Module 16 infant development and red flags

Question 1

Weight

Answer 1

gain 5-7oz weekly during first 6 months
dbl birth wt by 6 months
triple birth wt by 1 year

Question 2

height

Answer 2

increases 1 inch a month during first 6 months

length increases in sudden spurts

Question 3

head circumference

Answer 3

increases 1.5cm (0.6in) per month during first 6 months

- slows to 0.5cm per month after

Question 4

Postpartum depression is highest among

Answer 4

less than 19, between 20-24
Native
Asian/Pacific Islander
not a high school graduate
single
smoker
3 or more stressful events in the year prior
mothers of a term, low-birth wt baby
mothers of newborns admitted to NICU

Question 5

postpartum psychosis

Answer 5

severe psychotic disorder beginning within 4 weeks of PP includes:

• delusions
• hallucinations
• gross impairment of functioning

Question 6

developmental delay manifests in

Answer 6

• motor problems: cerebral palsy
• communication problems: receptive or expressive
• cognitive
• processing: peripheral (deaf/blind), central:(motor, language, and perceptual dysfunction)

Question 7

specific risk factors for developmental delay

Answer 7

• maternal infections during preg
• genetics
• maternal use of ETOH, tobacco, drugs
• children of low birth wt, premature, SGA, IUGR, multiples
• siblings with developmental delay
• NICU
• brith trauma

Question 8

3 month old physical development red flag

Answer 8

• wt gain < 1lb/month
• head circumference not increasing or increasing > 2 SD on growth curve
• problems with suck-swallow
• difficulty with sleep-wake cycle
• fussy baby

Question 9

3 month old motor skills red flags

Answer 9

• asymmetrical movements
• hyper or hypotonia
• no attempt to raise head when prone
• hands fisted with oppositional thumb
• no hand-to-mouth activity
• feedings take longer than 45 minutes
• waking hourly for feeds

Question 10

3 month language/hearing/vision/cognition red flags

Answer 10

• does not turn head to sound
• no verbalization/coos
• no visual tracking
• does not fix on object/face

Question 11

3 month psych/emotional red flag

Answer 11

• lacks social smile
• withdrawn or flat affect
• lack of consistent, safe child care
• lack of eye contact

Question 12

developmental red flags 6 months

Answer 12

Physical/sleep/temperament:
- hasnt dbl birth wt, head circumference not inc. or too large, poor feeding or sleep, poor self-calming
GROSS MOTOR
- persistent primitive reflexes, does not sit with support, head lag with pull to sit
FINE MOTOR
- not reaching for objects, doesnt hold rattle or hands together, doesnt grasp at clothes
LANGUAGE AND HEARING
- no babbling, does not respond to sound, parent concerned about hearing
PSYCH/EMOTIONAL
- no smiles, no response to play, withdrawn or flat affect, lack of eye contact
COGNITION and VISION
- parents concerned about vision, no reach or objects, doesnt look at caregiver

Question 13

developmental red flags for 9 months

Answer 13

PHYSICAL/SLEEP/TEMPER
- parents concerned about feeding or sleep
- persistent night wakening
- poor self-calming/regulation
GROSS MOTOR
- doesnt sit even in tripod position, no lateral prop reflex, asymmetric crawl or other movements
FINE MOTOR
- no self-feeding, no high chair sitting, no solid foods, does not pick up toy with one hand
LANGUAGE AND HEARING
- no single or dbl consonant sounds, doesnt respond to name or voice, lacks reciprocal vocalizations
PSYCH/EMOTIONAL
- intense or absent stranger anxiety, does not seek comfort from caregiver, poor eye contact
COGNITION AND VISION
- parents concern about vision, no visual awareness, does not reach out for toys, does not explore toys visually or orally

Question 14

developmental red flags for 12 months

Answer 14

PHYSICAL/SLEEP/TEMPER
- hasnt tripled birth wt, >2 SD change on growth curve, poor sleep-wake cycles, extreme separation anxiety
GROSS MOTOR
- not pulling self to stand, not exploring environment
FINE MOTOR
- persistently mouths objects, doesnt attempt to feed self or hold cup, cannot hold toy in one hand or transfer objects
LANGUAGE AND HEARING
- doesnt localize to sound, doesnt imitate, doesnt use 2 or 3 words, doesnt point, or uses only gestures or pointing
PSYCH/EMOTIONAL
- no response to games, reading, or other interactive activities, withdrawn or flat affect, poor eye contact

Question 15

post-partum depression screening

Answer 15

1, 2, 4, and 6 month visits

• Reassure: postpartum blues
• supportive care: postpartum blues, minor depression
• Refer: minor or major depression