Ped Growth and Development

Question 1

What do asymmetric v. symmetric birth growth defects suggest?

Answer 1

• Asymmetric at birth - suggests disturbance late in pregnancy (ex - head growth and length normal but low wt)
• Symmetric at birth - suggests restriction early in pregnancy (low head, length and wt across board)

Question 2

Intrauterine Growth Restriction

Small for Gestational Age

Low Birth Wt

Very Low Birth Wt

Answer 2

• Intrauterine growth restriction - fetus that has not reached growth potential for genetic or environmental reasons in utero
• Small for gestational age - birth wt in < 10th percentile for gestational wt (small parents or nutrition issue)
• Low birth wt - < 2500 g regardless of gestational age
• Very low birth wt - < 1500 g regardless of gestational age

Question 3

Growth St v. Growth References (when is ea used?)

Answer 3

• WHO- based on breast fed ideal babies (growth standard); normal or desirable
• CDC - based on averages across nation in time when mainly formula used (growth references); deviations not necessarily abnormal

**Use WHO charts 0-2 yo then CDC charts from 2 yo on

Question 4

Ideal Wt Formula

Ideal Ht Gain Rate

Answer 4

• Ideal wt = (2 x age) + 10

- Ht gain = 5 cm / yr from 2-12 yo

Question 5

Head Circumference

Answer 5

• Head circumference is at 90% of adult size at 3 yo (meas until age 2)
• Huge inc in head circumference = concerned for hydrocephalus

Question 6

Growth Trends by Age

Answer 6

• Wt gain starts high and rate slows w/ time; gain 1 birth wt in first 4 months then 8 months then 12 months
• Around 18 mo stop eating as much b/c not growing a lot (“picky”)
• Ht wt and head circum slow by 2 yo
• Lean / less fat - peak energy at preschool age
• School Age = growth is discontinuous; sudden spurts lasting avg 8 wks 3-6X a yr
• Growth acceleration in early adolescence; starts distally (enlarged hands and feet) plus growth of larynx, pharynx and lungs (changes voice)
• Linear Growth in mid - adolescence
• Wt follows ht; muscle mass inc then strength inc

Question 7

Adolescent Growth in Males v Females

Answer 7

• Females - acceleration inc shortly after thelarche (mean 10); peaks 6-12 mo b/f menarche
  - Peak is 8.3 cm / yr
• Males - genital development and linear development occur around same time; peaks around 13.5 yrs (starts 2-3 yrs after girls but lasts 2-3 yrs longer overall)
  - Peak is 9.5 cm / yr

Question 8

Patterns of Poor Growth

Answer 8

• Suspect endocrine if both wt and ht fall at same time (GH, thyroid hormone)
• Feeding problems, neglect/abuse, undernutrition (more wt problem); if chronic then ht and lastly had circum dec
• Over-nutrition –> inc wt first then ht catches up and may have precocious puberty from excess nutrition
• Overweight - 85-95th percentile
• Obesity - > 95th percentile
• Constitutional Growth Delay - very low on wt and ht curves then start growth spurt and puberty later than others; but continues longer so catch-up (“late bloomers”)
  - Normal variant
  - Often runs in families

Question 9

Definition of Failure to Thrive

Answer 9

• wt < 5% or wt decreases more than 2 percentiles

Question 10

Gross Motor Skills by Age

Answer 10

Sit 5 -8 mo

Crawl 8-10 mo

Walk 12-15 mo

Run and jump on 2 feet by 2 yo

Hop on 1 foot and tricycle by 3 yo

Question 11

Newborn Skills

Answer 11

• Track inanimate objects
• Turn to sound
• Interested in human faces and voices
• Primitive reflexes
  
  • Moro (startle) - abduct then adduct and cry
  • Hand grasp
  • Toe grasp
  • Fencer (asymmetrical tonic neck reflex)
  • Step reflex
• Large bicycling movements
• Head control
• Should have symmetric use of arms and legs

Question 12

Fine Motor Skills by Age

Answer 12

4 mo - Move hands to midline and mouth

6 mo - Voluntary grasp and transfer objects from hand to hand at midline

9 mo - Modified pincer grasp (fine, opposition)

12 mo - feed self w/ pincer

18 mo - use utensils

Question 13

Language Skills by Age

Answer 13

2-3 mo coos

6-9 mo babbles (rep syllables)

12 mo - first words (da da)

18 mo - single words

2 yo - two word phrases

Question 14

Responsive Skills by Age

Answer 14

Newborn - 6 mo respond to sound

6-9 mo respond to name

12 mo - look in response to question

18 mo - ID body parts and respond to commands

2 yo - follow 2 step commands

Question 15

Cognitive Skills by Age

Answer 15

• Sensorimotor Period – Object Permanence 9 mo
• Symbolic Thought - use one object to stand for something else
• Pretend Play
• Magical Thinking
• Logical Thinking - school age
• Abstract Thinking

Question 16

Signs of Cerebral Palsy

Answer 16

• STATIC; delay but do not gain then lose milestones over time
• Abnormal motor tone
• Persistent primitive reflexes
• Delayed motor milestones, usually gross motor
• Fine motor may also be delayed