Sihai network

What tests should be done if the child is not tall

Parents want their babies to grow tall and strong, so what has affected their children's height? Experts pointed out that there are many factors that lead to short stature, including many interactions, and many diseases that lead to short stature mechanism has not been clarified so far.

If a short child is found, how to check it?

1、 Physical examination

In addition to the routine physical examination, the following items shall be measured and recorded correctly: ① the measured values and percentiles of current height and weight; ② the annual growth rate of height (at least more than 3 months observation); ③ the target height calculated according to the height of their parents; ④ BMI value; ⑤ sexual development stages.

3、 Laboratory examination

1. Routine examination should be carried out for blood, urine and liver and kidney functions; blood gas and electrolyte analysis should be carried out for suspected renal tubular poisoning; karyotype analysis should be carried out for girls; in order to eliminate subclinical hypothyroidism, thyroid hormone level should be routinely detected.

2. Bone age (BA) is a good index to evaluate the development of organism. Bone age is the maturity of bone at all ages. The growth and development of each ossification center was observed by X-ray film of left wrist, palm and finger. At present, the most commonly used methods at home and abroad are G-P method (Greulich Pyle) and TW3 method (Tanner Whitehouse). Under normal circumstances, the difference between the bone age and the actual age should be between & plusmn; 1 year old, which is abnormal if it is too late or too much ahead.

3. Special inspection

(1) The indicators for special examination are: ① the height is lower than the normal reference value by 2sd (or lower than the 3rd percentile); ② the bone age is lower than the actual age by more than 2 years; ③ the height growth rate is lower than the 25th percentile (by bone age), that is to say, & lt; 7cm / RH for 2-year-old children; ④ the clinical manifestations of endocrine disorder or malformation syndrome; ⑤ the other reasons need to carry out pituitary function examination.

(2) GH-IGF-1 axis function test previously used physiological screening tests such as exercise and sleep have been rarely used, and most of them directly use drug stimulation test (see Table 2).

(3) The serum concentrations of insulin-like growth factor -1 (IGF-1) and insulin-like growth factor binding protein -3 (IGFBP-3) increased with age and development, and were related to nutrition and other factors.

(4) IGF-1 production test can be used to detect GH receptor function in children suspected of GH resistance (Laron syndrome). ① Method 1: rhGH was injected subcutaneously every night for 1 week according to 0.075-0.15u / (kg & middot; d), and blood samples were collected before injection, 5 and 8 days after injection respectively to determine IGF-1; method 2: rhGH was subcutaneously injected every night according to 0.3u / (kg & middot; d) for 4 days, Blood samples were collected before and after the last injection, and IGF-1 was measured. The serum IGF-1 of the normal subjects would be more than three times higher than its base value or reach the normal value corresponding to their age.

(5) The detection of other endocrine hormones is based on the clinical manifestations of children, and other hormone selection of children can be detected as needed

(6) Imaging examination of hypothalamus and hypophysis in short stature children, MRI examination of cranium should be carried out to exclude the possibility of congenital dysplasia or tumor.

(7) Karyotype analysis should be carried out for children suspected of chromosomal aberrations.

Experts remind us that children are our future and hope. If we find a disease, we should go to a regular professional hospital in time for examination and treatment. We should not delay the best treatment time of the disease, which will cause serious harm to children and families.