Child Development Milestones and Enuresis

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Questions and Answers

At what age is a child expected to start vocalizing?

10 months

18 months

6 months (correct)

17 months

What is the upper age limit for a child to normally begin sitting independently?

10 months (correct)

6 months

17 months

18 months

What developmental quotient (DQ) indicates developmental delay?

DQ > 70

DQ < 70 (correct)

DQ = 50

DQ = 100

What is the first line of management for enuresis in a child over 5 years?

Alarm therapy Signup and view all the answers

What is the primary protein in breast milk compared to cow milk?

Less and easily digestible Signup and view all the answers

What specific immunological property does colostrum provide?

Rich in IgA Signup and view all the answers

What is the management for bladder maturation delay in a previously dry child?

Non-pharmacological therapies Signup and view all the answers

What is a notable difference in fat content between breast milk and cow milk?

Both have the same fat content. Signup and view all the answers

What is the primary role of lactoferrin in infant health?

It protects against E.coli infection. Signup and view all the answers

Which of the following micronutrient deficiencies requires prophylactic treatment at birth?

Vitamin K Signup and view all the answers

What is a characteristic clinical feature associated with congenital Zika infection?

Visual defects due to macular scars Signup and view all the answers

What is a common age of onset for Kwashiorkor?

1 year to 5 years Signup and view all the answers

Which nutrient is particularly supplemented in preterm or low birth weight babies due to poor stores?

Iron Signup and view all the answers

Which type of juvenile idiopathic arthritis is characterized by involvement of 4 or fewer joints along with potential uveitis?

Oligoarticular JIA Signup and view all the answers

What symptom is NOT part of the acute phase of Kawasaki disease?

Myocardial ischemia Signup and view all the answers

At what age should Nevirapine prophylaxis start for a breastfeeding baby exposed to HIV?

At birth Signup and view all the answers

Which of the following is a common characteristic of congenital toxoplasmosis?

Microcephaly Signup and view all the answers

Which of the following is a treatment of choice for Kawasaki disease?

Intravenous immunoglobulin (IVIg) Signup and view all the answers

Which storage duration is suitable for breast milk in the refrigerator?

24 hours Signup and view all the answers

What is the defining feature of Henoch Schonlein purpura (HSP)?

Joint pain and renal involvement Signup and view all the answers

Which brain growth factor is known to influence early cognitive development?

Whey protein Signup and view all the answers

Which classification is used for low birth weight neonates?

LBW: < 2.5 kg Signup and view all the answers

What percentage does it indicate if a neonate is classified as small for gestational age (SGA)?

< 10th percentile Signup and view all the answers

Which of the following is NOT a complication associated with Kawasaki disease?

Strawberry tongue Signup and view all the answers

What is the most common arrhythmia associated with WPW syndrome?

Paroxysmal Supraventricular Tachycardia (PSVT) Signup and view all the answers

Which set of criteria is used to diagnose acute rheumatic fever?

Modified Jones’ criteria Signup and view all the answers

Which of the following is not a major criterion for acute rheumatic fever?

Monoarthralgia Signup and view all the answers

What is the recommended prophylaxis for a patient with a history of carditis due to rheumatic heart disease?

Benzyl Penicillin for 10 years Signup and view all the answers

What clinical feature indicates esophageal atresia in a neonate?

Excess frothing with salivation Signup and view all the answers

Which investigation is primarily used to diagnose hypertrophic pyloric stenosis in neonates?

Ultrasound Signup and view all the answers

Which condition is commonly associated with esophageal atresia?

Tracheoesophageal fistula (TEF) Signup and view all the answers

What is the acceptable ASO titre for the diagnosis of acute rheumatic fever?

≥ 300 IU/mL Signup and view all the answers

What is the most common type of Acyanotic CHD characterized by a pansystolic murmur?

Ventricular Septal Defect (VSD) Signup and view all the answers

What complication can lead to a reversal of shunt in patients with a left to right shunt?

Eisenmenger syndrome Signup and view all the answers

Which of the following murmurs is typically heard in a Patent Ductus Arteriosus (PDA)?

Loud continuous machinery murmur Signup and view all the answers

What is a common feature associated with Coarctation of the Aorta?

Hypertension of upper limbs Signup and view all the answers

What is the least incidence of complications seen in which Acyanotic CHD?

Atrial Septal Defect (ASD) Signup and view all the answers

Which medication is used for medical closure of the Ductus Arteriosus in preterm infants?

Ibuprofen Signup and view all the answers

What is the characteristic finding in a patient with Coarctation of the Aorta that suggests collateral circulation?

Radiofemoral delay Signup and view all the answers

Which of the following is a major characteristic of a left to right shunt in Acyanotic CHD?

Increased pulmonary blood flow Signup and view all the answers

Study Notes

Developmental Milestones

Vocalization: Expected by 6 months.
Sitting: Typically achieved by 10 months.
Standing: Generally occurs around 17 months.
Walking: Expected by 18 months.
Single Words: Usually spoken by 18 months.

Developmental Quotient and Delay

Developmental Quotient (DQ): Calculated as (Developmental Age x 100) / Chronological Age.
Developmental Delay: Defined as DQ < 70.
Global Developmental Delay: Associated with delays in two or more domains, indicating significant brain issues (e.g., Cerebral palsy).
Nocturnal Enuresis: Defined as having wet nights at least twice a month in children over 5 years of age.

Classification and Management of Enuresis

Categories:
- Type 10: Never dry since birth (most common).
- Type 20: Previously dry child.
Causes: Often related to maturational delay of the bladder.
Management:
- First-line therapy: Non-pharmacological approaches such as motivational therapy and alarm therapy.
- Second-line therapy: Medications like Desmopressin (oral) or anti-cholinergic agents (e.g., Oxybutynin).

Breastfeeding and Nutrition

Breast Milk: Provides 67 kcal/100ml; superior nutrition compared to cow milk (more lactose, less protein).
Immunological Properties: Colostrum is high in IgA, low in PABA, and contains Lactoferrin to protect against infections.
Factors for Brain Growth: Includes whey protein, taurine, cysteine, and PUFA (Docosa Hexaenoic Acid).
Micronutrient Deficiencies:
- Vitamin K: Prophylactic injection at birth.
- Vitamin D: Oral supplementation necessary.
- Iron: Required for preterm or low birth weight infants due to insufficient iron stores.
Breast Milk Storage:
- Room temperature: 6-8 hours,
- Refrigerator: 24 hours,
- Freezer: Up to 3 months.

Feeding Preterm Babies

Direct Breastfeeding: Allowed after 34 weeks of gestation.

HIV and Breastfeeding

Contradictions: Absolute in developed countries; relative in developing countries.
Exclusive Breastfeeding: Recommended for 6 months with gradual cessation.
Prophylaxis for Infants: Nevirapine from birth; Cotrimoxazole begins at 4-6 weeks, continuing until 6 weeks after stopping breastfeeding.

Nutritional Disorders

Protein Energy Malnutrition (PEM):
- Kwashiorkor: Typically occurs after 1 year.
- Marasmus: Severe wasting form of malnutrition.

Congenital Infections

Congenital Cytomegalovirus (CMV): Risk of severe complications if the mother has a primary infection during pregnancy. Treatment includes Ganciclovir.
Congenital Toxoplasmosis: Symptoms include sensorineural hearing loss, chorioretinitis, microcephaly, and diffuse parenchymal calcifications.
Congenital Zika: Notable for microcephaly and visual defects.

Rheumatic Disorders

Juvenile Idiopathic Arthritis (JIA): Arthritis lasting at least 6 weeks in children under 16 years.
- Oligoarticular JIA: Involves ≤ 4 joints, potential for uveitis.
- Polyarticular JIA: Involves ≥ 5 joints, may present with Rheumatic nodules.
- Systemic Onset JIA: Features quotidian fever, rash, and organomegaly.
Kawasaki Disease:
- Most common childhood vasculitis; presents with prolonged fever, conjunctivitis, rash, and strawberry tongue.
- Treatment includes IVIg and aspirin.

Neonatology

Classification of Neonates by Birth Weight:
- Low Birth Weight (LBW): < 2.5 kg.
- Very Low Birth Weight (VLBW): < 1.5 kg.
- Extremely Low Birth Weight (ELBW): < 1 kg.

Cardiovascular Conditions

Acyanotic Congenital Heart Disease (CHD):
- Includes Left-to-Right shunt lesions such as VSD, ASD, PDA, and obstructions like Coarctation of aorta.
- VSD: Characterized by pansystolic murmur.
- ASD: Noted for a wide fixed split of heart sounds.

Complications and Management of CHD

Shunt Complications:
- Early: Recurrent pneumonia, congestive heart failure.
- Late: Eisenmenger syndrome leading to cyanosis and clubbing.
Coarctation of Aorta:
- Symptoms include claudication pain and hypertension in upper limbs.
- Associated with collateral circulation formation via intercostal arteries.

Acute Rheumatic Fever

Modified Jones Criteria:
- Major: Carditis, arthritis, and chorea.
- Minor: Fever, elevated ESR/CRP, prolonged PR interval.
Prophylaxis:
- Benzyl Penicillin recommended; duration varies.
- Macrolides for penicillin-allergic patients.

Congenital Anomalies

Esophageal Atresia: Characterized by excess frothing and vomiting in neonates due to proximal GI obstruction. Commonly associated with tracheoesophageal fistula.

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Description

This quiz covers key developmental milestones for children, including vocalization, sitting, standing, walking, and language acquisition. Additionally, it explores developmental quotients and enuresis classification, management, and causes. Test your knowledge on these important topics in child development.