Growth & Development Flashcards
When does average newborn regain birthweight?
3rd week
When does birthweight double?
5 months
When does birthweight triple?
1 year
Infant younger than 3 weeks who hasn’t regained birthweight…
Reassure and re-evaluate in 1 week
Average infant height (50%)?
50cm
Birth length goes up 50% by age…?
1
Birth length is doubled by…?
4
Birth length is tripled by…?
13
Growth rate first year of life?
20 cm/year
Birth size reflection of?
Maternal factors and in utero conditions (vs. genetic growth potential)
Infant can cross percentiles in 1st 12-18 months as genetic, hormonal, and environmental factors overcome maternal ones
When are you half your adult height?
2
When do you worry about abnormality of growth?
Shifts across 2+ percentile lines on growth curve after 2
What has significant effect on linear growth velocity?
Chronic diseases
Normal head circumference at birth for full term newborn?
35cm
Normal head growth for first 6 months?
~1 cm/month
Normal head growth from 6-12 months?
~1/2 cm/month
Head circumference above 98 percentile for age?
Macrocephaly
Infant with increasing head circumference, but normal development…?
Measure parents’ heads- Normal familial macrocephaly
Is hydrocephaly present at birth?
Can be, doesn’t have to be
Signs of hydrocephaly
Irritability, lethargy, poor appetite, persistent vomiting, bulging fontanelle, neurological findings in infant with rapidly enlarging head
Normal development, no signs increased ICP, parents with big heads
Macrocephaly
Irritability, vomiting, bulging fontanelle, impaired upward gaze
Hydrocephaly
Which is scary… Large anterior fontanelle v. Bulging fontanelle?
Bulging…associated with increased ICP
Is a bulging fontanelle associated with papilledema?
No ( it’s chronic, not acute)
Weight drop first, then decreased length, spares head circumference
Inadequate calorie intake
Short stature with normal or elevated weight
Endocrine disorders
Microcephaly + Dysmorphic features
Chromosomal abnormalities
Weight and height decrease together
Chronic medical conditions
Head circumference below 5th percentile for age
Microcephaly
Acquired Microcephaly
Occurs in infants who had normal head circumference at birth
If head circumference decreases while weight and height stay the same, has to be a cause
A physical sign that a child is receiving inadequate nutrition for optimal growth and development.
FTT
Weight below 5th percentile for age
FTT
Weight that drops 2 major percentile channels
FTT
Weight less than 80% of ideal weight for age
FTT
Weight below 5th percentile on the weight-for-length curve
FTT
Which kids have specific growth charts?
Down, Turner, William’s
Don’t call growth abnormal unless comparing to the specific chart
When is it normal for kids to change % up to 2 channels up or down?
Between birth and 2
Consideration in FTT…?
New caretaker, improper mixing of formula
First thing to check with FTT?
Most cases from non-organic causes…evaluate diet first then look at mother/child interaction (feeding technique)
Labs/tests are not first step!
4 categories of organic causes of FTT?
- Chronic renal failure
- Thyroid and other metabolic disorders
- Disorders leading to inadequate absorption
- Disorders leading to inadequate utilization
*Something in history will suggest these causative factors
Throw ball while standing?
18 months
Throw overhand?
24 months
When can you stop factoring in prematurity for milestones?
2 years
28 week GA infant, now 2.5 months old… What aged milestones?
Full-term baby…corrected age is 38 weeks
Can follow mom around room through 180 degree arc
2 months (2 Sides)
Lift head and chest while prone
2 months (#2 rolling up)
Coo
2 months (two rhymes with coo)
Scratches/grabs clothes
4 months
Clutch/hold rattle
4 months (Looks like rattle)
Put objects deliberately in mouth
4 months
Sit up
6 months (6 looks like baby sitting, 6 month olds can sit)
Transfer cube from one hand to other
6 months
Crawl on bellies
6 months
Walk with hand held
12 months (1 year old can walk with one hand held)
Point
12 months (Need 1 finger to point)
Say one word besides mama and dada
12 months
Walks fast, falls occasionally, walks upstairs with hand held, climbs into and sits in chair
18 months
Feed themselves
18 months
How many cubes at 18 months?
2-3
How many cubes at 24 months?
4-6
How many cubes at 36 months?
8
6-cube tower?
2 years
Walk up stairs with alternating feet?
3 years
Ride a tricycle
3 years (3 wheels for 3 years)
Hop 3 times
3 years
Identify opposites
4 years
Draw 4 body parts
4 years
Rule of 4’s (6 items)
- Count to 4
- Recite a 4-word sentence
- Identify 4 primary colors
- Draw a 4-part person
- Build a gate out of blocks (4 looks like a gate)
- Stranger understands 4/4 of what they say
Tie a knot
5 years
Correctly grab a pencil
5 years
Print letters
5 years
Draw a square
5 years
Walk backward heel-to-toe
5 years (avoids school by walking backwards)
Draw circle
3 years
Draw cross
4 years
Draw square
5 years
Draw triangle
6 years
Draw diamond
7 years
Worry with lack of visual attention/fixation
2 months
Worry with lack of visual tracking
4 months
Worry with lack of steady head control while sitting
4 months
Worry with failure to turn to sound or voice
6 months
Worry with lack of smile or joyful expressions
6 months
Worry with inability to sit
9 months
Worry with lack of reciprocal vocalizations, smiles, or other facial expressions
9 months
Worry with failure to respond to name when called
12 months
Worry with absence of babbling
12 months
Worry with inability to walk independently
18 months
Worry with lack of simple pretend play
18 months
Worry with lack of language/gestures
18 months
Worry with lack of 2-word meaningful phrases
24 months
Worry with loss of previously acquired speech or social skills
Any age
50% intelligible speech
2 years
75% intelligible speech
3 years
100% intelligible speech
4 years
Stuttering can be normal until what age?
3 or 4 years (often disappears once vocab increases)
-Normal/reassure
When do you refer for stuttering?
- Persistence beyond preschool age
- Persists for more than 6-8 weeks
- Marked parental concern
- Associated symptoms like facial tics
Can serious language delays be explained by bilingual home, second child with siblings, or parents speaking for child?
No
First thing to do with language delay?
Hearing test
History of TORCH infection, hyperbilirubinemia, or meningitis + language delay?
Hearing evaluation
What impacts language and emotional development as well as ability to read?
Chronic hearing loss (including loss due to chronic otitis media)
Hearing loss that starts after what age has less of an impact than if it occurs before?
5 years
Most important intervention for language development in infant with congenital hearing loss?
Family involvement (including non-verbal communication)
- Family use of verbal and nonverbal communication has been shown to have the most positive impact on language acquisition in children with hearing loss
- This is more important than specific formal interventions
Goal of early intervention?
Provide services to aid in developmental progress (speech therapy, occupational therapy, physical therapy)
What outlines guidelines for education of children in U.S. who have developmental delays or other problems that may interfere with learning?
Individuals with disabilities education act ( IDEA)
Part C of IDEA covers what?
Early intervention services for kids under 3
- Goal is for kids to reach developmental potential and improve cognitive outcome
- Programs must be family based and culturally relevant
Does Feingold diet show benefit in managing ADHD or learning disabilities?
No
Is restricting sugar beneficial for managing/treating ADHD or behavioral disorders?
No, but don’t use sugar/candy as reward for good behavior
Mega vitamin therapy?
Increases disruptive behavior (no role with managing learning disabilities or behavioral problems)
Solutions for autism and other developmental disorders that have not been proven to be effective?
Sensory integration therapy, eye exercises, chelation therapy, hyperbaric O2 chambers
Systematic monitoring “structured surveillance” of a child’s development using standardized screening tools has been proven to identify delays in children much more often than physician questioning and observation alone “unstructured surveillance”
Yup
When do you use universal post-partum mood disorder screening?
First year after birth
When do you do general structured developmental screening?
9, 18, and 24 or 30 months
When do you do autism specific screening?
18 and 24 months
When do you do social emotional screening?
Whenever a screening instrument is abnormal
Average newborn loses up to what % of birthweight?
10%
What has been proven to identify delays in children much more often than physician questioning and observation alone?
Systematic monitoring: “Structured surveillance”
When do you do universal post-partum mood disorder screening?
In first year after birth
When do you do general structured developmental screening?
9, 18, and 24 or 30 months
When do you do autism specific screening?
18 and 24 months
When do you do social emotional screening?
Whenever a screening instrument is abnormal
When do you do kindergarten readiness screening?
4 years
What should be done at every health supervision visit from ages 5-18?
Social-emotional/mental health/psychosocial function screening
What do you do at every health supervision visit throughout adolescence?
Substance abuse-specific screening
Name 2 general developmental screens
- Ages and stages questionnaire (ASQ)
2. Parents’ evaluation of developmental status (PEDS)
Name a specialized developmental screen
Modified checklist for autism in toddlers (MCHAT)
Name 3 mental health/behavior screens
- Pediatric symptoms checklist (PSC)
- Connors 3
- Vanderbilt scales
3 ways development can go astray?
- Delay in development
- Deviation in order of skills acquisition or an atypical pattern of development
- Dissociation where different areas of development advance at different rates
-3Ds of developmental deviation
