rapid fire growth & development march 2008 board review
TRANSCRIPT
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Rapid Fire Growth & DevelopmentMarch 2008
Board Review
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A word from the esteemed
Dr. Shannon Wahl
“So much development [on the boards]. You must know in DETAIL all milestones as there
are multiple questions”
“…and when you think you know them all…
keep studying because these
questions really suck.”
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How old am I?
• What am I doing?• I am bringing my
hands together at midline
• I am 2 months old
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At what age do these reflexes disappear?Moro reflex gone by 4 months
Babinski reflex gone by 4 months…you hope
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Come on baby do the Locomotion
• Name the stages in order
• Crawling – belly is still on the floor
• Creeping- child is on hands and knees
• Cruising-standing with two-handed support on stationary objects
• Free walking
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How old am I?
• Baby on the Left?• One month of age• Head lagging boo• Baby on the
Right?• 5-6 months• My head is
working with my body
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Put your pills away!
• Name this grasp• Fine (mature)
pincer• Between
fingertips/nails• 12 months
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Name this finding
• Scissoring• Hypertonia• May be hypotonic
as infants• Diagnosis?• Cerebral Palsy• Static or
Progressive?• Static
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Look! Learn! Try it at home!
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Prone Babies
• The baby whose head is cleared off of the floor is how old
• 3 to 4 months• At 2 months, they
try and try but don’t succeed
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My name is Simon and I like to do my drawings• How old are the
children who drew these figures?
• Base age 3 years old
• ¼ year for each feature
• Eyes, nose, mouth, hair, and legs
4 ¼ yo 4 ¾ yo
Arms and EarsNote proportionality
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She is adorable
• What specific type of CP does she have?
• Hemiplegia– Ipsilateral arm and
leg; arm worse than leg
• Diplegia- lower extremities
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Knock your block off
2+4=6 Bridge of 3
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A full term female is born weighing 3kg
• She comes to the office at 2 weeks old and weighs 2.8 kg. What is your next step?– Reassurance. Babies may not regain birth
weight until 3 weeks old. – Reassess in one week!
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• She’s at the 50% for length & head circumference.
• What’s her length?– 50 cm!
• What’s her head circumference?– 35 cm!
A full term female is born weighing 3kg
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A full term female is born weighing 3kg
• What would she weigh at 5 months?– 6 kg– Babies double their weight by 5 months!
• What would she weight at one year?– 9 kg– Babies triple their weight by one year!
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Weight
• Average birth weight is 3.25 kg.• It’s OK to lose 10% of your birth weight.
– This occurs by age 1 week– By 2 weeks, you should be back to birth
weight.• Babies double their weight by 5 months
(Latin babies with abuelas may do this by three months)
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Wait!
• Babies triple their birth weight by 1 year.• They quadruple their birth weight by 2 ½
years.
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Case Scenario
• A 3 year old child presents for WCC• His weight is at the 50%.• His height has fallen from the 25% to
below the 5th percentile.• PE is otherwise normal and FHx is
noncontributory.• Why is this child short?
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You want choices?
• Poor nutrition• Constitutional growth delay• Growth hormone deficiency• Neglect• Lack of high heels
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Growth Hormone Deficiency
• The usual case scenario is a child that is gaining weight ok but is short.– Family history is non-contributory
(Constitutional Growth Delay)– Weight is maintained (Nutrition, Neglect)
• Hypothyroidism could also present with the same case scenario.
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Which is the most concerning?
• A 6 month old who doesn’t turn to voiceOR
• A 14 month old who doesn’t walk
• The 6 month old! This requires intervention!• The 14 month old may just be at the end of
normal for gross motor development
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Which is the most concerning?
• A 4 year old who stuttersOR
• A 3 year old with unintelligible speech
• Stuttering can be normal up to 4 years old and parents should be reassured.
• A 3 y.o. w/ unintelligible speech is VERY concerning & warrants a full evaluation.
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Which is the most concerning?
• A child who lines up toys (that’s all he ever does!)
OR
• A little boy who plays with Barbies
• Compulsive behaviors such as lining up toys as only form of play should be a tip off for autism.
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Autism
• Screening needs to start at 9mo– Goal is to identify ASD before 18mos
• Parental concerns– lack of eye contact and joyful expressions– lack of to-and-fro pattern of speech– lack of recognition of parents’ voice– keen awareness for environmental sounds but doesn’t
respond to name
– delayed onset of babbling past 9 months of age– Decreased/absent use of gestures (waving, pointing,
showing) & lack of expressions such as "oh oh" or "huh"
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True or False
• The mom of a 6 year old child is worried because the kindergarten teacher mentioned that the child often mistakes the letters B and D.
• True or false: This child likely has dyslexia.– FALSE!– This can be a normal finding up to age 7!
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Know your shapes!
3
44.5-5
5
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Things that make you go Hmmm.. Or help you to remember this stuff
Aka MnemonicsCourtesy of Dr. Hauser and Miami Children’s Hospital
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Mnemonics
• Follows to midline: the number “one” is the midline.
• One month old follows to midline
1
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Mnemonics
• 2MILES 2OCIALLY• Follows past midline: Can look at 2
sides at 2 months.• Recognizes parent: with their 2 eyes.
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Mnemonics
• Follows in a circle
• C s (Coos)• Baby is “tri”-
podding (on forearms)
3
1
2
3
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New monnix
• Rolls over: prone to supine first.
• Smiles at 2 mo, laughs at 4 mo. A laugh is like a double smile
• Rattle looks like a 4
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Bubonics
• Sit and Switch at Six!
•6a66les (babbles)• 6 looks like a baby sitting with a round
butt
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Moon Onyx
• Pincher starts at nine months.
• Throws ball: like a pitcher in a 9-inning baseball game.
• Waves bye like this cats with 9 lives
9
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Memory things
• Starts to walk alone at 1 year. 1 baby, 1 year: get it?
• Makes a mark with crayon (He’s trying to draw a one!)
• Follows 1 step commands with gesture. (Bring me a beer!)
• Speaks 1 (to 2) words (mama & dada don’t count)
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Ya know
• Child uses a cup alone, and can drop a cube into a cup. Think of the 5 as a cup.
• Says 4-6 words: that’s 5 +/- 1 (15)
51
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Remember
• 7-10 word vocabulary: that’s 8 +/- 1 (18)• When you turn 18 (yrs), you run away
to college. When child turns 18 (mo) he just runs!
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Don’t forget
• Parallel play: 2 parallel lines at 2 yrs old.
• 2 yrs:– 2 word sentences– Follows 2 step commands
• Do the two step! This dance move reminds you that at age 2, child can walk up/down steps alone.
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Easy as 1, 2, 3
• Now he’s 3!– Can ride a tricycle (3-wheeler)– Uses 3 word sentences– Knows (1) age, (2) name, and (3) gender– Builds bridge of 3 cubes– Usually can repeat 3 digits
• Can draw a circle. That one doesn’t fit, but remember: follows in a circle at 3 mo, draws a circle at 3 yrs.
• Plays in a group (3-some)
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4’s
• (age)/4 = fraction of intelligible speech– 25% at age one– 50% at age two– 75% at age three– 100% at age four
• FOUR years old• Copies a cross and square (4 ½). Both have 4
“corners.”• Asks questions: What for? (what 4?)• Names 4 body parts
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Last one
• Likes to defive (define) words• Almost ready for school:
– abides by rules– prints first name
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RED FLAGS… AGAIN
It is getting repeated for a reason folks
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RED FLAGS
• 2 months– No fixating/No visual attention
• 4 months– No visual tracking, No steady head control
• 6 months– Doesn’t turn to sound or voice
• 9 months– Doesn’t sit, Doesn’t babble
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Red Flags
• 18 months– Doesn’t walk independently
• 24 months– No single words
• 36 months– No 3 word sentences
• Older than 36 months– Unintelligible speech
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A word from the esteemed
Dr. Shannon Wahl
“So much development [on the boards]. You must know in DETAIL all milestones as there
are multiple questions”
“…and when you think you know them all…
keep studying because these
questions really suck.”