What do each of the following growth charts measure?

0-36 months

2-20 years

0-36 mos: Length and wt for age, Head circumference for age and Wt for length

2-20 yrs: Stature, Weight, and BMI for age

1. Crossing two major percentile curves
2. Below 3% for two consecutive visits

(wt falls 1st, then height, then head circum)

• H & P - guides further lab eval
• parent-child interaction
• feeding observation
• Inorganic - psychosocial; d/t lack of food

*preemies should catch up on growth in 1-2 yrs*

• look at growth curve, slope/percenitle changed?
• look at bone age: x-ray of hand, ossification det. age
• look at family: mid-parental height

boys: (mat height + pat height +5) / 2

girls: (mat height + pat height -5) / 2

in inches

• ht drops below 3rd %ile w/in first 2yrs
• delayed bone age
• ht appropriate for bone age
• eventually will catch up

Constitutional growth delay (late bloomers)

• ht % appropriate for predicted mid-parental ht
• bone age not delayed

Familial short stature

Growth pearls - Weight

1. back to BW by ____d
2. infants gain ____ g/day for first 3-4mos
3. 2x BW by __ mos
4. 3x BW by __ mos
5. 4x BW by __ mos
6. after age 2, nml wt gain is __lbs/yr until adolescence

1. 10-14
2. 20-30
3. 4
4. 12
5. 24
6. 5

Growth pearls - Height

1. Birth length increases by __ at 1 yr
2. BL doubles by __ yrs
3. BL triples by __ yrs
4. After age 2: avg ht increase is __ in/yr until adolescence

1. 50%
2. 4
3. 13
4. 2

Frontooccipital circumference (FOC)

1. Largest rate of growth b/t ____ mos (__ cm/wk)
2. Then ~__ cm/mon for rest of first yr
3. __cm total increase after first yr

1. 0-2 mos (0.5 cm/wk)
2. 1
3. 10

What is the most widely known test for dev't; evaluates gross motor, fine motor, language and social dev't?

Useful in kids birth - 6yrs

Denver Dev't Screening Test II

What is a program provided to children who have dev't delays or med problems that put them at risk for dev't delays?

Early Intervention

for pts 0-36mos

Autism spectrum disorder impair _____, ______, and _____.

What is the focus of treatment?

Socialization, Communication, Behavior.

Need formal dev't eval if suspected

Focus on improving behavior and socialization skills. No data supports diet or vit supplements

Newborn visit...

When?

What type dev't present?

First visit 1-3d

Reflexive dev't:

• Moro - arms out when "dropped"
• Rooting - stroke cheek, turn head towards
• Grasp - check symmetry
• Asymmetric tonic neck - "Fencer's reflex"
• Gallant - lie prone, stroke spine, wiggle

Anticipatory guidance

• Back to sleep
• Feeding (q2-3hrs)
• Elimination
• Fevers
• Cord care
• Car seat

Newborn

• Diarrhea
• Lower resp infxn
• Otitis media
• RSV
• Caries
• SIDS
• Type 1 & 2 DM
• Obesity
• High cholesterol
• Asthma

Dev't:

• social smile
• visual tracking
• responds to sounds and coos
• lifts head 45-90 degrees

2-3 months

Anticipatory guidance:

• tummy time
• sleeping through night
• safety - rolling over by next visit (front to back 1st), colic
• assess parental exhaustion, make plan

2-3 months

• 3 weeks to 3 months
• >3 hrs/day
• symptoms for >3wks
• at least 3 days/wk
• worse in evening or night

• R/O treatable conditions
• Simulate prenatal environment: tight swaddling, "jiggling" motion, rapid swinging, non-nutritive sucking, steady loud white noise
• ensure caregiver support

Dev't

• coos
• head and chest up when prone w/arms extended
• rolls over
• pulls to sit w/no head lag
• bears wt on legs
• reaches for objects, grasps rattle
• hands together midline

4-5 months

Guidance

• introduce solids
• teething (maybe)
• tummy time
• safety - falls, walkers (not safe), no honey

4-5 months

Dev't

• babbles
• sits w/o support
• works for toy out of reach
• looks for dropped toy
• rakes to get item
• transfers objects
• peek-a-boo

6-7 months

Guidance - safety

• choking
• medicines/poisons/cleaners
• stairway gates
• electric outlets
• water safety <120F

6-7 months

Dev't

• imitates speech sounds
• "ma-ma" and "da-da" non-specific
• gets to sitting
• crawls
• pulls to stand
• cruises
• thumb-finger grasp
• feeds self finger foods

8-10 months

Guidance

• introduce cup
• play social games
• brush teeth
• separation anxiety
• objects on table tops and counters

8-10 months

Dev't

• waves bye-bye
• indicates wants with gestures
• "ma-ma" and "da-da" specific
• 1-3 additional words
• walks holding on or independently
• stands alone
• stoops and recovers
• puts blocks in a cup

11-13 months

Guidance

• change to whole milk
• off bottle
• decrease in appetite
• language dev't
• car seat (backwards till 2yo)

11-13 months

Dev't

• 3-10 words
• jargon language
• follows one-step commands
• points to 1 body part
• runs
• crawls up steps
• uses a spoon
• cooperates in dressing
• scribbles

14-16 months

Guidance

• stair and window safety
• dev't - body parts, picture books
• temper tantrums - consistent discipline, reinforce good behavior, use time-outs
• future toilet training

14-16 months

Dev't

• 15-20 words
• follows directions
• walks up steps
• kicks a ball
• removes clothes
• tower of 2-4 blocks
• dumps raisins

17-19 months

Guidance

• review child-proofing
• encourage use of utensils
• son't force eating of use food as a reward
• brush teeth
• pretend play

17-19 months

Dev't

• Language: >50 words, puts 2 words together, speech 50% understandable to strangers
• Gross motor: up and down stairs, jumps, throws ball overhead
• Fine motor: puts on clothing, tower of 4-6 blocks, imitates stroke with crayon

Terrific Two's

Guidance

• toilet training
• limit TV
• schedule dental visit
• change to low fat milk

Two's

Dev't

• Language/Cog: speech 3/4 understandable, sentences of >3 words, gives 1st name, at least one color
• Gross motor: walks up/down stairs on alternating feet, walks on heels/toes, pedals tricycle
• Fine motor: tower of 6-8 blocks, brushes own teeth, interactive games, draws circle

Three years

Guidance

• fears, nightmares
• safety with animals, strangers, car safety
• spending time with parents
• curiosity about body parts

Three years

Dev't

• Language/Cog: speech completely understandable, uses prepositions, knows adjective and use of objects, 4 colors, plays board/card games
• Gross motor: balance on one foot 2-4 seconds
• Fine motor: dresses w/o help, draws a person with at least square, does buttons

Four years

Guidance

• nutrition
• safety
• school readiness
• dental care
• rules/expectations for behavior
• booster seats until age 8 or 4'9" tall

Four years

Dev't

• Language/Cog: counts to 5, alphabet, Left/Right, opposites, address and caregiver's name
• Gross motor: rides a bike, balance on one foot for 4-6 seconds, heel/toe walks, skips
• Fine motor: ties shoes, draws a triangle

Five years

Guidance

• school readiness
• safety
• nutrition
• ADHD id'd here

Five years

• school, safety, nutrition, behavior
• sleep
• exercise
• acne
• social history: activities, drugs/tobacco/ETOH, depression, sexuality, menstrual hx

Early adolescence

Bi - Body Image

H - Home environment

E - Education / Employment

A - Activities

D - Drugs/alcohol

S - Sexuality
S - Suicide

Virginia NBS

1. Screens for __ conditions
2. Takes __ days to process

1. 29
2. 3

Normal: mailed to physician

Abnormal: mailed to physician w/instructions to recollect

Critical: called to physician w/in 24 hrs

At risk infants - premature, exclusively breast fed.

Universal screening at 1yr

All adolescents at least once

Menstruating females annually

Risk factors:

• lives in home built before 1950
• sibling with elevated lead level
• emigration from another country
• parental vocation w/lead exposure
• urban environments w/known high lead level

Screen for risk factors 6mos - 6yrs

Check blood level 9-12mos, again at 2 yrs

• anorexia
• abd pain
• irritability
• insomnia
• decreased activity
• dev't delay
• loss of milestones
• anemia

Symptoms of lead toxicity

Blood pressure yearly starting at __ years

Cholesterol, lipid screening only if fam hx of early dz.

TB screening based on risk factors.

3

Urine test for STI is called _____

Pap smears __ years after sexual activity or __ years old

Nucleic acid amplification test (NAAT)

3, 21

Polysaccharide

< 2 years old

Vaccine schedule 0-6 years

Vaccine schedule 7-18 years

http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2010/10_0-6yrs-schedule-pr.pdf

http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2010/10_7-18yrs-schedule-pr.pdf

• DTap = 4
• IPV = 3
• Hib = 3 or 4
• PCV = 4
• MMR = 1
• Varicella = 1
• Hep B = 3
• Hep A = 2
• Rotavirus = 3

Yearly influenza ALL kids 6-59 mos

• DTaP #5
• IPV #4
• MMR #2
• Varicella #2

• DTaP
• HPV
• MCV4

What vaccines are contraindicated if severe allergy to the following?

1. Egg
2. Streptomycin, neomycin, polymyxin B
3. Neomycin
4. Gelatin

1. Influenza
2. IPV
3. MMR, Varicella
4. MMR, Varicella

mild local irritation

23-valent pneumococcal vaccine

before or with MMR

at least 6mos