Lecture 11: Developmental Assessments & Growth Abnormalities Flashcards
1
Q
When should developmental assessments occur?
A
Every well-child visit
2
Q
How common are developmental delays?
A
About 1 in 5 children have delays/conditions placing them at risk.
3
Q
What is birth to 3?
A
Federally funded home visits for developmental therapies
After 3, via school.
4
Q
What is the M-CHAT?
A
- Modified checklist for autism in toddlers
- 18-30mo
- two stages (20 questions for parent, then probing questions by provider w examples)
- takes 5 min (+2 min for scoring)
0-2: low, 3-7: mod, 8-20: severe
5
Q
What is the Denvver Developmental Screening Tool?
A
- 125 Question test for 2 weeks to 6 years
- Parent + direct obs
- Subjectively allows clinican to observe and assess overall behavior
- Normal = 0 delays and 1 caution max
6
Q
What are the main issues with the Denver developmental screen?
A
- Only identified about 50% of children that needed help
- Long time to do
- High sens but low spec (AKA it mainly rules out)
- Low sample size
7
Q
What is the Ages and Stages Questionnaires?
A
- 19 surveys
- 1 month to 5.5y
- Language, personal-social, fine/gross motor, problem solving
- Determines if a child is on schedule
8
Q
What are the 5 areas of the ASQ and the cutoff?
A
- Communication
- Gross Motor
- Fine Motor
- Problem Solving
- Personal/Social
Cutoff is 2 SD below the mean: at least 1 cutoff = diagnostic referral indicated.
Close to cutoff = rescreen after practicing 4-6months.
9
Q
Developmental Milestones for 1-2 months
A
V3-CHERT2S
* V - “vocal” (vocal reciprocal play, engages in vocalizations, alert responds to voices)
* C - Cooing
* H - Holds head erect and lifts head
* E - “Eyes” regards face and follows objects through visual field
* R - recognizes parents
* T - “turns and toys” turns from side to side and drops toys
* S - smiles spontaneously!
10
Q
Developmental Milestones for 3-5 months
A
“M-SPURTLE” - like a raspeberry!:)
- M - “mouth” reaches for and brings objects to mouth
- S - “sits” - sits with support!
- P - “puppy prop” weight supported on forearms w head up
- U - ulnar grasps thne later thumb opposition
- R - raspberry sound!
- T - “turns” from front to back
- L - “laughs” and “looks” towards voice
- E - “exists” can follow object in field of vision but the object no longer exists once they cannot see it
11
Q
Developmental Milestones for 6-8 months
A
“MICROBES” - microbes has 8 letters (6-8m)
- M - “midline” passes objects from hand to hand in midline
- I - inhibited by word no
- C - Commando crawl!
- R - Rolls from back to stomach
- O - “opposition” first scoops pellet then grasps it using thumb opposition
- B - “bye bye” immitation!
- E - “eats” feeds themselves puffs and cherios
- S - sits alone for a short period
12
Q
Developmental Milestones for 9-11 months
A
“CO-PRINCES”
- C - Crawls and commands. follows 1 step commands “come here”
- O - object permanence begins
- P - pat-a-cake and peek-a-boo imitations!
- R - Repetition of sounds “bababbaba”
- I - “index finger” uses thumb and index finger to pick up small items (neat pincer grasp)
- N - “name” recognition! (they know their name)
- C - Comprehension of words begins
- E - eats puffs and cheerios by themself
- S - “standing” can pull self into standing position and stand alone for short periods of time
13
Q
Developmental Milestones at 1 year
A
“T-MOWING”
- T - “tower” of 2 cubes
- M - “mama” and dada
- O - “objects” points if they want something!
- W - “words” can say 1-2 other words
- I - independently walks!!(if youre gonna mow you gotta walk by yourself!)
- N - neat pincer grasp is perfect!
- G - “gives” toys on request!
14
Q
Developmental Milestones at 18 months
A
“C-STRAW-BED”
- C - “command” unerstands 2 step commands!
- S - “sits and stairs” sits self in chair and walks up/down stairs w help
- T - “Tower” - builds tower of 3-4 cubes
- R - “recognizes” 3 body parts
- A - “animal” carries stuffed animal or doll
- W - “words” can say 4-20 words
- B - “ball” throws a ball!
- E - “Eats” w a spoon or fork!
- D - “Dumps” things out of cups/bottles
15
Q
when do children develop protodeclarative and protoimperative pointing? what does this mean?
A
15-18 mo
16
Q
Developmental Milestones at 2 years
A
“BI-TWO” (get it cuz theyre two)
- B - kicks “balls” and turns “book” pages by themselves!
- I - “imitates” imitative behaviors, parallel play, mimicry
- T - “tower” of 6-7 cubes
- O - “object” points to named objects or pictures
- W - “words” 50 word vocab, short phrases of 2+ words. giant leap in vocab and languade development!
17
Q
Developmental Milestones at 30 months
A
“WHIPCOT” turn the W to the left and its a 3 for 30 months (im strugglin hang w me)
- W - Walks backwards
- H - hops on one foot
- I - refers to self as “I”
- P - uses “prepositions”
- C - copies “Crude circle” and holds “crayon” in fist
- O - “object” pointing described by use of object (“what changes channe?” points to remote)
- T - talks enough to carry conversations
18
Q
Developmental Milestones at 3 years
A
- Holds crayon with fingers
- Tower of 9-10 cubes
- Copies circle
- Gives first and last name
- Rides tricycle with pedals
- Can dress with supervision
Rule of 3s: 3 numbers, 3 letters, 3 colors, 3 shapes, 3 wheels
idk i dont have one for this
19
Q
Developmental Milestones at 3-4 years
A
“CABNETS”
- C - Climbs stairs w alternating feet
- A - Answers “what do you like to do for fun?”
- B- buttons and unbuttons
- N - gives full “name”
- E - eats by self at mealtime (feeds self)
- T - takes of shoes and jacket
- S - knows own Sex
20
Q
Developmental Milestones at 4-5 years
A
- Runs and turns without losing balance
- Stands on 1 leg for 10s
- Draws a person without a torso
- Copy a square
- Knows days of the week
- What do you do if you’re cold/hungry? answers
- Self-care at toilet (might need help with wiping)
- Dresses self (need help with tying shoes)
21
Q
Developmental Milestones at 5-6 years
A
- Can catch a ball
- Skips smoothly
- Tells age
- Knows right and left hand
- Can describe favorite tv show with detail
- Does simple chores at home
- Good motor ability but little awareness of dangers
22
Q
Developmental Milestones at 6-7 years
A
- Knows morning from afternoon
- reads several one syllable words
23
Q
Developmental Milestones at 7-8 years
A
- Ties shoes
- Knows current day of the week
- Adds and subtracts 1 digit numbers
24
Q
Developmental red flags
A
- Persistence of Moro after 6 months
- No joyful expressions by 6 months
- No sitting by 9 months
- No babbling/pointing/gesturing by 12 months
- No single words by 16 months
- Not walking independently by 18 months
- Hand dominance prior to 18 months
- Failure of 2 word sentences by 24 months
- Failure of 3 word sentences by 36 months
- Regression at any point
25
What is the best predictor of cognition and school achievement?
Language development
## Footnote
2y: 50%
3y: 75%
4y: 100%
26
Weight gain
27
When is head circumference measured?
Birth to 24 months
28
What is the red flag when it comes to growth charts?
Major percentile drops
29
MC growth abnormality
Type 1: Head circumference **same**, but **weight drops faster than height**
30
MCC of type 1 growth abnormality
* Inadequate caloric intake
* Excess loss of calories
* Inability to use calories peripherally
31
Describe a type 2 growth abnormality
* Normal head circumference
* **Depressed ht and wt**
* D/t genetically short, endocrinopathies, growth delay, heart/renal dz, skeletal dysplasias
32
Describe a type 3 growth abnormality
* Decrease in Ht, Wt, and Head circumference
* D/t CNS issues, chromsomal defects, or in utero/perinatal insults
33
Average weight for a baby in america
7 lbs 7 oz
34
What does a symmetrical growth abnormality suggest?
* Chromosomal abnormality
* Drug/ETOH use
* Congenital infections
| Early pregnancy
35
What does an asymmetrical SGA suggest?
* Only weight is <= 10%
* **Pregnancy issue/placental issue later**
* Outlook is generally good
36
MCC of a LGA baby
Diabetic mother
| Risk of birth trauma
37
What is defined as FTT?
* **Under 3%** for weight
* Wt gain has declined across 2 major percentiles
38
What are the 4 things needed for a child to grow?
* Oxygen
* Substrate (surface on which an organism grows on)
* Hormones
* Love
39
What can cause FTT?
* Hormone deficiencies
* Lack of Love
* Chronic disease
* Deficiency in energy supply
* Structural GI issues (cleft, pierre, atresias)
40
Labs for FTT evaluation
* CMP/CBC
* CRP/ESR
* UA/UC/Stool culture/studies
* Thyroid
41
What should you avoid doing to a malnourished infant?
Overfeeding it immediately: **dumping syndrome**
42
3 Phases of FTT treatment
1. Normal food requirements (100% of their age-adjusted)
2. Intake increased to achieve catch-up growth
3. Varied diet once child is near ideal body weight
| Multivitamins and iron in every refeeding.
## Footnote
Start slow
43
When should you hospitalize a child based on weight?
Less than 60% of IBW based on their ht
44
What is the most critical parameter in evaluation of a child's growth?
Height velocity
any increase or decrease in height percentiles between 2yrs and puberty warrants evaluation
| Prob a endocrine issue
45
How is bone age evaluated?
Compare a radiograph of child's **left hand and wrist**, compare to greulich-pyle scale
46
Who is pathologic short stature more likely in?
Children with abnormal **growth velocity**
| Not following the curve
47
How do endocrine causes of short stature tend to manifest?
Normal or excessive wt gain
48
What is familial short stature? (FSS)
1. Normal birth wt and length
2. First 2 years: Linear growth velocity begins decelerating to match genetics
3. Resumes normal growth parallel to growth curve
4. Grows at a normal rate or below 3rd percentile
5. Still have puberty at normal age
49
How does constitutional growth delay present?
* Similar growth pattern to FSS
* **Key difference: Delayed puberty and growth spurt**
* **late bloomers**
50
What characterizes growth hormone deficiency in terms of growth?
* **Primary sign: Decreased growth velocity**
* Delayed skeletal maturation
* **Typically idiopathic**
51
How do we check growth hormone deficiency?
IGF-1 & IGBFP-3
| GH is pulsatile, so hard to measure accurately.
## Footnote
Insulin-like growth factor 1
If ambiguous, trial of GH tx is used.
52
Early s/s of GHD
* Micropenis with gonadotropin + GHD.
53
SEs of daily SC GH
* Benign intracranial hypertension
* Slipped capital femoral epiphysis
| **Use IGF-1 if GH resistance is noted**
54
What characterizes psychosocial short stature?
* Emotional deprivation
* GH secretion diminished, but GH replacement doesn't help.
55
What characterizes Prader-Willi syndrome?
* Chromsome 15
* Almond-shaped eyes, short, obese, hypogenitals, small hands, deficient GH
* Obsessed with late night snacking
* **Obsessive hyperphagia is hallmark**, seen at 3-4y
| Prader Willi is will raid kitchen at night
56
Tx for Prader Willi
GH replacement
57
Tx for Turner syndrome
* Estrogen replacement
* GH replacement
| **Think coarctation for turner**
58
Characteristics of congenital hypothyroidism in an infant?
* **Large fontanelles**
* **Thick tongue**
* Intellectual delays
* Poor tone
* Hoarseness
* Umbilical Hernias
| Tested via newborn screen
59
MCC of hypothyroidism in an infant?
Hypoplasia or aplasia of gland
| It just never made a thyroid gland.
## Footnote
Iodine deficiency in poorer areas
60
Characteristics of juvenile hypothyroidism
* Sluggish
* Dry hair
* Delayed puberty
* Delayed closure of fontanelles
* Galactorrhea
| Prolactin elevation can be seen
61
What gender is hyperthyroidism MC in?
Females
62
Tx for hyperthyroidism
* Methimazole **First line for kids**
* Antithyroid agents
* PTU (Propylthiouracil)
* **Surgery for large, very young, or pregnant**
63
Tx for Graves disease refractory to antithyroid agents
Iodine ablation
64
Temporary tx for neonatal graves disease
* BBs
* Steroids
| Can occur rarely if mom has graves, usually resolves in 1-3 months
65
What can cause GH excess resulting in tall stature?
Pituitary adenomas
| Gigantism
66
What is precocious puberty?
* Onset prior to 8 (before 7 if AA or hispanic)
* Either central or peripheral
67
What characterizes central precocious puberty?
* Idiopathic usually
* Activation of GnRH early, causing earlier sex steroids.
68
What characterizes peripheral precocious puberty?
* Ovarian or adrenal tumors
* Congenital adrenal hyperplasia
* Ovarian cysts
* McCune-Albright syndrome
* Exogenous estrogen
69
Concerns in precocious puberty for girls
* Skeletal maturation too early compared to linear growth, impairing adult stature
* Vaginal bleeding
* Odor
* **Temporarily tall**
70
Labs to evaluate precocious puberty in girls
* Radiograph of L hand and wirst
* Estradiol for ovarian tumor/cyst
* **LH and FSH are low in peripheral**
* MRI if suspecting central
* US of ovaries if suspecting peripheral
71
Tx for precocious puberty in girls
Leuprolide (GnRH analog) to inhibit Gn secretion, eventually suppressing LH and FSH levels.
72
How does precocious puberty in males tend to present?
* More likely to have CNS abnormalities
* Increased growth rate
73
Tx of precocious puberty in males
* Leuprolide
* Cranial MRI to r/o central
74
What characterizes benign precocious puberty?
* Premature adrenarche
* **Normal linear growth and no bone age advancement**
* No actual change in timing of puberty
75
When do we start delayed puberty workup in girls?
* No signs by 13 or menarche by 16 or not tanner stage 5 after 4 years of puberty
* Main cause: Constitutional growth delay
76
Tx for delayed puberty in girls
* Low dose estrogen
* Switch to OCPs after
77
What characterizes delayed puberty in boys?
* No secondary sexual characteristics by age 14
* 5 years since starting puberty but genital growth is incomplete.
* MCC: constitutional growth delay
78
Tx for delayed puberty in boys
Low dose testosterone
79
MCC of death due to galactosemia
* Progressive hepatic cirrhosis & E. coli sepsis
80
What does an untreated PKU pt look like?
* Severe mental impairment
* Hyperactivity
* Seizures
* Light complexion
* Eczema
81
Where is phenylalaine found in MC?
* Meat
* Eggs
* Cheese
* Aspartame
82
What kind of supplementation does galactosemia require?
Calcium replacement
