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  1. Growth & Development
  2. Definition of growth
    change in physical characteristics such as size or number as opposed to a change of function
  3. Normal patterns
    • rapid growth=fetal
    • deceleration period=newborn to 4mos
    • slow & steady=until puberty
    • Acceleration=puberty
    • deceleration=until maturity
  4. Variation in Organ's systems
    • brain=majority of growth is in the prenatal stage but continues during the 1st 1-2yrs of life. Implicaitons re:diet
    • lymphoid tissue=inc 1st yr
    • reproductive system=hormonal abn if puberty occurs early
  5. factors influencing growth
    • heredity=chromosomal or family
    • prenatal=placental abn, maternal nutrition, drugs, infections
    • hormonal=growth, thyroid, sex, insulin, adrenal steroids
    • disease=chronic
    • nutritional
    • environmental=living conditions or nurture
  6. objective measurements
    • ht
    • wt=back to birth by 2wks, double by 6mos, triple=1yr
    • head circumference=up to 36mos for proper growth
    • growth charts=limitations=more concern if child is on natural curve then crosses 2% lines.
    • bone age=radiograph hand/wrist
    • denition=eruptions of teeth
    • body proportions=upper to lower segment ratio, arm span to total ht
    • sexual maturation=tanner staging
  7. Tanner staging for pubic hair
    • 1=no hair
    • 2=sparse, downy hair at base symphysis pubis
    • 3=sparse, coarse hair across symphysis pubis
    • 4=adult hair quality, fills in pubic triangle, no spread to thighs
    • 5=adult quality & distribution including spread to medial thigh
  8. tanner staging for breast development
    • 1=preadolescent
    • 2=breast budding=areola & papilla
    • 3=continued enlargement but no separation
    • 4=areola & papilla form 2nd mound w/separation
    • 5=mature breasts
  9. Genital development (male)
    • 1=prepubertal
    • 2=scrotum enlarges w/testes & color changes to redness with generally no enlargment yet
    • 3=enlargement penis & tests/scrotum
    • 4=inc size penis & breadth & development glans
    • 5=mature
  10. Various in growth patterns
    • Short stature
    • failure to thrive
  11. Short stature
    ht is less than 3rd % & div into 3 classes
  12. 3 classes of short stature
    • family, racial, genetic
    • constitutional short & delay of puberty
    • attenuated growth
  13. smaller, subnormal velocity, abnormal bone age
    attentuated growth
  14. Small w/normal curve, velocity, abnormal bone age, delay in puberty, normal adult ht. Ht & wt deviates btwn 6-36 mos family hx & males more likely to be effected
    constitutional short stature & delay of puberty
  15. small but follows normal curve growth velocity is normal, bone age is normal, short adults
    familial, race, genetic
  16. normal adult ht if problem, corrected
    problems w/endocrine sys (hypothyr, cushing's, high deletion) inborn errors of metabolism chronic (infections, IBD, cardiac, bone) psychosoical issue
  17. Failure to thrive definition
    wt less than the 3% or wt that rapidly crosses several %. In severe cases, ht & head circumference can be affected
  18. DDx for fail to thrive
    grand & should include=pshychosocial issues
  19. Evaluation for fail to thrive
    • developmental screen
    • basic work up: CBC, lead level, BMP, urinalysis & culture, 3 day observed feeding w/calorie count
    • other: Torch titers, thyroid, alt
  20. Torch titers include
    • toxoplasmosis
    • syphillis, HBV
    • Rubella
    • cytomegalovirus
    • HSV
  21. fail to thrive prognosis
    variable, learning & behavior problems are common
  22. fail to thrive tx options
    • Under lying problems
    • multifocused
  23. Development Definition
    refers to the evolution of physical characteristics,language, motor skills & social skills
  24. Theories of development: freud, Erikson & piaget
    Erikson's psycho/social development
  25. trust vs mistrust
    0 to 18mos
  26. autonomy vs shame/doubt=me do toilet trng
  27. initiative vs guilt=what sex they are
  28. industry vs inferiority=peer pressure begins
  29. identity vs role confustion
  30. physical characteristics
    sex maturation via tanner stages
  31. language
    receptive & expressive using denver II or ELMS
  32. motor skills
    fine/adaptive & gross skills=denver
  33. cooing=
    2 to 3mos
  34. raspberry=
  35. babbling=
  36. momma & dada=
  37. momma & dada spec
  38. 50-70 words=
  39. 2 words together
  40. begins to understands strangers
  41. motor skills milestones
    progression from head then proximal to distal, head lag begins to disappear at 4mos
  42. sitting by what
  43. walking by what
  44. pincer grasp
  45. Social skills
    personal & social interactions using denver
  46. social smile
  47. anticipates at
  48. games at
  49. imitate at
  50. paralle play
  51. interactive play
  52. stranger anxiety
  53. separation anxiety
    • 8-15mos
    • peaks=15-18mos then leaves 2yo
  54. development stages
    • theories of development
    • physical characteristics
    • language
    • language milestones
    • motor skills
    • motor skills milestones
    • social skills
    • social skills milestones
    • other
Card Set:
2011-09-20 03:41:21

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