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                                  Notes on Growth in Paediatric Orthopaedics

                                              by Alain Dimeglio, M.D





I've taken excerpts from the article -- important points. I know some parents are super busy and

need to get to the facts. Well, here are the important points:





Alain Dimeglio, M.D. Growth in Pediatric Orthopaedics






First Five Years of Life


During the first 5 years of life, sitting height and subischial length grow about the same.Standing neonate height is 30% of the final height at maturity. By the age of 5 years, the standing height has doubled and is 60% of the final height. Height gain in the first year is as great as it is during the entire growth surge during puberty. At the age of 1 year, growth rate slows, with the child growing 10 cm between the ages of 1 and 2 years and 7 cm between the ages of 3 and 4 years.






From 5 years to 10 years


Between 5 and 10 years of age, there is a marked deceleration in growth, with standing height increasing approximately 5.5 cm per year. Two thirds (3.5 cm) of this growth occurs in the lower limb and one third (2 cm) in the sitting height. The trunk grows at a slower rate than the lower limbs and body proportions change.








During puberty, standing height increases by approximately 1 cm per month. At the onset of puberty, boys have 14% (± 1%) of their remaining standing height to grow. This is approximately 22.5 cm (± 1 cm) made up of 13 cm in sitting height and 9.5 cm in subischial leg length. Girls have 12% (± 1%) of their standing height to grow. This is approximately 20.5 cm (± 1 cm) made up of 12 cm in sitting height and 8.5 cm in subischial leg length.



Growth rate peaks during puberty between 13 and 15 years of bone age in boys and 11 and 13 years of bone age in girls. By the time girls and boys pass bone ages of 13 and 15, respectively, lower limb growth comes virtually to a standstill, with all remaining growth (4.5 cm) taking place in sitting height. These figures, ratios, and rates provide only a partial reflection of the growth phenomena.



Figure 2 on page 551 shows the proportion of leg length growth and sitting height growth for girls between ages 0 and 15 years.



In 93% of girls, breast budding occurs about one year before peak height velocity. This averages 11 years in bone age. Risser sign is still zero and the triradiate cartilage is open at the onset of puberty. Menarche occurs approximately 2 years after breast budding and final height is usually achieved 2.5 to 3 years after menarche.


A major problem with using the onset of menarche or Risser sign is that they occur after the pubertal growth rate has begun to slow. Menarche most often occurs when the rate of growth is slowing, usually between bone age of 13 and 13.5years and corresponds to Risser I on the iliac apophysis. At this stage, the average girl will gain an additional 4 cm of sitting height and 0.6 cm of subischial leg length. Menarche is not a precise indicator of puberty. Forty-two percent of girls have menarche before Risser I, 31% at Risser I, 13% at Risser II, 8% at Risser III, and 5% at Risser IV (13).




See figure 14 – Page 551 for three phases of peak growth





The first phase of the pubertal growth spurt corresponds to the acceleration in the velocity of growth and is the major portion of the pubertal growth spurt. This phase lasts 2 years from approximately 11 to 13 years of bone age in girls and 13 to 15 years of bone age in boys. The gain in standing height for girls during this phase is approximately 14.5 cm, made up of 6.5 cm in sitting height and 7 cm in subischial leg length. The gain in standing height for boys during this phase is approximately 16.5 cm, made up of 8.5 cm in sitting height and 8 cm in subischial leg length (12,13)



Triradiate cartilage closure occurs approximately halfway on the ascending limb of the pubertal curve and corresponds to an approximate bone age of 12 years for girls and 14 years for boys. After closure of the triradiate cartilage, there remains a significant amount of remaining growth—greater than 12 cm of standing height for girls and more than 14 cm for boys.



The second phase of the pubertal growth spurt is a period of deceleration in the rate of growth, which lasts 2.5 years from 13 to 15.5 years of bone age in girls and from 15 to 17.5 years of bone age in boys. During this phase, boys and girls gain approximately 6 cm in standing height with 4.5 cm coming from an increase in sitting height and 1.5 cm coming from an increase in the subischial leg length. During this phase, the increase in sitting height contributes 80% of the gain in the standing height.





A good way to tell the Adolescent growth spurt is about to begin....




          Excerpt from: Paediatric Orthopaedics, 2006

                       Lovell and Winter, P 59



    The foot is the first structure of the musculoskeletal system that begins to grow at puberty.The growth spurt of the foot occurs a few months before the start of puberty.Although it is the first to start growing during puberty, the foot is also the first musculoskeletal structure to stop growing.Growth of the foot stops at bone age of 12 years in girls and at a bone age of 14 in boys (i.e., 3 years before the end of growth).This makes the foot unique among the musculoskeletal structures in that its rate of growth mostly declines during puberty.



When puberty begins at approximately bone age 11 years in girls, the foot is already 22 cm long and has only 1.6 or 2% if its growth left.When puberty starts in boys, at approximately bone age of 13 years, the foot is about 24 cm long and has 2 cm or 2.5% of its growth remaining.








                                     Risser's Sign ---Growth Left in the Spine



                        Iliac Apophysis - (footnote #1)












Grading (based on iliac crest divided into 4 quadrants)