Please wait while the transcript is being prepared...
0:04
Now what I want to
do that you've had
some essential background about
routine growth screening,
I really want to take
this home and talk about
my cases that I've seen
in pediatric practice.
They really are cases
where just a look at
those growth curves could
have made a vital difference.
So this is a real patient.
I've substituted
very minor details
for patient confidentiality.
There was a boy, and he came
to the genetics clinic,
referred at 18 months to rule
out a skeletal dysplasia,
for example, like
achondroplasia,
where their bones are small.
When he came,
unfortunately there were
no growth curves,
and so we simply did
our one-point in
growth screening,
which is not as
useful as looking at
a whole trajectory
like I talked about.
But that one point showed
that the length
measurement was quite low.
It was three standard
deviations below the mean,
and the growth curves from
primary care were missing.
We also noticed on physical exam
that there was bowing
of the lower legs.
Now, I have told you
a very big hint.
I have told you that
if a z-score is
three standard deviations
below the mean
that something is
clinically wrong.
So we know that
just from that dot.
1:29
However, we wanted
to learn more,
and so what we did is we
made many phone calls
to the primary care doctor.
Don't you wish that
everybody carried
their growth curves with them
along with their vaccine record.
Right when we saw the curves,
we noticed that on the curve,
the baby had started out with
perfect growth at
the 50th percentile.
And at around six months of age,
the baby started to stop
growing between 6-10 months
and then continued
to really grow
much less than expected
through the 18 months.
That made us realize that unlike
skeletal dysplasia
where you would see
that the bones were short
from the very beginning,
something had gone on wrong.
Something had changed.
So that between 6 and 18 months
there was growth deceleration.
This should have been
flagged as a change
when this baby's growth curve
own trajectory deviated
down two percentiles.
