Peds Growth-Devo.txt

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Peds Growth-Devo.txt
2010-07-21 07:31:58
Pediatric Boards Growth Development

Peds Boards Growth & Development
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  1. Midparental Height
    Girls: [(dad's ht - 13) + mom's ht] / 2

    Boys: [(mom's ht + 13) + dad's ht] / 2

    All heights are in cm (13 cm = 5 in). Most children with in 5 cm of predicted height.
  2. Constitutional Growth Delay
    Initially normal height and weight which drop off proportionately in first 2 years of life.

    Grows parallel to but low on curve through middle childhood.

    Rapid growth in late childhood/adolescence yields normal adult height

    Bone age delayed but consistent with "height age"

    head circumference spared, if this is affected, investigate.
  3. birth weight doubles by
    4-6 months
  4. birth weight triples by
    12 months
  5. birth weight quadruples by
    24 months
  6. weight gain from 2 years until adolescence
    5 lbs/year (about 2 kg/year)
  7. birth length increases by 50% at
    1 year
  8. birth length doubles by
    3-4 years
  9. birth length triples by
    13 years
  10. average height increase from 2 years until adolescence
    2 in/year (about 5cm)
  11. average OFC at birth

    initial growth
    • Boys: 36cm
    • Girls: 35cm

    Fastest growth at 0-2 months (0.5 cm/wk)
  12. Reasons to hospitalize for failure to thrive
    • abuse/neglect or high likelihood of
    • severe malnutrition
    • medically unstable
    • failed outpatient management
    • need for close observation
  13. single growth point definitions of FTT
    • wt <3rd%
    • wt for ht < 5%
    • wt 20% or more below ideal wt for height
  14. series of growth point definitions for FTT
    wt gain < 20gm/day 0-3months

    wt gain< 15gm/day 3-6 months

    dropping down 2 or more major percentile lines (is this after a specific age or just after a curve is extablished?)
  15. Other than non-organic causes (most common) list general differential dx for FTT
    • Excessive loss
    • GI/malabsorption
    • Renal/RTA

    • Increased caloric requirement
    • Cardiopulm disorders/CHF
    • Malignancies
    • Hyperthyroidism
    • Chronic infection (fungal, HIV, etc.)
  16. most common pathologic causes (general) of microcephaly and the test of choice for evaluation
    bone abnormality or lack of brain development

    CT or MRI of head
  17. most common pathologic cause of macrocephaly and test of choice for evaluation

    head US
  18. primary microcephaly is due to
    genetic/chromosomal cause

    will be present at birth

    CT may be normal
  19. secondary microcepahly is due to
    infection (pre or post-natal), toxin, or CNS injury the arrests previously normal brain growth

    may present at birth or after several months (prenatal infections rarely cause head growth abnormalities before 4-6 months)

    Head CT often abnormal
  20. prenatal infections associated with intracranial calcifications which can lead to microcephaly
    • CMV
    • Toxoplasmosis
  21. differentiate presentation/physical exam of primary craniosynostosis from microcephaly
    primary craniosynostosis has abnormally shaped skul and palpably thickened suture lines

    suture form normally when lack of brain growth leads to premature closure
  22. cranial sutures are usually closed by
    12-24 months
  23. epidemiology of single suture craniosynostosis
    prevalence 0.1%

    85% of affected are caucasian

    3:2 M:F ratio

    most often sagital suture (50%)
  24. Supplement vitamin D in whom?
    • breast fed infants (start in first few days of life)
    • bottle fed infants taking less than 32oz of vitamin D fortified formula or whole milk
    • toddlers taking less than 32oz of cow's milk
    • Anyone getting less than 400IU from combined dietary sources
  25. What qualifies as iron supplementation?

    When do you start supplementing?

    How much do you supplement?
    infant formula, iron-fortified cereal, FeS04 drops

    supplement premie at 2 months, and term baby at 4-6 months

    1mg/kg/day of elemental iron (FeSO4 drops) by 6 months if exclusively breast fed (though should be starting cereal soon)
  26. Fluoride Supplementation
    Not in anyone under 6mo!!

    • Supplementation depends on fluoridation level of community water
    • <0.3PPM --> supplement at 6 months and increase at 3-6 years and again at 6-16 years
    • 0.3-0.6PPM --> begin at 3 years and increase at 6 years
    • >0.6PPM --> no supplementation

    Only pea-sized quantity of toothpaste until 6yo (avoid fluorosis)

    bottled water usually has no Fl, filtered water ok