Lecture Day 1 Normal Development Flashcards
Average brith weight?
When does it double by
3.3kg
double it by 3 months
Average head circumference at birth?
1 yr
2 yr
35cm
47cm
49cm
(big compared to rest of body)
When do teeth first appear?
6 months-2years
Phases of growth
pre-natal
infantile
childhood
pubertal
What drives growth in each stage: fetal infantile childhood pubertal
fetal 30%: uterine environment
Infantile (0-18 months) 15%: genetics, nutrition, health & happiness, thyroid
Childhood (40%): GH, TH, good health, genes
Pubertal 15% : Testosterone, oestrogen, GH
At end of puberty, the epiphyseal growth plates fuse & cause cessation of growth. Therefore, if puberty is early final growth will be reduced.
Normal requirement after first week until weaning:
- estimate for 5kg baby
150mls/kg/day
- 750mls/day
how to convert Oz to Mls
30mls per Oz
When to wean?
From 6 months
- iron containing food at 6 months
What foods to avoid before 6 months
egg and wheat
Puree when?
7 months
When doorstep milk and normal food
12 months
how many liters of maintenance fluids does an adult need
1 L 8 hourly
How do you calculate mainntence fluids for a child
1st 10kg: 100 mls/kg/day
2nd 10kg: 50 mls/kg/day
3rd +: 20mls/kg/day
Freddie is 28Kg and is vomiting requiring maintenance IV fluids calculate his hourly IV fluid requirement
(10 x 100) + (10 x 50) + (8 x 20)/24 = 69 mls/h
How is overweight/obesity classified in children
BMI (wt/h2) centiles
> 91st overweight
> 98th obesity
Effects of obesity in children
Type 2 diabetes
How much physical activity does a young child need?
How many steps a day? (for adults)
60 mins every day
12,000 steps (10,000)
What are the four categories for children
Gross motor
Fine motor
Speech & language
Social
When is develop most rapid
First 4 years of life
Gross motor development
6-8 weeks- Raises head to 45 degrees 6-8 months – Sits without support 8-9 months - crawling 10 months - walks around furniture 12 months – walking unsteadily 15 months – walks steadily 18 months – can run 2 years – jumps 3 years – hops 4 years – climbing frames 5 years – hops & skips
Causes of not walking
cerebral palsy Duchennes (Músculo-dystophy)- gower test- lie flat & stand without using hands (proximal weakness) MSK problem Neglect Bottom shufflers
Red flag:
9 months
can’t sit without support
Developmental warning signs
- Family history
- Maternal concern
• Persisting primitive reflexes: moro reflex (dropping head-symmetrical arms arising present at birth - 3 months), palmar grasp, sucking reflex, fencing reflex (turn head)
- Discordant development
- Regression- losing skills
Screening ar birth
eyes (red reflex), heart, hips; automated hearing screen
Screening at 1 week
Guthrie (PKU, hypothyroidism, CF, haemoglobinopathies, acylcarnitine)
8 weeks:
general examination
4-5 yrs
school entry
orthopedist
yearly height & weight, hearing
Describe eye development
birth 6/180
1 month 6/90
6 months 6/30
3-5 years 6/6
How many boys are red colour blind
6%
What is enuresis
- percentage at 5, 10 & teenagers
inappropriate voiding of urine after the age at which bladder control should have been achieved: dry day: 2-3 years; dry night 3-4 years
10% at 5, 5% at 10, 1% teenagers
What is encopresis
passage of faeces into the clothes by day or night. Soiling after 4 years is abnormal
2 year old with a history of asthma has a RR of 12 and a HR 80
12 year old with a history of asthma has a RR of 12 and a HR of 80
Which one do you attend to first?
2 year old as HR should be faster.
1st cause of bradycardia: hypoxia
Newborn:
- when should pass first urine
- pass meconium
- micturate in 24 hrs
- meconium in 48 hours
Causes of not passing meconium
Obstruction of bowel
CF: meconium ileus
How does the childs birthweight change after birth. When is it abnormal?
5% lose birthweight, regain by day 10, > than 10% weight loss abnormal.
- not feeding well, dehydrated
At 6 months, what percentage sleep through the night
90%
When are night terrors
(4-7 years)
When nightmares
(8-10)
Sleep walking
(5-10 years)
During prenatal growth, what foetal growth factors modulate growth
- IGF-2
- human placental lactose
- Insulin (hence why hyperinsulinaemia can result in macrosomia)
