Children's Normal Growth and Development

Question 1

What is the definition of normal?

Answer 1

Conforming to a standard

Question 2

What is normality during childhood?

Answer 2

Varies at different ages, some abnormal features correct with age, deformities are only significant if they are likely to persist and cause physical/mental health problems

Question 3

Where is the physis of the bone?

Answer 3

Between the epiphysis and the metaphysis

Question 4

Where does bone growth occur from?

Answer 4

Longitudinal growth from the physis by enchondral ossification
Circumferential growth from periosteum by appositional growth

Question 5

What areas of the body have the most bone growth?

Answer 5

Knees, shoulders, wrist = some physes contribute to growth more than others

Question 6

What are some factors that contribute to bone growth?

Answer 6

Diet/nutrition, vitamins, injury, illness, hormones

Question 7

What are some features of short stature in children?

Answer 7

Age <3 growth much more variable = can cross centiles, nutrition plays big part
Look at parent’s height, dysmorphic features make underlying endocrine/metabolic cause more likely

Question 8

How common is it for short stature to have an underlying pathological cause?

Answer 8

Only 1/5 children less than 2SD below the mean for their age will have an underlying pathological cause

Question 9

What are the major developmental milestones?

Answer 9

6-9 months = sit alone, crawls
8-12 months = stands
10-18 months = walks
24 months = jumps
3 years = manages stairs alone

Question 10

What are some minor developmental milestones?

Answer 10

1-6 months = loss of primitive reflexes (moro, grasp, stepping, fencing)
2 months = head control
9-12 months = few words
14 months = feeds self, uses spoon
18 months = stacks four blocks, understands 200 words
3 years = potty trained

Question 11

What are the variations of knee alignment?

Answer 11

Varum = bow legged
Valgum = knock kneed
All babies are born bow legged, should be normal by age 7

Question 12

What are some features of genu varum?

Answer 12

Normal in age <2, persisting mild genu varum can run in families

Question 13

When should underlying pathology be considered in genu varum?

Answer 13

Unilateral, severe, short stature > 2SD, painful

Question 14

What are some pathological causes of genu varum?

Answer 14

Skeletal dysplasia, rickets, tumour (e.g enchondroma), Blount’s disease, trauma (physeal injury)

Question 15

What is Blount’s disease?

Answer 15

Growth arrest of medial tibial physis of unknown aetiology, typical beak-like protrusion on x-ray

Question 16

When is the peak age of genu valgum?

Answer 16

Age 3 and a half

Question 17

When should genu valgum be referred?

Answer 17

Asymmetric, severe, >8cm intermalleolar distance at age 11

Question 18

What are some pathological causes of genu valgum?

Answer 18

Tumours (enchondroma, osteochondroma), rickets, neurofibromas, idiopathic

Question 19

What is intoeing?

Answer 19

Child walks with toes pointing in (e.g pigeon toed), often accentuated with running

Question 20

What are some causes of intoeing?

Answer 20

Femoral neck anteversion, internal tibial torsion, metatarsus adductus (usually a combo of several)

Question 21

How are genu valgum and varus treated?

Answer 21

Usually with surgery

Question 22

What are some features of femoral neck anteversion?

Answer 22

XS anteversion causes increased IR hip, sit in W position, can predispose to patellofemoral problems, rarely treated with surgery ( mean 30-40 degrees at birth, slowly unwinds to 10-15 degrees by maturity)

Question 23

What is the normal position of the femoral neck?

Answer 23

Normally points anteriorly

Question 24

What are some features of internal tibial torsion?

Answer 24

Usually seen aged 1-3, mostly resolved by age 6, surgery and bracing not required

Question 25

What are some features of metatarsus adductus?

Answer 25

Common, benign, resolves, serial casting may help in 6-12 month olds

Question 26

How is intoeing treated?

Answer 26

Define cause, reassure, chart, review, discharge unless severe

Question 27

How common are flat feet?

Answer 27

1 in 5 adults = all born with flat feet but develop medial arch once walking commences as tibialis posterior strengthens

Question 28

Do flat feet cause symptoms?

Answer 28

No = usually asymptomatic

Question 29

What are the two kinds of flat feet?

Answer 29

Fixed and flexible

Question 30

What usually causes flexible flat feet?

Answer 30

Generalised ligamentous laxity or tightness of gastrocsoleus complex = treated with stretching

Question 31

Is surgery used to treat flexible flat feet?

Answer 31

No = many resolve and orthotics may be unhelpful unless there is pain

Question 32

What are some ways to assess flexible flat feet?

Answer 32

Calf tightness assessment = need to relax gastrocs by flexing knee
Beighton score of hypermobility = out of 9, two points for each side

Question 33

What are some features of fixed flat feet?

Answer 33

Uncommon, may have underlying bony connection known as tarsal coalition, may benefit from surgery

Question 34

When should cavus feet be referred?

Answer 34

Worry if sensate, if there are claw toes, if parental feet are abnormal or if neuromuscular or progressive

Question 35

What are some features of curly toes?

Answer 35

Common in younger children, mostly 3rd or 4th toes, most resolve by age 6

Question 36

How should curly toes be treated?

Answer 36

Splinting or taping are ineffective, rarely in persisting cases can consider flexor tenotomy