Paediatrics Marrow Pg 51-60 (Growth & Development)

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

At what age do temper tantrums typically begin?

10-12 years

18-36 months (correct)

4-6 years

0-12 months

Tics are characterized by slow, rhythmic, voluntary movements.

False

What is a common simple vocal tic?

Throat clearing

Tourette's syndrome is characterized by the presence of both motor and vocal tics for at least ___ year(s).

1 Signup and view all the answers

Match the following types of tics to their descriptions:

Motor Tics = Repetitive movements Vocal Tics = Repetitive vocal sounds Simple Tics = Involuntary and basic Complex Tics = Involves more intricate actions or sounds Signup and view all the answers

What is a long-term problem associated with growth and development?

Dental malocclusion Signup and view all the answers

Behavioral therapy is suggested for treatment at 5 years of age.

True Signup and view all the answers

What is PICA?

The consumption of inedible or non-nutritive substances for at least 1 month. Signup and view all the answers

The consumption of inedible substances like chalk or paint for at least one month is known as __________.

PICA Signup and view all the answers

Match the following issues with their respective categories:

Dental malocclusion = Long-term problem Jaw pain = Long-term problem Behavioral therapy = Treatment PICA = Disorder Signup and view all the answers

Which of the following is NOT a cause of congenital developmental delay?

Severe head trauma Signup and view all the answers

Developmental deviance refers to the loss of previously acquired milestones.

False Signup and view all the answers

Provide an example of a condition associated with regression in developmental milestones.

Rett syndrome Signup and view all the answers

___ infections are a known cause of congenital developmental delay.

TORCH Signup and view all the answers

Match the following types of developmental disorders with their characteristics:

Developmental dissociation = Variation in attainment of milestones between 2 or more domains Developmental deviance = Attainment of milestones out of normal sequence Regression = Loss or previously acquired milestone Signup and view all the answers

What is the developmental quotient (DQ) if a child has a developmental age of 24 months and a chronological age of 30 months?

80 Signup and view all the answers

A global developmental delay is indicated when there is a delay in only one developmental domain.

False Signup and view all the answers

What is the upper limit for achieving head control in infants?

6 months Signup and view all the answers

The formula for calculating corrected age is: Corrected age = Postnatal age - ________.

Preterm correction Signup and view all the answers

Match the developmental screening test with its mnemonic:

Goodenough-Harris 'Draw a man' test = G Denver II = D Trivandrum development screening test = T Phatak's Baroda screening test = P Signup and view all the answers

What is a common factor that can trigger a breath holding spell in infants?

Anger Signup and view all the answers

Breath holding spells can persist until the age of 5 years.

True Signup and view all the answers

What is the recommended dosage of iron for preterm breastfed babies with a birth weight of 1.5-2.5 kg?

2 mg/kg/day Signup and view all the answers

What management step should be taken during a tonic clonic episode of a breath holding spell?

Turn the child sideways Signup and view all the answers

Preterm breastfed babies do not require any supplementation.

False Signup and view all the answers

What supplements are recommended for preterm breastfed babies weighing 1.5-2.5 kg?

Iron, Vitamin D, Vitamin K Signup and view all the answers

In the pallid type of breath holding spell, the child becomes _____ and may develop a syncope-like attack.

pale Signup and view all the answers

Match the type of breath holding spell to its corresponding description:

Cyanotic type = Due to increased sympathetic activity, may show cyanosis Pallid type = Due to increased parasympathetic activity, may develop syncope Both types = May have instances of Tonic Clonic movements if persistent None = No serious medical condition related Signup and view all the answers

For human milk fortification, preterm babies require __________, Vitamin D, and Vitamin K.

Iron Signup and view all the answers

Match the following supplements to their intended purpose for preterm breastfed babies:

Iron = Supports blood health Vitamin D = Promotes bone health Vitamin K = Aids in blood clotting Signup and view all the answers

Which of the following is a primary cause of nocturnal enuresis?

Decreased ADH secretion at night Signup and view all the answers

Secondary nocturnal enuresis occurs in individuals who have previously been dry at night for at least 6 months.

True Signup and view all the answers

What is the management approach that has the highest success rate for treating nocturnal enuresis?

Motivational and alarm therapy Signup and view all the answers

Passing urine at night time only is classified as __________ nocturnal enuresis.

monosymptomatic Signup and view all the answers

Match the following management strategies with their descriptions:

Motivational therapy = Verbal praising and gifts for dry nights Alarm therapy = Conditioning to the sensation of a full bladder Desmopressin = Short-term pharmacological treatment Oxybutynin = Long-term treatment to reduce bladder contractions Signup and view all the answers

What is one of the characteristics of transitional milk?

Increased sugar Signup and view all the answers

Mature milk is secreted before 14 days after birth.

False Signup and view all the answers

List two deficiencies commonly found in breast milk.

Vitamin K, Vitamin D Signup and view all the answers

The main function of hindmilk is to provide __________.

satiety (energy dense) Signup and view all the answers

Match the following types of vitamins with their supplementation dosages:

Vitamin K = 1 mg IM Vitamin D = 400 IU/day Vitamin B12 = Supplements may be necessary Iron = Not supplemented due to good bioavailability Signup and view all the answers

What is the recommended time frame for initiating breastfeeding after birth?

Within 1 hour after birth Signup and view all the answers

Exclusive breastfeeding is advised for infants up to 8 months of age.

False Signup and view all the answers

What is the primary feeding method for preterm babies born before 28 weeks gestation?

Total Parenteral Nutrition (TPN) Signup and view all the answers

The baby's mouth should be wide open and the ______ should touch the breast for correct latching.

chin Signup and view all the answers

Match the gestational age with the appropriate method of feeding:

< 28 weeks = Total Parenteral Nutrition (TPN) 28-31 weeks = Expressed breastmilk via tube 32-34 weeks = Feeding by paladai or katori spoon <blockquote> 34 weeks = Direct breastfeeding </blockquote> Signup and view all the answers

What is the primary immunoglobulin found in colostrum?

IgA Signup and view all the answers

Human milk oligosaccharides (HMOs) are digestible substances that promote gut health.

False Signup and view all the answers

What is the caloric value of breast milk per 100 mL?

67 kcal Signup and view all the answers

The predominant protein type in breast milk has a whey to casein ratio of _ to _.

80, 20 Signup and view all the answers

Match the following types of milk with their characteristics:

Colostrum = Thick, lemon yellow, rich in IgA Mature milk = Produced after the first few days, more nutritious Transition milk = Intermediate stage, follows colostrum Foremilk = Lower in fat, released at the beginning of a feed Signup and view all the answers

Study Notes

Temper Tantrums

Begins around 18-36 months of age and can persist until 6 years old
Characterized by physical and emotional outbursts, such as crying, kicking, pushing, and head banging
Management includes:
- Reassuring parents to remain calm
- Leaving the child alone in a safe space
- Distraction techniques
- Time-out techniques

Tics

Rapid, involuntary, repetitive movements or vocalizations
Onset usually occurs between 4-6 years old, peaking at 10-12 years old and persisting until 18-20 years old

Motor Tics

Simple: Eye blinking, Neck jerking, Shoulder shrugging
Complex: Echopraxia (repeating movements or postures of others)

Vocal Tics

Simple: Repeated throat clearing, Coughing, Sniffing
Complex: Echolalia (repeating other's speech), Palilalia (repeating one's own words or sentences)

Tourette's Syndrome

Onset before 18 years old
Characterized by both motor and vocal tics for at least one year
Management includes:
- Behavioral therapy
- Neuroleptics (Haloperidol, Clonidine) for long-lasting tics

Growth and Development

Long-term problems: Dental malocclusion, Jaw pain
Treatment: Behavioral therapy for children over 5 years old

PICA

Consumption of non-nutritive substances (e.g., chalk, mud, paint) for at least one month
Inappropriate for the child's developmental stage and cultural practices

Causes of Developmental Delay

Congenital Causes

Chromosomal abnormalities (e.g., Down's syndrome)
Genetic syndromes (e.g., Fragile X syndrome, Rett syndrome)
Congenital hypothyroidism
Brain anomalies
TORCH infections

Acquired Causes

Severe head trauma
Meningitis
Perinatal asphyxia

Variants of Developmental Disorders

Developmental dissociation: Variation in milestone attainment between two or more domains
- Example: Isolated language delay due to a hearing deficit
Developmental Deviance: Attainment of milestones out of the normal sequence
- Example: Early rolling (head control develops later) due to increased extensor tone in cerebral palsy
Regression: Loss of previously acquired milestones
- Example: Rett syndrome, Subacute sclerosing panencephalitis (SSPE), Leukodystrophy

Disorders of Development

Developmental quotient (DQ)
- Formula: DQ = (Developmental age (DA) / Chronological age (CA)) x 100
- Developmental delay: DQ < 70
- Global developmental delay: Delay in ≥ 2 domains, indicating a significant neurological disorder (e.g., cerebral palsy)
Evaluation of a preterm baby:
- Corrected age = Postnatal age - Preterm correction
- Preterm correction (calculated up to 2 years): 40 weeks - Actual weeks of gestation of preterm baby

Red Flag Signs for Developmental Delays

Milestone: Visual fixation or following
- Upper limit: 5 months
Milestone: Head control
- Upper limit: 6 months
Milestone: Vocalization
- Upper limit: 10 months
Milestone: Sitting without support
- Upper limit: 12 months
Milestone: Standing with support
- Upper limit: 12 months
Milestone: Standing/walking without support
- Upper limit: 18 months
Milestone: Single words
- Upper limit: Not specified

Tests for Developmental Assessment

Screening tests (Mnemonic: Good Doctor Treats Patients)

Goodenough-Harris 'Draw a man' test
Denver II
Trivandrum development screening test
Phatak's Baroda screening test

Definitive tests

Bayley II scale (Infant and toddler development)
Stanford Binet Intelligence scale
Wechsler Intelligence scale
Vineland adaptive behavior scale II

Behavioral Disorders in Children

Breath Holding Spells

Reflexive event
Begins around 6 months of age, peaks by 2 years, and persists till 5 years
Sequence of events: Provocative factors (anger, pain) → baby cries → holds breath in full expiration

Types

Cyanotic breath holding spells: Due to increased sympathetic activity (most common); Cyanosis occurs, but the child returns to normal after a few seconds; If persistent, may develop tonic-clonic movements
Pallid type: Due to increased parasympathetic activity; Child becomes pale and develops a syncope-like attack (lasting a few seconds); If persistent, an ECG should be performed to rule out Long QT syndrome

Management

Reassure parents (benign condition that resolves spontaneously)
Turn the child sideways during a tonic-clonic episode (to prevent aspiration)
Avoid picking up the child during the episode (can cause sudden decrease in cerebral perfusion)
Evaluate and treat for iron deficiency anemia
Atropine can be used for long-duration pallid spells

Bruxism

Teeth grinding
Onset and occurrence:
- Usually occurs after 5 years old (but can occur in preschool children)
- Associated with anxiety and stress disorders
- Often occurs during sleep

Management

Reassure parents
Treat underlying stress or anxiety
Mouth guards may be used during sleep

PICA

Consumption of inedible, non-nutritive substances, such as dirt, paint, or plaster
Occurs between 18-24 months of age
Often associated with iron deficiency anemia, developmental disabilities, or psychological disorders
Requires medical evaluation and management

Supplementation in Preterm Breastfed Babies

Birth weight	Supplements	Preterm birth	Human milk fortification (HMF)
1.5-2.5 kg	Iron (2 mg/kg/day) up to 1 year of age, Vitamin D, Vitamin K	Yes	Vitamin D, K, and Iron
< 1.5 kg	Iron (2 mg/kg/day) up to 1 year of age, Vitamin D, Vitamin K	Yes	Vitamin D, K, and Iron

Nocturnal Enuresis

Nearly complete bladder evacuation at night (≥ 5 years) for at least 2 times a month for 3 months
More common in males than females

Types

Based on Etiology

Primary (most common): Bedwetting since birth; Etiology: Delayed bladder maturation, Decreased ADH secretion at night
Secondary: Previously dry at night but now bedwetting; Etiology: UTI, Diabetes Insipidus (DI)/Diabetes Mellitus (DM), Stress, Bowel-bladder dysfunction

Based on Symptomatology

Monosymptomatic (most common): Passing urine at night
Polysymptomatic: Passing urine at night + lower urinary tract symptoms (LUTS) (hesitancy, urgency, dribbling)

Management

Motivational + alarm therapy: Highest success rate (60-70%)
Non-Pharmacological:
- Reassurance
- Behavioral modifications (voiding before bed, restricting fluids in the evening, avoiding caffeine)
- Motivational therapy (verbal praise, rewards for dry nights)
- Alarm therapy: Conditioning the child to the sensation of a full bladder (sensors in underwear to detect wetness and wake the child; simple alarms set to the usual bedwetting time)
Pharmacological:
- Short-term: Oral desmopressin
- Long-term: Oxybutynin / Tolterodine (decrease uninhibited bladder contractions)
- Imipramine: Not used due to adverse cardiovascular side effects

Breastfeeding

Initiation: As early as possible within 1 hour after birth
Exclusive breastfeeding: Infant only receives breast milk for the first 6 months of life
Correct latching position:
- Mouth covers areola
- Lips are flanged out (eversion)
Correct infant latch on position:
- Mouth wide open
- Chin touches the breast

Neonatal Reflexes Assisting Breastfeeding

Rooting reflex: Nipple touches the mouth, initiating the reflex
Sucking and swallowing reflex: Facilitates milk intake

Feeding in Preterm Babies

Gestational age at birth	Method of feeding
< 28 weeks	Total Parenteral Nutrition (TPN)
28-31 weeks	Expressed breast milk via nasogastric or orogastric tube
32-34 weeks	Feeding breast milk by paladai or katori spoon
> 34 weeks	Direct breastfeeding

Properties of Breast Milk

Immunological Properties

PLABB: Low levels of Para Amino Benzoic Acid (PABA) protect from malaria, Lactoferrin protects from E.coli, IgA is the predominant immunoglobulin in colostrum, Bifidus factor promotes the growth of Lactobacillus bifidus, Bile salt-stimulated lipase protects from giardiasis, Epidermal Growth Factor (EGF) promotes intestinal maturation, reducing the risk of bacterial infection

Human Milk Oligosaccharides (HMOs)

Most abundant solid in breast milk
Non-digestible, acting as a prebiotic
Increase favorable gut bacteria, reducing the risk of diarrhea and necrotizing enterocolitis

Nutritional Properties

Nutritive value: 67 kcal/100 mL

Nutrient	Features
Carbohydrates	6-7 g/dL (more than in cow milk). Lactose breaks down into Glucose + Galactose; Galactocerebroside promotes myelination
Proteins	0.9-1.1 g/dL (lower than in cow milk). Less protein means a lower solute load on kidneys, making it kidney-protective. Whey: Casein ratio is 80:20; Amino acids: Taurine & cysteine
Fats	3.5-4 g/dL (equal to cow milk). Rich in Polyunsaturated Fatty Acids (PUFAs) (e.g., DHA: Docosa Hexanoic Acid); Promotes myelination. Easily digestible. Promote brain growth.

Note: Cow milk is high in casein, which coagulates in the intestine, forming curd that is not easily digestible.

Composition of Breast Milk

Colostrum:
- Secreted during the first 3-4 days
- Thick and lemon yellow-colored
- Rich in IgA, Vitamin A, and anti-infective protein (Lactoferrin) (mnemonic: 3 AS)

Transitional Milk

Secreted after 5-14 days
Increased sugar and fat
Decreased protein and lactose

Preterm Milk

Milk secreted by mothers of preterm babies

Mature Milk

Secreted after 14 days
Compared to colostrum:
- Contains more Sodium, Iron, Protein, and Sugars (Calories) (mnemonic: SIPS)

Fore Milk and Hind Milk

	Foremilk	Hindmilk
Production	At the initiation of feeding	Towards the end of feeding
Consistency	Thin	Thick
Main component	Water	Fats
Function	Quenches thirst	Satiety (energy dense)
Appearance	White	Yellow

Deficiencies in Breast Milk

Micronutrients

Vitamins

Vitamin K
Vitamin D
Vitamin B12 (in vegetarian/vegan mothers)

Supplementation

Vitamin	Dose
Vitamin K	1 mg IM on the anterolateral aspect of the thigh (0.5 mg dose if birth weight < 1 kg)
Vitamin D	400 IU/day orally up to 1 year of age

Others

Iron
Zinc (not supplemented due to good bioavailability)

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers essential concepts related to temper tantrums and tics in children, including their onset, characteristics, and management strategies. Explore the complexities of motor and vocal tics, alongside insights into Tourette's Syndrome, all crucial for understanding child behavior and psychology.

Paediatrics Marrow Pg 51-60 (Growth & Development)

Choose a study mode

Podcast

Questions and Answers

At what age do temper tantrums typically begin?

Tics are characterized by slow, rhythmic, voluntary movements.

What is a common simple vocal tic?

Tourette's syndrome is characterized by the presence of both motor and vocal tics for at least ___ year(s).

Match the following types of tics to their descriptions:

What is a long-term problem associated with growth and development?

Behavioral therapy is suggested for treatment at 5 years of age.

What is PICA?

The consumption of inedible substances like chalk or paint for at least one month is known as __________.

Match the following issues with their respective categories:

Which of the following is NOT a cause of congenital developmental delay?

Developmental deviance refers to the loss of previously acquired milestones.

Provide an example of a condition associated with regression in developmental milestones.

___ infections are a known cause of congenital developmental delay.

Match the following types of developmental disorders with their characteristics:

What is the developmental quotient (DQ) if a child has a developmental age of 24 months and a chronological age of 30 months?

A global developmental delay is indicated when there is a delay in only one developmental domain.

What is the upper limit for achieving head control in infants?

The formula for calculating corrected age is: Corrected age = Postnatal age - ________.

Match the developmental screening test with its mnemonic:

What is a common factor that can trigger a breath holding spell in infants?

Breath holding spells can persist until the age of 5 years.

What is the recommended dosage of iron for preterm breastfed babies with a birth weight of 1.5-2.5 kg?

What management step should be taken during a tonic clonic episode of a breath holding spell?

Preterm breastfed babies do not require any supplementation.

What supplements are recommended for preterm breastfed babies weighing 1.5-2.5 kg?

In the pallid type of breath holding spell, the child becomes _____ and may develop a syncope-like attack.

Match the type of breath holding spell to its corresponding description:

For human milk fortification, preterm babies require __________, Vitamin D, and Vitamin K.

Match the following supplements to their intended purpose for preterm breastfed babies:

Which of the following is a primary cause of nocturnal enuresis?

Secondary nocturnal enuresis occurs in individuals who have previously been dry at night for at least 6 months.

What is the management approach that has the highest success rate for treating nocturnal enuresis?

Passing urine at night time only is classified as __________ nocturnal enuresis.

Match the following management strategies with their descriptions:

What is one of the characteristics of transitional milk?

Mature milk is secreted before 14 days after birth.

List two deficiencies commonly found in breast milk.

The main function of hindmilk is to provide __________.

Match the following types of vitamins with their supplementation dosages:

What is the recommended time frame for initiating breastfeeding after birth?

Exclusive breastfeeding is advised for infants up to 8 months of age.

What is the primary feeding method for preterm babies born before 28 weeks gestation?

The baby's mouth should be wide open and the ______ should touch the breast for correct latching.

Match the gestational age with the appropriate method of feeding:

What is the primary immunoglobulin found in colostrum?

Human milk oligosaccharides (HMOs) are digestible substances that promote gut health.

What is the caloric value of breast milk per 100 mL?

The predominant protein type in breast milk has a whey to casein ratio of ___ to ___.

Match the following types of milk with their characteristics:

Study Notes

Temper Tantrums

Tics

Motor Tics

Vocal Tics

Tourette's Syndrome

Growth and Development

PICA

Causes of Developmental Delay

Congenital Causes

Acquired Causes

Variants of Developmental Disorders

Disorders of Development

Red Flag Signs for Developmental Delays

Tests for Developmental Assessment

Screening tests (Mnemonic: Good Doctor Treats Patients)

Definitive tests

Behavioral Disorders in Children

Breath Holding Spells

Types

Management

Bruxism

Management

PICA

Supplementation in Preterm Breastfed Babies

Nocturnal Enuresis

The predominant protein type in breast milk has a whey to casein ratio of _ to _.