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Medicine II: Pediatrics > Child Development I > Flashcards

Flashcards in Child Development I Deck (100)
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1

Growth

Growth refers to increase in physical size and dimensions, i.e. gain in ht, wt, and head circumference with advancement in age.Transient shifts may occur between 4-18 months but a child should reach a stable rate by 1.5 years of age.

2

What can cause Asymmetric Growth

Brachial plexus paralysis – leading to limb shortening.
Congenital varicella syndrome or myleodysplasia.
Upper motor neuron lesions.

3

Growth in Relation to Health

The rate of growth rather than absolute size is a sensitive indicator of health or disease. Therefore, all parameters should be measured in a serially consistent manner and recorded in a growth chart. If a child has values outside ± 2 SD range on a normal distribution curve or a continued and unexplained shift in growth trend indicates a need for evaluation.

4

Certain childhood illnesses or conditions may affect growth:

‐Neurologic impairment/CP
‐Oro-­‐motor dysfunction (leading to FTT)
‐Endocrine dysfunction
‐Skeletal disease
‐Genetic condition (like Down Syndrome)

Children with Down Syndrome are typically at or near 3rd percentile for general population. Their average adult height is 5 ft for men, 4.5 ft for women.

5

The Importance of Head Circumference

The average head circumference is 34-35 cm at birth. It increases by 12 cm in the first year (46-47 cm).

Head circumference should be measured up until 3 yrs of age and thereafter if CNS pathology is suspected. A rapid increase in head size during the first year reflects normal growth and maturation of brain.

6

When do Fontanels and Sutures harden and close?

Fontanels are closed between 12-18 months. Sutures do not unite firmly until puberty

7

Height

The average length of FT is 50 cm. Length increases by 50% in first 12 months. The average growth is 12 cm in the 2nd year and 6-8 cm annually from 3-5 years of age. Adult height can be estimated by doubling the length at 2 years of age.

8

Changes in Height: Boys vs Girls

Girls attain maximal growth velocity before menarche and attain ultimate height 2 years after menarche. Boys grow fastest in late puberty concurrent with appearance of facial hair.

9

Height Predictions in Children with Defects

For children with marked deformity of the spine or lower extremity, height prediction can be obtained by measuring arm span. With significant bilateral atrophy of lower extremities due to lower motor neural lesion, a sitting height may be a better indicator of general growth than total height.

10

Height/Stature Progression

xx

11

Weight

Average FT neonate weighs approximately 3400 gm (range 2500/4600 gms). < 2500 gm are classified as low-birth-weight infants.

Babies lose up to 10% of body weight during 1st week of life. Weight Gain after 2nd week is about 1 oz every day during first 3 – 4 months. Weight is doubled by 5 – 6 months and tripled by 1 year of age.

During 2nd year of life average weight gain is about 2.5 kg (5.5 lbs) and 2 kg (4.5 lbs) annually from 3 – 5 years of age

12

Low Birth Weight

LBW:
-< 37 wks – Premature
-> 37 wks FT – small for gestational age

13

Development

Development refers to neuro-maturation, i.e. achievement of systemic functional milestones relative to advancing age.
Development is the acquisition and refinement of the advancing skills. The neurophysiologic basis of achievement of milestones in CNS maturation.

14

Variations in Development

Under normal circumstances achievement of milestones has a predictable pattern. Individual variations may occur in the timing than in the process of sequences. Delays in milestones and areas of involvement will guide you to a diagnosis and management

15

Development Milestone: 1 month

Eyes follow to midline

16

Development Milestone: 2 months

Has responsive smile

17

Development Milestone: 3 months

Coos and chuckles (vocal/social response)

18

Development Milestone: 4 months

Holds head steady in seated position and can lift head 90° when prone

19

Development Milestone: 5 months

Grasps cube on contact

20

Development Milestone: 6 months

Can sit on chair erect

21

Development Milestone: 7 months

Can sit erect momentarily (on hard surface)

22

Development Milestone: 8 months

Crawls by dragging rest of body/pelvis on floor

23

Development Milestone: 9 months

Stands holding on

24

Development Milestone: 10 months

Creeps (hands and knees on floor with feet and trunk raised) 4-point reciprocal

25

Development Milestone: 11 months

Cruises (both hands holding on and moving sideways)

26

Development Milestone: 12 months

Walks (one hand held)

27

Newborn Period:

Muscle tone is predominantly with semiflexion of the extremities. When in prone position head turns from side to side with neck hyper extension. Sweeping mouth against the surface.

Most movements in this period are involuntary and purposeless. Primitive Reflexes are present

If you put them in sitting position, full support is required, the back is rounded and head falls forward. Hands are loosely fisted and grasp reflexes can be elicited.

Temperament characteristics are discernible during first few months and contribute to parent child interaction

28

Infantile Reflex Development

Motor behavior in infancy is influenced by primitive reflexes (as CNS is immature). The reflexes produce a predictable and stereotypic movement. As neuromaturation occurs these primitive reflexes are suppressed and become part of mature reflex system.

29

T/F: Obligatory or persistent primitive reflexes are the earliest indicator of neuro-abnormality

True

30

Moro

Stimulated by sudden neck extension

Response is shoulder abduction, shoulder, elbow and finger extension followed by arm flexion adduction.

Suppressed at 4-6 mo