Developmental Assessment and Growth Abnormalities Flashcards
what is developmental surveillance
skilled individual monitors development over time as part of providing routine care and helps recognize children at risk for developmental disorder
what are the key elements of developmental surveillance
- listen to parent concerns
- obtain developmental history
- make careful observations
- periodically screen all infants and children
- refer children who fail screenings
- recognize conditions that put children at risk for delays
t/f developmental assessment should occur at all well child visits
true
what is a developmental delay
circumstance in which a child has not demonstrated a developmental skill by an age at while the vast majority of normally developing children have accomplished this task
what are developmental therapies
- speech language
- birth to 3
- 3 and up services through school
M-CHAT
Modified checklist for autism in toddlers
At what age do you screen toddlers to assess the risk of autism spectrum disorder
18-30 months
what are the 1st vs the 2nd portions of the M-CHAT
- 1st: 20 item yes/no parent report questionnaire
- 2nd: structures fu questions administered by a healthcare provider
what is the denver developmental screening tool II
- 125 performance based and parent reposted items are used to screen functioning in 4 areas
- personal-social
- gross motor
- language
- fine motor adaptive
how do you interpret denver developmental screening tool II
- normal: no delays and a maximum of one caution
- suspect: 2 or more cautions and/or one or more delays. re-screen in 1-2 weeks
what are the drawbacks of denver
- validity is low
- small sample size of normal
- does not require an advanced degree
- studies show only 50% with developmental needs are identified
- length of time it takes to complete and score
what is the ages and stages questionnaire
19 age specific surveys that asks parents about developmental skills that are common in daily life
what are the ages that are completed in the ages and stages questionnare?
1 month - 5.5 years
2 and 4 months
4 month intervals up to 24 months
6 month intervals until the child reaches 5 years old
what is tested in age and stages questionnaire ?
- language
- personal social
- fine motor
- gross motor
- problem solving
cutoff for age and stages questionnaire is ______below the mean
2 standard deviations
what is the interpretation of the age and stages
- if below cutoff in one or more areas: diagnostic referral indicated
- if close to cutoff, provide follow up activities to practice specific skills, then re-screen in 4-6 months
what are the developmental milestones at 1-2 months
- holds head erect and lifts head
- follows objects through visual field
- becomes alert in response to voices
- recognizes parents
- cooing
what are the developmental milestones at 3-5 months
- reached for and brings objects to mouth
- raspberry sound
- sits with support
- laughs
- puppy prop
what are the developmental milestones at 6-8 months
- babbling
- sits along for short period
- imitates “bye bye”
- cans start to feed self with puffs or cheerios
- commando crawl
what are the developmental milestones at 9-11 months
- crawls
- can stand alone for short period
- imitates patty cake or peek-a-boo
- neat pincer grasp
- follows 1 step commands
what are the developmental milestones at 1 year
- can start to walk independently
- mama and dada
- perfects neat pincer grasp
- points to desired objects
what are developmental milestones at 18 months
- throws a ball
- can walk up and down stairs with help
- can say 4-20 words
- can feed self with spoon
- protodeclarative pointing
- protoimperative pointing
what is protodeclarative vs protoimperative pointing
- protodeclarative: something interesting happens and they try to direct you to the event
- protoimperative: sees an object and looks at you and directs your attention to that object bc they want it
what are the developmental milestones at 2 years
- around 50 word vocabulary
- kicks ball on request
- points to named objects or pictures
- plays with mimicry
what are developmental milestones at 30 months
- walks backwards
- hops on 1 foot
- refers to self as 1
- can carry on conversation
- holds crayon with fist
what are the developmental milestones at 3 years
- gives 1st and last name
- can dress with supervision
- hold crayon with fingers
- rule of 3s (3 numbers, 3 letters, 3 colors, 3 shapes, 3 wheels)
what are the developmental milestones at 3-4 years
- climbs stairs with alternating feet
- knows own sex
- gives full name
- feeds self at mealtime
- takes off shoes and jacket
what are the developmental milestones at 4-5 years
- draws a stick person
- knows days of week
- knows answers to questions like what to do when you’re cold or hungry
- self care at toilet
- dresses self
what are the developmental milestones at 5-6 years
- can catch ball
- tells age
- knows right and left hand
- does simple chores at home
- little awareness of dangers
what are the developmental milestones 6-7 years
- knows morning or afternoon
- reads several one syllable printed words
what are the developmental milestones at 7-8 years
- ties shoes
- adds and subtracts 1 digit numbers
what are developmental red flags
- not sitting by 9 months
- persistence of moro past 6 months
- not walking independently by 18 months
- hand dominance before 18 months
- no babbling, pointing, gesturing by 12 months
- failure of 2 and 3 word sentences by 24 and 36 months respectively
- failure to smile or show joyful expressions by 6 months
- any regression of speech, language, or social skills
failure to address language impairment can lead to impaction of what
social and developmental behavior
what is the most predictive marker of cognition and school achievement
language developement
more predictive than any other milestone
when should weight be doubled by after birth? tripled?
- doubled by 6 months
- tripled by 1 year
what are the projected weight gain and growth for children by age
- 1-4 months: should gain approx 1.5-2lbs each month while growing 1-1.5 inches per months
- 4-7 months: gain another 1-1.5 lbs per months while growing another 2-3 inches total
- 8-12 months: grow .5-1 inch per month
- 8 months: average boy weighs 14.5-17.5 lbs while girls weigh about a half pound less
what is plotted on a growth chart
height, weight and head circumference
most kids fall between what percentiles
3rd and 97th
what is a type 1 growth abnormality
head circumference is preserved and the weight is depressed more than the height
what does a type 1 growth abnormality result from?
- inadequate caloric intake
- excessive loss of calories
- inability to use calories peripherally
what is a type 2 growth abnormality
normal head circumference with proportionate diminution of height and weight
what are type 2 growth abnormalities associated with
- genetically short stature
- endocrinopathies
- constitutional growth delay
- heart or renal disease
- skeletal dysplasias
what are type 3 growth abnormalities
all 3 parameters of growth are lower than normal
what are type 3 growth abnormalities are associated with
- CNS abnormalities
- chromosomal defects
- in utero or perinatal insults
what is SGA
infants below the 10th percentile
what are causes of IUGR
- results of poor maternal environment
- intrinsic fetal abnormalities
- congenital infections
- fetal malnutrition
what is symmetrical vs asymmetrical growth abnormalities
- symmetrical: weight, length, and head circumference all <10%
- asymmetrical: only weight is <10%
what is a symmetrical growth abnormality indicative of? what about asymmetrical?
- event early in pregnancy
- event late in pregnancy
LGA babies are MC seen in…..
diabetic mothers
LGA babies are at risk for what
birth trauma
what is failure to thrive?
abnormal pattern of weight gain
t/f a single observation of a child is enough to make a FTT diagnosis
false
what is the criteria of FTT
- weight consistently less than 80% of the median for the age
- weight that has fallen across two major percentiles on the growth chart
four fundamental constituents that ensure growth of a child
- oxygen
- substrate
- hormones
- love
What hormone deficits can result in failure to thrive
- growth hormone
- insulin like growth factor
- glucocorticoids
- thyroid hormone
what can cause an energy imbalance
- increase in energy needs
- decrease in energy supplies
What are conditions that increase energy usage
- chronic heart disease
- chronic lung disease
- chronic anemia
- chronic infections
- malignancy
what conditions can lead to decrease in energy supply
- poor caloric intake
- neuromuscular disorders
- GI disorders
what organ systems reflect evidence of malnutrition
- mucous membranes
- hair
- nails
- skin
what is the treatment of mild-moderate FTT
- consultation from dietician
- alert CPS is suspected cases of abuse/neglect
what are the goals of management of mild-moderate FTT
- nutritional rehab
- parental education
- behavioral intervention
why should you attempt to overfeed malnourished infants at the outset
vigorous refeeding may induce malabsorption and diarrhea
what is the 3 phase regimen for FTT treatment
- phase 1: begins with provision of 100% of the daily age-adjusted energy and protein requirements on day 1
- phase 2: intake is increased to provide adequate nutrition to achieve catch-up growth
- phase 3: varied diet is offered ad libitum as the child gradually approaches ideal body weight
what is the management of severe FTT
- hospitalization
- multidisciplinary team of sub-specialists
what is mild-moderate vs severe FTT
- mild-moderate: greater than 80% of ideal body weight for age
- severe: less than 60% of ideal body weight for height
how often do you follow up for FTT
initially weekly visits for progress
what are the MC problems evaluated by pediatric endocrinologists
growth disturbances
what is the most critical parameter in evaluation of a child’s growth
height velocity
it is more difficult to distinguish normal from abnormal growth in what ages
first 2 years of life
growth and height potential are determined by what
genetic factors
how do you calculate target height of a child
mean parental height plus 6.5cm for boys and subtract 6.5cm for girls
how do you assess skeletal maturation
xray of the left hand and wrist
normal variants of growth
- familial short stature
- constitutional growth delay
pathologic short stature is more likely in children with what abnormality
growth velocity abnormality
what are chronic illness/nutritional deficiencies vs endocrine causes of short stature
- chronic illness/nutritional deficiencies: poor linear growth associated with poor weight gain
- endocrine: associated with normal or excessive weight gain
what is familial short stature
- typically have normal birth weight and length
- first 2 years of life their linear growth velocity decelerates
- once target percentile is reached, the child resumes normal linear growth parallel to the growth curve
what is a constitutional growth delay
- delayed onset of puberty and growth spurt
- growth continues beyond the time the average child stops growing
what is the pattern of GH secretion? and what is GH secreted in response to?
- pulsatile pattern
- secreted in response to sleep, exercise, and hypoglycemia
GHD is characterized by what
decreased growth velocity and delayed skeletal maturation in the absence of other explanations
what are the early s/s of GHD
- normal birth weight with only slightly reduced length
- hypoglycemia
- micropenis
- truncal adiposity
what do you do when results of GH tests are ambiguous
trial of GH treatment can help determine whether an abnormally short child will benefit from GH
what is the treatment of GHD
subcutaneous recombinant GH 7 days per week
what are the SE of GH replacement
- benign intracranial hypertension
- slipped capital femoral epiphysis
recombinant IGF-1 is used to treat children with what
- GH resistance
- IGF-1 deficiency
what is psychosocial short stature associated with
emotional deprivation and undernutrition
what are the s/s of Prader-Willi Syndrome
- hypotonia at birth
- almond shaped eyes
- strabismus
- short stature
- obesity
- hypogenitalism
- small hands and feet with tapering fingers
- deficient GH
- obsessive hyperphagia noticed at 3-4 years
Treatment of Prader-Willi Syndrome
GH replacement
what are the s/s of turner syndrome
- webbed neck
- short stature
- shield chest
- amenorrhea
- coarc of aorta and GU malformations
what is the treatment of turner syndrome
- estrogen replacement
- GH replacement
what are the s/s of hypothyroidism
- growth retardation
- decreased physical activity
- hypothyroid sx
- delayed puberty
- thick tongue
- large fontanels
- poor muscle tone
- hoarseness
- jaundice
if hypothyroidism is untreated, it can lead to
neurocognitive impairement
what is the cause of most cases of pediatric hypothyroidism
hypoplasia or aplasia of the thyroid gland or failure of gland to migrate to its normal anatomic location
t/f even when the thyroid gland is completely absent, most newborns with congenital hypothyroidism appear normal at birth and gain weight normally for the first few months
true
how do you screen for screening for congenital hypothyroidism
newborn screening
abnormal newborn screening for hypothyroidism should immediately be followed up with what lab
FT4 and TSH level
what is the treatment of hypothyroidism
levothyroxine
what is the presentation of congenital hyperthyroidism
weight loss despite increased appetite
what is the management of hyperthyroidism
- BB to control nervousness and tachycardia
- PTU or methimazole
- radiation therapy
- surgery
neonatal graves disease usually occurs in what population
children whose mothers also have graves
what is neonatal graves disease
maternal TSH receptor antibodies cross placenta and stimulate excess thyroid hormone production in fetus and resolves over 1-3 months
what is constitutional tall stature
child who is taller than his or her peers and is growing at a velocity that is within the normal range for bone age
what is growth hormone excess
excessive secretion of GH by somatotroph adenomas causes gigantism in the prepubertal child
what is the management of growth hormone excess
treat the adenoma
what is precocious puberty
- pubertal development occurring below the age limit set from normal onset of puberty
- usually before age 8 in girls and 9 in boys
what is central precocious puberty
- activation of GnRH, increase in gonadotropin release, and increase in sex steroids
- events identical of normal puberty
what is peripheral precocious puberty
- exogenous source
- independent of gonadotropin secretion
- presents with markedly elevated estrogen levels and rapidly progressive pubertal changes
what are the s/s of precocious puberty
- breast development
- pubic hair growth
- menarche
- increased body odor
- accelerated growth
what are the labs for precocious puberty
- xray of left hand and wrist
- estradiol level to rule out ovarian tumor or cyst
- LH/FHS levels (normal in central and low in peripheral)
what is the treatment of precocious puberty
leuprolide
what is the MOA of leuprolide
GnRH analog that desensitizes and down-regulates pituitary GnRH receptors and thus decreases gonadotropin secretion
what is considered delayed puberty
- girls: no pubertal signs by 13 and menarche by 16
- boys: no secondary sexual characteristics by 14 or if more than 5 years have elapsed since the first signs of puberty
what is the MCC of delayed puberty
constitutional delay
what is the treatment of delayed puberty
- girls: low dose estrogen, later switch to OCPs
- males: low dose testosterone
what are the s/s of galactosemia
- vomiting
- jaundice
- hepatomegaly
what are the s/s of PKU
-MR (mitral regurg??)
-hyperactivity
-seizures
-light complexion
-eczema
