Growth and Development Flashcards
Growth
The increase in the size of the body as a whole or the increase in its separate parts
What is measured in growth charts initially?
Height
Weight
Head circumference
How often should growth be charted?
Every health visit
Serial measurements are more useful than single measurements
Take the average of 3 head circumference measurements
Rules of thumb for growth
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
What is considered adequate growth?
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
Growth and nutrition
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
Failure to thrive
An inability or failure to meet expected growth and developmental milestones
What does failure to thrive often result from?
Inadequate caloric intake is a leading cause
Often results from an underlying physiologic or pathologic condition (look into thyroid issues)
Development
Changes in function, including those influenced by the emotional and social environments
What can be used to evaluate development and what does it evaluate?
Denver Developmental Screening Tests Assess the development of children from birth to 6 yo Evaluates: Gross motor Language Fine motor-adaptive Personal-social
What are the gross motor milestones at 2 mos old?
Lifts shoulder while prone
What are the fine motor-adaptive milestones at 2 mos old?
Tracks past midline
What are the personal-social milestones at 2 mos old?
Smiles responsively
What are the language milestones at 2 mos old?
Cooing
Searches for sound with eyes
What are the gross motor milestones at 4 mos old?
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)
What are the fine motor-adaptive milestones at 4 mos old?
Reaches for object
Raking grasp
What are the personal-social milestones at 4 mos old?
Looks at hand
Begins to work toward toy
What are the language milestones at 4 mos old?
Laughs and squeals
What are the gross motor milestones at 6 mos old?
Sits alone
What are the fine motor-adaptive milestones at 6 mos old?
Transfers object hand to hand
What are the personal-social milestones at 6 mos old?
Feeds self, holds bottle
What are the language milestones at 6 mos old?
Babbles
What are the gross motor milestones at 9 mos old?
Pulls to stand
Gets into sitting position
What are the fine motor-adaptive milestones at 9 mos old?
Begins to pincer grasp
Bangs two objects together
What are the personal-social milestones at 9 mos old?
Waves bye-bye
Plays pat-a-cake
What are the language milestones at 9 mos old?
Says Dada and Mama, but non-specific.
Two-syllable sounds
What are the gross motor milestones at 1 yr?
Walks, stops, and stands
What are the fine motor-adaptive milestones at 1 yr?
Puts block in cup and drinks from a cup
What are the personal-social milestones at 1 yr?
Imitates others
What are the language milestones at 1 yr?
Says Mama and Dada specific
Says 1-2 other words
What are the gross motor milestones at 15 mos?
Walks backward (ask parent about that, the infant won’t show you)
What are the fine motor-adaptive milestones at 15 mos?
Scribbles
Stacks 2 blocks
What are the personal-social milestones at 15 mos?
Uses spoon and fork
Helps with housework
What are the language milestones at 15 mos?
Says 3-6 words
Follows commands
What are the gross motor milestones at 18 mos?
Runs
What are the fine motor-adaptive milestones at 18 mos?
Stacks 4 blocks
Kicks a ball
What are the personal-social milestones at 18 mos?
Removes garment
Feeds a doll
What are the language milestones at 18 mos?
Says at least 6 words
What are the gross motor milestones at 2 yrs?
Walks up and down stairs
Throws overhand
What are the fine motor-adaptive milestones at 2 yrs?
Copies lines
What are the personal-social milestones at 2 yrs?
Washes hands
Brushes teeth
Puts on Clothes
What are the language milestones at 2 yrs?
Puts two words together
What are the gross motor milestones at 3 yrs?
Walks steps with alternating feet
What are the fine motor-adaptive milestones at 3 yrs?
Wiggles thumb
What are the personal-social milestones at 3 yrs?
Uses a spoon well
Puts on a t-shirt
What are the language milestones at 3 yrs?
Says 3-word sentences
What are the gross motor milestones at 4 yrs?
Balances well on each foot and can hop
What are the fine motor-adaptive milestones at 4 yrs?
Copies a circle
What are the personal-social milestones at 4 yrs?
Brushes teeth without assistance
Dresses without help
What are the language milestones at 4 yrs?
Understands adjectives
Can name colors
What are the gross motor milestones at 5-6 yrs?
Skips and balances well
What are the fine motor-adaptive milestones at 5-6 yrs?
Copies a triangle and can draw a person with appropriate features
What are the language milestones at 5-6 yrs?
Able to define words and to understand opposites
Other developmental consideration
Hearing and vision screening
Anemia and lead screening at 12 mos
Cholesterol
Immunizations
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
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
Stage 1 breast Tanner staging
Preadolescent: juvenile breast with elevated papilla and small flat areola
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
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
Stage 4 breast Tanner staging
The areola and papilla separate from the contour of the breast to form a secondary mound
Stage 5 breast Tanner staging
Mature: areolar mound recedes into the general contour of the breast; papilla continues to project
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)
Delayed puberty
Absence of physical changes of puberty by age 13 in girls and age 14 in boys
Thelarche
Breast budding: 9-10 yo
Adrenarche/pubarche
Fine straight pubic hair (9-10 yo in males and females)
Menarche
1st menstruation (12 yo)
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
Characteristics of fibroadenoma
Rubbery
Physiologic leukorrhea
Clear vaginal d/c
If odor, pruritus, burning, color change: obtain culture
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
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
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)
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)
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
Tx for PCOS
Weight loss
Progesterone withdrawal
CHC
And exercise
What is considered frequent menstrual bleeding?
<21 day cycle
What is considered infrequent menstrual bleeding?
> 35 day cycle
What is considered irregular menstrual bleeding?
> 20 day variation in cycle length
What is considered prolonged duration of menstrual bleeding?
> 8 days of flow
What is considered shortened duration of menstrual bleeding?
<2 days of flow
What is considered heavy flow?
> 80 cc
What is considered light flow?
<8 cc
What subjects should adolescents be interviewed about?
Home Education Activities Drugs Diet Sexuality Suicide/depression
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
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/supportHow 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
