Chapter 5
Normal Growth
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Standard growth charts are used; they are available free from the CDC
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0-2 years, use the WHO growth charts and measure weight, recumbent length, and head circumference and plot these as well as the weight for length
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For >2 years, use the CDC growth charts and measure weight, standing height, and calculate BMI. All should be plotted.
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Rules of thumb
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Double birthweight in 4-5 months
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Double birth length by age 4 years.
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Chapter 6
Disorders of Growth
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The pattern of decreased growth may assist in the evaluation.
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Weight decreases first, then length, then head circumference: caloric inadequacy
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May be organic (increased work of breathing with congestive heart failure)
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Often is nonorganic (neglected child, material depression)
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All growth parameters less than the fifth percentile
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Normal variants: familial short stature, constitutional delay
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Endocrine disorders (especially with pituitary dysfunction)
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Declining percentiles but otherwise normal 6-18 months: “catch-down growth”
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Chapter 7
Normal Development
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Selected age appropriate issues
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Neonatal reflexes assist in evaluation of the newborn: moro, rooting, sucking, asymmetric tonic neck reflex
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Contractures of the joints at birth should be followed if the joint can be moved to the proper position; fixed deformities require pediatric orthopedic evaluation
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By no later than 1 year, examine for binocular vision with the light reflex and cover test
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Older children and adolescents who participate in sports need a careful cardiovascular and orthopedic risk assessment
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Developmental milestones
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Gross motor, fine motor, speech, and personal–social are the areas most used for comparison
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Selected age appropriate issues
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Bonding and attachment in infancy are critical for optimal outcomes
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Developing autonomy in early childhood: child explores but needs quick access to the caregivers.
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Stranger anxiety beginning at about 9 months: support the infant when they are exploring and when others are present
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Terrible twos: reinforce the desired behavior and try extinguishing the undesired behavior (by not responding to the behavior)
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Value of early childhood education: increases educational attainment and is preferably started before age 3.
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School readiness should be assessed, not just assumed, to have optimal educational outcome.
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Adolescent development divided into three phases
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Early adolescent: “Am I normal?”
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Middle adolescent: risk behaviors and exploration of parental and cultural values
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Late adolescent: “been there, done that”; emerge from risk behaviors and planning for the future adult roles.
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Chapter 8
Disorders of Development
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Developmental surveillance at every office visit; more careful attention at health maintenance visits
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Developmental screening using validated tool
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Done at 9, 18, and 30 months at a minimum
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Most common tools are Ages and Stages and Parents’ Evaluation of Developmental Status
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Abnormalities require definitive testing
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Autism screening using validated tool is done at 18 and 24 months
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Most common is the M-CHAT-R
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Abnormalities require definitive testing
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Language development is critical in early childhood
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Highly correlates with cognitive development
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Even with newborn hearing test, may need to re-test hearing at any age
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Speech therapy is more effective the younger it is started
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After age 6, school performance is assessed; if there are performance issues (academic or behavioral), there should be elaborated testing; testing should be done by psychologists, psychiatrists, developmental pediatricians, or educational experts
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Context of Behavioral problems
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Parental factors: mismatch in temperament of expectations between parent and child, depression, other health issues
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Social determinants of health
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Stress, lack of parental support, perceived prejudice, and racism
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Poverty: housing with environmental exposures, poor access to quality education, poor access to healthy nutrition (food deserts), toxic stress
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Adolescents are a special challenge; developing rapport and open communication is critical
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Adolescents may usually consent for sexual health, mental health, and substance abuse services
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As long as they are not homicidal, suicidal, or unable to give informed consent, adolescents should consent for above issues
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Confidentiality is critical unless there is information that would seem to allow harm to come to the individual or others
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