Pearls for Practitioners

Chapter 5

Normal Growth

  • Standard growth charts are used; they are available free from the CDC

    • 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

    • For >2 years, use the CDC growth charts and measure weight, standing height, and calculate BMI. All should be plotted.

  • Rules of thumb

    • Double birthweight in 4-5 months

    • Double birth length by age 4 years.

Chapter 6

Disorders of Growth

  • The pattern of decreased growth may assist in the evaluation.

    • Weight decreases first, then length, then head circumference: caloric inadequacy

      • May be organic (increased work of breathing with congestive heart failure)

      • Often is nonorganic (neglected child, material depression)

    • All growth parameters less than the fifth percentile

      • Normal variants: familial short stature, constitutional delay

      • Endocrine disorders (especially with pituitary dysfunction)

    • Declining percentiles but otherwise normal 6-18 months: “catch-down growth”

Chapter 7

Normal Development

  • Selected age appropriate issues

    • Neonatal reflexes assist in evaluation of the new­born: moro, rooting, sucking, asymmetric tonic neck reflex

    • 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

    • By no later than 1 year, examine for binocular vision with the light reflex and cover test

    • Older children and adolescents who participate in sports need a careful cardiovascular and orthopedic risk assessment

  • Developmental milestones

    • Gross motor, fine motor, speech, and personal–social are the areas most used for comparison

    • Selected age appropriate issues

      • Bonding and attachment in infancy are critical for optimal outcomes

      • Developing autonomy in early childhood: child explores but needs quick access to the caregivers.

        • Stranger anxiety beginning at about 9 months: support the infant when they are exploring and when others are present

        • Terrible twos: reinforce the desired behavior and try extinguishing the undesired behavior (by not responding to the behavior)

        • Value of early childhood education: increases educational attainment and is preferably started before age 3.

      • School readiness should be assessed, not just assumed, to have optimal educational outcome.

      • Adolescent development divided into three phases

        • Early adolescent: “Am I normal?”

        • Middle adolescent: risk behaviors and exploration of parental and cultural values

        • Late adolescent: “been there, done that”; emerge from risk behaviors and planning for the future adult roles.

Chapter 8

Disorders of Development

  • Developmental surveillance at every office visit; more careful attention at health maintenance visits

  • Developmental screening using validated tool

    • Done at 9, 18, and 30 months at a minimum

    • Most common tools are Ages and Stages and Parents’ Evaluation of Developmental Status

    • Abnormalities require definitive testing

  • Autism screening using validated tool is done at 18 and 24 months

    • Most common is the M-CHAT-R

    • Abnormalities require definitive testing

  • Language development is critical in early childhood

    • Highly correlates with cognitive development

    • Even with newborn hearing test, may need to re-test hearing at any age

    • Speech therapy is more effective the younger it is started

  • 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

  • Context of Behavioral problems

    • Parental factors: mismatch in temperament of expectations between parent and child, depression, other health issues

    • Social determinants of health

      • Stress, lack of parental support, perceived prejudice, and racism

      • Poverty: housing with environmental exposures, poor access to quality education, poor access to healthy nutrition (food deserts), toxic stress

    • Adolescents are a special challenge; developing rapport and open communication is critical

    • Adolescents may usually consent for sexual health, mental health, and substance abuse services

      • As long as they are not homicidal, suicidal, or unable to give informed consent, adolescents should consent for above issues

      • Confidentiality is critical unless there is information that would seem to allow harm to come to the individual or others

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Jun 24, 2019 | Posted by in PEDIATRICS | Comments Off on Pearls for Practitioners

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