What does this refer to:

maturation and development of physical characteristics including height, head circumference and weight.

Quantitative measure of physical development. 

What is the most common cause for baby who is large for gestational age?

what are risks associated with LGA?

(BCHHH)

most common: maternal diet

other: diabetic mother

RIsks associated:

birth trauma

hypoglycemia

cardiomyopathy

hypocalcemia

hyperbilirubinemia

fetal distress

hypoglycemia

hypocalcemia

What are factors that make a child more prone to being born small for their gestational age? (7)

AMPPDCCA

Advanced maternal age >35

Multiples

poor maternal diet

placenta insufficiency

drugs/alcohol

CMV infections

Chromosomal abnormalities

allow for quantitative assessmen of growth

trend or track development

allow for guidance to diet, nutrition and physical activity assessment and guidance

opens the door for discussion in regards to feedings, bonding, advancement of solid foods

Typical baby should ____ growth in first year of life.

THis is the reason nutrition is so imp.

height

weight

head circumference

height to weight ratio

True or False.

Predicted values for exclusively breast fed infants to plot high in first 6 months and lower from 6-12 mts of age.

NORMAL!

bc starting to be more active

Down Syndrome

Low birth weight or preemie charts (adjusted for specific known or predicted alternation sin growth patterns)

Malnutrition

Inadequate calorie intake

Caloric intake inappro for stage and age

Caregiver and child bond 

Stress

Socioeconomic factors

Chronic disease: asthma celiac disease, cardiac

hypothyroid

Cushings

IUGR (intrauterine growth restriction)

Familial: follows inherited pattern of height

slow growth first 2-3 yrs then low to normal growth; bone age and chronological age match

Constitutional growth delay: growth patterns follows familial dshort stature BUT there is a lag in onset of puberty or skeletal maturation

Potential for catch up growth

Bone age lags

Endocrine: usual presentation is no nutritional deficit with a deceleration in linear growth

Congential: IUGR

Genetic variants such as Trisomy 21 or Turner syndrome: look for presence of dysmorphic features

Skeletal abnormalities- dwarfism

Weight <5% on CDC growth chart

Weight: Heigh <5%

Decreased growth velocity in weight flling> 2 major percentiles over 3 to 6 mts.

What does this mean?

FAILURE TO THRIVE

Condition of under nutrition identified in the first 3 years of life.

Proportionate deline in heigh and weight with normal head circumference.

What type for failure to thrive?

Weight< heigh with normal head circumference.

What type for failure to thrive?

All growth parameters are lower than normal.

What type for failure to thrive?

**MOST COMMON: OCCURRING IN 8% CHILDREN

cause by inadequate deliver of calories

-not enough intake

-malabsorption ie IBD or celiac disease

-excess energy expenditure

Genetically determined short stature

Constitutional growth delay

Skeletal dysplasia

Renal Failure

Cardiac

Endocrine Disorders

What type for failure to thrive?

Chromosomal abnormailities

Central nervous system abnormalities

In utero or peri-natal injury

What type failure to thrive?

Idiopathic

Familial

Precocious puberty:

early onset in which child initially tall for age, but rapid bone maturity results and growth stops at an early age

Genetic disorder such as Marfans

CBC

CMP

LFTs

UA

TGT

IGF (insulin like growth factor)

celiac panel

bone age

Mom comes in complaining their baby has

non bilious vomiting

fussy

arching back

frequent gagging

What could it be?

How do you diagnose?

Clinical diagnosis and or upper GI (barium swallow)

REFLUX!!!

3 hrs of crying

3 or more days/week

for 3 weeks

Mom comes in complaining of child who has

non bilious vomiting

may or may be projectile

always progressive

most prevalent at 6 wks.

What could it be? How do you diagnose?

Pyloric Stenosis

Diagnose: US and palpable olive

1 in 5000

Male>Female

Absence of ganglion cells in bowel wall extending proximally from anus

Presentation usually early but can be later

None or late passage of meconium

Worsening constipation

Surgical intervention

Hirschspring disease: reason baby can't leave hospital till they poop

On exam: feel palpable stool in belly in LLQ- on digital rectal exam you will not palpate stool

Baby presents:

loose skin folds

diarrhea, foul smelling stools

vomiting

proximal muscle wasting

full abdomen

this is usually undetected till puberty.

hypotonia at birth

failure to thrive

developmental delay common (speech and coordination)

ages 2-4 compulsive eating, obesity, temper tantrum

YES!

How a child becomes able to do more complex things

NO

check how child is developing!

sensory-motor (0-2) INFANCY

preoperational (2-7) PRESCHOOL

Concrete operations (7-11) SCHOOL AGE

Formal Operations (11 onward) ADOLESCENT

Surveillance: flexible, longitudina, continuous, and cumulative process allowing healthcare professionals to identify children who may have developmental problems

Screening: administration of brief standardized tool to identify children at risk for development disorders. Typically done at 9,18 and 30 mts.

Motor: Raises head from pront- lifts cheat and holds heat up

Cognitive/Visual: tight grasp follow to midline- past miline- hands open at rest

Language: alert to sound- smiles socially and coos

Social: Regards face- recognizes parent- reaches for familiar things- anticipates feedings

What developmental milestone?

Motor: Rolls over- sits unsupported- crawls- pulls to stand- cruises- walks alone

Cognitive: hands to midline- raking grasp- transfer object- holds bottle or throws object- pincer grasp

Language: laugh, babbles, mama/dada, 2 words

Social: stranger- pat a cake- imitate actions

Motor: walks backward- creeps upstairs- runs- throws object while standing- stairs independantly

Cognitive: two blocks/imitate scribble-3 blocks/scribble on own- block tower/imitate pencil hold

Language: 4-6 words- 7-10 words, knows 5 body parts-2 word sentences/50 word vocabulary

Social: spoon and cup- imitates actions, plays in company of another child- parallel play

Language: 3 word sentence- pronouns- two step commands- plurals

Cogntive copy circle and undress self

Social plays with others, shares, group play

Motor: hop- skip- alternating feet- jump over low obstacles

Cogntiive: dress independantly- catch ball- ties shoe

Language: colors- song from memory- print name- asks why?

social: tall tales- cooperative play with group- competitive play- abides by rules?

delay: below avg or 75% in one or more ares

deviancy: atypical development in single area; abnormal pattern

disassociation: development in one area out of proportion with other areas

ages and stages questionaire

brigance screens II

child development inventory/review

dever II developmental

parents' evaluation of developmental status

screening for autism

Interest in other kids

proto-declarative pointing

show and tell

imitation

respond to name when called

polite to point