Physical development

Question 1

What is fastest time of growth ? WHat % of full growth?

Answer 1

Fetal, 30%

Question 2

Size @ birth depends on?

Answer 2

Placental supply ( IGF-2, lactogen, insulin)
Size of mother

Not father or GH

Question 3

IUGR can cause what later in life?

Answer 3

Obesity childhood

Question 4

Infantile phase of growth- is it fast? what % of final height and what does it depend on?

Weight gain @4 and @10 months

Answer 4

Rapid but less growth, 15% of final height and depends on nutrition and Thyroid- if is insufficient- called FAILURE TO THRIVE

@4months- doubled
@10months-tripled

Question 5

Childhood phase- what is it like? what % of final height? and depends on?

Answer 5

Slower and long, 40% of final height, depends on GH, IGG-1–> IGF-1, and nutrition and health. T4, VitD affect cartilage as well.

Question 6

Puberty- what kind of growth, and dependant on?

Answer 6

Adds 15% to final height, quite rapid again, Sex hormones –> close epiphyseal plates

Question 7

What are limits of growth charts to refer to specialist for small or tall stature?

Answer 7

<0.4 -99.6 th centile

Question 8

Head circumference

@birth in cm

Answer 8

33-35cm average @ birth

Question 9

Until what age is HC bigger than Chest circumference?

Answer 9

6 months

Question 10

What % of adult size @3y

Answer 10

90%

Question 11

What causes anencephaly?

Answer 11

TORCH

Question 12

Closure of anterior fontanelle?

Answer 12

about 1,5 yo

Question 13

Closure of posterior fontanelle?

Answer 13

about 1,5 months

Question 14

Closure of sutures

Answer 14

6 months

Question 15

Bone age what is it?

What diseases can affect?

Answer 15

Biological age - degree of epiphyseal plate fusion

Can be delayed in GH def, thyroid def, precocious puberty, adrenal gland disorders, orthopedic issues, Turner’s

Question 16

Puberty girls stages

Answer 16

1) breast development
2) Pubic hair and growth spurt
3) Menarche - around 2.5 yrs after start- end of growth

TANNER SCALE

Question 17

Puberty males stages

Answer 17

1) Testicular enlargement >4ml
2) Public hair & penis stage
3) Height spurt (when testicular enlargement 12-14ml) so later than girls but more significant

Question 18

Tests if pubertal stages abnormal:

Answer 18

Bone x-ray of hand and wrist

Pelvic US in girls

Question 19

Gastric development: feeding,…

Answer 19

24th week pregnancy- sucking reflex

GE sphincter insuff- until 6th w gestational age

Emptying stomach- fast phase 20 minutes (75%), slow phase 180 minutes

Intestinal passage time 9-96h

Insuff. anus sphincter: 10hrs of life

Question 20

Enzyme activity in gut newborn, @4 months then @18-36 months

Answer 20

Newborn: chymotripsin 50-60% of work
@ 4months- tripsin and lipase reaches adult levels
@18-36 months- (starch) Amylase

Question 21

Kcal/kg/day

Answer 21

0-6 months :109

6-12 months: 77

Question 22

Carbohydrates as % of diet in newborns?

Fats in newborns

Protein in newborns? g/kg/d

Water

Answer 22

40% 0-6 months
45% 6-12 months

55% 0-6 months
40% 6-12 months

1.2 g/kg/d- 1.8 g/kg/d

<10kg 100ml/kg/d
10kg-20kg 1000ml + 50ml per each 1kg of b.w. over 10kg
20kg-30kg 1500ml + 20ml per each 1kg of the b.w. over 20kg

Question 23

Breast feeding begins and ends?

Answer 23

Begins- few hours after delivery and can end @ 6 months or longer if child/mother wishes

Question 24

Content of milk during first 2 weeks

Answer 24

Lactation period
0-5 day – colostrum: antibodies (secretory IgA), neutrophils, macrophages,
lymphocytes B and T, interferon, lysozyme, growth factors.
5-14 day – intermediate milk: protein reach.
from 2nd week – mature milk: high fat and lactose content, less protein
content.

Question 25

Proteins in milk?

Answer 25

Casein and whey (taurine, IgA, enzymes,..)

Question 26

Carbohydrates in milk? and roles?

Answer 26

Lactose: absorption of Ca and Mg, dvt of lactobacillus Oligosaccharides: prevent infection of gut

Question 27

Are mineral contents in milk high or low- why?

Answer 27

Low to prevent osmotic factors in newborns

Question 28

CI to breastfeeding?

Answer 28

Absolute CI- Galactosemia, lactose intolerance, active TB/VZV active in mother, HTLV1&2, HIV in developed countries. Relative: cleft palate, cachexy

Question 29

NOT CI FOR BREASTFEEDING

Answer 29

Acute mother’s infectious disease; Hepatitis A (mother requires γ-globulins infusion); Hepatitis B (infant requires γ-globulins infusion and first dose of vaccine); Hepatitis C (with no important additional mother’s infection – HIV); CMV and EBV infections; Herpes simplex infection (except infection of the breast); Mastitis and irritable breast; Jaundice of breast-feeded baby; Delivery with cesarean section; Silicone implants of breast; Phenylketonuria (infant requires supplementation with low-phenylalanine modified milk).

Question 30

Requirements in vitamins mothers and babies? Vit D and Vit K

Answer 30

VIT D: Mothers in the 3rd trimester of pregnancy – 400IU/day; Full-term, breast-feeded, babies: 400IU/day since first day for mothers without supplementation in pregnancy; 400IU/day since the beginning of the 3rd week for mothers with supplementation in pregnancy. NOT IF Full-term, bottle-feeded, babies Vit K: -Healthy, breast-feeded, babies – between 2nd week and 3rd month 25mcg/day EVEN IN DIARRHEA OR JAUNDICE DON'T NEED IN BOTTLE FED BABIES,