Growth, Development & Preventative Care Flashcards
what do you measure at each well child visit?
length/stature
weight
head circumference
what is the best method to toilet training a toddler?
none - there is no consensus. parents need to do what works for their family.
children under 18 months should be allowed how much “screen time” per week?
Zero, but video calls don’t count
you should measure a child’s height while lying down until what age?
2 years of age, then can do standing
What are the BMI indicators for adiposity in children > 2 y.o.?
BMI>85th-95th = overweight
BMI > 95th = obese
what do you use to assess weight in children less than two years old?
weight for length ratio
when do we worry about children’s growth?
when they start moving across the curve - 2 or more percentiles up or down
people tend to more toward genetic potential between 6-18 months
how do you calculate genetic potential height (mid-parental height)
correct mother’s height by adding 5 inches for boys
correct father’s height by subtracting 5 inches for girls
average corrected heights of parents
target height is +/- 2 inches of average
What is the difference between the CDC and WHO growth chart?
CDC = formula fed
WHO = breast fed
may be more appropriate to use WHO for breastfed infants
what is expected growth in the first year?
-term infants return to birth weight by two weeks
gain 20-30 grams/day for 1-3 months
term infants 3x birth weight by 1 year
2 kg/year from ages 1-10 years
height doubles by 3-4 years of age
normal HC for a full term infant is 35 cm
what is microcephaly?
head circumference 2 standard deviations below the mean for average
<3rd percentile
what is macrocephaly?
HC >2 standard deviations above the mean (or >97th percentile)
How do you distinguish hydrocephalus from macrocephaly?
how do you distinguish plagiocephaly from craniosynostosis?
in plagiocephaly, ear on affected side shifted anteriorly (the flat side)
how do you manage positional plagiocephaly?
increase tummy time while awake
switch around in crib so head turns the other way
PT for torticollis
If persistent or severe after conservative therapy or presenting >8 months, helmet therapy
when should you do developmental screening?
30 months, if insurance is cheapskate, at 24 month well
what are the gross motor milestones?
rolls front to back - 4 months
no head lag when pulled to sit - 4-6 months
sits without support -7 months
begins creeping, pulls to stand - 9 months
takes independent steps - 1 year
what are the self-help milestones?
Holds own bottle- 8 months
fusses to be changed - 15 months
Uses a spoon well- 22 months
Pulls pants off- 24 months
What are the language milestones?
Coos- 2 months
Listens, then vocalizes when adult stops- 6 months
Waves “bye-bye”- 10 months
Says first word- 11 months
50+ words with 50% intelligibility (50% of speech understood by a stranger)- 24 months
what are the social/emotional milestones?
Social/Emotional
Reciprocal smiling (responds to adult face/voice)- 2 months
Recognizes caregiver visually- 5 months
Stranger anxiety- 6 months
Separation anxiety- 9 months
Gives objects to adults for action after demonstration (“requests” help)- 11 months
Proto-Imperative Pointing (Points to get desired object)- 12 months
Proto-Declarative Pointing (Points to express interest)- 14 months
Shows empathy- around 24 months
what is a key problem-solving milestone?
Seeks object after it falls silent to floor- 8 months
Social communication milestones
Affective reciprocity - 3-6 mos
Joint Attention 12-18 mos
Theory of Mind - 30 months
Intuitive Psychology 4-5 years +
What are the AAP recommended screenings for anemia?
Hgb/Hct screening at 1 year plus screening for iron deficiency risk
- premature
- exclusive breastfeeding >4 months without supplement
- early weaning to cow’s milk or non-iron fortified foods/iron poor diet
- feeding problems, slow growth
- low SES
- menstruating females
- special health care needs
Risk assessment at 15, 18, 24 months and 3 and 5 years and repeat screenings at any time for those at risk
When should testing for lead be done and in what children?
1 and 2 years in high-risk
- all Medicaid eligible children
- populations where >12% of children have elevated BLL
- recent immigrants, refugees
- homes built before 1978
what is the treatment for lead poisoning above >45 mcg/dL?
succimer 10 mg/kg PO every 8 hours for 5 days, then every 12 hours for 14 days
when should dyslipidemia screening occur?
1 x 9-11
1 x 17-19
Conduct risk assessment in even years until 8, then yearly
-hypothyroidism, PCOS and HTN are some unusual risk factors
what are BP screening guidelines?
Annual screening starting at 3
Every visit if patient is obese, taking meds that increase BP, have renal disease, history of aortic arch obstruction or coarctation or diabetes
Use correct cuff- length 80-100% arm, width-40%
What are the criteria for anaphylaxis?
The symptoms of anaphylaxis vary and can be difficult to recognize. If you experience any ONE of the following three conditions, you may be experiencing an anaphylactic episode:
• Your symptoms appear within minutes to several hours and involve skin, mucosal tissue (moist lining of the body cavities, such as the nose, mouth, and GI tract), or both. You also have trouble breathing or a drop in blood pressure (pale, weak pulse, confusion, loss of consciousness).
or
• You have two or more of the following symptoms that occur within minutes to several hours after exposure to a suspected allergenic food:
– Hives, itchiness, or redness all over your body and swelling of the lips, tongue, or the back of the throat
– Trouble breathing
– Drop in blood pressure
– GI symptoms such as abdominal cramps or vomiting
or
• Your blood pressure drops, leading to weakness or fainting, within minutes to several hours after exposure to a food to which you know you have an allergy.
What are the screen time guidelines for children from 2-5
limit to 1 hour/day
high quality programs co-watched with parent
