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Pediatrics > Lecture 11: Developmental Assessments & Growth Abnormalities > Flashcards

Lecture 11: Developmental Assessments & Growth Abnormalities Flashcards

1
Q

When should developmental assessments occur?

A

Every well-child visit

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2
Q

How common are developmental delays?

A

About 1 in 5 children have delays/conditions placing them at risk.

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3
Q

What is birth to 3?

A

Federally funded home visits for developmental therapies

After 3, via school.

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4
Q

What is the M-CHAT?

A
  • Modified checklist for autism in toddlers
  • 18-30mo
  • two stages (20 questions for parent, then probing questions by provider w examples)
  • takes 5 min (+2 min for scoring)

0-2: low, 3-7: mod, 8-20: severe

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5
Q

What is the Denvver Developmental Screening Tool?

A
  • 125 Question test for 2 weeks to 6 years
  • Parent + direct obs
  • Subjectively allows clinican to observe and assess overall behavior
  • Normal = 0 delays and 1 caution max
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6
Q

What are the main issues with the Denver developmental screen?

A
  • Only identified about 50% of children that needed help
  • Long time to do
  • High sens but low spec (AKA it mainly rules out)
  • Low sample size
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7
Q

What is the Ages and Stages Questionnaires?

A
  • 19 surveys
  • 1 month to 5.5y
  • Language, personal-social, fine/gross motor, problem solving
  • Determines if a child is on schedule
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8
Q

What are the 5 areas of the ASQ and the cutoff?

A
  1. Communication
  2. Gross Motor
  3. Fine Motor
  4. Problem Solving
  5. Personal/Social

Cutoff is 2 SD below the mean: at least 1 cutoff = diagnostic referral indicated.
Close to cutoff = rescreen after practicing 4-6months.

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9
Q

Developmental Milestones for 1-2 months

A

V3-CHERT2S
* V - “vocal” (vocal reciprocal play, engages in vocalizations, alert responds to voices)
* C - Cooing
* H - Holds head erect and lifts head
* E - “Eyes” regards face and follows objects through visual field
* R - recognizes parents
* T - “turns and toys” turns from side to side and drops toys
* S - smiles spontaneously!

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10
Q

Developmental Milestones for 3-5 months

A

“M-SPURTLE” - like a raspeberry!:)

  • M - “mouth” reaches for and brings objects to mouth
  • S - “sits” - sits with support!
  • P - “puppy prop” weight supported on forearms w head up
  • U - ulnar grasps thne later thumb opposition
  • R - raspberry sound!
  • T - “turns” from front to back
  • L - “laughs” and “looks” towards voice
  • E - “exists” can follow object in field of vision but the object no longer exists once they cannot see it
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11
Q

Developmental Milestones for 6-8 months

A

“MICROBES” - microbes has 8 letters (6-8m)

  • M - “midline” passes objects from hand to hand in midline
  • I - inhibited by word no
  • C - Commando crawl!
  • R - Rolls from back to stomach
  • O - “opposition” first scoops pellet then grasps it using thumb opposition
  • B - “bye bye” immitation!
  • E - “eats” feeds themselves puffs and cherios
  • S - sits alone for a short period
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12
Q

Developmental Milestones for 9-11 months

A

“CO-PRINCES”

  • C - Crawls and commands. follows 1 step commands “come here”
  • O - object permanence begins
  • P - pat-a-cake and peek-a-boo imitations!
  • R - Repetition of sounds “bababbaba”
  • I - “index finger” uses thumb and index finger to pick up small items (neat pincer grasp)
  • N - “name” recognition! (they know their name)
  • C - Comprehension of words begins
  • E - eats puffs and cheerios by themself
  • S - “standing” can pull self into standing position and stand alone for short periods of time
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13
Q

Developmental Milestones at 1 year

A

“T-MOWING”

  • T - “tower” of 2 cubes
  • M - “mama” and dada
  • O - “objects” points if they want something!
  • W - “words” can say 1-2 other words
  • I - independently walks!!(if youre gonna mow you gotta walk by yourself!)
  • N - neat pincer grasp is perfect!
  • G - “gives” toys on request!
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14
Q

Developmental Milestones at 18 months

A

“C-STRAW-BED”

  • C - “command” unerstands 2 step commands!
  • S - “sits and stairs” sits self in chair and walks up/down stairs w help
  • T - “Tower” - builds tower of 3-4 cubes
  • R - “recognizes” 3 body parts
  • A - “animal” carries stuffed animal or doll
  • W - “words” can say 4-20 words
  • B - “ball” throws a ball!
  • E - “Eats” w a spoon or fork!
  • D - “Dumps” things out of cups/bottles
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15
Q

when do children develop protodeclarative and protoimperative pointing? what does this mean?

A

15-18 mo

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16
Q

Developmental Milestones at 2 years

A

“BI-TWO” (get it cuz theyre two)

  • B - kicks “balls” and turns “book” pages by themselves!
  • I - “imitates” imitative behaviors, parallel play, mimicry
  • T - “tower” of 6-7 cubes
  • O - “object” points to named objects or pictures
  • W - “words” 50 word vocab, short phrases of 2+ words. giant leap in vocab and languade development!
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17
Q

Developmental Milestones at 30 months

A

“WHIPCOT” turn the W to the left and its a 3 for 30 months (im strugglin hang w me)

  • W - Walks backwards
  • H - hops on one foot
  • I - refers to self as “I”
  • P - uses “prepositions”
  • C - copies “Crude circle” and holds “crayon” in fist
  • O - “object” pointing described by use of object (“what changes channe?” points to remote)
  • T - talks enough to carry conversations
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18
Q

Developmental Milestones at 3 years

A
  1. Holds crayon with fingers
  2. Tower of 9-10 cubes
  3. Copies circle
  4. Gives first and last name
  5. Rides tricycle with pedals
  6. Can dress with supervision

Rule of 3s: 3 numbers, 3 letters, 3 colors, 3 shapes, 3 wheels

idk i dont have one for this

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19
Q

Developmental Milestones at 3-4 years

A

“CABNETS”

  • C - Climbs stairs w alternating feet
  • A - Answers “what do you like to do for fun?”
  • B- buttons and unbuttons
  • N - gives full “name”
  • E - eats by self at mealtime (feeds self)
  • T - takes of shoes and jacket
  • S - knows own Sex
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20
Q

Developmental Milestones at 4-5 years

A
  1. Runs and turns without losing balance
  2. Stands on 1 leg for 10s
  3. Draws a person without a torso
  4. Copy a square
  5. Knows days of the week
  6. What do you do if you’re cold/hungry? answers
  7. Self-care at toilet (might need help with wiping)
  8. Dresses self (need help with tying shoes)
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21
Q

Developmental Milestones at 5-6 years

A
  • Can catch a ball
  • Skips smoothly
  • Tells age
  • Knows right and left hand
  • Can describe favorite tv show with detail
  • Does simple chores at home
  • Good motor ability but little awareness of dangers
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22
Q

Developmental Milestones at 6-7 years

A
  1. Knows morning from afternoon
  2. reads several one syllable words
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23
Q

Developmental Milestones at 7-8 years

A
  1. Ties shoes
  2. Knows current day of the week
  3. Adds and subtracts 1 digit numbers
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24
Q

Developmental red flags

A
  1. Persistence of Moro after 6 months
  2. No joyful expressions by 6 months
  3. No sitting by 9 months
  4. No babbling/pointing/gesturing by 12 months
  5. No single words by 16 months
  6. Not walking independently by 18 months
  7. Hand dominance prior to 18 months
  8. Failure of 2 word sentences by 24 months
  9. Failure of 3 word sentences by 36 months
  10. Regression at any point
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25
Q

What is the best predictor of cognition and school achievement?

A

Language development

2y: 50%
3y: 75%
4y: 100%

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26
Q

Weight gain

A
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27
Q

When is head circumference measured?

A

Birth to 24 months

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28
Q

What is the red flag when it comes to growth charts?

A

Major percentile drops

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29
Q

MC growth abnormality

A

Type 1: Head circumference same, but weight drops faster than height

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30
Q

MCC of type 1 growth abnormality

A
  • Inadequate caloric intake
  • Excess loss of calories
  • Inability to use calories peripherally
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31
Q

Describe a type 2 growth abnormality

A
  • Normal head circumference
  • Depressed ht and wt
  • D/t genetically short, endocrinopathies, growth delay, heart/renal dz, skeletal dysplasias
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32
Q

Describe a type 3 growth abnormality

A
  • Decrease in Ht, Wt, and Head circumference
  • D/t CNS issues, chromsomal defects, or in utero/perinatal insults
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33
Q

Average weight for a baby in america

A

7 lbs 7 oz

34
Q

What does a symmetrical growth abnormality suggest?

A
  • Chromosomal abnormality
  • Drug/ETOH use
  • Congenital infections

Early pregnancy

35
Q

What does an asymmetrical SGA suggest?

A
  • Only weight is <= 10%
  • Pregnancy issue/placental issue later
  • Outlook is generally good
36
Q

MCC of a LGA baby

A

Diabetic mother

Risk of birth trauma

37
Q

What is defined as FTT?

A
  • Under 3% for weight
  • Wt gain has declined across 2 major percentiles
38
Q

What are the 4 things needed for a child to grow?

A
  • Oxygen
  • Substrate (surface on which an organism grows on)
  • Hormones
  • Love
39
Q

What can cause FTT?

A
  • Hormone deficiencies
  • Lack of Love
  • Chronic disease
  • Deficiency in energy supply
  • Structural GI issues (cleft, pierre, atresias)
40
Q

Labs for FTT evaluation

A
  • CMP/CBC
  • CRP/ESR
  • UA/UC/Stool culture/studies
  • Thyroid
41
Q

What should you avoid doing to a malnourished infant?

A

Overfeeding it immediately: dumping syndrome

42
Q

3 Phases of FTT treatment

A
  1. Normal food requirements (100% of their age-adjusted)
  2. Intake increased to achieve catch-up growth
  3. Varied diet once child is near ideal body weight

Multivitamins and iron in every refeeding.

Start slow

43
Q

When should you hospitalize a child based on weight?

A

Less than 60% of IBW based on their ht

44
Q

What is the most critical parameter in evaluation of a child’s growth?

A

Height velocity

any increase or decrease in height percentiles between 2yrs and puberty warrants evaluation

Prob a endocrine issue

45
Q

How is bone age evaluated?

A

Compare a radiograph of child’s left hand and wrist, compare to greulich-pyle scale

46
Q

Who is pathologic short stature more likely in?

A

Children with abnormal growth velocity

Not following the curve

47
Q

How do endocrine causes of short stature tend to manifest?

A

Normal or excessive wt gain

48
Q

What is familial short stature? (FSS)

A
  1. Normal birth wt and length
  2. First 2 years: Linear growth velocity begins decelerating to match genetics
  3. Resumes normal growth parallel to growth curve
  4. Grows at a normal rate or below 3rd percentile
  5. Still have puberty at normal age
49
Q

How does constitutional growth delay present?

A
  • Similar growth pattern to FSS
  • Key difference: Delayed puberty and growth spurt
  • late bloomers
50
Q

What characterizes growth hormone deficiency in terms of growth?

A
  • Primary sign: Decreased growth velocity
  • Delayed skeletal maturation
  • Typically idiopathic
51
Q

How do we check growth hormone deficiency?

A

IGF-1 & IGBFP-3

GH is pulsatile, so hard to measure accurately.

Insulin-like growth factor 1
If ambiguous, trial of GH tx is used.

52
Q

Early s/s of GHD

A
  • Micropenis with gonadotropin + GHD.
53
Q

SEs of daily SC GH

A
  • Benign intracranial hypertension
  • Slipped capital femoral epiphysis

Use IGF-1 if GH resistance is noted

54
Q

What characterizes psychosocial short stature?

A
  • Emotional deprivation
  • GH secretion diminished, but GH replacement doesn’t help.
55
Q

What characterizes Prader-Willi syndrome?

A
  • Chromsome 15
  • Almond-shaped eyes, short, obese, hypogenitals, small hands, deficient GH
  • Obsessed with late night snacking
  • Obsessive hyperphagia is hallmark, seen at 3-4y

Prader Willi is will raid kitchen at night

56
Q

Tx for Prader Willi

A

GH replacement

57
Q

Tx for Turner syndrome

A
  • Estrogen replacement
  • GH replacement

Think coarctation for turner

58
Q

Characteristics of congenital hypothyroidism in an infant?

A
  • Large fontanelles
  • Thick tongue
  • Intellectual delays
  • Poor tone
  • Hoarseness
  • Umbilical Hernias

Tested via newborn screen

59
Q

MCC of hypothyroidism in an infant?

A

Hypoplasia or aplasia of gland

It just never made a thyroid gland.

Iodine deficiency in poorer areas

60
Q

Characteristics of juvenile hypothyroidism

A
  • Sluggish
  • Dry hair
  • Delayed puberty
  • Delayed closure of fontanelles
  • Galactorrhea

Prolactin elevation can be seen

61
Q

What gender is hyperthyroidism MC in?

A

Females

62
Q

Tx for hyperthyroidism

A
  • Methimazole First line for kids
  • Antithyroid agents
  • PTU (Propylthiouracil)
  • Surgery for large, very young, or pregnant
63
Q

Tx for Graves disease refractory to antithyroid agents

A

Iodine ablation

64
Q

Temporary tx for neonatal graves disease

A
  • BBs
  • Steroids

Can occur rarely if mom has graves, usually resolves in 1-3 months

65
Q

What can cause GH excess resulting in tall stature?

A

Pituitary adenomas

Gigantism

66
Q

What is precocious puberty?

A
  • Onset prior to 8 (before 7 if AA or hispanic)
  • Either central or peripheral
67
Q

What characterizes central precocious puberty?

A
  • Idiopathic usually
  • Activation of GnRH early, causing earlier sex steroids.
68
Q

What characterizes peripheral precocious puberty?

A
  • Ovarian or adrenal tumors
  • Congenital adrenal hyperplasia
  • Ovarian cysts
  • McCune-Albright syndrome
  • Exogenous estrogen
69
Q

Concerns in precocious puberty for girls

A
  • Skeletal maturation too early compared to linear growth, impairing adult stature
  • Vaginal bleeding
  • Odor
  • Temporarily tall
70
Q

Labs to evaluate precocious puberty in girls

A
  • Radiograph of L hand and wirst
  • Estradiol for ovarian tumor/cyst
  • LH and FSH are low in peripheral
  • MRI if suspecting central
  • US of ovaries if suspecting peripheral
71
Q

Tx for precocious puberty in girls

A

Leuprolide (GnRH analog) to inhibit Gn secretion, eventually suppressing LH and FSH levels.

72
Q

How does precocious puberty in males tend to present?

A
  • More likely to have CNS abnormalities
  • Increased growth rate
73
Q

Tx of precocious puberty in males

A
  • Leuprolide
  • Cranial MRI to r/o central
74
Q

What characterizes benign precocious puberty?

A
  • Premature adrenarche
  • Normal linear growth and no bone age advancement
  • No actual change in timing of puberty
75
Q

When do we start delayed puberty workup in girls?

A
  • No signs by 13 or menarche by 16 or not tanner stage 5 after 4 years of puberty
  • Main cause: Constitutional growth delay
76
Q

Tx for delayed puberty in girls

A
  • Low dose estrogen
  • Switch to OCPs after
77
Q

What characterizes delayed puberty in boys?

A
  • No secondary sexual characteristics by age 14
  • 5 years since starting puberty but genital growth is incomplete.
  • MCC: constitutional growth delay
78
Q

Tx for delayed puberty in boys

A

Low dose testosterone

79
Q

MCC of death due to galactosemia

A
  • Progressive hepatic cirrhosis & E. coli sepsis
80
Q

What does an untreated PKU pt look like?

A
  • Severe mental impairment
  • Hyperactivity
  • Seizures
  • Light complexion
  • Eczema
81
Q

Where is phenylalaine found in MC?

A
  • Meat
  • Eggs
  • Cheese
  • Aspartame
82
Q

What kind of supplementation does galactosemia require?

A

Calcium replacement

Pediatrics (41 decks)

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