GANGGUAN

PERTUMBUHAN PADA
ANAK

Miftakhur Rohmah, SST, M.Keb

Prodi D-IV Kebidanan Stikes Strada
 Gangguan pertumbuhan
G ro w th C h a rt
1 9 5

1 9 0
97
1 8 5

1 8 0

1 7 5 50
1 7 0

1 6 5 3
1 6 0

1 5 5

1 5 0

• Perawakan normal
1 4 5

H e ig h t 1 4 0

(c m ) 1 3 5

• Pertumbuhan
1 3 0

1 2 5

1 2 0

1 1 5

1 1 0
terganggu
1 0 5

1 0 0

9 5

9 0

8 5

8 0
2 4 6 8 1 0 1 2 1 4 1 6 1 8

A g e (y e a rs )
 Gangguan pertumbuhan
G ro w th C h a rt
195

190
97
185

180

175 50
170

165 3
160

155

150

• Perawakan pendek
145

H e ig h t 140

(c m ) 135

• pertumbuhan normal
130

125

120

115

110

105

100

95

90

85

80
2 4 6 8 10 12 14 16 18

A g e (y e a rs )
 ETIOLOGI PERAWAKAN
PENDEK
Perawakan pendek dapat disebabkan oleh kelainan
endokrin ataupun non endokrin seperti
• Genetik atau familial
• Kelainan kromosom atau sindrom tertentu
• Penyakit kronis
• Gangguan gizi
• Intra Uterine Growth Retardation (IUGR)
• Constitutional Delay of Growth and Pubeerty (CDGP)
• Kelainan endokrin : defisiensi GH, Hipotiroidisme, dll.
 PERAWAKAN PENDEK

KECEPATAN TUMBUH NORMAL?

YA TDK

VARIAN NORMAL PATOLOGIS

PROPORSI ? DISMORFISM ?

BB/TB?
 PERAWAKAN PENDEK

PATOLOGIS

PROPORSIONAL
DISPROPORSIONAL

BB/TB  BB/TB 

KELAINAN
ENDOKRIN
•MALNUTRISI DISMORFIK
•DEFISIENSI GH
•INFEKSI KRONIS
•HIPOTROID
•PENYAKIT
•KORTISOL KRONIS
•PSEUDOHIPOPARA (ORGANIK)
TIROID •PSIKOSOSIAL
•IUGR
 PERAWAKAN PENDEK

PATOLOGIS

DISPROPORSIONAL KELAINAN DISMORFIK

•DISPLASIA TULANG •KELAINAN KROMOSOM

A/HIPO CHONDROPLASIA •SINDROM-SINDROM ( IUGR)
•KELAINAN METABOLIK PRADER-WILLI, NOONAN,
•GANGGUAN SPINAL
 PERAWAKAN PENDEK

VARIAN NORMAL

FAMILIAL SS CONSTITUTIONAL DELAY OF

GROWTH AND PUBERTY

USIA TULANG = USIA USIA TULANG < USIA

KRONOLOGIS KRONOLOGIS
TINGGI DEWASA < TINGGI DEWASA >
PERSENTIL-3 PERSENTIL-3
SESUAI POTENSI SESUAI POTENSI
GENETIK GENETIK
RIWAYAT KELUARGA (+)
Pola-pola pertumbuhan linier
Pola-pola pertumbuhan linier
 Sindrom Turner (ST)

 Tinggi dewasa 137-146.8 cm

 Etiologi perawakan pendek
aksis longitudinal tubuh
gangguan tulang panjang lebih berat dari vertebra
(Lippe, 1993)
 Rosenfeld et al (1994)
Pemberian dini terapi GH
Kombinasi GH + oxandrolone
Estrogen  induksi pubertas
 Penatalaksanaan

• Familial short stature : tidak diterapi

• Constitutional delay of growth and puberty
(CDGP): tidak diterapi
• Tergantung kausal : nutrisi, infeksi, dll
• Hormonal : GH, tiroid, sex steroid
Anak umur 5 tahun ,)
Tall Stature
 Introduction

• Definition
Tall stature : height above 97th percentile
for age, sex and race.
• GH excess, occurs during childhood when
open epiphyseal growth plates allow for
excessive linear growth
• Cause
– Intrinsic
– Acquired
 Growth cessation

• Puberty  sex steroid

(estrogen)  
epiphyseal fusion
• Bone age
– Girls 14 – 16 yrs
– Boys 18 – 20 yrs
• Sex steroid & growth
– Low dose: stimulate
– High dose: inhibit
 Short Stature

Mother and fathers heights.

- MPH = M(cm) + F (cm) 13 cm /2.
MPH range 8 cm.
- FH short stature: males <165 cm
females <152 cm
- FH delayed puberty:
menarche >14 yrs in females and continued growth after
high school in males.
 Soal

• Data anak lelaki

– usia 7tahun 4 bulan : 110 cm; bone age 5
tahun
– usia 8 tahun : 114 cm; bone age; 6 tahun
– usia 9 tahun 6 bulan : 122 cm; bone age 7
tahun
• Tinggi ayah 172 cm, tinggi ibu 166 cm
• Ibu menarche 15 tahun
EVALUASI PERTUMBUHAN ANAK INI!
 Grow th Chart
195 Familial Short Stature
190

185

180

175

170

165

160

155

150

145

Height 140

(cm) 135

130

125

120

115

110

105

100

95

90

85

80
2 4 6 8 10 12 14 16 18

Age (years)
 Grow th Chart
195
Constitutional Delay of Growth & Puberty
190

185

180

175

170

165

160

155

150

145

Height 140

(cm) 135

130

125

120

115

110

105

100

95

90

85

80
2 4 6 8 10 12 14 16 18

Age (years)
 Pathological short stature

Proportionate: IUGR
syndromes
chronic illness
drugs
psychsocial deprivation
Disproportionate: Syndromes (partic Turner S)
hypothyroidism
Skeletal dysplasias
 IUGR/SGA

Intrauterine growth retardation or small for gestational age.

Very common.
Birth weight <10th PC for gestational age.
Catch-up growth above 3rd PC usually occurs by 6 most of
age but may drag on to 2 yrs.
Short stature by 2 yrs usually associated with short final
height.
As a group these children do not reach MPHs.
Approx 10% become short adults.
 Turner Syndrome

Consider in all girls with unexplained short

stature or Ht below MPH range.
Commonest feature is short for MPH
(100%).
50% will only have short stature as clinical
feature.
Present with short stature, poor HG or
delayed puberty.
 Normal Growth
The ICP (infant/child/puberty) model of growth (Karlberg model)

Mathematically growth is characterised by 3 periods of growth

Infant - Birth to 2 years. Rapid growth at birth declining
rapidly over the first 2 years of life – less growth hormone
dependent.
Childhood - 2 years until puberty. Relatively constant
annual growth - growth hormone dependent.
Puberty - growth primarily dependent on sex steroids and
increased growth hormone release. Sex steroids cause eventual
fusion of skeletal epiphyses and growth arrest.
 Intrinsic tall stature

 Familial genetic tall stature /

constitutional
 Cerebral gigantism (Soto’s syndrome)
 Marfan syndrome
 Homocystinuria
 Multiple endocrine neoplasia type 2b
 Acquired tall stature
Infant of diabetic mother (hyperinsulinism)
Obesity (tall child normal adult height)
Sexual precocity (tall child but short adult)
Primary hypogonadism (eunuchoid)
Hyperthyroidism

Growth hormone excess (Gigantism,

acromegaly)
 Evaluation – Lab
• Growth pattern
– Parallel or not
– Potential genetic height
• Bone age (prediction of final height)
• As indicated
– Chromosome
– Mutation analysis
– Others (hormonal, imaging, cardiovascular,etc)
Marfan-arachnodactyly
 Soto's syndrome

• rare genetic disorder with excessive physical

growth during the first 2 to 3 years of life.
• large at birth, large heads (macrocrania)
• .
 Therapy

• Causal
• Constitutional Tall stature
– reassurance
– Boys: testosterone 500mg/m2/month
– Girls: estradiol 0,1 mg/day
 PENDEKATAN DIAGNOSIS GANGGUAN
PERTUMBUHAN
Kreteria awal untuk pemeriksaan lebih lanjut :
1. Tinggi badan lebih dari 2,5 dibawah tinggi badan rata-
rata untuk umur kronologisnya
2. Kecepatan tumbuh dibawah persentil ke 25 kurva
kecepatan tumbuh atau kurang dari 4 cm /tahun pada
anak berumur 4-10 bulan.
3. Prakiraan tinggi dewasa dibawah potensi tinggi
genetiknya.
4. Kecepatan tumbuh melambat setelah umur 3 tahun
dan turun menyilang garis persentilnya pada kurva
panjang/tinggi badan .
 PENDEKATAN DIAGNOSIS GANGGUAN
PERTUMBUHAN
ANAMNESIS
Riwayat perinatal, panjang / berat lahir, trauma
lahir
Riwayar tumbuh kembang
Asupan nutrisi
Riwayat penyakit
Lingkungan psikosoaial
 PENDEKATAN DIAGNOSIS GANGGUAN
PERTUMBUHAN
PEMERIKSAAN FISIK
Stigmata sindrom dismorfik / kromosom
Tingkat kecerdasan
Tanda / gejala penyakit sistemik
Tanda KEP
Tingkat maturasi kelamin
Antropometri
 PENDEKATAN DIAGNOSIS
GANGGUAN PERTUMBUHAN
PEMERIKSAAN PENUNJANG

 TSH
 LED, darah rutin (CBC)
 Elektrolit, BUN, creatinin, urinalisis,
tinja
 Skrining TBC
 Umur tulang (bone age)
 Rujuk untuk pemeriksaan GH / IGF-1
ACHONDROPLASIA
 HIPOTIROID
DIDAPAT

HIPOTIROID
KONGENITAL
 KESIMPULAN
Pertumbuhan menggambarkan keadaan
kesehatan seorang anak
Pemantauan pertumbuhan memerlukan
pengukuran teratur dengan alat yang
tepat,
penting interpretasi hasil pemantauan
Perlu diingat bahwa gangguan
pertumbuhan lebih sering disebabkan oleh
kelainan non-endokrin
SELAMAT BELAJAR