Lecture Day 1 Normal Development

Question 1

Average brith weight?

When does it double by

Answer 1

3.3kg

double it by 3 months

Question 2

Average head circumference at birth?
1 yr
2 yr

Answer 2

35cm
47cm
49cm

(big compared to rest of body)

Question 3

When do teeth first appear?

Answer 3

6 months-2years

Question 4

Phases of growth

Answer 4

pre-natal
infantile
childhood
pubertal

Question 5

What drives growth in each stage:
fetal
infantile
childhood 
pubertal

Answer 5

fetal 30%: uterine environment
Infantile (0-18 months) 15%: genetics, nutrition, health & happiness, thyroid
Childhood (40%): GH, TH, good health, genes
Pubertal 15% : Testosterone, oestrogen, GH

At end of puberty, the epiphyseal growth plates fuse & cause cessation of growth. Therefore, if puberty is early final growth will be reduced.

Question 6

Normal requirement after first week until weaning:

- estimate for 5kg baby

Answer 6

150mls/kg/day

- 750mls/day

Question 7

how to convert Oz to Mls

Answer 7

30mls per Oz

Question 8

When to wean?

Answer 8

From 6 months

- iron containing food at 6 months

Question 9

What foods to avoid before 6 months

Answer 9

egg and wheat

Question 10

Puree when?

Answer 10

7 months

Question 11

When doorstep milk and normal food

Answer 11

12 months

Question 12

how many liters of maintenance fluids does an adult need

Answer 12

1 L 8 hourly

Question 13

How do you calculate mainntence fluids for a child

Answer 13

1st 10kg: 100 mls/kg/day
2nd 10kg: 50 mls/kg/day
3rd +: 20mls/kg/day

Question 14

Freddie is 28Kg and is vomiting requiring maintenance IV fluids calculate his hourly IV fluid requirement

Answer 14

(10 x 100) + (10 x 50) + (8 x 20)/24 = 69 mls/h

Question 15

How is overweight/obesity classified in children

Answer 15

BMI (wt/h2) centiles
> 91st overweight
> 98th obesity

Question 16

Effects of obesity in children

Answer 16

Type 2 diabetes

Question 17

How much physical activity does a young child need?

How many steps a day? (for adults)

Answer 17

60 mins every day

12,000 steps (10,000)

Question 18

What are the four categories for children

Answer 18

Gross motor
Fine motor
Speech & language
Social

Question 19

When is develop most rapid

Answer 19

First 4 years of life

Question 20

Gross motor development

Answer 20

6-8 weeks- Raises head to 45 degrees	
6-8 months – Sits without support	
8-9 months - crawling	
10 months - 	walks around furniture
12 months – walking unsteadily 	
15 months – walks steadily	
18 months – can run
2 years – jumps
3 years – hops
4 years – climbing frames
5 years – hops & skips

Question 21

Causes of not walking

Answer 21

cerebral palsy 
Duchennes (Músculo-dystophy)- gower test- lie flat & stand without using hands (proximal weakness)
MSK problem
Neglect 
Bottom shufflers

Question 22

Red flag:

9 months

Answer 22

can’t sit without support

Question 23

Developmental warning signs

Answer 23

• Family history
• Maternal concern

• Persisting primitive reflexes: moro reflex (dropping head-symmetrical arms arising present at birth - 3 months), palmar grasp, sucking reflex, fencing reflex (turn head)

• Discordant development
• Regression- losing skills

Question 24

Screening ar birth

Answer 24

eyes (red reflex), heart, hips; automated hearing screen

Question 25

Screening at 1 week

Answer 25

Guthrie (PKU, hypothyroidism, CF, haemoglobinopathies, acylcarnitine)

Question 26

8 weeks:

Answer 26

general examination

Question 27

4-5 yrs | school entry

Answer 27

orthopedist | yearly height & weight, hearing

Question 28

Describe eye development

Answer 28

birth 6/180 1 month 6/90 6 months 6/30 3-5 years 6/6

Question 29

How many boys are red colour blind

Answer 29

6%

Question 30

What is enuresis - percentage at 5, 10 & teenagers

Answer 30

inappropriate voiding of urine after the age at which bladder control should have been achieved: dry day: 2-3 years; dry night 3-4 years 10% at 5, 5% at 10, 1% teenagers

Question 31

What is encopresis

Answer 31

passage of faeces into the clothes by day or night. Soiling after 4 years is abnormal

Question 32

2 year old with a history of asthma has a RR of 12 and a HR 80 12 year old with a history of asthma has a RR of 12 and a HR of 80 Which one do you attend to first?

Answer 32

2 year old as HR should be faster. 1st cause of bradycardia: hypoxia

Question 33

Newborn: - when should pass first urine - pass meconium

Answer 33

- micturate in 24 hrs | - meconium in 48 hours

Question 34

Causes of not passing meconium

Answer 34

Obstruction of bowel | CF: meconium ileus

Question 35

How does the childs birthweight change after birth. When is it abnormal?

Answer 35

5% lose birthweight, regain by day 10, > than 10% weight loss abnormal. - not feeding well, dehydrated

Question 36

At 6 months, what percentage sleep through the night

Answer 36

90%

Question 37

When are night terrors

Answer 37

(4-7 years)

Question 38

When nightmares

Answer 38

(8-10)

Question 39

Sleep walking

Answer 39

(5-10 years)

Question 40

During prenatal growth, what foetal growth factors modulate growth

Answer 40

- IGF-2 - human placental lactose - Insulin (hence why hyperinsulinaemia can result in macrosomia)