Rapid Fire Growth & Development

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Nov 17, 2013 (3 years and 8 months ago)

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Rapid Fire Growth &
Development

March 2008

Board Review

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.”

How old am I?


What am I doing?


I am bringing my
hands together at
midline


I am 2 months old

At what age do these reflexes
disappear?

Moro reflex gone by 4
months

Babinski

reflex gone by 4
months…you hope

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



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

Put your pills away!


Name this grasp


Fine (mature)
pincer


Between
fingertips/nails


12 months

Name this finding


Scissoring


Hypertonia


May be hypotonic
as infants


Diagnosis?


Cerebral Palsy


Static or
Progressive?


Static

Look! Learn! Try it at home!

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

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 Ears

Note proportionality

She is adorable


What specific type
of CP does she
have?


Hemiplegia


Ipsilateral

arm and
leg; arm worse than
leg


Diplegia
-

lower
extremities

Knock your block off

2+4=6

Bridge of 3

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!


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

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!


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)

Wait!


Babies triple their birth weight by 1 year.


They quadruple their birth weight by 2 ½
years.

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 5
th

percentile.


PE is otherwise normal and
FHx

is
noncontributory.


Why is this child short?

You want choices?


Poor nutrition


Constitutional growth delay


Growth hormone deficiency


Neglect


Lack of high heels

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.

Which is the most concerning?


A 6 month old who doesn’t turn to voice

OR


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

Which is the most concerning?


A 4 year old who stutters

OR


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.

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.

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
"



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!

Know your shapes!

3

4

4.5
-
5

5

Things that make you go
Hmmm.. Or help you to
remember this stuff


Aka Mnemonics

Courtesy of Dr. Hauser
and Miami Children’s
Hospital

Mnemonics


Follows to midline:
the number “one” is
the midline.


One month old
follows to midline


1

Mnemonics


2MILES 2OCIALLY


Follows past midline: Can look at 2
sides at 2 months.


Recognizes parent: with their 2 eyes.

Mnemonics


Follows in a
circle


C s (Coos)


Baby is “tri”
-

podding (on
forearms)


3

1

2

3

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


Bubonics


Sit and Switch at Six!


6a66les

(babbles)


6 looks like a baby sitting with a round
butt

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

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)

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)



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!


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.

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)


4’s


(age)/4 = fraction of intelligible speech


25% at age one


50% at age two


75% at age three


100% at age four


F
O
U
R

years old


Copies a cross and square (4 ½). Both have 4
“corners.”


Asks questions: What for? (what 4?)


Names 4 body parts



Last one


Likes to
defive

(define) words


Almost ready for school:


abides by rules


prints first name


RED FLAGS… AGAIN

It is getting
repeated for a
reason folks

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

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

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.”