Peds Growth and Development Flashcards
What measurement are the best indicators of general health
serial measurements
What helps identify children at risk
failure to conform to expected patterns of growth
When are well child checks preformed
- 2 weeks and/or 1 month
- 2, 4, 6 mos
- 9 mo
- 12, 15 mos
- 18 mos
- 2 yrs
- annually after 2
- 4 yo
In premature infants, when does catch-up growth occur
the first 2-3 years of life
What should be measured at all office visits
- weight
- height
- head circumference (under 2)
3 different growth charts
- newborn (based on gestational age)
- birth to 3 years
- 2 years to 18 years
What special growth charts are there
- turner syndrome
- down syndrome
- other syndromes
- prematurity
Can expect weight loss when? How much
during the first 3-4 days of life, about 10%
When should infants regain their birth weight by
day 14
How should infants be weighted
only wearing a dry dipaer
How much weight should a child gain a month (up to 3 years)
0-3 mnth: 1kg 3-6 mnth: 0.6 kg 6-9 mnth: 0.5 kg 9-12 mnth: 0.4kg 1-3 yrs: 0.25 kg
How much should a child grow a month (up to 6 years old)
0-3mnths: 3.5 cm 3-6mnths: 2cm 6-9mnth: 1.5 cm 9-12 mnth: 1.2 cm 1-3 yrs: 1cm 4-6 yrs= 3cm /yr
Head circumference in an indicator of what
brain growth up to 2 years old
When do most cranial sutures close
by 6 months
BMI greater than what is a risk factors for obesity
greater than 95%
When should children be tested for lead
between 9 and 12 months and again at 2 and 3
When should children be tested for iron deficiency
Hgb or Hct at 12 months and again at 2,3,4,5 and 6 years
When is STD testing started? When is HIV testing started
STD: 11
HIV: 16-18
What is the definition of development
the acquisition of skills considered appropriate for a given age, based on population standards
What is the importance of developmental screening
- identify delays and their etiologies
- maximize potential of a child with appropriate interventions when available
- provide support and reassurance to the family
Four parts of development
gross motor
fine motor
language
social
When does the greatest progress of gross and fine motor skills occur
during the first 3 years of life
Gross motor and fine motors skills during the first year
rapid acquisition of gross and fine motor skills
Gross motor and fine motor skills at 12 months to 3 years
- reaction time quickens
- improved hand eye coordination and manual dexterity
Gross motor and fine motor skills at 4 years and older
- large muscle movement and coordination are being perfected
- fine motor skills are gradually improving
Early gross motor milestones? When do they occur
rolls back to stomach: 4-10 months
sits steadily: 6-9 months
pulls to standing: 7-12 months
stands alone: 9-16 months
Complex gross motor patterns and when they occur
walks well: 13 months stoops and recovers: 15 months kicks ball forward: 2 years throws ball overhand- 3 years balances on 1 foot- 4 years catches a ball- 5 years
Fine motor skills and when they occur
rake: 5-7 months
radial digital grasp between side of index finer and thumb: 8-10 months
perfection of pincer grasp: 10-12 months
scribbles: 15 months
vertical or circular strokes, tower of 6 cubes: 24 months
Two universal hearing screening tests
Auditory brainstem response (ABR)
Otoacoustic emissions (OAE)
What population is the ABR used in? How does it work?
used in newborns and infants
-sounds are played into the baby’s ears and the brains response to the sound is measured
What is the OAE used for? In who? How does it work?
in newborns and infants to assess cochlear fx
-sounds are played into the ear and cochlear response is measured
What questions to ask parents about their childs hearing at 0-3 months. 4-6 months. 7-9 months.
0-3: does your baby startle to loud noises?
4-6: does your baby turn his eyes or head at the sound of your voice
7-9: does baby make string of sounds like “ba ba ba, da, da, da”
What is the number one cause of speech delay
hearing loss
When should you refer a child for a profession speech or language assessment
- not talking by 2 years old
- unintelligible speech by 3
- no sentences by 3
- child is embarrassed by their speech at any age
- other known disorder is present such as mental retardation, hearing loss, autism, dysarthia, stuttering
Assessment of vision in infants
- red reflex
- eye alignment
- eye movements
Assessment of vision in older children
observe how they fixate and track until more formal vision testing can be done (after age 3)
What does the corneal light reflex help assess for
misalignment of the eyes
How to check for strabismus?
cover/uncover test
Vision in a full term newborn
focuses on face and briefly track objects
Vision at 1 month
follow a moving object 60 degrees horizontally and 30 degrees vertically
Vision at 2 mnths
track across midline, responsive smile, follows movement 6 feet away
Vision at 3 months
track 180 degrees, looks at hands
Vision at 4-5 months
reaches for object 12 inches away, notices raisin 1 foot away, familiar smile
Personal social skills for: 2 mos 6 mos 9 mos 12 mos 18 mos 2 years 4 years
2 mos: social smile 6 mos: reaches for objects 9 mos: feeds self, passes object hand to hand 12 mos: plays appropriately with toy 18 mos: drinks from cup 2 years: uses spoon 4 years: puts on t shirt
What is the pneumonic for communicating with children
ONE VOICE
O: one voice should be heard during the procedure
N: need parental involvement
E: educate patient before the procedure about what is going to happen
V: validate child with words
O: offer the most comfortably, non threatening position
I: individualize your game plan
C: choose appropriate distraction to be used
E: eliminate unnecessary people not actively involved with the procedure
What is something you need to take into account when assessing an infant;s growth and development
if they were premature or not and the degree of prematurity
they may only have the skills appropriate to their gestational age
Three leading causes of death in adolescents
- unintentional
- suicide
- homicide
Four questions to ask in a suicide triage
- in the past few weeks have you wished you were dead?
- in the past few weeks, have you felt that you or your family would be better off f you were dead?
- in the past week, have you been having thoughts about killing yourself
- have you ever tried to kill yourself?
