1. Pediatric Health Supervision Flashcards
What are disorders of growth and development often associated with in the general health and well being of children?
Disorders of growth and development are associated with disease ranging from severe and chronic illness as well as indicator of neglect and abuse.
Periodic monitoring is done to monitor and screen for disease state. Accurate measurements of height, weight and head circumferences should be obtained at every health supervision visit.
What is the routine office visit schedule for the first 3 years of life as according to the American Academy of Pediatrician (AAP)?
2 weeks
1, 2 ,4, 6, 9, 12, 15, 18 months
24, 30, 36 months (2, 2.5, 3 years)
Describe the purpose and types of growth charts by age.
Purpose
- abnormalities may be from endocrine imbalance or other issues.
Growth charts: (WHO 0-2 y/o; CDC >2 year old)
- head circumference
- length/height chart
- weight
- body mass index (BMI)
What is the rule of thumb in growth for weight in a newborn?
- Weight loss first few days - 5-10% of birth weight
- Return to birth weight - 7-10 days
- Double birth weight - 4-5 months
- Triple birth weight - 12 months
How is the trajectory of growth affected by inadequate caloric intake?
Weight falls first.
Then height.
Finally, head circumference.
List the possible causes of reduced caloric intake.
- Inadequate feeding.
- Child not receiving adequate attention/stimulation.
- Increased caloric needs due to chronic illness (heart failure and cystic fibrosis).
Describe possible causes of increased head circumference.
- Familial megacephaly.
- Hydrocephalus.
- “Catch-up” growth in a neurologically normal premature infant.
List and be able to interpret specific growth patterns requiring evaluation.
WEIGHT, LENGTH, HEAD CIRCUMFERENCE < 5th %-ILE.
DIAGNOSIS TO CONSIDER
- familial short stature
- constitutional short stature
- intrauterine insult
- genetic abnormality
FURTHER EVALUATION
- midparental heights
- evaluation of pubertal development
- examination of prenatal records
- chromosome analysis
List and be able to interpret specific growth patterns requiring evaluation.
DISCREPANT PERCENTILES (e.g. weight 5th, height 5th, head circumference 50th, and other)
DIAGNOSIS TO CONSIDER
- normal variant (familial or constitutional)
- endocrine growth failure
- caloric insufficiency
FURTHER EVALUATION
- midparental heights
- thyroid hormones
- growth factors, growth hormone testing
- evaluation of pubertal development
List and be able to interpret specific growth patterns requiring evaluation.
DECLINING PERCENTILES
DIAGNOSIS TO CONSIDER
- catch-down growth
- caloric insufficiency
- endocrine growth failure
FURTHER EVALUATION
- complete history and physical exam
- dietary and social history
- growth factors, growth hormone testing
Define FAMILIAL versus CONSTITUTIONAL short stature.
FAMILIAL (genetic)
- parents tend to be shorter height than average
- lower weight, length, and head circumference but is genetically normal
CONSTITUTIONAL
- (pre)adolescent child by age who starts puberty later than others
- short stature with normal growth rate for bone age, delayed pubertal growth spurt but eventual achievement of normal adult stature
- usually a family member had delayed growth/puberty
- lead to delays in secondary sexual development
Know how to plot and interpret a growth chart.
Just know it!
Describe the MORO REFLEX during the newborn period.
Allowing infant’s head to gently move back suddenly resulting in a startle.
Aduction / upward movement of arms –> adduction / flexion.
Flexion of the legs.
Appears: Birth
Disappears: 6 months
Describe the ROOTING REFLEX during the newborn period.
Touching the root of the newborn’s mouth resulting in the lowering of the lower lip on the same side with tongue movement toward the stimulus. Face turns toward stimulus.
Appears: Birth
Disappears: 4-6 months
Describe the SUCKING REFLEX during the newborn period.
Almost any object placed in the newborn’s mouth resulting in vigorous sucking.
Later replaced by voluntary sucking.
Describe the GRASP REFLEX during the newborn period.
Placing finger in palm results in flexing of infant’s fingers.
Appears: Birth
Disappears: 6 months
Describe the ASYMMETRIC TONIC NECK REFLEX during the newborn period.
Infant in supine position and turning head to a side. Placement results in ipsilateral extension of the arms and the leg into a “fencing” position. Contralateral side is flexed.
Delay warrants a CNS evaluation.
