Development

Question 1

Development

Answer 1

Cephalo-caudal and a proximo-distal progression.

Question 2

developing brain.

Answer 2

Interaction of heredity and the environment on
the Interaction of heredity and the environment on
the developing brain.

Question 3

Median Age

Limit Age:

Answer 3

• Median Age: is the age when 50% of the
population achieve a milestone • Limit Age: is the age that a milestone should
have been achieved (2SD from the mean)

Question 4

Walking unsupported

Answer 4

The median age is 12 months The limit age is 18 months (2 SDs from the mean).

Question 5

Age Groups

Answer 5

Neonate Birth to 1 month • Infant 1 month to 1 year • Toddler 1-3 years • Preschool 3-6 years • School age 6 to 12 years • Adolescent 13 years to 18 years

Question 6

Corrected age

Answer 6

Instructions*:
• Document the infant’s gestational age in weeks. (Mother/caregiver can self-report, or referral information from medical provider may be used.)
• Subtract the child’s gestational age in weeks from 40 weeks (gestational age of term infant) to determine the adjustment for prematurity in weeks.
• Subtract the adjustment for prematurity in weeks from the child’s chronological postnatal age in weeks to determine the child’s gestation-adjusted age.
∗ For WIC nutrition risk determination, adjustment for gestational age should be calculated for all premature infants for the first 2 years of life.

Question 7

Visual acuity

Answer 7

Visual acuity is poor in the newborn but increases to adult levels by 4 years of age.

Question 8

Stranger anxiety

Answer 8

Stranger anxiety – should dissipate by age 2 ½ to 3 years

Question 9

Temper tantrums

Answer 9

Temper tantrums: occur weekly in 50 to 80% of
children – peak incidence 18 months – most
disappear by age 3

Question 10

Maturation of reflex sphincter control

myelination of extrapyramidal tracts

Answer 10

Maturation of reflex sphincter control &
myelination of extrapyramidal tracts ( occurs
by 18 months ) which are necessary for bowel
and bladder control.

Question 11

Developmental age for each stream

Answer 11

Developmental age for each stream

(developmental age/ chronological age) x 100 > 85% is normal, 70 - 85% is suspect, < 70 %is abnormal

Question 12

Red Flags

Answer 12

• No social smiling by 2 months • Not sitting alone by 9 months • Not crawling by 1 year • Not walking by 18 months • No speech by 18 months • Hand preference development < 1 year (this
usually develops at 18–24 months)
(hemiplegia)

Question 13

Develpmintal delay

Answer 13

• Mild, moderate or severe • A gradual :steady developmental delay from birth, e.g.
genetic, lack of stimulation, chronic illness • New onset: after previously normal development, e.g.
new-onset deafness or visual impairment, autism, neurodegenerative condition.

Question 14

Global developmental delay

Answer 14

Genetic disorder or syndrome, e.g. Down syndrome; metabolic disorder, e.g. phenylketonuria; brain abnormality, e.g. hydrocephalus Antenatal disorder – congenital infection; teratogens Birth asphyxia Prematurity Congenital Hypothyroidism Neurological insult – head trauma; meningitis, encephalitis; metabolic, e.g. hypoglycaemia

Question 15

—

Answer 15

Hand dominance is not acquired until 1–2 years
or later, asymmetry of motor skills during the
first year of life is always abnormal and may
suggest an underlying hemiplegia. • Late walking (>18 months old) needs to be
differentiated from the normal locomotor
variants ( bottom-shuffling or commando
crawling).

Question 16

Cp

Answer 16

Often accompanied by disturbances of cognition,
communication, perception, sensation, behaviour and seizure
disorder and secondary musculoskeletal problems.

Early detection is crucial for initiating
rehabilitation services and treatment as soon as
possible.

Question 17

Cp

Answer 17

Significant delay (at least 2 SDs below the mean with standardized tests) in at least two developmental domains

Question 18

Care for a Child with Developmental Delay

Answer 18

Care for a Child with Developmental Delay
Team: • Neurodevelopmental paediatrician • Speech and language therapist • Physiotherapists, occupational therapist • Teacher, psychologist • Social worker and health visitor

Question 19

Growth

Development

Answer 19

• quantitative change of child body

- qualitative change in child function and skills

Question 20

Factors affect growth

Answer 20

Geans
Inviroment
Hormones
Nutrition

Question 21

Factors affect growth

Answer 21

Geans
Inviroment
Hormones
Nutrition

Height is a highly heritable.

Question 22

Hormones Involved in Growth

Answer 22

• Growth hormone – Major hormone secreted by pituitary gland
• Insulin-like growth factor-I
– Peptide produced by liver and other tissues in response to GH – Mediates part of GH action in linear growth
• Insulin – Required for substrate utilization
• Thyroid hormone – Critical for normal metabolism and growth
• Sex hormones
– Speed linear growth during puberty – Lead to growth plate fusion at end of growth (estrogen)
• [Cortisol - excess impairs linear growth]

Question 23

Nutrition and Growth

Answer 23

Nutrition and Growth
• Nutrients fuel growth; protein is especially important • Suboptimal nutrition is the most common cause of
growth failure worldwide
– Usually poverty-related – In developed countries, this most often results from dietary self-
restriction, calorie/macronutrient deficiency or imbalance of
energy intake/utilization
13
• “Picky eaters” (especially toddlers) • Anorexia nervosa/bulemia • Ballerinas, gymnasts, elite athletes • Drugs that reduce appetite (e.g. stimulants for Rx of ADHD)

Question 24

Nutrition and Growth

Answer 24

Nutrition and Growth
• Nutrients fuel growth; protein is especially important • Suboptimal nutrition is the most common cause of
growth failure worldwide
– Usually poverty-related – In developed countries, this most often results from dietary self-
restriction, calorie/macronutrient deficiency or imbalance of
energy intake/utilization
13
• “Picky eaters” (especially toddlers) • Anorexia nervosa/bulemia • Ballerinas, gymnasts, elite athletes • Drugs that reduce appetite (e.g. stimulants for Rx of ADHD)

Question 25

Infancy

Answer 25

The infancy phase of ICP model is
assumed to begin at mid-gestation and
tails off at 12 months of age

Question 26

IGF-1

Answer 26

Many of GH actions are mediated by IGF-1
• GH is the most potent regulator of IGF-1
production in the postnatal life
• IGF- 1 has a negative feed back on GH
secretion • The liver is the principal source of IGF-1 in the
circulation

Question 27

Classical GH-deficiency

Answer 27

Neonatal hypoglycemia Micropenis Normal growth 4-6 months, thereafter low growth velocity

Question 28

I ndication for growth hormone therapy

Answer 28

I ndication for growth hormone therapy • Growth hormone deficiency • Turner syndrome • SHOX gene insufficiency • SGA • Noonan syndrome • ISS • Chronic renal inufficiency

Question 29

Gh

Answer 29

In spite of high GH level, IGF-1 level is decreased

in malnutrition

Question 30

P uberty

Answer 30

Occurs btw 8 & 14yrs of age in girls and 9 & 14yrs of age

in boys. [range of 12-20yrs]

Question 31

Measurement of Growth

Answer 31

Accurate height measurements using stadiometer

or recumbent infant box

Question 32

Normal wt gain

Answer 32

Newborn loses up to 10% of birth weight • Regained wt by 10 days (7-14 day) • Wt gain - 25-30 g/day for the first 3 months of
life. • First year - 400 g gain/month. • Second year - 200 g gain/month • then gains 2 kg /year up to 10 years.