Rapid Fire Growth & Development

1. Rapid Fire Growth & Development March 2008 Board Review

2. 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.”

3. How old am I? • What am I doing? • I am bringing my hands together at midline • I am 2 months old

4. At what age do these reflexes disappear? Moro reflex gone by 4 months Babinski reflex gone by 4 months…you hope

5. Come on baby do the Locomotion • Name the stages in order • Crawling – bellyis still on the floor • Creeping- child is on hands and knees • Cruising-standing with two-handed support on stationary objects • Free walking

6. 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

7. Put your pills away! • Name this grasp • Fine (mature) pincer • Between fingertips/nails • 12 months

8. Name this finding • Scissoring • Hypertonia • May be hypotonic as infants • Diagnosis? • Cerebral Palsy • Static or Progressive? • Static

9. Look! Learn! Try it at home!

10. 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

11. 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

12. She is adorable • What specific type of CP does she have? • Hemiplegia • Ipsilateral arm and leg; arm worse than leg • Diplegia- lower extremities

13. Knock your block off Bridge of 3 2+4=6

14. 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!

15. A full term female is born weighing 3kg • She’s at the 50% for length & head circumference. • What’s her length? • 50 cm! • What’s her head circumference? • 35 cm!

16. 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!

17. 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)

18. Wait! Babies triple their birth weight by 1 year. They quadruple their birth weight by 2 ½ years.

19. 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?

20. You want choices? Poor nutrition Constitutional growth delay Growth hormone deficiency Neglect Lack of high heels

21. 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.

22. 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

23. 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.

24. 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.

25. Autism • Screening needs to start at 9mo • Goal is to identify ASD before 18mos • Parental concerns • lack of eye contact andjoyful expressions • lack of to-and-fropattern 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"

26. 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!

27. Know your shapes! 3 4 5 4.5-5

28. Things that make you go Hmmm.. Or help you to remember this stuff Aka Mnemonics Courtesy of Dr. Hauser and Miami Children’s Hospital

29. Mnemonics • Follows to midline: the number “one” is the midline. • One month old follows to midline 1

30. Mnemonics • 2MILES 2OCIALLY • Follows past midline: Can look at 2 sides at 2 months. • Recognizes parent: with their 2 eyes.

31. Mnemonics • Follows in a circle • C s (Coos) • Baby is “tri”- podding (on forearms) 1 3 2 3

32. 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

33. Bubonics • Sit and Switch at Six! • 6a66les (babbles) • 6 looks like a baby sitting with a round butt

34. 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

35. 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)

36. 1 Ya know 5 • 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)

37. 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!

38. 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.

39. 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)

40. 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

41. Last one • Likes to defive (define) words • Almost ready for school: • abides by rules • prints first name

42. RED FLAGS… AGAIN It is getting repeated for a reason folks

43. 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

44. 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

45. 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.”