Peds Exam 1 Lecture 3: Growth, Development, & Health Promotion Flashcards
How do you measure a 1 y/o child’s length/stature?
In the recumbent position using a foxed headboard with a movable footboard. Measure from the vertex of the skull to the soles of the feet.
Can you use a device on a balance beam scale to measure the stature of children over 2 y/o?
NO - this does not allow for proper posture
What is the best way to weigh an infant?
Naked
can leave on CLEAN diaper for older infants only
What is the best anthropometric indicator of adiposity in children and adolescents?
BMI
Is BMI at the 86th percentile considered normal, overweight, or obese?
Overweight
BMI >85-95 = overweight, BMI >95 = obese
How do you measure an infants head circumference?
Using a narrow, non-stretchable tape measure - start just above the supraorbital ridges & go around the head at the same level as the prominence of occiput.
For a growth chart, shifts across how many percentile lines may indicate abnormality?
2+
How do you calculate a child’s genetic potential/mid-parental height?
- Correct mother’s height by adding 5 in for boys
- Correct father’s height by subtracting 5 in for girls
- Average corrected heights of parents
- Target height = +/- 2 in
When looking at a weight for height growth chart for a patient who’s short & underweight for age, how do you determine b/w familial short stature and failure to thrive/constitutional delay?
- Family short stature: height & weight will be proportional to each other
- Failure to thrive: will have a pronounced drop in weight initially, followed by a less pronounced drop in height (may have decrease in head circumference if severe)
In a predominantly breastfed infant, which growth chart is the best predictor for their growth? (CDC or WHO)
WHO - pt may appear as if underweight on the CDC growth curve.
True or False: Healthy breastfed infants typically put on more weight than formula-fed infants in the first year.
False
Growth “Rule of Thumb”
- Term infants are back to birth weight by 2 wks of age, then gain 20-30 g/day for 1st 3 months
- Term infants triple birth weight by 1 y/o
- Term infants gain 2 kg/yr ages 1-10
- Height doubles by 3-4 y/o
- Normal head circumference for full-term infant = 35 cm
Major difference in presentation of plagiocephaly vs craniosynostosis
In plagiocephaly, the infant’s ear is displaced anteriorly. In craniosynostotis, the ear is displaced posteriorly.
What are the four major differences b/w macrocephaly and hydrocephalus?
Macrocephaly is the enlargement of the head. On the growth curve it is >97th percentile but parallels growth curve. There are no split sutures <12 mo old. There is NO increased ICP.
Hydrocephalus is the dilation of the ventricular system. On the growth curve, it crosses percentiles. There is both split sutures <12 mo old & increased ICP.
Management of plagiocephaly
Tummy time, reposition in crib, PT, and helmet therapy
What does helmet therapy do in plagiocephaly?
Applies custom corrective pressure to redirect the baby’s natural head growth and normal shape.
At what ages (months) do babies need developmental screenings?
9 mo, 18 mo, & 30 mo
At what month should an infant be able to sit without support?
7 months
At what month will an infant begin creeping (crawling on hands and knees) and pulls to stand?
9 months
At what month do infants typically begin standing well and taking independent steps?
12 months
At what month can a child use a spoon well?
22 months
When is a child typically able to pull his/her pants off?
24 months
At what month does a baby listen and then vocalize when an adult stops talking?
6 months
Around what month does a baby typically say his/her first word?
11 months
When does a baby begin reciprocal smiling (in response to adult face/voice)?
2 months
When a baby seeks an object after it falls silently to the floor, what does this demonstrate?
Object permanence & problem solving (this typically happens around 8 months)
What is protoimperative pointing?
Pointing to something because they want it (typically around 12 months)
What is protodeclarative pointing?
Pointing to something/someone to share an experience (typically around 14 months)
What cues do infants contribute to the development of attachment?
Prefers looking at faces, social smile (selective), selective eye contact, crying in distress, babbling, stranger/separation anxiety
What are the four components of joint attention?
- Orienting and attending to a social partner
- Coordinating attention b/w ppl & objects
- Sharing affect and emotional states w/ ppl
- Being able to draw others’ attention to objects or events to indicate need or to share experiences
What does theory of mind indicate?
That the child has developed an appreciation that other people don’t think/feel the same way that he/she does.
Indications to screen for iron deficiency at 1 y/o
Prematurity, exclusively breastfeeding>4 mo w/out supplementation, early weaning to cow’s milk (or non-iron fortified foods), feeding problems, poor growth, low SES
Neurotoxic effects of lead poisoning
School failure, cognitive loss, hyperactivity, aggression, inattention, distractibility, and delinquent behaviors
Manifestations of lead poisoning
Most are asx, but may have: abd colic, constipation, growth failure, hearing loss, microcytic anemia, dental caries, spontaneous abortions, renal dz, osteopenia, CVD
When do you use chelation for lead poisoning? And with what?
BLL>45 mcg/dL, Succimer
Appropriate size BP cuff in children
Bladder length should be 80-100% of arm circumference, width at least 40&
What position should infants be in while taking BP? Older children/adolescents?
Infants should be supine, older children/adolescents should be seated
When should yearly vision screening begin?
Age 4 (or cooperative 3 y/o)
Why you should identify hearing loss by?
3 months
What are typically the first teeth to erupt?
Front bottom central incisors (b/w 6 & 10 months)
When do you become concerned that a patient has not developed any teeth?
At one year
What are the best ways to prevent dental caries?
- no night bottle
- no juice/soda via bottle or sippy cup
- encourage cup use at early age
- limit sweet snacks & drinks
- limit juice & sweets to mealtimes
- fluoride
How much toothpaste should you be using for a child under 3 y/o?
The size of a grain of rice
How much toothpaste should you be using for a child over 3 y/o?
The size of a pea
Until when should an infant be in a rear facing car seat?
Until 2 y/o AND when reach the max weight by manufacturer
Booster seat should be used until a child is:
4 ft 9 in
When should a child learn to sleep alone?
6-8 months (before separation anxiety starts)
At what age do you begin the discussion of toilet training?
18-24 months
Signs of toilet training readiness (there are a lot…)
- asks to use potty chair or wear big kid undies
- can put on/take off clothes
- demonstrates independence, uses “no”
- follows parent to bathroom, expresses interest
- has regular/predictable BMs
- imitates parent behavior
- is able to follow simple instructions
- reports soiled diaper, wants a clean diaper
- stays dry for 2 hrs or after naps
- uses words, facial expressions, or movements indicating the need to urinate/defecate
What is the child-oriented approach to toilet training?
- when child shows readiness, start allowing him/her to accompany parent to bathroom
- child then becomes interested
- let them voluntarily use potty chair
- once interest, take them to potty chair 2-3x a day
- praise success
- make the process relaxed & pleasant
How long is the “operational conditioning” toilet training program designed to take?
24-48 hrs (LOL)
What is the association b/w media and child development?
Earlier age of media use & greater cumulative hrs in front of a screen is associated w/ poorer executive functioning (working memory, cognitive flexibility, inhibitory control)
What are the media recommendations for a child 18-24 months?
High quality programming, have parent watch with child and make into an interactive event
True or False: Positive reinforcement is associated with effective discipline at any age (infant, toddler, school-age, adolescent).
True
