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Growth and Development Flashcards

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1
Q

Growth

A

The increase in the size of the body as a whole or the increase in its separate parts

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2
Q

What is measured in growth charts initially?

A

Height
Weight
Head circumference

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3
Q

How often should growth be charted?

A

Every health visit
Serial measurements are more useful than single measurements
Take the average of 3 head circumference measurements

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4
Q

Rules of thumb for growth

A

5-10% of birth weight is lost in first few days
7-10 days of age: return to birth weight
4-5 months: birth weight is doubled
12 mos: birth weight is tripled

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5
Q

What is considered adequate growth?

A

20-30 g of daily weight gain for first 3-4 mos (~ 2 lbs/mo)
15-20 g/day for 5-12 mos
Avg length 20 in at birth and 30 in at 12 mos

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6
Q

Growth and nutrition

A

100 kcal/kg for 1st 10 kg
50 kcal/kg for next 10 kg
20 kcal/kg for weight >20 kg
Premature infants and catch-up growth: Typically within 6 mos…realistically about 2 yrs for full development/size/skills

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7
Q

Failure to thrive

A

An inability or failure to meet expected growth and developmental milestones

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8
Q

What does failure to thrive often result from?

A

Inadequate caloric intake is a leading cause

Often results from an underlying physiologic or pathologic condition (look into thyroid issues)

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9
Q

Development

A

Changes in function, including those influenced by the emotional and social environments

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10
Q

What can be used to evaluate development and what does it evaluate?

A 
Denver Developmental Screening Tests
Assess the development of children from birth to 6 yo
Evaluates:
Gross motor
Language
Fine motor-adaptive
Personal-social
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11
Q

What are the gross motor milestones at 2 mos old?

A

Lifts shoulder while prone

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12
Q

What are the fine motor-adaptive milestones at 2 mos old?

A

Tracks past midline

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13
Q

What are the personal-social milestones at 2 mos old?

A

Smiles responsively

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14
Q

What are the language milestones at 2 mos old?

A

Cooing

Searches for sound with eyes

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15
Q

What are the gross motor milestones at 4 mos old?

A

Lifts up on hands
Rolls front to back
If pulled to sit from supine, no head lag (head keeps up with rest of the body)

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16
Q

What are the fine motor-adaptive milestones at 4 mos old?

A

Reaches for object

Raking grasp

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17
Q

What are the personal-social milestones at 4 mos old?

A

Looks at hand

Begins to work toward toy

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18
Q

What are the language milestones at 4 mos old?

A

Laughs and squeals

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19
Q

What are the gross motor milestones at 6 mos old?

A

Sits alone

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20
Q

What are the fine motor-adaptive milestones at 6 mos old?

A

Transfers object hand to hand

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21
Q

What are the personal-social milestones at 6 mos old?

A

Feeds self, holds bottle

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22
Q

What are the language milestones at 6 mos old?

A

Babbles

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23
Q

What are the gross motor milestones at 9 mos old?

A

Pulls to stand

Gets into sitting position

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24
Q

What are the fine motor-adaptive milestones at 9 mos old?

A

Begins to pincer grasp

Bangs two objects together

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25
What are the personal-social milestones at 9 mos old?
Waves bye-bye | Plays pat-a-cake
26
What are the language milestones at 9 mos old?
Says Dada and Mama, but non-specific. | Two-syllable sounds
27
What are the gross motor milestones at 1 yr?
Walks, stops, and stands
28
What are the fine motor-adaptive milestones at 1 yr?
Puts block in cup and drinks from a cup
29
What are the personal-social milestones at 1 yr?
Imitates others
30
What are the language milestones at 1 yr?
Says Mama and Dada specific | Says 1-2 other words
31
What are the gross motor milestones at 15 mos?
Walks backward (ask parent about that, the infant won't show you)
32
What are the fine motor-adaptive milestones at 15 mos?
Scribbles | Stacks 2 blocks
33
What are the personal-social milestones at 15 mos?
Uses spoon and fork | Helps with housework
34
What are the language milestones at 15 mos?
Says 3-6 words | Follows commands
35
What are the gross motor milestones at 18 mos?
Runs
36
What are the fine motor-adaptive milestones at 18 mos?
Stacks 4 blocks | Kicks a ball
37
What are the personal-social milestones at 18 mos?
Removes garment | Feeds a doll
38
What are the language milestones at 18 mos?
Says at least 6 words
39
What are the gross motor milestones at 2 yrs?
Walks up and down stairs | Throws overhand
40
What are the fine motor-adaptive milestones at 2 yrs?
Copies lines
41
What are the personal-social milestones at 2 yrs?
Washes hands Brushes teeth Puts on Clothes
42
What are the language milestones at 2 yrs?
Puts two words together
43
What are the gross motor milestones at 3 yrs?
Walks steps with alternating feet
44
What are the fine motor-adaptive milestones at 3 yrs?
Wiggles thumb
45
What are the personal-social milestones at 3 yrs?
Uses a spoon well | Puts on a t-shirt
46
What are the language milestones at 3 yrs?
Says 3-word sentences
47
What are the gross motor milestones at 4 yrs?
Balances well on each foot and can hop
48
What are the fine motor-adaptive milestones at 4 yrs?
Copies a circle
49
What are the personal-social milestones at 4 yrs?
Brushes teeth without assistance | Dresses without help
50
What are the language milestones at 4 yrs?
Understands adjectives | Can name colors
51
What are the gross motor milestones at 5-6 yrs?
Skips and balances well
52
What are the fine motor-adaptive milestones at 5-6 yrs?
Copies a triangle and can draw a person with appropriate features
53
What are the language milestones at 5-6 yrs?
Able to define words and to understand opposites
54
Other developmental consideration
Hearing and vision screening Anemia and lead screening at 12 mos Cholesterol Immunizations
55
Anticipatory guidance
Information given to caretakers to assist in facilitating optimal growth and development- these are to be carried out at every physical exam from birth to adolescence
56
Anticipatory guidance for car seats
<1 yr or 20 lbs: rear-facing seat >1 yr or 20 lbs: front-facing seat 4-8 yrs and 40-80 lbs: booster seat <12 yoa: always sit in the back with seat belt buckled
57
Stage 1 breast Tanner staging
Preadolescent: juvenile breast with elevated papilla and small flat areola
58
Stage 2 breast Tanner staging
The breast bud forms under the influence of hormonal stimulation. The papilla and areola elevate as a small mound, and the areolar diameter increases
59
Stage 3 breast Tanner staging
Continued enlargement of the breast bud further elevates the papilla. The areola continues to enlarge; no separation of breast contours is noted
60
Stage 4 breast Tanner staging
The areola and papilla separate from the contour of the breast to form a secondary mound
61
Stage 5 breast Tanner staging
Mature: areolar mound recedes into the general contour of the breast; papilla continues to project
62
Precocious puberty
Classically defined as sexual development prior to age 8 yo in girls and 9 yo in boys (however, these ages have recently changed in literature to suggest 7 yo in white females and 6 yo in AA females)
63
Delayed puberty
Absence of physical changes of puberty by age 13 in girls and age 14 in boys
64
Thelarche
Breast budding: 9-10 yo
65
Adrenarche/pubarche
Fine straight pubic hair (9-10 yo in males and females)
66
Menarche
1st menstruation (12 yo)
67
Nl variants in breasts
Breast buds are pea-sized masses below the nipple Growth and rate vary btwn breasts All females have some degree of asymmetry Masses: u/s is best test of choice Fibroadenoma is MC mass
68
Characteristics of fibroadenoma
Rubbery
69
Physiologic leukorrhea
Clear vaginal d/c | If odor, pruritus, burning, color change: obtain culture
70
Pattern of menses in adolescents
In general, initial menses are anovulatory and irregular | Irregularity can last up to 2-5 yrs: resolves as the hypothalamic-pituitary-gonadal axis system matures
71
Gynecomastia
Breast enlargement in boys Affects 50-60% boys in early adolescence Usually benign and self-limited: freely movable resolves on its own Large, hard, fixed or d/c: further investigation
72
Primary amenorrhea
Complete absence of menstruation by 16 yo and with breast development Or by 14 yo without breast development 98% have menarche by 15 yo Typically a functional or anatomic variant (hypothalamus, pituitary, ovaries, uterus, or vagina)
73
Secondary amenorrhea
The cessation of menses for more than 3 consecutive mos after previous start of menarche PREGNANCY is the main cause, even if it is denied by the pt (or parent)
74
Amenorrhea- what to consider
Outflow tract obstructions or abnormalities for primary amenorrhea Genetic components such as Turner or Fragile X Hormone eval such as FSH and LH- may indicate ovarian dysgenesis Prolactin and TSH Secondary: pregnancy, stress, PCOS MCC
75
Tx for PCOS
Weight loss Progesterone withdrawal CHC And exercise
76
What is considered frequent menstrual bleeding?
<21 day cycle
77
What is considered infrequent menstrual bleeding?
>35 day cycle
78
What is considered irregular menstrual bleeding?
>20 day variation in cycle length
79
What is considered prolonged duration of menstrual bleeding?
>8 days of flow
80
What is considered shortened duration of menstrual bleeding?
<2 days of flow
81
What is considered heavy flow?
>80 cc
82
What is considered light flow?
<8 cc
83
What subjects should adolescents be interviewed about?
``` Home Education Activities Drugs Diet Sexuality Suicide/depression ```
84
How to talk to teens about sex
Be specific in your questions -Many teens don't consider oral/anal sex to be "having sex" Allow them to ask questions and don't act surprised by what you hear Be prepared to talk about contraception, safe sex practices
85
Rape considerations
``` Obtain thorough hx Forensics collection ("rape kit") Thorough physical exam Photos when possible (trauma, injuries) Full STD work up and tx Refer for counseling/support ```
86
How to talk to teens about diet
Childhood obesity is increasing annually Be sensitive when talking to your pts about dietary habits and weight. Women are esp sensitive to critiques of body image Anorexia and bulimia should always be on your radar when dealing with adolescent pts

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