Normal growth and developement of children Flashcards
When is an abnormality in childhood likely to be pathological?
When it is unilateral
Where do bones grow from longitudinally?
From the growth plate (physis) by enchondral ossification
Where do bones grow from circumferentially?
Periosteum by appositional growth
When does bone strength peak?
Early 30s
What area of bones will children break?
Growth plates - the shaft is unlikely to break
What factors affect the growth plate?
Diet/ nutrition Sunshine, vit D Injury to growth plate Illness - flu and gastroenteritis will show growth arrests in bone Hormones (GH)
What should a child be doing by 6-9 months?
Sit alone, crawl
What should a child be doing by 8-12 months?
Stand, mouth a few words
What should a child be doing by 14-17 months?
Walk, feed self, use spoon, understand 200 words
What should a child be doing by 24 months?
Jump
What should a child be doing by 3 years?
Manage stairs, potty trained
What should a baby be able to do by 2 months?
Head control - this is an important milestone
What are variations of normal?
Genu varum (bowing) or valgum (knocked knees)
Intoeing
Flat feet
Curly toes
How does allingment of legs change with age?
Born varum
3 years, legs are valgum
By 7 years legs are straight
When is genu varum pathological?
Unilateral
Severe
Short stature
Painful
What can cause pathological genu varum?
Skeletal dysplasia Rickets Tumour - enchondroma Blounts disease Trauma - physeal injury
What is blounts disease?
Growth arrest of the medial tibial physis of unknown aetiology
Typical beak like protrusion on x-ray
What can cause pathological valgum?
Tumours - enchodroma, oseochondroma (bony projections around growth plate)
Rickets
Neurofibromatosis
Idiopathic
What is considered a large genu valgum?
Lare intermalleolar distance of over 8cm
What 3 things can cause intoeing?
Femoral neck anteversion
Internal tibial torsion
Metatarsal adductus
What is the degrees of the femoral neck at birth?
30-40 degrees
What is the degrees of the femoral neck at maturity?
10-15 degrees
What will interal tibial torsion show clinically?
Internal tibial torsion is an inward twisting of the tibia, which leads to intoeing of the foot
What should you do about intoeing?
Define cause - foot, leg or hip Reassure Chart/ photograph Review Discharge unless persisting and severe
What is flat feet?
We are all born with it but most develop medial arch once walking as tibialis posterior strengthens but in flat feet this does not happen
What needs to be determined in flat feet?
If flexible or fixed
How can it be determined if flat feet are flexible or fixed?
Active dosriflexion of big toe
What causes flexible flat feet?
Generalised ligamentous laxity or tightness gastosoleus complex
What can cause a rigit flat foot?
Underlying bony connection called tasal coaltion from the tarsal bone to navicular
What toes are likely to be curly?
3rd or 4th toe
In adolescence, what should be checked in a presentation of anterior knee pain?
HIPS - commonly slipped upper femoral epiphysis
