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Peds > Growth and Development > Flashcards

Growth and Development Flashcards

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
Q

What are the personal-social milestones at 9 mos old?

A

Waves bye-bye

Plays pat-a-cake

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26
Q

What are the language milestones at 9 mos old?

A

Says Dada and Mama, but non-specific.

Two-syllable sounds

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27
Q

What are the gross motor milestones at 1 yr?

A

Walks, stops, and stands

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28
Q

What are the fine motor-adaptive milestones at 1 yr?

A

Puts block in cup and drinks from a cup

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29
Q

What are the personal-social milestones at 1 yr?

A

Imitates others

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30
Q

What are the language milestones at 1 yr?

A

Says Mama and Dada specific

Says 1-2 other words

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31
Q

What are the gross motor milestones at 15 mos?

A

Walks backward (ask parent about that, the infant won’t show you)

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32
Q

What are the fine motor-adaptive milestones at 15 mos?

A

Scribbles

Stacks 2 blocks

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33
Q

What are the personal-social milestones at 15 mos?

A

Uses spoon and fork

Helps with housework

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34
Q

What are the language milestones at 15 mos?

A

Says 3-6 words

Follows commands

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35
Q

What are the gross motor milestones at 18 mos?

A

Runs

36
Q

What are the fine motor-adaptive milestones at 18 mos?

A

Stacks 4 blocks

Kicks a ball

37
Q

What are the personal-social milestones at 18 mos?

A

Removes garment

Feeds a doll

38
Q

What are the language milestones at 18 mos?

A

Says at least 6 words

39
Q

What are the gross motor milestones at 2 yrs?

A

Walks up and down stairs

Throws overhand

40
Q

What are the fine motor-adaptive milestones at 2 yrs?

A

Copies lines

41
Q

What are the personal-social milestones at 2 yrs?

A

Washes hands
Brushes teeth
Puts on Clothes

42
Q

What are the language milestones at 2 yrs?

A

Puts two words together

43
Q

What are the gross motor milestones at 3 yrs?

A

Walks steps with alternating feet

44
Q

What are the fine motor-adaptive milestones at 3 yrs?

A

Wiggles thumb

45
Q

What are the personal-social milestones at 3 yrs?

A

Uses a spoon well

Puts on a t-shirt

46
Q

What are the language milestones at 3 yrs?

A

Says 3-word sentences

47
Q

What are the gross motor milestones at 4 yrs?

A

Balances well on each foot and can hop

48
Q

What are the fine motor-adaptive milestones at 4 yrs?

A

Copies a circle

49
Q

What are the personal-social milestones at 4 yrs?

A

Brushes teeth without assistance

Dresses without help

50
Q

What are the language milestones at 4 yrs?

A

Understands adjectives

Can name colors

51
Q

What are the gross motor milestones at 5-6 yrs?

A

Skips and balances well

52
Q

What are the fine motor-adaptive milestones at 5-6 yrs?

A

Copies a triangle and can draw a person with appropriate features

53
Q

What are the language milestones at 5-6 yrs?

A

Able to define words and to understand opposites

54
Q

Other developmental consideration

A

Hearing and vision screening
Anemia and lead screening at 12 mos
Cholesterol
Immunizations

55
Q

Anticipatory guidance

A

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
Q

Anticipatory guidance for car seats

A

<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
Q

Stage 1 breast Tanner staging

A

Preadolescent: juvenile breast with elevated papilla and small flat areola

58
Q

Stage 2 breast Tanner staging

A

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
Q

Stage 3 breast Tanner staging

A

Continued enlargement of the breast bud further elevates the papilla. The areola continues to enlarge; no separation of breast contours is noted

60
Q

Stage 4 breast Tanner staging

A

The areola and papilla separate from the contour of the breast to form a secondary mound

61
Q

Stage 5 breast Tanner staging

A

Mature: areolar mound recedes into the general contour of the breast; papilla continues to project

62
Q

Precocious puberty

A

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
Q

Delayed puberty

A

Absence of physical changes of puberty by age 13 in girls and age 14 in boys

64
Q

Thelarche

A

Breast budding: 9-10 yo

65
Q

Adrenarche/pubarche

A

Fine straight pubic hair (9-10 yo in males and females)

66
Q

Menarche

A

1st menstruation (12 yo)

67
Q

Nl variants in breasts

A

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
Q

Characteristics of fibroadenoma

A

Rubbery

69
Q

Physiologic leukorrhea

A

Clear vaginal d/c

If odor, pruritus, burning, color change: obtain culture

70
Q

Pattern of menses in adolescents

A

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
Q

Gynecomastia

A

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
Q

Primary amenorrhea

A

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
Q

Secondary amenorrhea

A

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
Q

Amenorrhea- what to consider

A

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
Q

Tx for PCOS

A

Weight loss
Progesterone withdrawal
CHC
And exercise

76
Q

What is considered frequent menstrual bleeding?

A

<21 day cycle

77
Q

What is considered infrequent menstrual bleeding?

A

> 35 day cycle

78
Q

What is considered irregular menstrual bleeding?

A

> 20 day variation in cycle length

79
Q

What is considered prolonged duration of menstrual bleeding?

A

> 8 days of flow

80
Q

What is considered shortened duration of menstrual bleeding?

A

<2 days of flow

81
Q

What is considered heavy flow?

A

> 80 cc

82
Q

What is considered light flow?

A

<8 cc

83
Q

What subjects should adolescents be interviewed about?

A 
Home
Education
Activities
Drugs
Diet
Sexuality
Suicide/depression
84
Q

How to talk to teens about sex

A

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
Q

Rape considerations

A 
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
Q

How to talk to teens about diet

A

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

Peds (11 decks)

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