Normal growth and developement of children

Question 1

When is an abnormality in childhood likely to be pathological?

Answer 1

When it is unilateral

Question 2

Where do bones grow from longitudinally?

Answer 2

From the growth plate (physis) by enchondral ossification

Question 3

Where do bones grow from circumferentially?

Answer 3

Periosteum by appositional growth

Question 4

When does bone strength peak?

Answer 4

Early 30s

Question 5

What area of bones will children break?

Answer 5

Growth plates - the shaft is unlikely to break

Question 6

What factors affect the growth plate?

Answer 6

Diet/ nutrition 
Sunshine, vit D 
Injury to growth plate
Illness - flu and gastroenteritis will show growth arrests in bone 
Hormones (GH)

Question 7

What should a child be doing by 6-9 months?

Answer 7

Sit alone, crawl

Question 8

What should a child be doing by 8-12 months?

Answer 8

Stand, mouth a few words

Question 9

What should a child be doing by 14-17 months?

Answer 9

Walk, feed self, use spoon, understand 200 words

Question 10

What should a child be doing by 24 months?

Answer 10

Jump

Question 11

What should a child be doing by 3 years?

Answer 11

Manage stairs, potty trained

Question 12

What should a baby be able to do by 2 months?

Answer 12

Head control - this is an important milestone

Question 13

What are variations of normal?

Answer 13

Genu varum (bowing) or valgum (knocked knees)
Intoeing
Flat feet
Curly toes

Question 14

How does allingment of legs change with age?

Answer 14

Born varum
3 years, legs are valgum
By 7 years legs are straight

Question 15

When is genu varum pathological?

Answer 15

Unilateral
Severe
Short stature
Painful

Question 16

What can cause pathological genu varum?

Answer 16

Skeletal dysplasia
Rickets
Tumour - enchondroma
Blounts disease
Trauma - physeal injury

Question 17

What is blounts disease?

Answer 17

Growth arrest of the medial tibial physis of unknown aetiology
Typical beak like protrusion on x-ray

Question 18

What can cause pathological valgum?

Answer 18

Tumours - enchodroma, oseochondroma (bony projections around growth plate)
Rickets
Neurofibromatosis
Idiopathic

Question 19

What is considered a large genu valgum?

Answer 19

Lare intermalleolar distance of over 8cm

Question 20

What 3 things can cause intoeing?

Answer 20

Femoral neck anteversion
Internal tibial torsion
Metatarsal adductus

Question 21

What is the degrees of the femoral neck at birth?

Answer 21

30-40 degrees

Question 22

What is the degrees of the femoral neck at maturity?

Answer 22

10-15 degrees

Question 23

What will interal tibial torsion show clinically?

Answer 23

Internal tibial torsion is an inward twisting of the tibia, which leads to intoeing of the foot

Question 24

What should you do about intoeing?

Answer 24

Define cause - foot, leg or hip
Reassure
Chart/ photograph
Review
Discharge unless persisting and severe

Question 25

What is flat feet?

Answer 25

We are all born with it but most develop medial arch once walking as tibialis posterior strengthens but in flat feet this does not happen

Question 26

What needs to be determined in flat feet?

Answer 26

If flexible or fixed

Question 27

How can it be determined if flat feet are flexible or fixed?

Answer 27

Active dosriflexion of big toe

Question 28

What causes flexible flat feet?

Answer 28

Generalised ligamentous laxity or tightness gastosoleus complex

Question 29

What can cause a rigit flat foot?

Answer 29

Underlying bony connection called tasal coaltion from the tarsal bone to navicular

Question 30

What toes are likely to be curly?

Answer 30

3rd or 4th toe

Question 31

In adolescence, what should be checked in a presentation of anterior knee pain?

Answer 31

HIPS - commonly slipped upper femoral epiphysis