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Pediatrics Clerkship > Aquifer - Growth and Development > Flashcards

Aquifer - Growth and Development Flashcards

1, 28, 29

1
Q

Calculate corrected age for premature infants.

A

Subtract gestational weeks of premature infant from the average gestational period of 40 weeks.

Subtract the result from the chronological age to obtain the corrected age

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2
Q

Use of corrected age on growth charts should be discontinued after the child reaches ___ (age).

A

2 years

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3
Q

Use corrected age to plot ___ and for charting ___.

A

Growth parameters; developmental progress

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4
Q

95% of typically developing children start walking between ___ months of age. This broad age range is due to normal variations in neurological maturation, biomechanical factors, and the temperament/motivation of the child.

A

9-17

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5
Q

Describe the gait seen when toddlers begin to walk independently and how this changes with time.

A

Wide-based, with a waddling gait and intermittent toe walking

Gait will narrow, arms will come down and reciprocal arm movements will be added. Waddling at the hip will decrease, knees and ankles will move more

By 3 years of age, a heel strike will be present and the gait will begin to approximate an adult’s

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6
Q

What causes a child to be “pigeon-toed” aka intoeing? Prognosis?

A

Internal tibial torsion, in which the foot turns inward when the patella faces straight ahead

Very common in childhood, typically resolves with growth and weight bearing usually by 4 years of age, process of correction may take several years

Usually caused by femoral anteversion in preschool- and school-aged children –> both the feet and knees turn inward, resolves spontaneously by 8-12 years

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7
Q

How should children with flat feet be monitored?

A

Flat feet are common in children. The pedal arch develops in the first 8 years of life. Most importantly, determine whether the foot and ankle are flexible. If the foot has full ROM, the child can be monitored. If there is decreased flexibility, other conditions should be considered.

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8
Q

Explain why the following question is important: You mentioned that he always seems to be standing. Tell me more about that.

A

Toddlers who appear to prefer to stand than sit may do so because of abnormally tight muscles, possibly due to a neuromuscular disorder.

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9
Q

Explain why the following question is important: Does your child have a favorite toy?

A

Demonstration of an intense interest in one “toy” or object to the exclusion of others is atypical at this age and may be a symptom of an underlying developmental disorder

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10
Q

Explain why the following question is important: Does your child seem to use one hand more than the other?

A

Presence of handedness should not occur before 18-24 months of age and therefore may indicate weakness of one side

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11
Q

Explain why the following question is important: How much does your child talk? How much does your child seem to understand what you say?

A

Language development is very dynamic during the toddler years. Simple rule of thumb is sentence length equals age in years (1 year olds should have several single words, 2 years can speak in 2 word sentences, etc.)

Reasons for an apparent delay in expressive and receptive language are numerous and range from a hearing deficit to an adaptive or behavioral response to the environment.

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12
Q

Explain why the following question is important: Does your child get along with his/her siblings?

A

Difficult interactions with family members, or lack of interest, are both concerning and would require further evaluation.

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13
Q

Explain why the following question is important: How does your child do with people s/he doesn’t know?

A

Child’s level of willingness to interact with strangers and the appropriateness of the interaction may be an indicator of a behavioral disorder.

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14
Q

Explain why the following question is important: Does your child play games?

A

Lack of interest in sharing toys or engaging in activities with others at this age may be a sign of an underlying developmental disorder.

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15
Q

Explain why the following question is important: Does your child like to imitate what you do?

A

Imitation of adult daily activities, such as cleaning or cooking, is developmentally appropriate at around 18 months of age. Lack of interest would be atypical.

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16
Q

Explain why the following question is important: Are there any skills that it seems like your child had developed and then lost?

A

Loss, or regression, of milestones once achieved may be due to a number of factors but always necessitates further evaluation

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17
Q

Explain why the following question is important: Has your child’s development every been a concern at past health care visits?

A

May help define the timeframe in which a delay became apparent to a health care provider

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18
Q

Define developmental surveillance.

A

Checking miletones

Systematic collection of data over time, which can help identify children at risk for developmental delays

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19
Q

Define developmental screening.

A

The use of standardized tools to identify and refine that recognized risk

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20
Q

Define developmental evaluation.

A

Complex process aimed at identifying specific developmental disorders that are affecting a child

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21
Q

When should developmental screening tests be administered, according to the AAP?

A

9, 18, and 24 or 30 months

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22
Q

Many developmental disorders affect some domains of development and not others. For example, autism spectrum disorders primarily interfere with ___. Cerebral palsy is characterized by ___ with variable impact on other domains. Genetic and metabolic disorders may cause ___.

A

Social interactions; motor dysfunction; global delay

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23
Q

What is autism spectrum disorder?

A

Developmental disorder that primarily interferes with healthy social interaction

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24
Q

Overall prevalence of autism spectrum disorder in the US?

A

1/68 children (1.5%)

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25
Q

Routine screening for autism spectrum disorder should occur in all children at what ages?

A

18 and 24 months

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26
Q

What should be used to screen for autism spectrum disorders?

A

Modified Checklist for Autism in Toddlers (M-CHAT) - parent completed questionnaire that is validated as a screening tool to identify children between 16-30 months of age who are at risk fo autism spectrum disorders

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27
Q

What 4 problems seen in preterm infants are risk factors for developmental delay?

A
  1. Bronchopulmonary dysplasia (BPD)
  2. Retinopathy of prematurity (ROP)
  3. Hyperbilirubinemia
  4. Periventricular leukomalacia (PVL)
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28
Q

What is BPD?

A

Chronic lung disease of premature infants resulting from damage to immature and insufficiently flexible alveolar tissue associated with intubation, positive pressure ventilation, and oxygen toxicity. It may cause poor growth in part due to increased caloric requirements, repeated pulmonary infections, or CHF.

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29
Q

Why might development by delayed in infants with BPD?

A

Prolonged or repeated hospitalization due to illness, underlying neurological disease, or both

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30
Q

What is retinopathy of prematurity (ROP)?

A

Extraretinal fibrovascular proliferation that may cause retinal detachment and blindness

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31
Q

Who is at risk for ROP?

A

All premature infants, particularly those weight <1500 g are at risk. ~50% of infants <1200 g develop ROP.

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32
Q

Why might development by delayed in infants with ROP?

A

Degree of visual impairment

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33
Q

Why might development by delayed in infants with hyperbilirubinemia?

A

Bilirubin is a potential neurotoxin, particularly in preterm or critically ill infants. Severe hyperbilirubinemia may lead to kernicterus, which is characterized by abnormal motor developmet (choreoathetoid cerebral palsy) and sensorineural hearing loss.

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34
Q

What is periventricular leukomalacia (PVL)?

A

Result of damage to the white matter surrounding the ventricles in the brain as a result of hypoxia, ischemia, and inflammation

It is correlated with intraventricular hemorrhage (bleeding from the delicate vessels of the neuronal and glial proliferation zone germinal matrix that surrounds the lateral ventricles in preterm infants and fetuses. PVL with cysts is highly correlated with cerebral palsy.

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35
Q

A family history of infant deaths raises the possibility of what 2 problems?

A

Chromosomal/genetic abnormality

Metabolic disorder

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36
Q

What is spasticity?

A

Increased muscle resistance that is velocity-dependent - this means that resistance is greater when passive movement is rapid and less when the passive movement is slow.

37
Q

What can be a sign of increased calf tone and what should be examined?

A

Toe-walking - check for decreased ankle dorsiflexion

38
Q

How does low tone manifest?

A

Slumped posture, poor head control, soft muscles, patient slipping through your hands when held under the armpits

39
Q

List common features seen in more than 50% of infants with Down syndrome. (6)

A
  1. Upslanting palpebral fissures
  2. Small ears (usually <34 mm at maximum dimension in a term infant)
  3. Flattened midface
  4. Epicanthic folds
  5. Redundant skin on the back of the neck (nuchal skin)
  6. Hypotonia

Other: small brachycephalic head, Brushfield spots, small shaped mouth, single transverse palmar crease, short fifth finger with clinodactyly, wide spacing and a deep plantar groove betwen the first and second toes, intestinal stenosis, umbilical hernia, predisposition to leukemia, heart defects

Intellectual disability

40
Q

What is the most consistent finding in infants with Down syndrome?

A

Hypotonia

41
Q

List the 3 karyotypes that can cause the Down syndrome phenotype.

A
  1. Trisomy 21 (47 XY +21) - most common and most likely, regardless of the mother’s age
  2. Unbalanced chromosome translocation resulting in extra chr21 material
  3. Mosaicism for a trisomy 21 cell line
42
Q

Standard laboratory diagnosis of Down syndrome?

A

Lymphocyte karyotype

(FISH studies of uncultured cells have not replaced this study).

43
Q

List indications for chromosomal analysis in pediatric patients.

A

Clinical features of a known chromosome disorder
Unrecognized malformation syndrome
Known genetic condition but with additional or more severe findings
Mental retardation and other unusual findings (including short stature)
Born stillborn with multiple malformations
Features of a chromosome breakage syndrome
With a tumor (including leukemia) that may be associated with chromosome abnormalities

Multiple pregnancy losses
Family history of chromosome rearrangement

44
Q

Incidence of Down syndrome in the US?

A

1/700 births

45
Q

Risk factors of Down syndrome?

A

Can occur in any couple regardless of age

Risk increases as mother’s age increases (unknown reason) - however, the majority of infants with Down syndrome are born to women younger than 35 years of age (many more total pregnancies in these younger women)

46
Q

List some of the conditions that occur with increased frequency in children with Down syndrome.

A 
Hearing loss (75%)
OSA (50-79%)
OM (50-70%)
Eye disease (60%) including cataracts (15%) and severe refractive errors (50%)
CHD (50%)
Neurological dysfunction (1-13%)
GI atresias (12%)
Hip dislocation (6%)
Thyroid disease, especially hypothyroidism (4-18%)
Transient myeloproliferative disorder (4-10%)
Leukemia (1%)
Hirschsprung disease (<1%)
47
Q

Why is it virtually impossible to absolutely exclude mosaicism in trisomy 21?

A

Only a small number of cells are actually examined as part of the chromosome analysis, and these are usually all from the same cell type. However, these results can imply that the baby is probably not mosaic. Unless there is cytogenetic findings of mosaicism or the patient has atypical clinical findings, it is presumed that a patient with trisomy 21 in all cells examined is non-mosaic.

48
Q

List the referrals or evaluations recommended during the first 10 years of life of a child with Down syndrome.

A
  1. Annual thyroid screening (increased incidence of hypothyroidism even if not present at birth)
  2. Vision screening (increased incidence of vision problems)
  3. Hearing screening (increased incidence of hearing problems)
  4. CBC in first month (leukemoid reactions or transient myeloproliferative disorders)
  5. Referral to a pediatric cardiologist (increased incidence of structural heart disease)
  6. Hgb/Hct beginning at 1 year of age, and then annually (iron deficiency anemia due to lower dietary iron intake than peers)
  7. Referral for evaluation by early intervention

In addition, there is an increased incidence of atlantoaxial instability, so careful H&P should be performed at every visit or when symptoms possibly attributable to spinal cord impingement are reported.

49
Q

What are the prenatal screening tests that estimate the chance a fetus has Down syndrome?

A

Maternal serum screening and fetal U/S (looking at nuchal skin thickness, nasal bone ossification, other growth parameters)

50
Q

What are the prenatal diagnostic tests for Down syndrome?

A

Chromosome analysis of amniotic fluid cells and CVS

51
Q

What is the most common genetic cause of intellectual disability? The most common hereditary cause?

A

Trisomy 21; Fragile X syndrome

52
Q

What causes Fragile X syndrome?

A

Expansion of a trinucleotide repeat segment (CGG) just outside the coding region of the FMR1 gene on the X-chromosome.

Affected males: >200 repeats
52-200 repeats: premutation with the potential to expand
Normal individuals: <50 repeats

53
Q

Prevalence of fragile x?

A

1/4,000 males (virtually all mothers of affected sons are carriers of at least a premutation)

54
Q

Inheritance pattern of Fragile X?

A

X-linked trait, most affected individuals are male

55
Q

Presentation of Fragile X?

A

Early childhood findings can be subtle
Females with a full mutation: range from asymptomatic to mental retardation and/or psychiatric or behavioral problems
Males: large tests (after puberty), large ears, evidence of a mild connective tissue abnormality (joint laxity, pectus excavatum, flat feet)

56
Q

What sex chromosomal disorder is most likely to be associated with physical differences at birth?

A

Turner syndrome (45, X)

57
Q

Physical findings in Turner syndrome?

A 
Lymphedema in utero
Webbed neck
Low ear placement
Edema of the hands and feet
Hyperconvex nails
Shield chest with widely spaced nipples

Additional findings:
-Coarctation of the aorta (20% of affected girls)
-Short stature
-Delayed sexual maturation (gonadal dysgenesis)
Normal IQ

58
Q

Incidence of Turner syndrome?

A

1/2,000 female live births (incidence at conception is much higher)

59
Q

Presentation of Klinefelter syndrome (47 XXX or 47 XYY)?

A

Boys are typically normal appearing at birth

Findings vary, but usually include infertility due to testicular atrophy
Eunuchoid body habitus and gynecomastia in adolescence
IQ varies (usually low-normal)
60
Q

Incidence of trisomy 13 (Patau syndrome)?

A

1/10,000

61
Q

Clinical features of Patau syndrome?

A 
Microphthalmia
Microcephaly
Severe ID
Polydactyly
Cleft lip and palate
Cardiac and renal defects
Umbilical hernias
Cutis aplasia
62
Q

Incidence of trisomy 18 (Edwards syndrome)?

A

1/6,000

63
Q

Clinical features of Edwards syndrome?

A 
Severe ID
Prominent occiput
Micrognathia
Low-set ears
Short neck
Overlapping fingers
Heart defects
Renal malformations
Limited hip abduction
Rocker-bottom feet
64
Q

What screens for development between 0-8 years of age for those with a developmental delay and who may need a more formal evaluation?

A

PEDS (Parents’ Evaluation of Developmental Status)

65
Q

How should children with suspected developmental problems be evaluated?

A

<3 years old: ECI, other specialists

3-5 years: school system

66
Q

BMI = ?

A

Weight (kg)/Height (m^2)

67
Q

Overweight and obese classification in chidlren?

A

Overweight: BMI in the 85th-95th percentile for age

Obese: >95th percentile for age

68
Q

HEEADSSS?

A 
Home
Education and Employment
Eating disorder screening
Activities
Drugs
Sexuality
Suicide risk and depression
Safety (fights, car, weapons)
69
Q

Important components of a pre-participation evaluation?

A

CV screening (undx cardiac illnesses like HOCM place athletes at risk fo sudden cardiac death)
Hx of LOC or concussion
Recovery from significant MSK injuries
Assessing general health
Counseling on health-related issues
Assessing fitness level for specific sports

70
Q

When should newborns follow-up after discharge?

A

In the first week after birth

If discharged before 48 hours, must be seen within 48 hours

71
Q

Frequency of breastfeeding in newborns?

A

10-15 minutes on each side, every 2-4 hours; may last up to 60 minutes, but gradually become shorter in duration

Goal: 8-12 feedings at the breast every 24 hours

Breastfed babies tend to take frequently small feedings

72
Q

Voiding patterns in newborns?

A

Day 3: 3-4x/day
Day 6: 6-8x/day
Urine should be pale yellow

“3-5 voids/day by 3-5 days and 4-6 voids by 5-7 days”

73
Q

Stooling patterns in newborns?

A

Day 3: 3-4x/day, meconium should no longer appear in the stool and BM should begin to appear yellow
Day 6-7: 3-6x/day

Stool passed by breastfed infants has little odor

74
Q

What is the ASQ?

A

Ages and Stages Questionnaire - widely used developmental screening tool consisting of a series of parent or caregiver completed questions; screens 5 developmental areas - communication, gross motor, fine motor, problem solving, personal-social

For children 0-48 months

75
Q

Early signs of hunger in an infant?

A

Increased alertness, increased physical activity, mouthing, rooting

76
Q

Signs that feeding is inadequate (feeding pattern)?

A

More than 4 hours between feedings or if feeding for shorter durations

77
Q

Benefits of breastfeeding for infants?

A

Maternal-infant bonding
Protection against some infections (OM, respiratory, diarrhea)
Reduced rates of SIDS
Reduced rates of some allergic reactions

78
Q

Benefits of breastfeeding for mothers?

A

Decreased postpartum bleeding and more rapid uterine involution
Lactational amenorrhea and delayed resumption of ovulation with increased child spacing
Earlier return to pre-pregnancy weight
Improved bone remineralization postpartum with reduction in hip fractures in the postmenopausal period
Decreased cost relative to formula
Readily available, no preparation time

79
Q

Describe the nutritional components of breast milk.

A

Perfect balance of carbohydrates, fats (lipids), and proteins

Also provides antibodies, oligosaccharides, lactoferrin, lysozyme, growth factors, bifidobacteria, and other non-nutritive substances that protect against infection and promote growth

80
Q

True or false - infants younger than 12 months should not be fed unmodified cow milk.

A

True

81
Q

Major carbohydrate in both human milk and standard formulas?

A

Lactose

82
Q

Proteins contained in human milk vs. formula?

A

Human milk contains a combination of whey proteins (70%) and casein (30%)

Casein:whey ratio of cow-milk based formulas varies

Unmodified cow milk: ~80% casein and 20% whey proteins + 3x the protein content of human milk

83
Q

Common problems with breastfeeding?

A

Enlarged, tender breasts (commonly cause by engorgement, mastitis, or plugged ducts)
Improper latch and suckle
Prolonged feedings
Infants fall asleep before they finish feeding
Maternal inexperience/anxiety

84
Q

Typical order of the stages of puberty in girls? Age of onset?

A

Start puberty between 8-13 years

  1. Breast buds (10-11)
  2. Pubic hair (10-11)
  3. Growth spurt (12)
  4. Menarche (12-13)
  5. Adult height (15)
85
Q

Typical order of the stages of puberty in boys? Age of onset?

A

Start puberty between 10-15 years

  1. Testicle growth (12)
  2. Pubic hair (12)
  3. Penis/scrotal growth (13-14)
  4. First ejaculations (13-14)
  5. Growth spurt (14)
  6. Attainment of adult height (17)
86
Q

How many Tanner stages are there and what stage marks the onset of puberty?

A

5 classes based on pubic hair and genitalia

Stage 2

87
Q

Tanner stages for boys?

A
  1. Childlike phallus, testicular volume <1.5 mL, no pubic hair
  2. Childlike phallus, testicular volume 1.6-6 mL, reddened/thinner/larger scrotum, small amount of fine hair along the base of the scrotum and phallus
  3. Increased phallus length, testicular volume 6-12 mL, greater scrotal enlargement, moderate amount of curly/pigmented/coarser hair extending laterally
  4. Increased phallus length and circumference, testicular volume 12-20 mL, further scrotal enlargement and darkening, coarse/curly/adult-like hair that doesn’t yet extend to the medial surface of thighs
  5. Adult scrotum and phallus, testicular volume >20 mL, adult-type hair extending to medial surface of thighs
88
Q

Describe in utero oxygenation.

A

In utero: oxygenated blood from the placenta is transported to the fetus by the umbilical vein. A portion of this blood perfuses the liver. The remainder bypasses the liver through the ductus venosus and enters the IVC. 1/3 of this blood crosses the PFO to the left atrium and is pumped to the coronary/cerebral/upper body circulations. The other 2/3 combines with venous blood from the upper body in the R atrium and is directed to the R ventricle and out the pulmonary artery.

Vasoconstriction of the pulmonary arterioles produces high pulmonary vascular resistance, allowing only 10% of blood from the RV to flow through the pulmonary vasculature. The remaining 90% is shunted through the PDA to the descending aorta.

89
Q

Successful transition to extrauterine life involves?

A
  1. Removal of the low-resistance placental circulation by cutting the umbilical cord
  2. Initiation of air breathing by the newborn infant
  3. Reduction of the pulmonary arterial resistance
  4. Gradual closure of the PFO and PDA over the first 3-7 days of life

Pediatrics Clerkship (14 decks)

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