Growth and Development Flashcards
Growth parameters of constitutional growth delay
CA>BA=HA (delayed growth now, will catch-up later)
Growth parameters of genetic short stature
CA=BA>HA (short now, will likely always be short)
Infants regain BW by…
10-14 days
Children double BW by…
4 months
Children triple BW by…
12 months
Children quadruple BW by…
24 months
Normal weight gain per year after age 2?
5 lbs per year until adolescence
Birth length (BL) increases by 50% by…
1 year
BL doubles by…
4 years
BL triples by…
13 years
Average height increase per year after age 2?
2 inches per year until adolescence
Risk factors for FTT?
Prematurity, congenital malformations, intrauterine exposures (infections, toxins, drugs, etc.)
Definitions of FTT (6)?
1) Weight </=2 major %iles
Indications for FTT admission (6)?
1) Evidence of abuse/neglect
2) High risk for abuse/neglect
3) Severe malnutrition
4) Medically unstable
5) Failure of OP management
6) Need for close observation
Normal head growth per month?
1cm per month for the first year, majority within first 6 months (brain weight doubles by 6 months and triples by 1 year)
Tests of choice for macro-microcephalic?
U/S for macro, CT/MRI for micro
Primary craniosynostosis presentation?
Macrocephaly, abnormally shaped head, and palpably thickened suture
What drives head/skull growth?
Brain growth (that which causes poor brain growth–pre- and postnatal infections, toxins, genetic/chromosomal abnormalities, or CNS injury–causes poor head growth and thus microcephaly)
50%ile HC for full-term infant?
35cm girls, 36cm boys
Formula for midparental height (in cm)?
(Mom’s height + Dad’s height +/-13)/2
+13 if boy, -13 if girls
Benign causes of macrocephaly (2)?
1) Enlargement of subarachnoid space
2) Genetic megalencephaly (normal CT)
Most common type of craniosynostosis?
Scaphocephaly–premature fusion of sagittal suture–long narrow skull
2nd most common type of craniosynostosis?
Anterior plagiocephaly–closure of a coronal suture–asymmetry of orbits
3rd most common type of craniosynostosis?
Trigonocephaly–fusion of metopic suture–triangular skull
Syndromes associated with craniosynostosis (4)?
1) Crouzon syndrome (B/L coronal sutures, normal IQ, normal hands/feet)
2) Apert syndrome (multiple sutures, low IQ syndactyly)
3) Carpenter syndrome (multiple sutures, syndactyly, MR, heart/ortho/eye problems)
4) Pfeiffer syndrome (brachycephaly, midface hypoplasia, finger/toe abnormalities)
Key for craniosynostosis?
If >1 suture involved, assume genetic disorder and neuro abnormalities
Treatment for flat heads?
1) If positional–keep awake child prone, resolves in 2-4 months (helmet if severe or unremitting?)
2) If craniosynostosis, surgery between 6-12 months
Clues to developmental delay (5)?
1) No head control by 3 months
2) Fisting beyond 3-4 months
3) Primitive reflexes persisting past 6 months
4) Fewer than 50 words/no 2-word phrases by 2 years
5) Echolalia beyond 30 months
Labs for developmental delay?
1) Check NBS
2) Lead level
3) TSH/free T4 (consider)
Consider MRI in developmental delay if…(7)?
1) CP
2) Abnormal head shape/size
3) Craniofacial malformation
4) Loss/stagnation of developmental skills
5) Neurocutaneous abnormalities
6) Seizures
7) IQ<50
Bottom of “normal” IQ?
75
Percent of children with mild MR with chromosomal abnormalities?
4-8%
Common causes of language development problems (6)?
1) Hearing problem
2) MR
3) Dysphasia
4) Dysarthria
5) Structural problems
6) Child abuse/neglect
Board clues to language delay (6)?
1) Absence of babbling by 9-12 months
2) Absence of ANY words by 18 months
3) Absence of meaningful phrases by 24 months
4) Unintelligible speech (to strangers) by 3 years
5) Inability to use language to communicate after 3 years
6) Difficulty with language comprehension after 3 years
Goal of hearing screening?
Identify loss of >/=35dB in 500-4000 Hz range
Reasons to screen for hearing loss (12)?
1) Parental concern
2) Hx of bacterial meningitis
3) Neonatal infections associated with hearing loss (CMV, HSV, rubella, toxo, syphilis)
4) Significant head trauma (esp. temporal bone)
5) Associated genetic syndrome
6) Exposure to ototoxic meds
7) Neurodegenerative disorder
8) Head/neck malformation
9) Abnormal skin/hair/eye pigmentation
10) Iris heterochromia
11) Family hx of childhood hearing loss
12) Confirmed associated infectious disease (measles, mumps)
What age to start BP screening?
3 years
BP readings–pre-hypertension?
90-95 %ile
BP readings–hypertension??
> 95th %ile (on 3 separate occasions)
Who to screen for dyslipidemia (3)?
1) Children/adolescents with family hx of dyslipidemia or premature CVD (</= 65yo for women)
2) Family hx not known
3) Other risk factors (overweight/obese), HTN, + smoking, DM
Ages for lead screening?
6-72 months (usually 1yo and 2yo)
Blood lead level for intervention?
> 10 mcg/dL (education, environmental changes, and close monitoring)
Risk factors for lead poisoning (6)?
1) House built before 1950
2) House built before 1978 being remodeled
3) Sibling/playmate with elevated lead
4) Folk remedies with lead
5) Immigrated or adopted from area with high lead
6) Parent with occupational exposure
Symptoms of lead poisoning?
Abdominal pain, lethargy, behavioral changes, poor school performance, hypochromic microcytic anemia (basophilic stipling common but not specific)
What age to screen for anemia?
9-12 months
Screening UA?
ONLY for sexually active kids between 11yo and 21yo (look for leukocytes->GC/CT) as part of STD screening
What age to screen for autism
18 months and 24 months
What age to use standardized developmental screening tool?
9-, 18-, and 24-30 month visits
What age for dental eval?
High-risk–12 months of age or 6 months after first tooth eruption (whichever is earlier)
Low risk–12 months if pediatric dentist available; otherwise no later than 3yo
Tooth eruption delayed beyond what age requires investigation?
1 year of age (hypothyroidism, genetic syndromes, other developmental conditions)
What has been reported with use of OTC teething gels?
Methemoglobinemia
What dental trauma should be referred to dentist?
Loosening of secure teeth, chipping/breaking of crown, laceration of gingiva, bleeding around tooth
What antibiotic for dental infections?
Penicillins (clinda if allergic); mostly aerobic bacteria, but increase anaerobes in abscesses
Preferred discipline methods?
- Time-out from 9 months to 5-6 years old
- Loss of privilege after 5 years old
Infectious disease screening for international adoptions (5)?
1) TB
2) O&P x3 (including Giardia/Crypto)
3) Hep B
4) Congenital syphilis
5) HIV
If O&P negative and eosinophilia present, screen for…?
Strongyloides via serology
If from sub-Saharan Africa, SE Asia, or certain Latin American countries, screen for…?
Schistosoma via serology
Lead level at which to chelate?
> 45mcg/dL
If first dose of DTaP is given before 12 months of age, how many total doses are needed?
4
If first dose of DTaP is after 12 months of age, how many total doses are needed?
3
What strains does Menactra cover?
A, C, Y, and W-135 (no B coverage–Bad for Babies)
Who gets MMR after measles exposure?
> 6 months old, within 72 hours of exposure (if <12 months old, does not count toward vaccine series)
Who gets measles Ig after measles exposure?
> 6 months, 72 hours-6 days from exposure
MMR should not be given until how long from measles Ig?
5-6 months
MMR should not be given until how long from other live virus vaccines?
At least 4 weeks
What vaccines are contraindicated in egg protein allergy?
Influenza and yellow fever (NOT MMR)–should be skin tested first
Age for first dose of rotavirus vaccine?
6-14 weeks of age
Once started, when should rotavirus vaccine series be completed?
8 months of age
What to give infant (<12 months) traveling to Hep A endemic area?
Hep A Ig (NOT vaccine)
