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Rapid Fire Growth Development

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    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 allkeep 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 monthsyou hope

    5. 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

    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 dont 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 year for each feature Eyes, nose, mouth, hair, and legs

    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

    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. Shes at the 50% for length & head circumference. Whats her length? 50 cm! Whats her head circumference? 35 cm! A full term female is born weighing 3kg

    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. Its 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 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 doesnt turn to voice OR A 14 month old who doesnt 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 (thats 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 and joyful expressions lack of to-and-fro pattern of speech lack of recognition of parents voice keen awareness for environmental sounds but doesnt 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

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

    29. Mnemonics Follows to midline: the number one is the midline. One month old follows to midline

    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)

    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

    35. Memory things Starts to walk alone at 1 year. 1 baby, 1 year: get it? Makes a mark with crayon (Hes trying to draw a one!) Follows 1 step commands with gesture. (Bring me a beer!) Speaks 1 (to 2) words (mama & dada dont count)

    36. 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: thats 5 +/- 1 (15)

    37. Remember 7-10 word vocabulary: thats 8 +/- 1 (18) When you turn 18 (yrs), you run away to college. When child turns 18 (mo) he just runs!

    38. Dont 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 hes 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 doesnt fit, but remember: follows in a circle at 3 mo, draws a circle at 3 yrs. Plays in a group (3-some)

    40. 4s (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 ). 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 Doesnt turn to sound or voice 9 months Doesnt sit, Doesnt babble

    44. Red Flags 18 months Doesnt 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 allkeep studying because these questions really suck.