Children's Normal Growth and Development Flashcards Preview

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Flashcards in Children's Normal Growth and Development Deck (36)
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1
Q

What is the definition of normal?

A

Conforming to a standard

2
Q

What is normality during childhood?

A

Varies at different ages, some abnormal features correct with age, deformities are only significant if they are likely to persist and cause physical/mental health problems

3
Q

Where is the physis of the bone?

A

Between the epiphysis and the metaphysis

4
Q

Where does bone growth occur from?

A

Longitudinal growth from the physis by enchondral ossification
Circumferential growth from periosteum by appositional growth

5
Q

What areas of the body have the most bone growth?

A

Knees, shoulders, wrist = some physes contribute to growth more than others

6
Q

What are some factors that contribute to bone growth?

A

Diet/nutrition, vitamins, injury, illness, hormones

7
Q

What are some features of short stature in children?

A

Age <3 growth much more variable = can cross centiles, nutrition plays big part
Look at parent’s height, dysmorphic features make underlying endocrine/metabolic cause more likely

8
Q

How common is it for short stature to have an underlying pathological cause?

A

Only 1/5 children less than 2SD below the mean for their age will have an underlying pathological cause

9
Q

What are the major developmental milestones?

A
6-9 months = sit alone, crawls
8-12 months = stands
10-18 months = walks
24 months = jumps
3 years = manages stairs alone
10
Q

What are some minor developmental milestones?

A

1-6 months = loss of primitive reflexes (moro, grasp, stepping, fencing)
2 months = head control
9-12 months = few words
14 months = feeds self, uses spoon
18 months = stacks four blocks, understands 200 words
3 years = potty trained

11
Q

What are the variations of knee alignment?

A

Varum = bow legged
Valgum = knock kneed
All babies are born bow legged, should be normal by age 7

12
Q

What are some features of genu varum?

A

Normal in age <2, persisting mild genu varum can run in families

13
Q

When should underlying pathology be considered in genu varum?

A

Unilateral, severe, short stature > 2SD, painful

14
Q

What are some pathological causes of genu varum?

A

Skeletal dysplasia, rickets, tumour (e.g enchondroma), Blount’s disease, trauma (physeal injury)

15
Q

What is Blount’s disease?

A

Growth arrest of medial tibial physis of unknown aetiology, typical beak-like protrusion on x-ray

16
Q

When is the peak age of genu valgum?

A

Age 3 and a half

17
Q

When should genu valgum be referred?

A

Asymmetric, severe, >8cm intermalleolar distance at age 11

18
Q

What are some pathological causes of genu valgum?

A

Tumours (enchondroma, osteochondroma), rickets, neurofibromas, idiopathic

19
Q

What is intoeing?

A

Child walks with toes pointing in (e.g pigeon toed), often accentuated with running

20
Q

What are some causes of intoeing?

A

Femoral neck anteversion, internal tibial torsion, metatarsus adductus (usually a combo of several)

21
Q

How are genu valgum and varus treated?

A

Usually with surgery

22
Q

What are some features of femoral neck anteversion?

A

XS anteversion causes increased IR hip, sit in W position, can predispose to patellofemoral problems, rarely treated with surgery ( mean 30-40 degrees at birth, slowly unwinds to 10-15 degrees by maturity)

23
Q

What is the normal position of the femoral neck?

A

Normally points anteriorly

24
Q

What are some features of internal tibial torsion?

A

Usually seen aged 1-3, mostly resolved by age 6, surgery and bracing not required

25
Q

What are some features of metatarsus adductus?

A

Common, benign, resolves, serial casting may help in 6-12 month olds

26
Q

How is intoeing treated?

A

Define cause, reassure, chart, review, discharge unless severe

27
Q

How common are flat feet?

A

1 in 5 adults = all born with flat feet but develop medial arch once walking commences as tibialis posterior strengthens

28
Q

Do flat feet cause symptoms?

A

No = usually asymptomatic

29
Q

What are the two kinds of flat feet?

A

Fixed and flexible

30
Q

What usually causes flexible flat feet?

A

Generalised ligamentous laxity or tightness of gastrocsoleus complex = treated with stretching

31
Q

Is surgery used to treat flexible flat feet?

A

No = many resolve and orthotics may be unhelpful unless there is pain

32
Q

What are some ways to assess flexible flat feet?

A

Calf tightness assessment = need to relax gastrocs by flexing knee
Beighton score of hypermobility = out of 9, two points for each side

33
Q

What are some features of fixed flat feet?

A

Uncommon, may have underlying bony connection known as tarsal coalition, may benefit from surgery

34
Q

When should cavus feet be referred?

A

Worry if sensate, if there are claw toes, if parental feet are abnormal or if neuromuscular or progressive

35
Q

What are some features of curly toes?

A

Common in younger children, mostly 3rd or 4th toes, most resolve by age 6

36
Q

How should curly toes be treated?

A

Splinting or taping are ineffective, rarely in persisting cases can consider flexor tenotomy

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