Growth & Development Flashcards
What are the normal growth patterns in infants
0-6 months: 2cm every month and 170g every week
6-12 months: 1cm every month and 110g every week
First week will lose 5-10% of birth weight but should be double by 4-5 months
Fontanelles close between 10-24 months
Preterm age calculated by total age - (40 weeks - actual gestation)
Discuss the definitions of age and two predicted height methods
Chronological age
Height age: age at which height it at 50th percentile
Bone age: skeletal maturation which reflects residual growth potential by assessing growth plates in hands
Target Height:
boys = (Father’s height + Mother’s height +13)/2
Girls = (Father’s height + Mother’s height -13)/2
Predicted Height:
- estimated based on chronological and bone age
What are the criteria for failure to thrive?
- weight for age <3rd percentile
- weight for length <3rd percentile
- cross 2 major percentile lines
- weight <80% ideal weight for age (weight same percentile as height percentile)
- infant not gaining weight despite sufficient intake
What are the timings for puberty in girls and boys
Girls: 8-13
Boys: 9-14
Girls reach peak height velocity 2 years earlier
What is the physiology of puberty?
Hypothalamus secretes GnRH stimulating pituitary to release LH and FSH (usually greatest during sleep) -> LH and FSH lead to gonads to grow and secrete testosterone (males) or estrogen and progesterone (females) -> sex hormones lead to puberty changes (testosterone cause hair growth in both and growth spurt in males and estrogen leads to breast development and growth spurt)
Discuss the sequence of puberty changes in boys and girls
Girls: boobs, pubs, grow and then flow (though adult breasts and pubic hair occur following menarche)
Boys: testis enlargement -> pubic hair -> penis growth -> peak height velocity -> adult genital and then adult pubic hair
What does the Denver Development Screening tool assess
Social contact
Fine motor skills
Language
Gross motor
What is short stature?
> 2SD below mean height based on sex and age
Height is assessed when:
- low growth rate of <5cm/year
- downward crossing of percentiles after age of 18 months
- height below 3rd percentile
- height significant below target height percentile
Discuss the approach to short stature
Child following percentile on growth and weight, with height in target height percentile:
- constitutional delay where normal growth velocity following percentile for age >3 (retarded before then), delayed bone age, delayed pubertal maturation, family history
- familial short stature: normal growth velocity following percentile for age >3, normal bone age, family history
Pathologic when have abnormal proportions (upper to lower body ratio should be 1.7 at birth, 1.3 at 3 and 1.0 at 8 or if arm to height ratio is greater than 5cm or 4%)
- marker of skeletal dysplasia: Prader-Willi, Turner, Down’s, achondrodysplasia (high upper to lower segment ratio)
Normal proportions assess 0-3 growth and 2-17 growth
- prenatal abnormal growth due to IUGR or genetic syndrome
- postnatal abnormal growth due to malnutrition, chronic disease, medication (glucocorticoids), endocrinopathy
Increased weight for height ratio pathological growth:
- endocrinopathy due to growth hormone deficiency: IGF-1 resistance, hypothyroidism, glucocorticoid excess, poorly controlled diabetes
Decreased weight for height ratio (both are low):
- malnutrition or systemic disease
Discuss the differential for failure to thrive
Inadequate caloric intake: - food insecurity - inappropriate feeding technique - mood or eating disorder - cardiopulmonary disease or GI disorder - difficulty eating (cleft palate or GERD) Inadequate absorption: - cow's milk protein allergy - IBD - celiac - GI obstruction Excessive metabolic demand - hyperthyroidism - malignancy - JIA - chronic respiratory or heart disease Defective utilization of nutrients: - inborn errors of metabolism
Discuss the outpatient and inpatient management of failure to thrive
Outpatient: - increased caloric intake for catch up growth - limit empty calories - 3 meals a day with snacks in between - structured mealtimes - offer solids before liquids Inpatient: - fail outpatient - concern for safety - risk of refeeding syndrome - nasogastric tube feeding
List some major developmental milestones
2 months: head control -> hold head up in sitting at 4 months
6 months: transfer object to hand and sits well unsupported
8 months: stand with assistance
1 year:
- pincer grip by 10 months and stacking cubes
- walks
- 1st word, 10 words by 1 year
2 years:
- 2 word sentences, uses crayons, goes down stairs
4 years:
- copies rectangle, self grooms
- tells stories and compound sentences
Discuss the definition of intellectual disability
Deficit in both intellectual and adaptive functioning before age of 18
- intellectual: low IQ
- adaptive: limitations to conceptual, social and practical
Global developmental delay: below age 5 who fail to meet milestones in >=2 areas of intellectual functioning
Discuss the definition of cerebral palsy and the early signs
Non-progressive syndromes characterized by motor and postural dysfunction due to abnormal neurodevelopment
- early after birth have dyskinetic movements or later due to abnormal posture, abnormal movement and not meeting motor development
- motor is uncoordinated, stereotypic and limited in cerebral palsy
What are the syndromes of cerebral palsy
Spastic syndromes:
- positive signs of spastic hyperteonia (velocity dependent increase in tone) and hyper-reflexia
- negative slow effortful voluntary movements, impaired fine motor control
Dyskinetic syndromes
Ataxic syndromes
