Development Flashcards
Initial weight loss
8-10% regained by days 7-14
Weight doubles in newborn by
5-6 months
Weight triples in newborn by
1 year
Weight quadruples by
2 years
Weight gain per month during months 6-12
12-20 oz
Weight gain per month during first 6 months
5-7 oz (150-210g)
Length increase in 1 year
50%
Length doubles by
4 years
Posterior Fontanel closes by
6-8 weeks/2-3 month
Anterior fontanel
Closes 12-18 months
Primary teeth
Central incisor
Lateral
Canine (bicuspid)
First and second molar
Social smile
Begins 6 weeks
Developed at 2 month
Stranger anxiety
6-7 start. ——12 months
Separation anxiety
8-18 months
Survival reflexes
Breathing
Hiccups
Sneeze
Suck and swallowing
(B) temperature
Cry
Shiver
Tuck in legs
(C) feeding
Sucking
Rooting
Crying
Non survival reflexes
Babinski Stepping Swimming Moro Startle Grasping
Newborn vision
Blink and pupil constriction
Night terror
Partial arousal deep non rem sleep
Minimum recollection
~2-4 years
Nightmare
Remembers
Starts ~3 years
Gender identification
2 years
Gender preferences
3-4 years
Gender notions
5-6 years show notions about how genders should act, dress behave
School age weight gain
5-7 lbs
School age height
2 inches per year
Thimerosal
Thimerosal is added to vials of vaccine that contain more than one dose (multi-dose vials) to prevent growth of germs, like bacteria and fungi.
No connection to autism
Thimerosal is a mercury-based preservative that has been used for decades in the United States in multi-dose vials (vials containing more than one dose) of medicines and vaccines. There is no evidence of harm caused by the low doses of thimerosal in vaccines, except for minor reactions like redness and swelling at the injection site. However, in July 1999, the Public Health Service agencies, the American Academy of Pediatrics, and vaccine manufacturers agreed that thimerosal should be reduced or eliminated in vaccines as a precautionary measure.
Atlantooccipital instability
AAI
Common in down syndrome and other genetic disorders
Sports that should not be done our diving, contact sports, weightlifting, equestrian
Should an adolescent take salt tablets during physical activity
Do not take salt tablets = hypernatremia/delayed gastric emptying
Should adolescence take protein supplements
Protein supplements should not be taken for the risk of hypercalcemia , Dehydration if too much protein
Post physical activity and adolescent shit and just how much protein with carbs
Ingest 10-20 g Protein with carbs (1.0 to 1.5 g /kg)
What type of liquid intake should an adolescent take during physical activity
Plain water before, during, and after activity less than one hour
> 1 hour = sodium/CHOS (sports drink) but no direct evidence
Avoid caffeine/carbonated/energy drinks!!!!!
Should children participants boxing ?
The AAP opposes boxing
What heart problem is strictly contra indicated for a child to participate in physical activity on a sports form
Carditis = sudden death needs further evaluation
Other heart problems that need further evaluation for physical activity clearance
congenital heart , heart murmur, Dysrhythmia, HTN, mitral valve prolapse wolf Parkinson’s white syndrome , Kawasaki’s , Marfan
Anything congenital with surgery need further clearance
Consult cardiologist
Stricter heart disease, rheumatic fever, cardiomyopathy, coronary artery disease
Fever / diarrhea wait till illness subsides
Precocious puberty
Before 8 years female
Before 9 in males
Puberty onset females
9-10 years
Puberty on set in males
11-12 years
Delayed puberty
Female- after 13 years
Male- after 14 years
First physical sign of female puberty
Breast buds
Then pubic hair
First physical sign of male puberty
Testicular growth
Menarche start
12 years
Before 9.5 = precocious
11-year old boy is developing sexual characteristics, can you cancel the family based on the knowledge that puberty is considered precocious and boys if secondary sexual characteristics appear prior to age____.
9 years In boys
age 8 in girls (breast) / pubic hair before (9) and mended before (9.5)
Spermarche
13-14 years
How long does it take to go from Tanner stage 2 to 5 MAles
4 years
Tanner stage 2 male
Enlargement of scrotum and testes; scrotum Redddens & roughens
Tanner stage 3 Males
Penis enlarges primarily in length
Tanner stage 5 male
Adult size and shape
Stage 1 breast development
Pre-adolescent breast with nipple elevation
Stage 2 breast development
Breast budding with areolar enlargement
Breast enlargement before pubic hair
Stage 3 breast development
Breast enlargement without separate contour with nipple
Stage 4 breast development
Projection of areola and nipple as a secondary mound to breast
Stage 5 breast development
Adult breast with areola receding and nipple projecting from the breast
Pubic hair development and males and females
stage 1: pre-adolescent without pubic hair
Stage 2: sparse, pale, fine pubic hair
Stage 3: darker, curled, increased amount
Stage 4 : hair is adult but does not cover entire area
Stage 5: adult
Stuttering
Speech dysfluency with initial onset during preschool years
Males >females
Spontaneously revolves without intervention
Stuttering management
Encourage parents to avoid excessive attention to stuttering
Refer to speech and language it’s causing problems with communication
Obesity
Body mass index greater than 95th percentile
Percentage of ideal body weight greater than or equal to 120%
Acts of commission
Abuse
Acts of omission
Neglect
At what age does the does a child understand the concept of cheating
Seven years old
Head circumference that is 2 to 3 standard deviation‘s below the mean for Age, sex and gestation
Microcephaly
Genetics
Secondary cause : affected fetus in utero
TORCH ,HIV , STD, Malaria, varicella zoster, cytomegalovirus, fetal exposure to toxic substances including alcohol or medication, prenatal hypoxia trauma, poor nutrition during the first six months
Head circumference greater than 2 to 3 standard deviations from the mean for age, sex and gestation
Macrocephaly
Causes can be hydrocephalus (increased cerebrospinal fluid) , intracranial neoplasms, enlargement of the school, increase spring size, benign family trait
Management of macrocephaly
CT, MRI, or ultrasound of head, surgical shunt placement with hydrocephalus or tumor resection, genetic counseling
Increase production impaired absorption or obstruction in flow through spinal fluid leading to increased CSF and cerebral ventricles
Hydrocephalus
Child it has apparent large head, sluggish, feeding, vomiting, piercing cry, irritability
Older children have personality changes, confusion, decline academic performance
Hydrocephalus
Hydrocephalus diagnosis/ mangement
May have physical findings of bulging anterior fontanelle, setting sun sign, separated school sutures, slow PERRL, hypertonia, Spastic
Children present with strabismus, ataxia, optic atrophy
CT scan/ultrasound
Managed with shunts , to of neoplasm
Diffuse swelling of soft tissue that cross the suture line
Caput
“Everything is caput “
Due to compression of trauma the scalp during dissent of the baby through the birth canal may have bruising
Disappears within the first few days of life
Collection of blood found by the suture lines usually surrounding the parietal bones
Cephalohematoma
Occur secondary from difficult delivery and trauma OK forceps used, I’m normal presentation, possible cranial hemorrhage
Presents hours to days after delivery
More commonly unilateral
Management requires observance for hyperbili
Due to the prolonged absorption of the large hematoma typically will resolve on its own over a few weeks to months
Premature closure of one or more of the cranial sutures causing a skull deformity
Craniosynostosis
Normally suture line will remain open to three years of age
Cause unknown
Plain skull X-ray
Surgery to open fused line
When should you refer a child that stuttering
> than 6 months, stops talking, for greater than 6 years
BMI in 85th to 95th %
Overweight
BMI > 95%
Obesity
A young girl just has her menses her parents want to know if she will grow any more how much for a girls height increase?
1 to 3 inches post menarche
How many kg/kcal/day should a child have from birth to 6 months
120 kg/kcal/day
How many kg/kcal/day for a child 7 months - 1year
100 kg/kcal/day
How many kg/kcal/day for child 2-10years?
70-100 kg/kcal/day
How many kg/kcal/day for child adolescent ?
45 kg/kcal/day
When can a child start eating solid foods
6 months
Why is vitamin D recommended in all infants especially breast-fed infants?
Because they’re not recommended to get much sunlight causing deficiency = rickets
When should you recommend vitamin D supplementation and how much?
2 months to adolescence at 400 IU
Who should you recommend iron for , what age and how much?
Breast-fed infants because it’s not available in human milk at 6 months
1mg/kg/day
Who needs fluoride supplementation
Those who have low fluoride in water supply
Varnish Q6 months
@1st tooth -5 years
How often should I pediatrician check a child’s weight
Each visit until two years of age and then annually
What is the recommended amount of whole milk per day
16 to 20 ounces
What should a child drink whole milk?
1 years of age, 2% skim at 2years
First primary teeth come in at what age
6m-2 years
First permanent teeth come in at what age?
6 years-12 years
Order of teeth coming in
Come little children munch meat
Central, lateral, cuspids/bicuspids, first molar, second molar
Car seats safety
Rear facing till 2years
5 point harness
Apgar stands for what
Appearance, pulse, grimace, activity, respirations
Apgar scoring
5 areas = 10 points = 3PTS/piece
Appearance, pulse, grimace, activity, respirations
Trust versus mistrust
Birth to one year
Erickson psych development
Erickson=viking
Autonomy versus shame and doubt
1-3 years
Erickson psych development
Erickson=viking
Initiative versus guilt
3-6 years
Erickson psych development
Erickson=viking
Industry versus inferiority
6-12 years
Erickson psych development
Erickson=viking
Identity versus role confusion
12-18 years
Erickson psych development
Erickson=viking
Jean Piaget cognitive theorist
Senisormotor birth-2 years. REFLEX
Preoperational/pre-concept 2-4 years; Fantasy
Intuitive /pre operational 4-7 years ; Causation
Concrete 7-11 years; Memory
Formal operational 11-15 years ; Logical complex
ID
Freud psych sexual the principle of pleasure
Ego
Freud psych sexual the principle of reality
Super ego
Freud Psychosexual the principle of morality
Septic work up a fever of unknown origin until what age
3 month
Dosage for Tylenol
15 mg/kg a 4-6
Dosage for Motrin
DONT GIVE < 6 months
10 mg/kg Q6-8 hours
Let’s screens are performed at _____.
12 months and 24 months and in high risk
At what lead level is chelation therapy recommended?
45
At what age is blood pressure screening started?
3 years
At what age is anemia screening
HGb 4m , High risk or early cows milk
Hct 2 years
At what age does the AAP recommend screen time
No screen time until 18 months of age and no more than 2 hours /day
Normal newborn vital signs
120 to 170 heart rate
30 to 80 respirations
<112/74 blood pressure
What is gynecomastia and when does it resolve?
Enlarged breast tissue in MAles resolves 12 to 18 months
Breast development starts at what age
9 to 10 years
97% by 12 years of age
Developmental milestones 2 month old
MOTOR
2 months=2 ways 180 degrees turn head
Pulls up prone = tummy time
SOCIAL
Social smile/coo
Developmental milestones for a 4 month old
MOTOR
Good head control, roll over, grasp shake rattle
SOCIAL
Imitate
Laugh
Four month old sitting on his parents lap , rolling over laughing shaking that rattle
Developmental milestones for a 6 month old
MOTOR
Passes objects one hand to other
Reach out grab object - raking grasp
Sit
COG
Turn to voice
LANG
Babbles ma ma ma , daDA
STRANGER ANXIETY
Developmental milestones for a 9 month old
MOTOR
7-9 mFinger grasp
8-10m pincer grasp
COG
Object permanence play peekaboo
LANG
Bye mama dada
Developmental milestones for 1 year old
MOTOR
Points with one finger
Walking at one year
Can mark on paper
SOCIAL
“NO”
1 more word than mama and dada
COG
LANG
No
One more word than mama and dada
Developmental milestones for a 15-month-old
MOTOR
Drink from cup
Walk on own
SOCIAL
3-6 words
COG
Follows single command
LANG
Developmental milestones for an 18-month-old
MOTOR Stacks 3 blocks Start step walking Use utensils Hand dominance
SOCIAL
COG
Scribble
Point to body part
1 step command
LANG
Development milestones for a 22 to 24 month old
MOTOR Walks up stairs 6 cubes (2x3= 6 every year 3 more cubes) Kick a ball Jump
SOCIAL
Pretend play
LANG
30-50 words (1/2 @ 2 years)
50% what they say is intelligible
Development milestones for a 3-year-old( 36 months)
MOTOR
9 cubes
Tricycle ‘copy circle
SOCIAL
Good/bad concepts
COG
Imitate vertical line
Knows a friends name
LANG
75% intelligible
Developmental milestones for a 4-year-old
MOTOR
Draw 4 part person
SOCIAL
Pretend play advanced
COG
Knows 4 colors
Dress self
LANG
100 % speech intelligible
Developmental milestones for a 5 year old
MOTOR
Skip alternate feet
Walk backwards —-away from kindergarten
SOCIAL
Role play a story
COG
Count 5 bocks
Knows colors
LANG
Define words
Developmental milestones for a 6 year old
MOTOR
Rides a bike
Tie shoes
SOCIAL
COG
Knows right to left
Can counting 10 objects
LANG
Peak incidence of sudden infant death syndromes _____ . Uncommon before ___(age) and after ____ (age).
2 to 4 months; uncommon before 2 weeks/after 6 months
Developmental delay diagnostic tool questionnaire for ages 4 months- 5 years
Ages and stages
The Denver to screening for risk for developmental delay it’s from ages ___ to ___.
Birth to 6 years
The M chat screens for what?
16 months to 30 months for autism spectrum disorder
Dubowitz Ballard estimates what?
Gestational age of a newborn
Elasticity of Cartlidge in ears Plantar creases over sole of feet (AA) Thickness and size of breast tissue Hypertonic flexion of knees Eyes fused or open
Dubowitz Ballard
Primitive reflexes
Rooting, sucking, Moro, grasp (Palmer; plantar), placing/stepping, tonic neck, Babinski
Primitive reflexes that disappear by 3 to 4 months
Rooting, sucking, moral, grasp, tonic Neck
Primitive reflex that disappears first?
Placing/stepping
Disappears at 1 to 2 months
Primitive reflex that disappears at 12 months
Babinski
After this is concern for Neuro
What age should you be using household items
15 to 18 months “sipper cup”
Hand dominance is established by
18 months
Mandatory screening of specific metabolic disorders in all states:
PKU, hemoglobinopathoes, congenital hypothyroidism, galactosemia
First tooth eruption
6 month; Central around 8 to 12 months
Primary tooth eruption sequence complete at___years.
Three years
Papapular granular enlargement of male breast a crane and healthy adolescent
Gynocomastia
Influence of too little androgens or too much estrogen a mammory tissue affects 40 to 66% of males
Pubertal gynecomastia
Pubertal gynecomastia on sets at what age____?peak is at ____(years). And resolves by____.
10 to 12 years Onset; peaks at 13 to 14 years; resolved by 16 to 17 years
When will neonatal gynecomastia resolve
Results in 2 to 3 weeks;
usually bilateral asymmetric as a result of crossing the placenta maternal hormones
How do you differentiate pathological versus pubertal gynecomastia
Pubertal gynecomastia has a movable, disc shaped below the areola, can be tender, 3 cm diameter
Pathological: delayed sexual maturation, asymmetric/hard/fixed breast tissue, signs of chronic disease
Primary Amenorrhea is the failure to onset menses in females ____ years with normal pubertal growth.
Or ____years with absence of normal pubertal growth.
Or girls who have not started menses _____years S/P sexual maturity.
16 years
14 years
Or 2 years after sexual maturity
Primary Causes of amenorrhea
Familiar, obstruction of flow, ovarian tumor, androgen excess, estrogen deficiency (ovarian failure)
Absence of menses >3 cycles or at least six months after mensuration has started
Secondary amenorrhea
Causes a secondary amenorrhea
Pregnancy, medication, significant stress, hysterectomy, uterine dysfunction after abortion/infection/C-section, hypothalamus/pituitary/adrenal disorder
Diagnosis and treatment for amenorrhea
Pregnancy test/treat underlying cause
Treatment of Central precocious puberty
Gonadotropin releasing hormone
Thelarche
Breast development
Pubarche
Pubic hair development
Lack of secondary sexual characteristics in males
Hypogonadism—-abnormal testicular maturation after 17 years
Breast development occurs at what age
8 to 10.4 years (Caucasian); 6.6 to 9.5 (black)
A mother of a 14-year-old girl indicates she is concerned because the girl has not yet started to Menstrate. The PE/ history is normal. Breast development and pubic hair have been present for 12 months. The most appropriate initial step would be to:
Do a pregnancy test
Reassure, educate the family, and follow up
Draw LH and FSH levels
Obtain a buccal smear for chromosomal analysis
Reassure educate the family and follow up
Breast buds are the first sign of puberty and girls, 1.5 -3 years after thelarche to menses
Pregnancy test would be indicated for secondary amenorrhea
11 month old African-American boy has just started walking and is found to have severely bowed legs. In the history learned that he is exclusively breast-fed with very little other food intake. You must consider:
Trauma
Developmental variation
Chromosomal abnormality
Rickets
Rickets are often connected to nutrition by 11 months of age babies need a variety of foods, breastmilk is lower in vitamin D
Children with trauma may present with a past history of falls or accidents. Developmental variations like physiologic genu verum, common in children younger than 18 months and usually resolved by three years
Chromosomal abnormality‘s can affect bone in tooth development but would also present with other abnormal
Parent completed child monitoring system for children 4 to 48 months
Ages and stages
Screens in personal social, fine motor adaptive, language, and gross motor domains and children’s birth to six years
Denver 2
Repetition or prong prolongation of sound syllables or short words
Pauses
Signs of physical tension and struggling with speech
Avoidance of words that are hard
What does this describe?
S/s stuttering
Solids start
6 months
Cereal, veggies, fruit, meat
Temp > what C is fever
> 38 C
Ballard and dubowitz tests what
Gestational age
Elasticity of cartilage in ears, eyes fused, hypertonic flexion, plantar creases over sole, flat areola = preterm
When do you refer for stuttering?
> 6 months stuttering
Stops speaking altogether
6 years at onset
Usually resolves on own
Tests if hip is easily subluxable and can be dislocated from acetabulum
Barlow
Bring leg inward push down
Both feet held together one leg at a time examiner abducts (leg outward) and brings up and inward
Ortalani maneuver — hip is outside acetabulum and CLICk is felt putting back into place
Newborn blood sugar
<40= infection, IDM, LGA
> 80= stress
When do you screen for depression
11 to 21 years
When do you screen for autism
18 and 30 months
When do you screen for anemia HGB/HCT
9 to 12 months and 1 to 5 years for at risk children
