Growth And Development Flashcards
- What are the major domains of child development?
Domains: Gross motor, fine motor, language (receptive/expressive), social/personal, cognitive
- What are the expected developmental milestones at 6 months?
6 months: Sits with support, transfers hand-to-hand, babbles, recognizes familiar faces
- What are the developmental milestones at 12 months?
12 months: Cruises or walks, pincer grasp, says 1–2 words, waves bye-bye, follows simple commands
- What are the developmental milestones at 18 months?
18 months: Runs, feeds self with spoon, 10–25 words, points to body parts, temper tantrums begin
- What are the developmental milestones at 2 years?
2 years: Jumps, builds 6-block tower, 2-word phrases, 50+ words, follows 2-step commands
- What are the developmental milestones at 3 years?
3 years: Pedals tricycle, copies circle, 3-word sentences, knows name/age/gender, group play
- What are red flag signs in development at 6 months?
Red flags (6 mo): No head control, no social smile, no response to sound, persistent fisting
- What are red flag signs in development at 12 months?
Red flags (12 mo): No babbling, no gestures, not pulling to stand, not responding to name
- What are red flag signs in development at 2 years?
Red flags (2 yrs): No 2-word phrases, <50 words, not following simple commands, hand dominance
- What is the concept of developmental surveillance and its components?
Surveillance: Ongoing monitoring of development during routine visits
- Includes history, milestone review, parental concerns, physical exam
- What are the developmental milestones at 4 years of age?
4 years: Hops on one foot, copies a cross, 4-word sentences, counts to 4, knows colors
- What are the developmental milestones at 5 years of age?
5 years: Skips, copies a square or triangle, prints letters, full sentences, knows address/phone number
- What is the Denver Developmental Screening Test (DDST-II)?
DDST-II: Screens children from birth to 6 years in four domains (gross motor, fine motor, language, social)
- Identifies developmental delay, not a diagnostic tool
- What is the Ages and Stages Questionnaire (ASQ)?
ASQ: Parent-completed developmental screening tool from 1–66 months
- Covers communication, motor, problem-solving, personal-social
- What is the role of the Modified Checklist for Autism in Toddlers (M-CHAT)?
M-CHAT: Used at 18 and 24 months to screen for autism risk
- A positive screen prompts further evaluation
- What are the early signs of autism spectrum disorder (ASD)?
Early ASD signs: Lack of joint attention, poor eye contact, no pointing or social smiling, speech delay, repetitive behaviors
- What is the difference between developmental delay and developmental regression?
Delay: Slower progression of milestones
- Regression: Loss of previously acquired skills (more concerning, often neurologic/metabolic)
- What is global developmental delay and when is it diagnosed?
GDD: Delay in ≥2 developmental domains in children <5 years
- Often a precursor to intellectual disability diagnosis
- What conditions are associated with macrocephaly and microcephaly in children?
Macrocephaly: Hydrocephalus, genetic syndromes (e.g., Sotos)
- Microcephaly: Congenital infections, Zika, FAS, chromosomal abnormalities
- What is the role of early intervention in developmental delays?
Early intervention: Enhances cognitive/social outcomes
- Includes PT/OT, speech therapy, parent training, applied behavior analysis (ABA)
- What are the causes and evaluation of short stature in children?
Short stature: Height <3rd percentile or <–2 SD for age/gender
- Evaluate with growth chart review, bone age, labs (CBC, ESR, TSH, IGF-1), family history
- What is the difference between familial short stature and constitutional delay of growth and puberty?
Familial: Normal bone age, consistent growth percentile, family history of short stature
- Constitutional delay: Delayed bone age, delayed puberty, late growth spurt
- What is the role of bone age in evaluating growth problems?
Bone age (X-ray of left hand/wrist): Assesses skeletal maturity
- Delayed in constitutional delay, normal in familial short stature
- What are common endocrine causes of short stature?
Endocrine causes: GH deficiency, hypothyroidism, Cushing’s, panhypopituitarism
- Usually with delayed bone age and poor weight gain
- What are the features and causes of tall stature in children?
Tall stature: Height >97th percentile
- Causes: Familial, Klinefelter, Marfan, Sotos, endocrine (precocious puberty, hyperthyroidism)
- What is failure to thrive (FTT) and how is it classified?
FTT: Weight <5th percentile or crossing 2 major percentiles downward
- Classified as organic or non-organic
- What are the causes of organic failure to thrive?
Organic FTT: GI (malabsorption), cardiac, renal, endocrine, genetic/metabolic disorders, infections
- What are the causes of non-organic (psychosocial) FTT?
Non-organic FTT: Neglect, poverty, improper feeding, psychosocial stress, parent-child conflict
- What are the key steps in evaluating a child with suspected FTT?
Evaluation: History (feeding, prenatal), growth charts, physical exam, screening labs, home visit if needed
- What is catch-up growth and when does it typically occur?
Catch-up growth: Rapid growth after resolution of underlying cause (e.g., prematurity, illness)
- Seen in first 6–12 months after intervention
- What are the normal growth velocity patterns in children by age group?
Birth–1 year: ~25 cm/year
1–2 years: ~12 cm/year
2–4 years: ~7 cm/year
4–puberty: ~5–6 cm/year
Pubertal: 8–10 cm/year (girls), 10–12 cm/year (boys)
- What are the causes and features of disproportionate short stature?
Disproportionate short stature: Unequal body segment ratios
- Causes: Rickets, skeletal dysplasias (achondroplasia, hypochondroplasia)
- How does hypothyroidism affect growth and development in children?
Hypothyroidism: Poor linear growth, delayed bone age, constipation, bradycardia, fatigue
- May cause developmental delay if congenital
- What is psychosocial dwarfism and how is it managed?
Psychosocial dwarfism: Growth failure due to emotional neglect/stress
- Improved with removal from stressful environment
- What is constitutional delay of growth and puberty and how is it managed?
Constitutional delay: Late growth spurt, delayed puberty, normal final height
- Often needs reassurance; short-term low-dose sex steroids if psychosocial concern
- What are normal patterns of weight gain in infancy and childhood?
Birth–3 months: ~25–30 g/day
3–6 months: ~20 g/day
6–12 months: ~15 g/day
1–2 years: ~2–3 kg/year
Preschool+: ~2 kg/year
- What is mid-parental height and how is it calculated?
Mid-parental height:
- Boys: (Father’s + Mother’s height + 13) / 2
- Girls: (Father’s + Mother’s height – 13) / 2
- ±8.5 cm range
- What is the significance of crossing percentiles on a growth chart?
Crossing ≥2 major percentiles suggests pathologic growth issue (e.g., endocrine, chronic disease, FTT)
- What are the CDC and WHO growth standards and when are they used?
WHO: Birth–2 years, based on breastfed infants (optimal growth)
CDC: >2 years, reference population
- What is the difference between growth charts for term and preterm infants?
Preterm infants: Use Fenton or Olsen curves until 50–52 weeks corrected age
- Switch to WHO/CDC once catch-up complete
- What are the Tanner stages of sexual maturity in boys?
Tanner in boys: Stage 1 (prepubertal), Stage 2 (testes enlarge), Stage 3 (penis lengthens), Stage 4 (penis widens, scrotum darkens), Stage 5 (adult genitalia)
- What are the Tanner stages of sexual maturity in girls?
Tanner in girls: Stage 1 (prepubertal), Stage 2 (breast bud), Stage 3 (breast enlargement), Stage 4 (areola forms mound), Stage 5 (adult breast)
- What are the normal ages and sequence of puberty in boys?
Boys: Testicular enlargement (11–12 yrs), pubic hair, penile growth, growth spurt (~13.5 yrs), voice change, facial hair
- What are the normal ages and sequence of puberty in girls?
Girls: Thelarche (8–13 yrs), pubarche, growth spurt, menarche (~12.5 yrs, ~2 years after thelarche)
- What is precocious puberty and how is it classified?
Precocious: Onset <8 years (girls) or <9 years (boys)
- Central (GnRH-dependent) vs peripheral (GnRH-independent)
- What are the causes of central vs peripheral precocious puberty?
Central: Early HPG axis activation (e.g., idiopathic, CNS lesion)
- Peripheral: Estrogen/testosterone excess (e.g., tumors, CAH, McCune-Albright)
- What is delayed puberty and when is it considered abnormal?
Delayed: No thelarche by 13 or menarche by 15 in girls
- No testicular enlargement by 14 in boys
- What are the causes of delayed puberty in boys and girls?
Delayed puberty: Constitutional delay, hypogonadotropic hypogonadism (Kallmann), hypergonadotropic (Turner, Klinefelter), chronic disease
- How is bone age used in the evaluation of precocious or delayed puberty?
Bone age: Advanced in precocious puberty; delayed in constitutional delay or hypothyroidism
- What are the key investigations for a child with abnormal pubertal development?
Labs: LH/FSH, estradiol/testosterone, bone age, GnRH stimulation test, MRI brain, karyotype (Turner/Klinefelter), pelvic ultrasound (girls)
- What are red flags of abnormal puberty in girls?
Red flags (girls): Breast development before 8 yrs, menarche before 9 yrs, rapid progression, signs of virilization (e.g., clitoromegaly)
- What are red flags of abnormal puberty in boys?
Red flags (boys): Testes >4 mL before 9 yrs, rapid growth spurt, pubic hair or penile growth before 9 yrs, signs of feminization
- What is thelarche and what is premature thelarche?
Thelarche: Breast development
- Premature thelarche: Isolated breast development <2 years or around 6–7 years without other signs of puberty
- What is adrenarche and how does it differ from gonadarche?
Adrenarche: Maturation of adrenal zona reticularis → body odor, pubic/axillary hair
- Gonadarche: HPG axis activation → testicular/enlargement, breast development
- What is premature adrenarche and when is it concerning?
Premature adrenarche: Pubic/axillary hair <8 yrs (girls) or <9 yrs (boys)
- Concerning if rapid progression, growth acceleration, advanced bone age (check for CAH)
- What is gynecomastia in boys and when should it be investigated?
Gynecomastia: Common during mid-puberty (Tanner III), resolves in 6–18 months
- Investigate if prepubertal, rapid growth, painful, hard, or asymmetric
- What are causes of tall stature with delayed bone age?
Causes (tall + delayed bone age): Hypothyroidism, constitutional delay, GH excess before closure
- What are causes of tall stature with advanced bone age?
Causes (tall + advanced bone age): Obesity, precocious puberty, congenital adrenal hyperplasia, Sotos syndrome
- What are causes of failure of catch-up growth in preterm infants?
Causes: Chronic lung disease, poor nutrition, severe GERD, cerebral palsy, postnatal infections
- What is the relationship between nutrition and pubertal timing?
Nutrition affects leptin and energy balance → triggers hypothalamic-pituitary-gonadal axis
- Obesity → earlier puberty (especially girls)
- Malnutrition → delayed puberty
- What are the developmental milestones at 1 month?
1 month: Lifts head slightly when prone, follows face, startles to sound, regards face
- What are the developmental milestones at 2 months?
2 months: Lifts head 45 degrees prone, coos, social smile, tracks past midline
- What are the developmental milestones at 3 months?
3 months: Lifts head and chest, opens hands, laughs, recognizes caregiver
- What are the developmental milestones at 4 months?
4 months: Rolls front to back, reaches for objects, babbles, enjoys play
- What are the developmental milestones at 5 months?
5 months: Rolls both ways, grasps with palmar grasp, responds to name
- What are the developmental milestones at 7 months?
7 months: Sits without support briefly, rakes small object, babbles with consonants, stranger anxiety begins
- What are the developmental milestones at 8 months?
8 months: Sits steadily, transfers objects hand to hand, says ‘dada’ nonspecifically, waves bye
- What are the developmental milestones at 9 months?
9 months: Pulls to stand, pincer grasp developing, says ‘mama/dada’ specifically, plays peekaboo
- What are the developmental milestones at 10 months?
10 months: Cruises along furniture, refined pincer grasp, understands ‘no’, imitates sounds
- What are the developmental milestones at 11 months?
11 months: Stands momentarily, puts objects in container, says 1–2 words, follows 1-step commands
- What are the developmental milestones at 13 months?
13 months: Walks independently, uses 3–5 words, drinks from cup, waves goodbye
- What are the developmental milestones at 14 months?
14 months: Stands from squat, scribbles, brings object to show, separation anxiety
- What are the developmental milestones at 15 months?
15 months: Walks well, tower of 2 blocks, 10–15 words, imitates activities
- What are the developmental milestones at 16 months?
16 months: Walks backwards, uses spoon with spills, identifies 1 body part
- What are the developmental milestones at 17 months?
17 months: Runs stiffly, shows empathy, points to pictures in book
- What are the developmental milestones at 19 months?
19 months: Kicks ball, 2–3 word phrases, 50+ word vocabulary, follows 2-step commands
- What are the developmental milestones at 20 months?
20 months: Builds 4-block tower, removes clothes, names objects in pictures
- What are the developmental milestones at 21 months?
21 months: Squats in play, points to 4+ body parts, joins in pretend play
- What are the developmental milestones at 22 months?
22 months: Jumps in place, aligns two or more objects, helps with household tasks
- What are the developmental milestones at 23 months?
23 months: Understands opposites, combines 2 words, names at least 3 body parts
- What are the developmental milestones at 24 months?
24 months: Runs well, kicks ball, 2–3 word sentences, 50+ words, parallel play, copies lines
- What are the developmental milestones at 25 months?
25 months: Begins toilet training, uses possessive pronouns (mine), turns pages in a book
- What are the developmental milestones at 26 months?
26 months: Points to and names pictures, uses 2–word questions (e.g., what that?)
- What are the developmental milestones at 27 months?
27 months: Begins pretend play with dolls/toys, names friends and familiar people
- What are the developmental milestones at 28 months?
28 months: Walks up stairs alternating feet with help, speaks in 2–3 word sentences
- What are the developmental milestones at 29 months?
29 months: Uses action words (jump, run), plays make-believe games
- What are the developmental milestones at 30 months?
30 months: Builds 8-block tower, uses fork, understands concept of one vs many
- What are the developmental milestones at 32 months?
32 months: Begins to understand time-related words (now, soon), follows 2 unrelated commands
- What are the developmental milestones at 34 months?
34 months: Uses plurals, tells name and age, shows wide range of emotions
- What are the developmental milestones at 36 months?
36 months: Pedals tricycle, copies circle, 3–4 word sentences, knows gender, group play
- What are the developmental milestones at 3.5 years?
3.5 years: Walks heel-to-toe, balances briefly on one foot, asks lots of questions, names 2 colors
- What are the developmental milestones at 4 years?
4 years: Hops on one foot, copies a cross, knows full name, plays cooperatively, tells stories
- What are the developmental milestones at 4.5 years?
4.5 years: Stands on one foot 10 seconds, counts to 10, follows three-part commands
- What are the developmental milestones at 5 years?
5 years: Skips, copies triangle, prints letters, ties shoelaces, understands future/past
- What are the language milestones expected by 5 years?
By 5 yrs: Speaks in full sentences, uses tenses, counts to 10, knows >2000 words, asks why/how questions
- What are the social-emotional milestones at 5 years?
By 5 yrs: Cooperates with peers, shows sympathy, follows rules, prefers same-gender playmates
- What are the gross motor skills expected at 5 years?
By 5 yrs: Skips, jumps forward 2–3 feet, throws overhand, balances on one foot >10 seconds
- What are the fine motor skills expected at 5 years?
By 5 yrs: Cuts with scissors, draws person with 6 parts, copies square/triangle, buttons clothes
- What are school readiness indicators at age 5?
School readiness: Toilet trained, separates from parents, follows directions, basic self-care, social interaction
- What are the cognitive skills expected at 5 years?
Cognitive skills: Sorts by shape/color, understands time sequence, engages in fantasy play, counts objects
