2-6 Month Development

Question 1

What is indicated if a jump of more then 2 growth lines is seen?

Answer 1

Can indicate pathology

Question 2

What is the normal pattern of growth following birth?

Answer 2

Normal infants may have up to a 10% drop in weight following birth. This should be regained by 10 days of life.

Question 3

How much weight will infants gain the first 4 months of life?

Answer 3

Infants will gain about 30 grams per day (an ounce).

Question 4

If surveillance questions demonstrate a risk for delay , what should be done?

Answer 4

A screening test should be administered.

Assessment tools generally look at:
Gross Motor, Fine Motor, Personal-Social, Cognitive (Language & Problem Solving)

Question 5

Which parameter is closely tied with proper cognitive development?

Answer 5

Speech

Question 6

Any deficits in speech should trigger what assessment?

Answer 6

A hearing assessment even if they passed their birth hearing screen.

Question 7

When does screening for autism occur and what is the screening tool?

Answer 7

Screening for autism occurs between 18-24 months.

Modified Checklist for Autism (M-CHAT) is the gold standard screening tool

Question 8

What med should Infants be started on between birth to 2 months?

Answer 8

multivitamin

Question 9

Developmental milestones from newborn - 2 weeks?

Answer 9

social – regards face, social smile

fine motor - grasp reflex, tracks past midline

language - vocalizes (cries, coos), alerts to bell

gross motor - moves head side to side, lifts shoulders when prone

Question 10

What is colic?

Answer 10

<3 months with at least 3 hours of crying at least 3 days a week. Dx of exclusion

Question 11

Crying pattern over first weeks of life

Answer 11

Increases during 2 week to 9 week time period. Peaks at 6 weeks.

Question 12

Normal breathing pattern of newborn

Answer 12

newborns pause normally during breathing

occurs both during feeding and when not feeding

Question 13

What is considered apnea in the newborn?

Answer 13

> 20 seconds without discernible air exchange

can be accompanied by cyanosis

distinguish perioral vs. labial/lingual cyanosis

all cyanosis is serious regardless of whether apnea is concurrent

Question 14

SIDS peak incidence

Answer 14

1-4 months

Question 15

Risk Factors for SIDS

Answer 15

male gender		
low birth weight
lower socioeconomic status
maternal smoking
seasonal distribution/winter 
young maternal age
high parity
single parenthood
multiple gestation
prematurity
unsafe sleep conditions

Question 16

4 month old developmental milestones

Answer 16

social – looks at hand, copies facial expressions, happy

fine motor – reaches for object

language - laughs, squeals

gross motor- chest-up with arm support, holds head steady, no head lag; works for toy, rolls front to back

Question 17

4 month old primitive reflexes

Answer 17

Moro – disappears by 4 to 6 months

rooting – disappears by 4 to 6 months

sucking – replaced by voluntary sucking

grasp reflex – disappears by 3 to 4 months (plantar 6-15 months)

asymmetric tonic neck reflex – disappears by 2 to 3 months

Question 18

When can parents start to introduce table foods?

Answer 18

around 4-6 months of age

Question 19

What is the most common cause for chronic tearing in newborns?

Answer 19

Dacryostenosis

Question 20

What causes dacryostenosis?

Answer 20

Caused by congenital narrowing of the tear duct that prevent proper tear drainage. Duct still developing.

Question 21

What is the presentation of dacryostenosis?

Answer 21

chronic tearing, conjunctiva are generally clear, and the patient should not be in discomfort

Question 22

When does dacryostenosis generally clear up by? If it does not clear up/symptoms are concerning, what should you do?

Answer 22

Should clear up by 6 mo of age.
If persists after 6 mo or symptoms seem more concerning (swelling, skin discoloration, signs of infection) then refer to opthalmology.

Question 23

What differentiates candida diaper dermatitis from irritant diaper dermatitis.

Answer 23

Satellite lesions

*be sure to look at mouth and other areas where fungus can spread.

Question 24

Treatment for Seborrheic Dermatitis (Cradle Cap)

Answer 24

Nothing – if mild can self resolve
Mineral Oil (Emollient) – if just to head
Hydrocortisone x 1 week – if red
Anti-Fungal Cream or shampoo x 2 weeks

Question 25

6 month developmental milestones

Answer 25

Gross Motor: Sits unsupported, propped up on hands

Fine Motor: Transfers hand-to-hand, rakes, can feed self crackers

Personal/Social: may display social anxiety to strangers

Cognitive: Language- Babbles, may stop for a moment if hears “no”
Problem Solving- Bangs toys together, touches reflection

Question 26

How many hours do newborns sleep per day

Answer 26

16-17 hours per day

Question 27

Which foods are highly allergic?

Answer 27

cow’s milk, chicken egg, peanut, tree nut, seafood

Question 28

What is the current recommendation to decrease risk of allergy formation?

Answer 28

Recent studies have shown that delayed introduction is not better and in fact earlier introduction decreases risk of allergy formation.

Children who have already done well with eating other foods should be given a taste of highly allergic foods at home with an oral antihistamine near by. If they tolerate it then continue feeding.