Children's Normal Growth and Development Flashcards
What is the definition of normal?
Conforming to a standard
What is normality during childhood?
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
Where is the physis of the bone?
Between the epiphysis and the metaphysis
Where does bone growth occur from?
Longitudinal growth from the physis by enchondral ossification
Circumferential growth from periosteum by appositional growth
What areas of the body have the most bone growth?
Knees, shoulders, wrist = some physes contribute to growth more than others
What are some factors that contribute to bone growth?
Diet/nutrition, vitamins, injury, illness, hormones
What are some features of short stature in children?
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
How common is it for short stature to have an underlying pathological cause?
Only 1/5 children less than 2SD below the mean for their age will have an underlying pathological cause
What are the major developmental milestones?
6-9 months = sit alone, crawls 8-12 months = stands 10-18 months = walks 24 months = jumps 3 years = manages stairs alone
What are some minor developmental milestones?
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
What are the variations of knee alignment?
Varum = bow legged
Valgum = knock kneed
All babies are born bow legged, should be normal by age 7
What are some features of genu varum?
Normal in age <2, persisting mild genu varum can run in families
When should underlying pathology be considered in genu varum?
Unilateral, severe, short stature > 2SD, painful
What are some pathological causes of genu varum?
Skeletal dysplasia, rickets, tumour (e.g enchondroma), Blount’s disease, trauma (physeal injury)
What is Blount’s disease?
Growth arrest of medial tibial physis of unknown aetiology, typical beak-like protrusion on x-ray
When is the peak age of genu valgum?
Age 3 and a half
When should genu valgum be referred?
Asymmetric, severe, >8cm intermalleolar distance at age 11
What are some pathological causes of genu valgum?
Tumours (enchondroma, osteochondroma), rickets, neurofibromas, idiopathic
What is intoeing?
Child walks with toes pointing in (e.g pigeon toed), often accentuated with running
What are some causes of intoeing?
Femoral neck anteversion, internal tibial torsion, metatarsus adductus (usually a combo of several)
How are genu valgum and varus treated?
Usually with surgery
What are some features of femoral neck anteversion?
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)
What is the normal position of the femoral neck?
Normally points anteriorly
What are some features of internal tibial torsion?
Usually seen aged 1-3, mostly resolved by age 6, surgery and bracing not required
What are some features of metatarsus adductus?
Common, benign, resolves, serial casting may help in 6-12 month olds
How is intoeing treated?
Define cause, reassure, chart, review, discharge unless severe
How common are flat feet?
1 in 5 adults = all born with flat feet but develop medial arch once walking commences as tibialis posterior strengthens
Do flat feet cause symptoms?
No = usually asymptomatic
What are the two kinds of flat feet?
Fixed and flexible
What usually causes flexible flat feet?
Generalised ligamentous laxity or tightness of gastrocsoleus complex = treated with stretching
Is surgery used to treat flexible flat feet?
No = many resolve and orthotics may be unhelpful unless there is pain
What are some ways to assess flexible flat feet?
Calf tightness assessment = need to relax gastrocs by flexing knee
Beighton score of hypermobility = out of 9, two points for each side
What are some features of fixed flat feet?
Uncommon, may have underlying bony connection known as tarsal coalition, may benefit from surgery
When should cavus feet be referred?
Worry if sensate, if there are claw toes, if parental feet are abnormal or if neuromuscular or progressive
What are some features of curly toes?
Common in younger children, mostly 3rd or 4th toes, most resolve by age 6
How should curly toes be treated?
Splinting or taping are ineffective, rarely in persisting cases can consider flexor tenotomy
