Peadiatrics Flashcards
Developmental milestones for neonate
GM- moves all limbs, normal muscle tone
FM- Looks and startles
S&L- Cries
Social- cries, limes being picked up and cuddled
Developmental milestones for 6 weeks
GM- good head control
FM- fixes and follows
S&L- startles in response to loud noises
Social- social smile
Developmental milestones for 6 months
GM- sits unsupported with rounded back, rolls from prone to supine
FM- palmar grasp transfers objects between hands
S&L- babbles, understands simple nouns- mamma dada
Social- reaches for objects, puts objects in mouth and feeds themselves with fingers
Developmental milestones for 9 months
GM- sits unsupported with straight back, crawls, stands with support
FM- inferior pincer grip, object permanence
S&L- inappropriate sounds, imitates adult conversation
Social- plays peekaboo, waves by bye 8mo- fear of strangers, 10mo- separation anxiety
Developmental milestones for 12 months
GM- walks alone, casting objects, full pincer grip
FM- builds a tower with 2 bricks, holds a cup
S&L-1-3words should have said 1st words, understands simple commands
Social- plays happily near primary caregiver
Developmental milestones for 18 months
GM- runs jumps, casting objects should stop
FM- builds a tower with 4 bricks, scribbles to and fro
S&L- naming explosion 1-6 word phrases, 22 words,
Social- imitates adult behaviour
Developmental milestones for 2 yrs
GM- walks up stairs using 2 feet, tip toe
FM- throws a ball, turns pages of a book, draws a vertical line builds a tower with 8 bricks
S&L- joins words together, understands verbs
Social-uses a spoon, toddler tantrums
Developmental milestones for 3 yrs
GM- walks up stairs with 1 foot and down with 2, rides a bike,
FM- draws a circle builds a bridge, uses a fork, Griffith beads
S&L- understands colours
Social- imaginative play, friends, shares toys with friends, bowel control
Developmental milestones for 4 yrs
GM- walks up and down stairs like adult
FM- draws a cross, builds a tower with 12 bricks, threads beads on a string
S&L- coherent conversation
Social- has best friend, bladder control, dresses self
Developing schemas
Schemas- patterns to help us make sense of the word around us
Schema- assimilation- accommodation- equilibration
Paigets 4 stages of cognitive development
Sensorimotor- reflexes, explore environment, object permanence
Pre operational- reasoning dominated by perception, concrete objects
Concrete operations- law of conservation, thick logically about real
Formal operations- think logically about abstract ideas, test hypothesis
Cognitive development by ages
Infancy (0-2)- object permanence, sensory and perceptual maturation, attachment
Early childhood (2-6)- locomotion, learning, language development, fantasy play, group play
Mid childhood (6-12)- skill acquisition, self evaluation,, cause and effect, conservation, friendships
Adolescent (12-18)- physical and sexual maturation, peer group and sexual relationships, abstract thinking
Puberty Tanner staging girls
I 8- no noticeable changes
II 9-11- thelarche breast buds develop, sparse pubic hair
III-12 axillary hair growth, acne, height increases fastest, breast tissue growth no contours, pubic hair covers pubes
IV- 13 menses, pubic hair doesn’t spread to medial thighs, projection of papilla and areolar, breast mound formation
V-15 regular menses, pubic hair spreads to medial thighs, adult breasts
Puberty tanner staging boys
I 9-10 no noticeable changes, testicular volume <4mls <2.5 cm bead 3
II 11- testicular volume>= 4mls, 2.5-3.2cm bead 4 sparse pubic hair from base of penis, scrotal thickening
III13- testicular size 3.3-4cm bead 10, thicker curlier pubic hair spreads to pubis, voice deepens, increase in penile length, increase muscle mass
IV 14 testicular size 4.1-4.5cm bead 16, increase penile growth, scrotal darkening, acne growth fastest, axillary hair, pubic hair doesn’t spread to medial thighs
V 15 testicular size >4.5 cm bead 20, facial hair, cessation of growth
What is precocious puberty?
Early puberty
Puberty before 9 in boys and 8 girls
What are the 3 types of precocious puberty?
True central- Gn dependent, early maturation of HPG axis, sequential development, correct sexual characteristics for gender pathological in 40-75% boys and 10-20% girls raised FSH and LH, increased bone age increased growth
Peripheral-Excess secretion of sex steroid hormones, Gn independent, non sequential, Iso/contra sexual
Benign pubertal variant- Isolated androgen mediated sexual characteristics
Premature thelarche
Premature adrenarche
Common in Afro Caribbean
What are the causes of precocious puberty?
True Central- Idiopathic, genetics, Neurogenic- CNS tumours harmatomas, lesions, Inflammation
Pituitary Gn releasing tumours, early sex steroid exposure- McCune Albright syndrome, Prematurity
Peripheral- Both- primary hypothyroidism, CAH, exogenous steroids
Girls-Ovarian tumour- granulosa Iso sertoli/leydig gonadoblastoma contra, Ovarian cyst
Boys- leydig cell tumours Rx- radical orchiectomy , germ cell tumours secrete bHCG stimulates leydig testosterone production, familial testotoxicosis- gene mutation early maturation of leydig production of testosterone
Benign pubertal variants:
Premature thelarche- idiopathic occurs around age of 2 waxes and wanes doesn’t progress beyond tanner stage 3
Premature adrenarche- pubic/axillary hair growth, acne body odour, mild increase height and bone age risk factor for developing PCOS can lead to TCPP
Investigations for precocious puberty
Hx- stages, development, FHx
Examination- height, weight, testicular size tanner staging
Bloods- FBC, U&E, TFT, FSH, LH, oestrogen, progesterone, testosterone, cortisol, DHEA, hCG, alpha fetal protein
GnRH stimulation test
Imaging- X ray, MRI pituitary, pelvic USS,
management for precocious puberty
BPV- reassure
TCPP- block with GnRH agonists
PPP- anti adrenals aromatase inhibitors
What is delayed puberty?
Girls- 13 no thelarche, 14- no pubic hair, 16 no menses, >5yrs between onset of thelarche and menarche
Boys- 14 no testicular enlargement vol<4mls
15-no pubic hair, >5yrs to finish penile and testicular growth from their onset
Causes of delayed puberty
Hypergonadotrophic hypogonadism:
Acquired- chemo/radiotherapy, surgery, autoimmune, trauma,
Congenital- Turners syndrome, Kleinfelters syndrome, POI,
Hypogonadotrophic hypogonadism:
Congenital- craniofacial abnormalities, kallmans syndrome, PWS
Acquired- chronic illness, endocrine- Cushing’s, hypothyroidism, DM, anorexia low BMI, intense Exercise
Investigations for delayed puberty
Hx- FHx
Examination- height weight growth charts tanner stage
Bloods- FSH, LH, Progesterone, Oestrogen, AMH, testosterone, TFT, cortisol, glucose,
Karyotyping/ genetic testing
Imaging- X ray, pelvic USS
Management for delayed puberty
Management:
Watch and wait
Boys <14 give anabolic steroids
HRT girls>12 and boys>14 no sig
