Normal paediatric growth and development Flashcards
what is normal the physiologic evolution of the leg alignment at different ages
newborn- varum
1 1/2 to 2 years neutral
2 to 3 1/2 years months valgum
neural from 4-7 years
unilateral deformity=?
will not usually resolve with time, pathological
when is a deformity significant
only if it is likely to persist and cause physical or mental health problems later in life
describe how bones grow
longitudinal from the growth plate (physis) by enchondral ossification
cartilage model forms, primary ossification in shaft, secondary ossification in epiphyses, continued growth at epiphyseal growth plate
(cartilage laid down, inavded by blood supply, mineralised)
when is bone strength at its maximum
30 years old
when does bone mass begin to reduce
post menopausal or T 50s
who looses bone mass faster, men or women
loose at same rate, men just start with more
what fractures can affect growth plates
diet/ nutrition
sunshine, vitamins (vit D and A)
injury (to growth plate)
illness (chicken pox/ virus can temporarily halt bone growth, seen in growth arrests marks in bone later)
hormones (GH)
what plays a big part in growth of under 3s
nutrition- naturally much more varied anyway
what give an increase chance of underlying genetic or endocrine disorders
dysmorphic features in short statured individuals
what are the normal developmental movement stages from 6-9 months to 3 years
6-9 months- sits alone, crawls
8-12 months- stands
14-17 months- walks
24 months- jumps
3- manages stairs alone
what are the normal developmental neurological stages from 1-6 months to 3 years
1-6 months- loss of primitive relfexes (moro, grasp, stepping, fencing)
2 months head control
9-12 months few words
14 months feeds self, uses spoon
18 months stacks 4 blocks, understands 200 words
3 years potty trained
what can overtreatment and overinvestigation lead to
fear of doctors, feelings of stigmatisation, psychologic distress
what is varum
bow leg
what is valgum
knock kneed
when could a genu varum be abnormal or have an underlying patholgy
unilateral
severe (>2sd/16 degrees from mean)
short stature (>2sd)
painful
what measurements for genu varum
intercondylar and intermalleolar distances
name 5 causes of pathologic genu varum
skeletal dysplasia (genetic disorder) rickets (vit D deficiency) tumours (e.g. enchondroma) blounts disease trauma (physeal injury)
what is blounts disease
growth arrest of medial tibial physis of unknown aetiology
what is seen on x ray in blounts disease
beak like protusion
what is the risk of blounts
part of bone becoming avascular- falling apart
severe deformity
what pathologies can cause genu valgum
tumours (rare); enchondroma, osteochondroma (bony projections around growth plate)
rickets
neurofibromatosis
idiopathic
when should you refer genu valgum
in asymmetric, painful, severe
what is intoeing
walking with toes pointing inward, often accentuated with running
what can intoeing be related to
metatarsus adductus (foot) (most likely) femoral neck anteversion (thigh/hip) internal tibial torsion (knee/leg)
What is femoral neck anteversion
inward twisting of the thigh bone
what position do children with femoral neck anteversion sit in
W position
what is the normal angle of femoral neck anteversion
mean 30-40 degrees at birth, slowly unwinds to 10-15 degrees at maturity
what can femoral neck anteversion predispose to
patellofemoral problems
what is internal tibial torsion
inwards twisting of the tibia which leads to intoeing
when in internal tibial torsion usually seen and when does it usually resolve
1-3 years
vast majority resolve by 6 years
what is metatarsus adductus
when the front half of the foot turns inward- common and benign, resolves
what should you do in intoeing
define cause reassure chart/photograph review discharge unless persisting and severe
is flat feet normal
yes, only develop arch when we start walking as tibialis posterior strengthens
1 in 5 adults have flat feet, usually asymptomatic
what are the different types of flat feet
flexible- arch appears when on tiptoes (no abnormal bone fusion)
fixed stays flat (possible abnormal bone fusion)
what can flexible flat feet be caused by
generalised ligamentous laxity or tightness gastrocsleus complex (tight calf muscles)
exclude marfans or neurological muscular conditions
what score assess hypermobility
modified beighton score
when should hypermobility make you worried about
CTD
what might be the underlying cause of rigid flat feet
tarsal coalition (tarsal bars forming between bones which restrict movement)
when might fixed flat feet benefit from surgery
if painful
which toes are most likely to be curly, what treatment
3rd or 4th
non, splinting or taping ineffective, vast majority resolve by 6 years
rarely can do flexor tenotomy surgery
what is anterior knee pain, who gets it and what causes it
localised patellar tenderness
females>males, adolescent
check hips (especially for slipped upper femoral epiphysis in children) but usually resolves with phsyio
metatarsal abductus is flexible or fixed
fixed
what inter mallelous distance suggest valgum
> 8cm
what intercondylar distance suggest varum
> 6cm
