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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.
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.
birth weight doubles by
birth weight triples by
birth weight quadruples by
weight gain from 2 years until adolescence
5 lbs/year (about 2 kg/year)
birth length increases by 50% at
birth length doubles by
birth length triples by
average height increase from 2 years until adolescence
2 in/year (about 5cm)
average OFC at birth
Fastest growth at 0-2 months (0.5 cm/wk)
Reasons to hospitalize for failure to thrive
- abuse/neglect or high likelihood of
- severe malnutrition
- medically unstable
- failed outpatient management
- need for close observation
single growth point definitions of FTT
- wt <3rd%
- wt for ht < 5%
- wt 20% or more below ideal wt for height
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?)
Other than non-organic causes (most common) list general differential dx for FTT
- Excessive loss
- Increased caloric requirement
- Cardiopulm disorders/CHF
- Chronic infection (fungal, HIV, etc.)
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
most common pathologic cause of macrocephaly and test of choice for evaluation
primary microcephaly is due to
will be present at birth
CT may be normal
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
prenatal infections associated with intracranial calcifications which can lead to microcephaly
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
cranial sutures are usually closed by
epidemiology of single suture craniosynostosis
85% of affected are caucasian
3:2 M:F ratio
most often sagital suture (50%)
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
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)
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