Development Flashcards
When do babies
1. Double
2. Triple
4. Quadrouple
their birth weight?
- 4 months
- 12 months
- 24 months
When does height
1. Increase by 50%
2. Double
3. Triple
from a baby’s birth length
- 1 year
- 4 years
- 13 years
How fast does head circumference increase in the first 2 months of life?
0.5 cm a week
Familial short stature
Also called genetic short stature
Growth is parallel to the standard curves
Normal variant
BMI is normal
Bone age is CONSISTENT with chronological age
Constitutional growth delay
Decrease in weight and height in infancy, then follows the lower points of the growth curve in middle childhood
There is then an accelerated growth in late adolescent to achieving expected adult height
Puberty is delayed - catch up growth occurs with puberty onset
If height is affected but HC and weight are preserved, what kind of conditions should be considered
Bony dysplasias and underlying endocrinologic disease
What is the bone age in
1. Familial short stature
2. Constitutional growth delay
- Bone age is consistent with chronological age
- Bone age is delayed for the child’s chronological age, but is consistent with height age
What are 2 first line treatments for primary enuresis? Which has the lower relapse rate?
Alarm therapy and DDAVP
Alarm therapy has lower relapse rate
What is the normal age rage for a child to cling to transitional objects?
18-24 months
Selective mutism diagnosis
Overlaps with specific phobia
Talk almost exclusively at home but rarely/never at other settings
1 month or more
Treatment for selective mutism
Fluoxetine + behavioural therapy
Isolated expressive language disorder
Also called late talker syndrome
Age appropriate receptive language and social skills
Variation of normal
Sleep onset association type insomnia
The child learns to fall asleep only under certain conditions or associations
When child experiences brief arousal overnight, they are not able to get back to sleep without the same associations being present
Tx: establish sleep schedule and bedtime routine. Can do either rapid (“cry it out”) or gradual withdrawal/extinction of parental assistance at sleep onset. Warn about post extinction burst
Signs of toilet readiness
Shows an interest in the potty
Dry in their diapers for several hours in a row (not necessarily overnight)
Regular and predictable bowel movements, or knows when they are voiding or stooling
Able to follow one or two simple instructions
Able to balance and sit on potty
Can communicate when they need to use the potty (doesn’t have to be full sentences)
Wants to be independent
Able to walk to potty
Desire to please based on positive relationships with caregivers
Risks for completed suicide
Prior attempts
Method other than ingestion
Have a plan (nonimpulsive)
No regret
Still actively suicidal
Criteria for ASD
All 3 of: issues with social-emotional reciprocity, nonverbal communicative behaviours, relationships
2/4 of: sensory, transitions, interests, motor movements
ASD vs OCD
Stereotyped behaviours are calming or preferred
Tics and compulsive routines are often distressing
OCD does not have impairment in social communication or interaction
Rett syndrome
X linked dominant disease
Dev regression after relatively normal birth-1 yr
Hallmark is repetitive hang wringing movements
How to manage school refusal
Send back to school, reward for each completed day
If ongoing refer to psych and psychology
Typically separation anxiety in younger children, social phobia in older
Childhood-onset fluency disorder
Greater part word repetition (m-m-mommy), single-syllable work repetition, and sound prolongation
Movements of the head, face (blinking, grimacing), neck, irregular inspirations or expirations, emotional symptoms
Impact on function
Often between 2-4 years
Treatment of stuttering
Refer to SLP
Positive family history, symptoms for >4 weeks, stuttering is impacting the social, emotional, or behavioural functioning.
Meeting criteria for childhood-onset fluency disorder, or 3 or more dysfluencies per 100 syllables, avoidances or escapes (head nod, pauses, blinking), discomfort or anxiety while speaking, suspicion of an associated neurologic or psychotic disorder
Serotonin syndrome triad
Mental status changes (agitation, delirium)
Autonomic instability (dilated pupils, labile BP, sweating)
Neuromuscular symptoms (clonus, tremor, hyperreflexia)
Typical onset within 24 hours of medication start or change
Medications used for
1. Serotonin syndrome
2. Neuroleptic malignant syndrome
- Cyproheptadine antidote, benzos for sedation
- Dantrolene, bromocriptine, amantadine
Neuroleptic malignant syndrome features
Fever, muscle rigidity “lead pip rigidity”, autonomic instability, delirium, hyporeflexia
Elevated CK, metabolic acidosis, high end tidal CO2, elevated WBC, low iron
Onset within 1-2 weeks of starting or changing therapy
Dyslexia definition
The inability to develop the capability to read at an expected level despite an otherwise normal intellect
Most commonly caused by a difficulty in the phonological processing
Issue is the struggle to read!
Management for dyslexia
Accommodations
Teaching phonemic awareness
Non-REM parasomnias
“Non-remembering” ones!
Sleepwalking, sleep terrors, confusional arousals
Typically first third of night
Avoidance or increased agitation with comforting or waking
REM parasomnias
Remember them!
Nightmares, hyponogogic hallucinations, sleep paralysis
Typically last third of night
Sagittal craniosynostosis
Dolichocephaly or scaphocephaly (boat shaped)
Most common
Frontal bossing, prominent occiput
M > F
Coronal Craniosynostosis
Unilateral = plagiocephaly – flattened forehead on affected side, nose deviation to normal side
Bilateral = brachycephaly – flattened forehead
F > M
Lambdoid craniosynostosis
R > L, M > F
Head is a trapezoid shape
Ipsilateral ear appears posterior when looking down
Metopic craniosynostosis
Trigonocephaly
Pointed forehead
Treatment of breath holding spells
Ignore once spell started
Iron deficiency may or may not be present, regardless some children respond to tx
ARFID
Food is restricted or avoided because of adverse feeding or eating experiences or the sensory qualities of the food
Results in significant unintended weight loss or nutritional deficiencies, and problems with social interactions
No issues with perceived body weight or shape
Intellectual disability
Common deficits in adaptative and intellectual functioning
Adaptive skills: conceptual (language, reading, writing, numbers, time), social, practical (ADLs) - deficit in at least 1/3
Tier 1 labs for ID
Microarray, fragile X
CBC, glucose, BGP, UCr, lytes, AST/ALT, TSH, CK, ammonia, lactate
Amino acids, acylcarnitine profile, carnitine, homocysteine
Urine organic acids, creatinine metabolites, purines, pyrimidines, and glycosaminoglycans
+/- copper, ceruloplasmin, biotinidase
Ferritin, B12 if dietary restrictions present, lead if risk factors
How long is it normal to have letter reversal when writing
7 years
Developmental coordination disorder
Below expectation for acquisition and execution of coordinated motor skills
Interferes with ADLs, school, or work
Dx with OT or PT using MABC-2
Positional plagiocephaly vs lambdoid synostosis
PP: frontal bossing same as flat side, ear is displaced anteriorly
LS: frontal bossing opposite flat side, ear is displaced posteriorly
Treatment for positional plagiocephaly
Does not usually spontaneously improve
Repositioning and PT ASAP
Helmeting – better if started before 6 mo
< 4 mo mild to moderate = positioning, PT
> 4 mo severe = positioning, PT, helmet
Screen time for
1. < 2 years
2. 2-5 years
3. > 5 years
- none
- 1 hr or less
- depends on use and function
Play stages for 2-5 years
<2 yrs = solitary
2 yrs = parallel
3 yrs = associative (same activity, but less interaction)
4 yrs = cooperative (interest in both activity and other children)
5 yrs = rules
Ages for
1. CARS
2. ADOS
3. Social reciprocity scale
- 2+
- 12mo to adult
- preschool (2.5-4.5) and school aged (4-18)
