Growth, Development & Preventative Care

Question 1

what do you measure at each well child visit?

Answer 1

length/stature

weight

head circumference

Question 2

what is the best method to toilet training a toddler?

Answer 2

none - there is no consensus. parents need to do what works for their family.

Question 3

children under 18 months should be allowed how much “screen time” per week?

Answer 3

Zero, but video calls don’t count

Question 4

you should measure a child’s height while lying down until what age?

Answer 4

2 years of age, then can do standing

Question 5

What are the BMI indicators for adiposity in children > 2 y.o.?

Answer 5

BMI>85th-95th = overweight

BMI > 95th = obese

Question 6

what do you use to assess weight in children less than two years old?

Answer 6

weight for length ratio

Question 7

when do we worry about children’s growth?

Answer 7

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

Question 8

how do you calculate genetic potential height (mid-parental height)

Answer 8

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

Question 9

What is the difference between the CDC and WHO growth chart?

Answer 9

CDC = formula fed

WHO = breast fed

may be more appropriate to use WHO for breastfed infants

Question 10

what is expected growth in the first year?

Answer 10

-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

Question 11

what is microcephaly?

Answer 11

head circumference 2 standard deviations below the mean for average

<3rd percentile

Question 12

what is macrocephaly?

Answer 12

HC >2 standard deviations above the mean (or >97th percentile)

Question 13

How do you distinguish hydrocephalus from macrocephaly?

Answer 13

Question 14

how do you distinguish plagiocephaly from craniosynostosis?

Answer 14

in plagiocephaly, ear on affected side shifted anteriorly (the flat side)

Question 15

how do you manage positional plagiocephaly?

Answer 15

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

Question 16

when should you do developmental screening?

Answer 16

30 months, if insurance is cheapskate, at 24 month well

Question 17

what are the gross motor milestones?

Answer 17

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

Question 18

what are the self-help milestones?

Answer 18

Holds own bottle- 8 months

fusses to be changed - 15 months

Uses a spoon well- 22 months

Pulls pants off- 24 months

Question 19

What are the language milestones?

Answer 19

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

Question 20

what are the social/emotional milestones?

Answer 20

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

Question 21

what is a key problem-solving milestone?

Answer 21

Seeks object after it falls silent to floor- 8 months

Question 22

Social communication milestones

Answer 22

Affective reciprocity - 3-6 mos

Joint Attention 12-18 mos

Theory of Mind - 30 months

Intuitive Psychology 4-5 years +

Question 23

What are the AAP recommended screenings for anemia?

Answer 23

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

Question 24

When should testing for lead be done and in what children?

Answer 24

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

Question 25

what is the treatment for lead poisoning above >45 mcg/dL?

Answer 25

succimer 10 mg/kg PO every 8 hours for 5 days, then every 12 hours for 14 days

Question 26

when should dyslipidemia screening occur?

Answer 26

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

Question 27

what are BP screening guidelines?

Answer 27

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%

Question 28

What are the criteria for anaphylaxis?

Answer 28

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.

Question 29

What are the screen time guidelines for children from 2-5

Answer 29

limit to 1 hour/day

high quality programs co-watched with parent