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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.
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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.
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birth weight doubles by
4-6 months
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birth weight triples by
12 months
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birth weight quadruples by
24 months
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weight gain from 2 years until adolescence
5 lbs/year (about 2 kg/year)
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birth length increases by 50% at
1 year
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birth length doubles by
3-4 years
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birth length triples by
13 years
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average height increase from 2 years until adolescence
2 in/year (about 5cm)
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average OFC at birth
initial growth
Fastest growth at 0-2 months (0.5 cm/wk)
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Reasons to hospitalize for failure to thrive
- abuse/neglect or high likelihood of
- severe malnutrition
- medically unstable
- failed outpatient management
- need for close observation
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single growth point definitions of FTT
- wt <3rd%
- wt for ht < 5%
- wt 20% or more below ideal wt for height
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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?)
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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.)
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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
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most common pathologic cause of macrocephaly and test of choice for evaluation
hydrocephalus
head US
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primary microcephaly is due to
genetic/chromosomal cause
will be present at birth
CT may be normal
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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
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prenatal infections associated with intracranial calcifications which can lead to microcephaly
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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
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cranial sutures are usually closed by
12-24 months
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epidemiology of single suture craniosynostosis
prevalence 0.1%
85% of affected are caucasian
3:2 M:F ratio
most often sagital suture (50%)
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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
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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)
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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
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