). They provide information on various endocrine diseases.

Growth disorders

Gigantism is a disease accompanied by a sharp increase in growth that does not correspond to age and goes beyond the limits of permissible fluctuations by more than 2 sigma.

This disease occurs when overproduction of growth hormone begins at a young age with open growth zones.

Cerebro-pituitary dwarfism (dwarfism) - growth retardation, in which the body length is more than 20% behind the age norm, the final height is less than 130 cm in men and 120 cm in women.

Violations of puberty are observed with delayed sexual development, premature sexual development, genetic diseases (Turner-Shereshevsky syndrome, etc.), as well as with severe somatic pathology. At the same time, underdevelopment or premature development of the genital organs, discrepancy between weight and height indicators of the age norm, often violations of the emotional-volitional sphere, etc. are noted. The development of sexual characteristics in children is assessed according to the tables in points, taking into account the stages of development.

3. Semiotics of lesions of the endocrine system

The cause of endocrine diseases can be a number of factors: trauma, infectious diseases, local circulatory disorders, malnutrition, tumors, hereditary predisposition, autoimmunization processes, CNS lesions, disorders in embryogenesis, etc.

When the hypothalamic-pituitary system is affected, children experience growth retardation or acceleration, obesity, hirsutism, dystrophy of the reproductive system, stretch marks on the skin, hypertension, osteoporosis, malnutrition, impaired hair and teeth growth, infantilism, progeria, etc.

With damage to the thyroid gland and a decrease in its function, dry skin, mucous edema, decreased reflexes, adynamia, decreased appetite, constipation, decreased sweating, cold intolerance, decreased intelligence, growth retardation, low voice timbre, and others; if the function of the gland is increased, then there is an increase in tendon reflexes, tremor, weight loss, tachycardia, bulging eyes, goiter, hyperhidrosis and other symptoms.

With damage to the adrenal glands and a decrease in their function, asthenia develops, gastrointestinal disorders (diarrhea, nausea, vomiting, anorexia, abdominal pain) are observed, the skin darkens and becomes bronze in color, especially in the folds and places of friction of the skin; if the function of the adrenal glands is increased, then obesity, hypertension, hypertrichosis, growth retardation, premature sexual development and others are observed; if the function of the glands is impaired, then an adrenogenital syndrome occurs, in which there are violations of sex differentiation, abnormal development of the genital organs, premature sexual development, weight and height indicators are ahead of age, but the growth zones close quickly. Such people in adulthood are undersized, girls have a low voice, hirsutism.

With lesions of the pancreas, with a decrease in insulin production, diabetes mellitus develops, and with its increased production, hyperinsulinism occurs.

The main symptoms of diabetes mellitus are thirst (polydipsia), weight loss with increased appetite, polyuria, dry skin and mucous membranes, weakness, skin itching, a diabetic blush on the cheeks, when the condition worsens, headache, nausea, vomiting, abdominal pain, and the smell of acetone join. from the mouth, dysfunction of the central nervous system, loss of consciousness (coma). Hyperinsulinism is manifested by a sharp feeling of hunger, weakness, headache, hand tremor, drowsiness, if no help is provided, vision is further impaired, consciousness is lost, convulsions occur (hypoglycemic coma occurs).

In case of violation of the development of the genital organs, it is possible, upon examination, to see their indefinite (intersex) state or the presence of anomalies in the structure. The anomalies characteristic of boys include the following.

1. Hypospadias - lower cleft urethra. In this case, the curvature of the penis and the location of the urethral opening at any level from the lower surface of the head to the perineum are often noted.

2. Epispadias - upper cleft urethra. In this case, there is a curvature of the penis, pulling it up and retracting into the surrounding tissues.

3. Hypoplasia of the penis (micropenis) - a sharp shortening of the penis with its total length in a newborn less than 1 cm. It can be combined with other defects.

4. Phimosis is a congenital narrowing of the foreskin that prevents the head from being exposed.

5. Paraphimosis - infringement of the head by the foreskin, a complication of phimosis.

6. Agenesia of the testicles according to the type of anorchia (their absence) or monorchia (the presence of one testicle).

7. Cryptorchidism - a delay in lowering the testicle into the scrotum on its natural path. There are inguinal and abdominal cryptorchidism.

In newborns, it is often associated with intrauterine growth retardation, immaturity, or prematurity.

8. Dropsy of the testicle - accumulation of fluid between the outer and inner sheets of the own testicle shell.

Anomalies characteristic of girls include agenesis, hypoplasia or hypertrophy of the clitoris, adhesions of the labia minora or labia majora, infection of the hymen, splitting of the clitoris, aplasia of the labia and hymen.

4. Semiotics of endocrine system disorders (pituitary gland, thyroid gland, parathyroid glands, adrenal glands, pancreas)

Violation of the hormone-forming or hormone-releasing function of the pituitary gland leads to a number of diseases. For example, excessive production of somatotropic hormone leads to the development of gigantism, or acromegaly, insufficiency of the same hormone leads to pituitary dwarfism. Violation of the formation or release of gonadotropic hormones causes hypogonadism, or premature puberty. Excess production of ACTH forms a picture of Itsenko-Cushing's disease, insufficiency of hormones of the anterior pituitary gland leads to the development of pituitary cachexia, and the posterior lobe - to diabetes insipidus.

Thyroid dysfunction is observed in acute, subacute and chronic autoimmune thyroiditis.

With diffuse toxic goiter, there is an increased secretion and release of thyroid hormones, which determine the symptoms of the disease. A decrease in the secretion of thyroid hormones leads to the development of hypothyroidism, especially congenital hypothyroidism. With insufficient intake of iodine from food, which is part of the thyroid hormones, endemic goiter develops.

The parathyroid glands regulate the processes of calcification and decalcification in the bones. In congenital hypoparathyroidism, bone formation is disturbed, autonomic lability and excitability (pylorospasm, diarrhea, tachycardia) increase, convulsions and laryngospasm may develop, requiring emergency care. Hyperparathyroidism is accompanied by severe muscle weakness, constipation, bone pain, bone fractures, while cysts form in the bones, and calcifications in soft tissues.

The function of the adrenal glands is impaired in hormonally active tumors of the glands (aldosterome, glucosterome, androsterome, corticoestrome). The symptomatology of diseases in this case is determined by the hormone producing the tumor tissue. With a sudden decrease or cessation of secretion of hormones by the adrenal cortex, acute adrenal insufficiency develops.

Chronic insufficiency of the adrenal cortex, or Addison's disease, is rare in children and develops mainly after 10 years. Also, when the adrenal glands are affected, diseases such as primary hyperaldosteronism, hypoaldosteronism, congenital dysfunction of the adrenal cortex, or congenital adrenogenital syndrome, pheochromocytoma develop.

Pancreatic dysfunction leads to diseases such as diabetes mellitus, and tumor lesions of the pancreas lead to glucogonoma, insulinoma, somatostatinoma, gastrinoma, vipoma, pancreatic tumors with carcinoid syndrome, etc.

Diabetes mellitus is a chronic disease caused by absolute or relative insulin deficiency, which leads to disruption of all types of metabolism, especially carbohydrate metabolism. In the structure of endocrine diseases of childhood, diabetes mellitus is the most common disease. Diabetes mellitus in children is 2-5% of the total number of patients with this pathology.

In most children, it is a genetically determined disease. Inheritance is possible by recessive and dominant type. Hereditary predisposition is present in 11-60% of children. Genetic defects leading to the development of the disease in children are different: inferiority in the synthesis, release and destruction of insulin; increased insulin resistance of insulin-dependent tissues; neutralization of insulin due to mutation of the gene-regulator, which causes a high content of insulin antagonists. Significance in the etiology of diabetes mellitus in children is overeating, which contributes to a decrease in glucose tolerance, infectious diseases, mental and physical injuries, and vaccination. Diabetes mellitus occurs in all periods of childhood, but most often during periods of the most intensive growth of the child.

Federal State Budgetary Educational Institution
higher education
"Bashkir State Medical University"
Ministry of Health of the Russian Federation
Department of propaedeutics of childhood diseases
Physical development of children.
Factors affecting physical development.
Laws of physical development and principles
estimates. Semiotics of violations.
Lecture for students
Specialty - 31.05.02. – Pediatrics
Discipline - Propaedeutics of childhood diseases
Professor Khairetdinova T.B.
2016

Physical development is a dynamic process of growth and biological maturation of a child in a particular period of life.

Physical development is a set
morphological and functional
signs in their relationship and dependence on
environmental conditions that characterize
maturation process in each given
moment of time
WHO defines indicators of physical
development as one of the fundamental
criteria in a comprehensive assessment of the state
child's health.

Criteria for assessing physical development:

Body mass
body length
Head circumference
chest circumference
cells
Proportionality
these indicators

An assessment of the physical development of children is necessary because:

developmental disorder may be the first
clinical sign of chronic
diseases, chromosomal and genetically determined
pathology;
the appearance of a lag in physical development can
be a sign of malnutrition
improper upbringing and violation of hygiene in the family;
anthropometric research is necessary for
establishing the biological age of the child, the pace of his
biological maturation.

Environmental factors are directly related to the growth and development of the child

Nutrition factor
Inappropriate feeding can
lead to the blocking of the genetic program.
The growth rate is directly proportional to the amount
protein in the diet, the presence of vitamins
and micronutrients.
Mode
- adequate sleep
- properly organized wakefulness
Psycho-emotional stimulation
Climate - geographical conditions
chronic diseases

Basic laws of children's growth

The law of absolute growth is the law of steady
growth and development of the body.
The law of steady deceleration of growth energy
- slower growth rate with age
determining its maximum in utero
period and further in the first months of life.
Law of speed hopping
growth.
Falling growth rate wears intermittent
character and, along with a decrease in speed
growth, there are periods when this rate
increases.

Change in body proportions (2nd month of intrauterine development - 25 years)

Patterns of changes in the main anthropometric indicators in the process of growth and development of children

In the intrauterine period, the most intense
increase in both length and body weight. Only between the first and
in the second month, the fetus increases in length by almost 3 times, and in
mass by 10 times.
The body length of a full-term newborn ranges from 46 cm to
56 cm, and on average for boys - 50.7 cm, for girls - 50.2 cm.
It is generally accepted that if a newborn child has a length
45 cm or less, then he is not full-term.
The average body weight of a full-term newborn is
for boys 3494 g, for girls - 3348 g.
fluctuations in body weight at birth are 2500-4000 g.

body length

In the first days after birth, body length is slightly
decreases, because birth tumor on the head
dissolves within 2 days.
In the first year of life, body length increases by 3 cm
monthly (in the I quarter), then 2.5 cm per month (in the II
quarter), and then already 1.5 -2 cm per month (III quarter), 1 cm (IV
quarter).
By the year the child's height is 75-76 cm.
During the second year, growth increases by 12-13 cm.
For the third year of life -7-8 cm, in the subsequent - 5-6 cm per year.
Absolute body gain during prepubertal growth
jump in boys reaches 47-48 cm, in girls 36-38 cm.
Doubling the length of the body of a newborn occurs by 4 years,
tripling by age 12.

10. Body weight

The maximum weight loss is observed in most
children by 3-5 days of life and is 6-8%.
Every month in the first half of the year, the weight increases by
800 g, in the second half of the year - by 400 g.
By six months, the body weight of children reaches an average of 8200 g,
and by the year 10-10.5 kg, further weight gain
is 2 kg per year.
After infancy up to 10 years of age
body weight is calculated:
10.5 kg (average weight of a 1 year old child) + 2хn
During puberty, weight gain is
5-8 kg.

11. Chest circumference

Chest circumference of a full-term newborn
is 34 cm.
By the year it reaches 48 cm.
The average rate of increase in chest circumference per
the first year of life is 1.25-1.3 cm in
month, in the next 2-3 years - 2-3 cm per year.

12. Head circumference

Term head circumference
the newborn is 34-36 cm.
By the year of life, the head circumference is 46-47 cm.
By 5 years - 50-51 cm.

13. Empirical formulas and nodal points for calculating somatometric data in children

MEASURABLE SIGN
CALCULATION METHOD
BODY LENGTH
Full-term newborn
average height of girls
boys
46-56 cm
50.2 cm
50.7cm
In the first year of life:
Height at birth + quarterly increases:
1 quarter -3cm monthly (9cm/quarter)
2nd quarter -2.5cm monthly (7.5cm/quarter)
3rd quarter -1.5 (2.0) cm monthly (4.56.0 cm/quarter)
4 quarter - 1.0 cm monthly (3.0 cm / quarter)
average height at 6 months
if height at birth is not known:
66 cm
2.5 cm - 66 cm at 6 months + 1.5 cm (for each missing month up to 6 months, 2.5 cm is deducted,
for each subsequent - 1.5 is added
cm)
average increase in the 1st year of life
25 cm
average growth in 1 year
75 cm
MPC*
± 4 cm

14. Empirical formulas and nodal points for calculating somatometric data in children

Older than a year:
average increase in the 2nd year of life
12-13 cm
average increase in the 3rd year of life
7-8 cm
average growth in 4 years (doubling)
100 cm (doubling the height of a newborn)
8 cm - 100 cm + 6 cm (for each missing year
up to 4 years, 8 cm is deducted, for each
subsequent - 6 cm is added)
average height at 5 years
110 cm
8 cm - 110 cm + 6 cm (for each missing up to 5
years year subtracted 8 cm, for each subsequent
add 6 cm)
average height at 8 years old
from 2 to 15 years:
130 cm
7 cm - 130 cm + 5 cm
(for each missing year up to 8 years, a year is taken away
7 cm, for each subsequent 5 cm is added)
from 8 to 15 years:
90+5 n, where n is the child's age in years
average height at 10 years old
140 cm
tripling
newborn
12 years
MPC
1-5Years±6.0cm

15. Empirical formulas and nodal points for calculating somatometric data in children BODY WEIGHT

Full-term newborn
average weight of girls
average weight of boys
In the first year of life:
2501-4000 gr.
3348 gr.
3494 gr.
Method 1: Birth weight +
monthly
increments:
1st month - 600 gr.
2nd month - 800 gr.
3rd month - 800 gr.
Then 50 gr. less than previous
months
Method 2: According to the average monthly increase:
1st half year - 800 gr./month.
2 half-year - 400 gr./month.
Calculation up to 6 months: M born. +800n
Calculation after 6 months: M born. + 800 x 6 +
+400(n-6), where n is age in months

16.

average weight at 6 months if birth weight is not
known:
8200 gr.
800 gr. - 8200 gr. + 400 gr. (per month up to 6
deducted by 800 gr, for each month over 6
add 400 gr.)
doubling the birth weight
4-5 months
average weight gain for the 1st year
7150 gr.
average weight per year
(triple the weight of the newborn)
MPC
10.0-10.5 kg
1-3 months ± 850 gr. 4-6ms. ± 1000 gr. 7-9ms. ± 1200 gr.
10-12 months ± 1500 gr.
Older than a year:
from 2 to 11 years old
10 (10.5) kg + 2n, where n is age in years
average weight at 5 years (doubling the weight of a one-year-old
child)
19 kg
2 kg -19 kg + 3 kg (for each year up to 5 years, 2 kg is deducted, for each subsequent after 5 years
add 3 kg)
average weight at 10 years (threefold weight
one year old child)
30 kg
over 10 years old:
1. 30kg + 4(n-10), where n is age in years
2. Vorontsov formula:
Three times the age + last digit in years:
from 12 to 18 years old:
5p-20 kg, where n is age in years
MPC
1-5 lay ±3 kg
6-10 years ± 6 kg
11-18 years ± 10 kg

17. A valuable way to assess physical development

- zone 1 (up to the 3rd centile) - "very low" level;
- zone 2 (from the 3rd to the 10th centile) - "low"
level;
- zone 3 (from 10th to 25th centile) - level "below
average";
- zone 4 (from the 25th to the 75th centile) - "average"
level;
- zone 5 (75th to 90th centile) - level
"above average";
- zone 6 (from the 90th to the 97th centile) - "high"
level;
- zone 7 (from the 97th centile) - "very high"
level.

18. Comprehensive assessment of physical development

BIOLOGIST. LEVEL
MORPHOFUNCTION.
CONDITION
"COMPLETE
AGE"
HARMONIOUS
"ABOVE
AGE"
DISHARMONIC
"LAGGING FROM
AGE"
SHARP
DISHARMONIC
GENERAL
DELAY
PHYSICAL
DEVELOPMENT
GROWTH
MASS, OKR.
CHEST
FUNCTIONAL.
INDICATORS
Any
average,
higher
middle,
below
average.
Any
average,
higher
middle,
below
average.
М±σ R and more for
developed
muscles
M + 2.1 σ R and
higher
From m±l,l σ R
up to М±2 σ R
due to the increase
or lower.
fat deposits
from m+1,1 σ R
up to М+2 σ R
from M-2,l σ R and
below
up to M+ 2.1 σR and
higher
from M-2,l σ R and
below
Growth
short
for any Mt, O gr
m-2.1σ R
and below

19. Assessment of the level of age development (according to "dental age")

Age
in years
Floor
delayed
development
Corresponds
age
Accelerated
development
5,5
m
-
0-3
> 3 post. teeth
well
-
0-4
> 4 post teeth
m
0
1-5
5
well
0
1-6
6
m
0-2
3-8
8
well
0-2
3-9
9
m
Less than 5
5-10
10
well
Less than 6
6-11
11
m
8
8-12
12
well
8
8-13
13
6,0
6,5
7,0
7,5

20. Algorithm for assessing the physical development of the child

Determine the passport age of the child
Determine the age group of the child
Carry out anthropometric measurements according to generally accepted
methods (weight, body length, chest circumference, head circumference)
Find the position of the received measurements in centile
intervals according to the tables of standards for each indicator in
depending on the age of the child
Assess the harmony of physical development
With harmonious development, determine the somatotype
With inharmonious development (disharmonious or sharply
disharmonious) to determine by what criterion
disharmony

21. The form of the final record of anthropometric research

1.
2.
3.
4.
5.
6.
7.
Date of measurement
Date of Birth
Child's passport age
Age group
The result of each measurement in cm, kg, numbers in brackets
centile zones
For body weight, it is recommended to record both the second assessment -
according to body length
A general assessment of anthropometric data is formulated:
The degree of harmony of physical development
The rate of physical development (somatotype) with harmonious development
With inharmonious development, the most deviant
a sign indicating how many age intervals it lags behind
or ahead of the passport age of the child

22. Variability of physical development

Hypotrophy is a disorder of the physical
development of the child of I-II years of life
way by reducing the actual weight
body compared to the proper one.
The diagnosis of congenital malnutrition is made immediately
after the birth of a child. For this, it is carried out
calculation of the mass-growth coefficient (MRC).
MRK = Body weight of the newborn (g) / Body length
newborn (cm)
Normal MRK = 60-80.

23. Hypostatura is the same lag in height and body weight in children of the first year of life compared to the average standard indicators with

Hypostature is the same growth retardation and
body weight in children of the first year of life according to
compared with the average standard
indicators of the corresponding age.
Paratrophy is the result
chronic disorder
feeding children
first year of life
which is characterized
weight gain
compared to
regulatory data
by 10% or more.

24. Nanism (dwarfism) - a violation of physical development, expressed as a lag in growth compared to the average norm for age, sex

Nanism (dwarfism) - a violation of the physical
development, expressed as a lag in growth in terms of
compared with the average for age, gender,
populations, races.
Gigantism is a clinical syndrome based on
which lies hyperproduction of somatotropic
hormone, which leads to an excessive increase
growth.

Fundamental criteria for a comprehensive assessment of the child's health Presence or absence of chronic (including congenital) diseases Functional state of organs and systems Resistance and reactivity of the body Level and harmony of physical and neuropsychic development

The term "physical development of a child" refers to the dynamic process of growth (increase in length and weight of the body, individual parts of the body) and the biological maturation of the child in a particular period of childhood. The term "physical development of the child" refers to the dynamic process of growth (increase in length and individual parts of the body) and the biological maturation of the child in a particular period of childhood

The most stable indicator of physical development is body length (height). The most stable indicator of physical development is body length (height). Body weight, in contrast to length, is a more variable sign; therefore, body weight is compared with body length. The circumference of the chest and head is the third mandatory sign for assessing physical development.

Other indicators of an in-depth assessment of the morphofunctional state of the body Somatometric - torso length, sitting height, arm, leg length, shoulder width, pelvis; the circumference of the shoulder, thigh, lower leg, abdomen, etc. Somatoscopic - the shape of the chest, feet, posture, the state of fat deposition, muscles, puberty Functional - vital capacity of the lungs, hand compression force, backbone force, stroke volume of the left ventricle, etc.

When assessing physical development, it is now customary to verify biological age or biological maturity, evaluating which in children takes into account somatoscopic and somatometric data, the timing of the appearance of ossification points, the timing of eruption of milk and permanent teeth and their number, the presence and severity of signs of puberty. When assessing physical development, it is now customary to verify biological age or biological maturity, evaluating which in children takes into account somatoscopic and somatometric data, the timing of the appearance of ossification points, the timing of eruption of milk and permanent teeth and their number, the presence and severity of signs of puberty.

The leading indicators of the biological development of children of primary school age are the number of permanent teeth, skeletal maturity, and body length. When assessing the level of biological development of middle-aged and older children, the severity of secondary sexual characteristics, ossification of bones, the nature of growth processes are of greater importance, while body length and the development of the dental system are of lesser importance. The leading indicators of the biological development of children of primary school age are the number of permanent teeth, skeletal maturity, and body length. When assessing the level of biological development of middle-aged and older children, the severity of secondary sexual characteristics, ossification of bones, the nature of growth processes are of greater importance, while body length and the development of the dental system are of lesser importance.

Anthropometric indicators of a newborn child are quite stable, genetic factors at this age have little effect. Therefore, even relatively small deviations from the average statistical indicators, as a rule, indicate a problem in the state of the newborn. In the most severe cases, especially when not only the weight but also the length of the fetus suffers, we have to talk about a delay in the development of the fetus, which is often combined with various malformations. Anthropometric indicators of a newborn child are quite stable, genetic factors at this age have little effect. Therefore, even relatively small deviations from the average statistical indicators, as a rule, indicate a problem in the state of the newborn. In the most severe cases, especially when not only the weight but also the length of the fetus suffers, we have to talk about a delay in the development of the fetus, which is often combined with various malformations.

This delay can be either symmetrical, i.e. with a uniform decrease in body weight and length, which indicates a more severe lesion, and asymmetric. With an asymmetric delay, if the body length prevails, we can talk about intrauterine malnutrition. Excess weight is more often characteristic of edematous syndrome or obesity, for example, in children born to mothers with diabetes. This delay can be either symmetrical, i.e. with a uniform decrease in body weight and length, which indicates a more severe lesion, and asymmetric. With an asymmetric delay, if the body length prevails, we can talk about intrauterine malnutrition. Excess weight is more often characteristic of edematous syndrome or obesity, for example, in children born to mothers with diabetes.

Body length is an indicator characterizing the state of plastic processes in the body. In children of the first year of life, a monthly increase in body length: in the first quarter - 3 cm in the second - 2.5 cm in the third - 1.5-2 cm in the fourth - 1 cm The total increase for 1 year is 25 cm. You can also use the following formula: child 6 months. has a body length of 66 cm, for each missing month, 2.5 cm is subtracted from this value, for each month after 6, 1.5 cm is added.

Body weight - reflects the degree of development of internal organs, muscle and bone systems, fatty tissue. Unlike body length, body weight is a fairly labile indicator that reacts relatively quickly and changes under the influence of various causes, both endo- and exogenous. Immediately after birth, the body weight of the child begins to decrease somewhat, i.e. there is a so-called physiological loss of body weight, which by the 3-5th day of life should be approximately 5-6%, the restoration of body weight should occur by the 7-10th day of life.

These changes in body weight are due to the mechanisms of adaptation of the newborn. After recovery, body weight steadily begins to increase, and the rate of its increase in the first year is the higher, the younger the age. These changes in body weight are due to the mechanisms of adaptation of the newborn. After recovery, body weight steadily begins to increase, and the rate of its increase in the first year is higher, the lower the age.

A number of formulas for an approximate calculation of body weight in the first year of life Body weight (b.w.) can be defined as the sum: b.w. at birth plus 800 g x n, where n is the number of months. during the first half of the year, and 800 g is the average monthly increase in b.w. during the first half of the year. For the second half of life b.t. equal to: m.t. at birth, the pole of the increase in b.t. for the first half of the year (800 x 6) plus 400 g x (n-6) - for the second half of the year, where n is the age in months, and 400 g is the average monthly increase in b.w. for the second half of the year. M.t. a child of 6 months is 8200 g, 800 g is subtracted for each missing month, 400 g is added for each subsequent month. But this formula does not take into account individual fluctuations in body weight at birth, therefore it is less reliable.

Monitoring changes in head circumference is an integral component of medical control over physical development. This is due to the fact that the circumference of the head also reflects the general laws of the biological development of the child, namely the first (cerebral) type of growth; growth disorders of the skull bones can be a reflection or even the cause of the development of pathological conditions (micro- and hydrocephalus). After birth, the head grows quite rapidly in the first months and years of life and slows down its growth after 5 years. Monitoring changes in head circumference is an integral component of medical control over physical development. This is due to the fact that the circumference of the head also reflects the general laws of the biological development of the child, namely the first (cerebral) type of growth; growth disorders of the skull bones can be a reflection or even the cause of the development of pathological conditions (micro- and hydrocephalus). After birth, the head grows quite rapidly in the first months and years of life and slows down its growth after 5 years.

Approximate head circumference can be estimated using the following formulas: For children under 1 year old: head circumference at birth plus 1.5 cm x n for the first half of the year and head circumference plus 0.5 x n for the second half of the year. The head circumference of a 6-month-old baby is 43 cm, for each missing month we subtract 1.5 cm, for each subsequent month add 0.5 cm, or an average of 1 cm per month.

Chest circumference is one of the main anthropometric parameters for analyzing changes in the transverse dimensions of the body. The circumference of the chest reflects both the degree of development of the chest, closely correlating with the functional indicators of the respiratory system, and the development of the muscular apparatus of the chest and the subcutaneous fat layer on the chest. At birth, the circumference of the chest is about 2 cm less than the circumference of the head, and then the rate of expansion of the chest is ahead of the growth of the head, by about 4 months these circumferences are compared, after which the circumference of the chest steadily increases compared to the circumference of the head.

Formulas for an approximate assessment of the rate of development of the chest: For children under 1 year old, the monthly increase in the first half of the year is 2 cm, in the second half of the year - 0.5 cm. The chest circumference of a 6 month old child is 45 cm, for each missing month up to 6 you need to subtract 2 cm, and for each subsequent month after 6, add 0.5 cm.

For children from 2 to 15 years old, body length can be calculated by the formula: body length at 8 years old - 130 cm, subtract 7 cm for each missing year, add 5 cm for each exceeding year. For children from 2 to 15 years old, body length can be calculated according to the formula: body length at 8 years old - 130 cm, subtract 7 cm for each missing year, add 5 cm for each exceeding one. Body weight for children from 2 to 12 years old: at 5 years old body weight 19 kg, for each missing year subtract 2 kg, and for each subsequent add 3 kg.

Head circumference. At 5 years old - 50 cm, 1 cm is subtracted for each missing year, and 0.6 cm is added for each subsequent year. Head circumference. At 5 years old - 50 cm, 1 cm is subtracted for each missing year, and 0.6 cm is added for each subsequent year. Chest circumference at the age of 2 to 15 years: up to 10 years 63 cm minus 1.5 cm (10-n) where n is the number of years of a child under 10 years old, over 10 years old - 63 + 3 cm (n-10).

The physical development of children is influenced by genetic and exogenous factors. The influence of heredity affects mainly after two years of life, and there are two periods when the correlation between the height of parents and children is most significant, this is the age from 2 to 9 years and from 14 to 18 years. At this age, the distribution of body weight relative to body length can vary significantly due to pronounced constitutional features of the physique.

Exogenous factors, in turn, can be divided into intrauterine and postnatal. Intrauterine factors - the state of health of the parents, their age, the environmental situation in which the parents live, occupational hazards, the course of pregnancy, etc. Postnatal factors - factors that affect the physical development of the child in the course of his life: these are the conditions of nutrition, education, diseases endured by the child, social conditions. So, a moderate nutritional deficiency delays the increase in body weight, but, as a rule, does not affect the length of the body. Longer qualitative and quantitative starvation, unbalanced nutrition with micronutrient deficiencies lead less often not only to a lack of body weight, but also to short stature with a change in body proportions.

Young children are characterized by high motor activity, which is a stimulator of osteogenesis and cartilage growth. However, physical mobility should be adequate for the age of the child. For example, excessive vertical load when lifting weights leads to the opposite effect - inhibition of growth. Young children are characterized by high motor activity, which is a stimulator of osteogenesis and cartilage growth. However, physical mobility should be adequate for the age of the child. For example, excessive vertical load when lifting weights leads to the opposite effect - inhibition of growth. The physical development of children is influenced not only by proper wakefulness, but also by sleep, since it is during sleep that all the main metabolic changes that determine the growth of the child's skeleton are carried out (and growth hormone is released during sleep).

In young children, especially in the first year of life, there is a close interdependence of physical and neuropsychic development. The absence or lack of positive, as well as an excess of negative emotions affects the physical condition, and can be one of the causes of growth disorders. In young children, especially in the first year of life, there is a close interdependence of physical and neuropsychic development. The absence or lack of positive, as well as an excess of negative emotions affects the physical condition, and can be one of the causes of growth disorders. Climatic and geographical conditions are environmental factors that affect growth and development. For example, there was an acceleration of growth in the spring, deceleration in the autumn-winter period. Hot climates and high mountains inhibit growth, but can accelerate the maturation of children.

In the postnatal period, endocrine regulation of growth is of great importance. Growth-promoting hormones are pituitary growth hormone, thyroid hormones, and insulin. Growth hormone stimulates chondrogenesis, while thyroid hormones have a greater effect on osteogenesis. The influence of STH has relatively little effect on the growth of a child up to 2-3 years old and is especially large in the period from 7 to 10 years. In the postnatal period, endocrine regulation of growth is of great importance. Growth-promoting hormones are pituitary growth hormone, thyroid hormones, and insulin. Growth hormone stimulates chondrogenesis, while thyroid hormones have a greater effect on osteogenesis. The influence of STH has relatively little effect on the growth of a child up to 2-3 years old and is especially large in the period from 7 to 10 years. The greatest growth effect of thyroxin is determined in the first 5 years of life, and then in the prepubertal and pubertal periods. Thyroxine stimulates osteogenic activity and increased bone maturation. Androgens, acting in the prepubertal and pubertal periods, enhance the development of muscle tissue, endochondral ossification and chondroplastic bone growth. The action of androgens as growth stimulants is short-lived.

Throughout childhood, the rate of growth of children is not the same. The phase of intensive growth and primary increase in body weight continues until 4 years of age. The most pronounced increase in body weight. Normally eating children acquire rounded shapes. Throughout childhood, the rate of growth of children is not the same. The phase of intensive growth and primary increase in body weight continues until 4 years of age. The most pronounced increase in body weight. Normally eating children acquire rounded shapes. The first phase of rapid growth (stretching) is from 5 to 8 years of age. Body weight increases proportionally, but lags behind body length indicators. The second phase - adding body weight - age from 9 to 13 years. Body weight increases faster than body length. The second phase of rapid growth is between 13 and 16 years. Growth stops in girls at about 17 years of age, and in boys at 19 years of age.

Changes in body length with age are characterized by varying degrees of elongation of various body segments. So the height of the head increases only 2 times, the length of the body - 3 times, and the length of the lower limbs - 5 times. The most dynamic changes are in two segments - the upper part of the face and the length of the leg. Changes in body length with age are characterized by varying degrees of elongation of various body segments. So the height of the head increases only 2 times, the length of the body - 3 times, and the length of the lower limbs - 5 times. The most dynamic changes are in two segments - the upper part of the face and the length of the leg. The growth rate has a pronounced craniocaudal gradient, in which the lower segments of the body grow faster than the upper ones. For example, the foot grows faster than the lower leg, and the lower leg faster than the hip, this affects the proportions of the body. In practice, various indices of development proportionality are often used.

The most widely used definition of the relationship between the upper and lower segments of the body (Chulitskaya II index). In addition to changes in the ratios between body lengths, age-related changes in proportions also significantly affect the ratios between body length and various transverse dimensions (for example, chest circumference and body length - Erisman index) - The most common is the determination of the ratios between the upper and lower body segments (Chulitskaya II index ). In addition to changes in the ratios between body lengths, age-related changes in proportions also significantly affect the ratios between body length and various transverse dimensions (for example, chest circumference and body length - Erisman index) - Chulitskoy Index I (shoulder circumference, thigh tibia and body length). A decrease in the index confirms the child's malnutrition. When using various indices, the idea of ​​the degree of harmony of the child's physique is significantly refined.

In practical work, the physical development of a child is usually assessed by comparing his individual indicators with age standards. In practical work, the physical development of a child is usually assessed by comparing his individual indicators with age standards. Currently, the centile method is used for this purpose, which is easy to work with, since when using centile tables or graphs, calculations are excluded. Two-dimensional centile scales "body length - body weight", "body length - chest circumference", in which body weight and chest circumference are calculated for the proper body length, make it possible to judge the harmony of development. Physical development is considered harmonious, in which body weight and chest circumference correspond to body length, i.e. fall in the 25th-75th centile. With disharmonious physical development, these indicators lag behind due (10-25 - 10-3) or exceed them (75-90 - 90-97) due to increased fat deposition.

Currently, a comprehensive scheme for assessing the physical development of children is being increasingly used. It involves both the biological level and the morphofunctional state of the organism. Currently, a comprehensive scheme for assessing the physical development of children is being increasingly used. It involves both the biological level and the morphofunctional state of the organism. The physical development of children is assessed in the following sequence: first, the correspondence of the calendar age to the level of biological development, which corresponds to the calendar age, is determined if most of the indicators of biological development are in the middle age range (M1). If the indicators of biological development lag behind the calendar age or are ahead of it, this indicates a delay (retardation) or acceleration (acceleration) of the rate of biological development.

Then anthropometric and functional indicators are evaluated. To evaluate the former, the centile method is used and functional indicators, as already noted, are compared with age standards. Functional indicators in children with harmonious development range from M1 to M2 or more. In children with disharmonious and sharply disharmonious physical development, these indicators are usually below the age norm. Then anthropometric and functional indicators are evaluated. To evaluate the former, the centile method is used and functional indicators, as already noted, are compared with age standards. Functional indicators in children with harmonious development range from M1 to M2 or more. In children with disharmonious and sharply disharmonious physical development, these indicators are usually below the age norm. Somatograms are also used to assess anthropometric indicators.

Modern anthropometric indicators in young people in the period of completion of growth are much higher than they were 100 years ago. This process, called acceleration and observed over the past 100 years, has affected mainly young populations in developed and prosperous countries. Acceleration is most pronounced in urban children and among the more affluent segments of the population. The known causes of acceleration are good and more nutritious nutrition, a varied set of stimuli (sports, travel, communication), and a decrease in the incidence of infectious diseases that retard the development of the child. Modern anthropometric indicators in young people in the period of completion of growth are much higher than they were 100 years ago. This process, called acceleration and observed over the past 100 years, has affected mainly young populations in developed and prosperous countries. Acceleration is most pronounced in urban children and among the more affluent segments of the population. The known causes of acceleration are good and more nutritious nutrition, a varied set of stimuli (sports, travel, communication), and a decrease in the incidence of infectious diseases that retard the development of the child.

Acceleration is considered as the result of a complex interaction of exogenous and endogenous factors: a change in the genotype due to large migration of the population and the emergence of mixed marriages, changed dietary habits, clinical conditions, scientific and technological progress and its impact on the environment. Acceleration was noted in all age groups, starting from prenatal. Over the past 40-50 years, the body length of newborns has increased by 1-2 cm, children 2 years old - by 4-5 cm. The average height of 15 year old children has increased by 20 cm over 100 years. There is also a faster development of muscle strength, accelerated biological maturation.

There are harmonious and disharmonious types of acceleration. There are harmonious and disharmonious types of acceleration. The first includes children whose anthropometric indicators and biological maturity are higher than those for this age group. The second group includes children who have increased body growth in length without accelerating sexual development or early puberty without increasing growth in length.

But if earlier the process of acceleration was considered only as a positive phenomenon, then in recent years there is information about a more frequent disproportion in the development of individual body systems in such children, especially neuroendocrine, cardiovascular. According to numerous publications, the process of acceleration in economically developed countries is currently slowing down. There is no reason to believe that in the future a significant decrease in the age of puberty is expected, as well as an increase in body length above the norm of average height that has been established for millennia. But if earlier the process of acceleration was considered only as a positive phenomenon, then in recent years there is information about a more frequent disproportion in the development of individual body systems in such children, especially neuroendocrine, cardiovascular. According to numerous publications, the process of acceleration in economically developed countries is currently slowing down. There is no reason to believe that in the future a significant decrease in the age of puberty is expected, as well as an increase in body length above the norm of average height that has been established for millennia.

If we talk about the assessment of body length indicators, then low growth is growth below the average, for a given age, values ​​\u200b\u200bmore than 2, or below the third percentile, which corresponds to a deviation from them by 10%. If we talk about the assessment of body length indicators, then low growth is growth below the average, for a given age, values ​​\u200b\u200bmore than 2, or below the third percentile, which corresponds to a deviation from them by 10%. Dwarf growth: Growth rates are 3 below average and therefore below the 0.5 percentile. Large growth, macrosomia: Growth rates exceed the average by 1-3, or are above the 97th percentile. Gigantic Growth, Gigantism: Growth rates exceed the average by more than 3.

About 3% of children and young men are classified as undersized. Most of them are somatically quite healthy. They can show psychic vulnerability when it comes to their short stature. Short stature may be due to family, constitutional factors, when both parents or at least one of them are short. Constitutional dwarf growth is always associated with a specific pathology of genes or chromosomes, regardless of whether it can be confirmed by scientific methods or not. About 3% of children and young men are classified as undersized. Most of them are somatically quite healthy. They can show psychic vulnerability when it comes to their short stature. Short stature may be due to family, constitutional factors, when both parents or at least one of them are short. Constitutional dwarf growth is always associated with a specific pathology of genes or chromosomes, regardless of whether it can be confirmed by scientific methods or not.

Causes of pathological short stature: Primary short stature with low birth weight Secondary short stature due to metabolic disorders (including pathology of the endocrine glands), which appear only after birth Growth disorders associated mainly with the development of long tubular bones

Two main groups of short stature: Proportional short stature with general retarded development. At the same time, age-related physiological proportions are preserved (the ratio of the size of the head to the body, limbs). In a newborn, the ratio of the length of the head and body corresponds to 1:4, at the age of 6 years - 1:5, by 12 years - 1:7, in adults - 1:8. Disproportionate short stature usually occurs with isolated disorders in the most active areas of growth. Normal ratios between the sizes of the head, torso and limbs are violated.

The most common causes of proportionate short stature Constitutional (familial) short stature. This group includes healthy children of healthy parents, whose growth is below average. Such children remain below their peers. Body weight and length at birth may be normal, ossification of the skeleton (the appearance of ossification nuclei) occurs at the usual time. The level of growth hormone in the blood is normal.

The most common causes of proportionate short stature Initial short stature. The frequency of the phenomenon is determined by the prevalence of short stature in previous generations and preferential marriages between people of short stature. Its signs already at birth are low indicators of body weight and length. The child is born with all signs of maturity, pregnancy usually has a normal duration. The proportions of the body in children are observed, the ossification of the skeleton and mental development, as well as the puberty period, proceed normally, which makes it possible to exclude the pathology of metabolic processes.

The most common causes of proportionate short stature Alimentary short stature. The causes of alimentary short stature are either malnutrition or a violation of the absorption of nutrients. The most adverse effect is the lack of proteins. These children are particularly susceptible to infectious diseases.

Consequences of quantitative and qualitative malnutrition Anorexia in severe mental or physical disorders. Diabetes mellitus, difficult to compensate and regulate. Mauriac's syndrome (diabetes mellitus, short stature, hepatomegaly, congestion in the portal vein system, obesity, chronic acetonuria, hypercholesterolemia). Diabetes insipidus. Short stature is a consequence of a metabolic disorder due to a lack of antidiuretic hormone (adiuretin). At the same time, there is almost always a lesion of the anterior pituitary (growth hormone) or hypothalamus (vegetative centers).

Consequences of quantitative and qualitative malnutrition Insufficient nutrition with homelessness, neglect of children, as a manifestation of severe hospitalism (not only in orphanages, but also in some families), with kwashiorkor associated with a chronic lack of protein in food. Frequent vomiting due to psychogenic disorders or as a result of anatomical abnormalities (stenosis of the esophagus or duodenum, hernia of the diaphragm, Hirschsprung's disease, gastric and duodenal ulcer). Digestive disorders (maldigestion), including cystic fibrosis and other diseases. Malabsorption (malabsorption), partial or complete after extensive resection of the small intestine, Crohn's disease, celiac disease, etc.

The most common causes of proportional short stature Short stature in the last three groups of causes is combined into the concept of short stature of intestinal origin. Low growth due to hypoxia. It occurs in chronic diseases of the lungs and respiratory tract, heart disease, chronic severe anemia (children attract attention with pallor and constant cyanosis or cyanosis when moving). They suffer from shortness of breath, have a chronic cough, fingers in the form of drumsticks.

The most common causes of proportional short stature Short stature with impaired puberty: hypogonadotropic hypogonadism, late puberty Frohlich's adiposogenital dystrophy ovarian dysgenesis (Shereshevsky-Turner syndrome)

Low growth on the basis of cerebral and hormonal pathology. Low growth on the basis of cerebral and hormonal pathology. Cerebral causes: slow-growing brain tumors residual effects of stem encephalitis, tuberculous meningoencephalitis and neurosyphilis microcephaly, hydrocephalus alcoholic embryopathy

Hormonal pathology Pituitary short stature caused by hypofunction of the anterior pituitary gland, primarily by GH deficiency, and very significant (growth begins to slow down from the age of 2, dwarf growth is formed by the end of school age) Hypopituitarism (Simmonds b-n) - a decrease in all pituitary functions Important signs are struma, myxedema, delayed ossification of the skeleton, dementia

Low disproportionate growth Chondrodystrophy (achondroplasia, chondrodysplasia). Predominantly hereditary pathology of cartilage cells, manifested by a violation of the growth of long tubular bones and the base of the skull. Imperfect osteogenesis. The disease is based on hereditary inferiority of osteoblasts, leading to increased fragility of bones with minimal causes and shortening of the limbs precisely because of multiple fractures.

Low disproportionate growth of Mucopolysaccharidosis. Malformations of the spine. A decrease in the size of the body with a normal length of the limbs is characteristic. Vitamin D - resistant forms of rickets (rickets-like diseases). Hereditary hypophosphatasia (Ratban's syndrome). Cystinosis (Abdergalden-Fanconi disease). Rachitic change of bones and short stature.

High growth High initial growth. As a rule, there is a family predisposition to high growth. In many previous generations, a significant number of tall people are noted, as in cases of primordial short stature. Arachnodactyly (Marfan's syndrome) is a hereditary (autosomal dominant) widespread mesodermal dysplasia: tall stature, thin long bones, a pronounced pattern of leptosomal asthenia, long hands and feet, often chest deformity, general muscular hypotension. Often ectopia of the lens and dilatation of the aorta.

High growth Pituitary gigantism (eosinophilic adenoma of the anterior pituitary gland in children). Adults have acromegaly. Children are tall and slender. High growth at early puberty (early puberty is a strong stimulus to growth, but this is temporary, and then growth stops). Chromosomal aberrations. Klinefelter's syndrome (XXY - chromosomopathy) with primary underdevelopment of the testicles. Heller-Nelson syndrome. Syndrome HUU, XXXXY.

Deviation in the increase in b.w. Hypotrophy - reduced body weight. Eutrophy is a state in which an increase in body weight and an increase in body length do not go beyond the limits of physiological ratios (i.e. this is a state of normal nutrition). Dystrophy is a condition in children whose body weight is 15-20% lower than normal. They attract the attention of thinness, thin limbs, poor development of muscles and subcutaneous fat. Atrophy is the condition of a child whose body weight is 30% below the average or below the 3rd percentile.

Constitutional factors Prematurity, newborns with intrauterine dystrophy (other points are also important - embryopathies, chromosomal abnormalities). Asthenic physique. (Children are usually healthy.) Marfan's syndrome. Progressive lipodystrophy.

Chronic digestive disorders Malabsorption of monosaccharides, disaccharides. Congenital insufficiency of enterokinase. Tryptophan malabsorption (Hartnup syndrome). Enteropathic acrodermatitis (impaired absorption of zinc).

Overweight Overweight should be considered body weight (taking into account body length) 15% higher than the average, which exceeds the 97th percentile. With obesity, body weight exceeds the average for a given age by 25% or more.

Causes of overweight Constitutional factors. Unreasonable high-calorie nutrition (excess of proteins, carbohydrates, fats and fluids). Adverse mental and social conditions that most strongly affect children in a state of depression, as well as resigned and weak-willed children with weak self-awareness, and the feeble-minded. Cerebral diseases. Diencephalic or diencephalic-pituitary obesity, adiposogenital dystrophy.

Causes of overweight Endocrine disorders: hypothyroidism, hypercortisolism, Cushing's syndrome. Primary metabolic disorders: type I glycogenosis, Mauriac's syndrome (diabetes mellitus). Obesity in other syndromes: Pickwickian syndrome; Prader-Willi syndrome; Ahlstrom-Halgren syndrome (obesity + blindness + retinal dystrophy), reduced glucose tolerance with the development of diabetes mellitus, hearing loss due to damage to the inner ear.

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Deviations in body length can manifest as growth retardation or tall stature Significant degrees of growth retardation are called dwarfism, and tall stature is called gigantism The main causes of rustu disorder (in descending order of the frequency of pathology) are as follows: constitutional, cerebro-endocrine, somatogenic (chronic diseases of various body systems with dysfunction of one or another organ), hereditary and diseases, social factors.

Deviations in body weight have the form of its decrease or increase In young children, deviations in body weight of less or more than 10% of the normative indicators (in the presence of other characteristic signs) are called hypotrophy and paratrophy, respectively. An increase in body weight in children of other age groups is more than 14% per due to excess fat deposition is called obesity. The main causes of weight loss in children are alimentary, constitutional, somatogenic, cerebro-endocrine and other factors.

Deviations in head circumference can manifest as a decrease (microcephaly) or increase (often hydrocephalus) children after birth.

Deviation in the circumference of the chest can be either in the direction of decrease or increase. The causes of such disorders are abnormalities in the development of the chest and lungs, respiratory diseases, the degree of physical fitness and muscle development, constitutional features of the skin.

22) 1. Anatomical and physiological features of the respiratory system in children. Research methodology

The right lung consists of three lobes: upper, middle and lower, and the left lung consists of two: upper and lower. The middle lobe of the right lung corresponds to the lingular lobe in the left lung. Along with the division of the lungs into lobes, knowledge of the segmental structure of the lungs is of great importance. The formation of the structure of the lungs occurs depending on the development of the bronchi. After the division of the trachea into the right and left bronchi, each of them is divided into lobar bronchi, which are suitable for each lobe of the lung. Then the lobar bronchi are divided into segmental. Each segment has the form of a cone or pyramid with the apex directed towards the root of the lung.

The anatomical and functional feature of the segment is determined by the presence of self-ventilation, terminal artery and intersegmental septa made of elastic connective tissue. The segmental bronchus with the corresponding blood vessels occupies a certain area in the pulmonary lobe. The segmental structure of the lungs is already well expressed in newborns. There are 10 segments in the right lung and 9 in the left lung.

Oxygen reserves in the body are very limited, and they are enough for 5-6 minutes. The body is supplied with oxygen by the process of respiration. Depending on the function performed, two main parts of the lung are distinguished: the conductive part for supplying air to the alveoli and bringing it out and the respiratory part, where gas exchange occurs between air and blood. The conductive part includes the larynx, trachea, bronchi, i.e. the bronchial tree, and the actual respiratory part includes the acini, consisting of the afferent bronchioles, alveolar ducts and alveoli.

External respiration refers to the exchange of gases between atmospheric air and the blood of the capillaries of the lungs. It is carried out by simple diffusion of gases through the alveolar-capillary membrane due to the difference in oxygen pressure in the inhaled (atmospheric) air and venous blood flowing through the pulmonary artery into the lungs from the right ventricle.

Assessment of the function of external respiration is carried out according to such groups of indicators as:

1) pulmonary ventilation (frequency (f), depth (Vt), minute respiratory volume (V), rhythm, volume of alveolar ventilation, distribution of inhaled air);

2) lung volumes (vital capacity (VC, Vc), total lung capacity, inspiratory reserve volume (IRV, IRV), expiratory reserve volume (ERV), functional residual capacity (FOE), residual volume (OO));

3) respiratory mechanics (maximum ventilation of the lungs (MVL, Vmax), or respiratory limit, respiratory reserve, forced vital capacity (FEV) and its relation to VC (Tiffno index), bronchial resistance, inspiratory and expiratory volumetric velocity during calm and forced breathing);

4) pulmonary gas exchange (value of oxygen consumption and carbon dioxide release in 1 min, composition of alveolar air, oxygen utilization factor (KIO2));

5) gas composition of arterial blood (pressure of oxygen (pO2) and carbon dioxide (pCO2), the content of oxyhemoglobin in the blood and arteriovenous difference in Hb and oxy-Hb).

The need for oxygen in children is much higher than in adults, this is due to a more intense metabolism.

The superficial nature of breathing, its irregularity is compensated by a higher respiratory rate. In a newborn, the respiratory rate (RR) is 40-60 per 1 min, in a 10-year-old - 20, in an adult - 16-18. In children, due to the high respiratory rate, the minute volume of breathing per 1 kg of body weight is much higher than in adults.

VC and maximum ventilation in children are significantly less than in adults.

All these anatomical and functional features of the respiratory system create the prerequisites for a milder respiratory failure, which leads to respiratory failure in children.

(in decreasing order of frequency of pathology) are as follows: constitutional, cerebro-endocrine, somatogenic (chronic diseases of various body systems with impaired function of one or another organ), social factors.

In young children, deviations in body weight less than or more than 10% of the normative indicators (in the presence of other characteristic signs) are called, respectively hypotrophy and paratrophy. The increase in body weight in children of other ages is more than 14% due to overweight. The main reasons for deviations in body weight of children are alimentary, constitutional, somatogenic, cerebro-endocrine and other factors.

They can manifest as a decrease (microcephaly) or an increase (a common variant is hydrocephalus). The main causes of deviations in the bypass of the chairman are intrauterine brain development disorders, trauma and hypoxia of the brain during childbirth, trauma, infectious diseases and brain tumors in children after birth.

Deviations in the contour of the chest can be both decreasing and increasing. The causes of such disorders are abnormalities in the development of the chest and lungs, diseases of the respiratory system, the degree of physical fitness and muscle development, constitutional features, etc.

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