Paediatrics Marrow Pg 31-40 (Growth & Development)
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Questions and Answers

What is considered true microcephaly?

  • Head circumference for age > -2 SD
  • Head circumference for age < -2 SD
  • Head circumference for age < -3 SD (correct)
  • Head circumference normal for age

    • Familial microcephaly is caused by a dominant inheritance pattern.

    False

    What common maternal factor can cause secondary microcephaly during pregnancy?

    TORCH infections

    Phenylketonuria is caused by a deficiency of __________.

    <p>phenylalanine hydroxylase</p> Signup and view all the answers

    Match the following conditions with their associated features:

    <p>Trisomy 21 = Down syndrome Cornelia de Lange syndrome = Joined eyebrows (synechiae) Rubinstein Taybi syndrome = Broad thumb PKU = Mousy/musty urine odour</p> Signup and view all the answers

    What is the primary purpose of measuring mid arm circumference (MAC)?

    <p>Determine nutritional status</p> Signup and view all the answers

    Skin fold thickness is measured at the abdomen, triceps, and wrist.

    <p>False</p> Signup and view all the answers

    Name one of the organizations that developed growth monitoring charts for children under 5 years.

    <p>WHO</p> Signup and view all the answers

    The Harpenden's calliper is used for measuring ______.

    <p>skin fold thickness</p> Signup and view all the answers

    Match the mid arm circumference (MAC) color code to its nutritional status:

    <p>Red = Severe malnutrition (&lt; 6 mm) Yellow = Malnutrition (11.5 - 12.5 cm) Green = Normal (&gt; 12.5 cm) Blue = Adequate nutrition (10 - 12 cm)</p> Signup and view all the answers

    What is the primary instrument used to measure length in children under 2 years old?

    <p>Infantometer</p> Signup and view all the answers

    What is the age range for adolescence?

    <p>10-19 years</p> Signup and view all the answers

    Height is measured in children older than 2 years while lying down.

    <p>False</p> Signup and view all the answers

    Thelarche refers to the development of breast tissue in males.

    <p>False</p> Signup and view all the answers

    At what age is height equal to arm span?

    <p>11 years</p> Signup and view all the answers

    At birth, the head circumference is approximately ___ cm.

    <p>34</p> Signup and view all the answers

    What are the two phases of postnatal growth?

    <p>Infancy and Toddler</p> Signup and view all the answers

    Match the following measurements with their respective values at birth:

    <p>Height = 50 cm Head Circumference = 34 cm Chest Circumference = 31 cm</p> Signup and view all the answers

    During puberty, males experience an increase in the size of the ______.

    <p>testis</p> Signup and view all the answers

    What happens to the arm span compared to height after the age of 11?

    <p>Arm span exceeds height by 1-2 cm</p> Signup and view all the answers

    Match the following phases of growth with their respective time periods:

    <p>Infancy = 1st year Toddler = 1-3 years Preschool child = 3-6 years School age = 6-12 years</p> Signup and view all the answers

    The growth spurt during puberty affects arm span but not height.

    <p>False</p> Signup and view all the answers

    What is the typical increase in head circumference per month during early life?

    <p>2 cm</p> Signup and view all the answers

    Which law of growth describes the pattern from head to toe?

    <p>Cephalocaudal growth</p> Signup and view all the answers

    Brain tissue reaches 90% of its growth by the age of 4.

    <p>False</p> Signup and view all the answers

    What is the Tanner stage where breast buds first appear in females?

    <p>I</p> Signup and view all the answers

    At what ages do males typically complete growth maturation?

    <p>20-22 years</p> Signup and view all the answers

    The average birth weight in India is between ___ kg.

    <p>2.8-3</p> Signup and view all the answers

    In Tanner stage IV for males, the testicular size is significantly darkened.

    <p>True</p> Signup and view all the answers

    At what Tanner stage does pubic hair resemble the adult pattern?

    <p>V</p> Signup and view all the answers

    Match the following growth types with their descriptions:

    <p>Cephalocaudal = Growth from head to toe Distal = Growth of limbs and fingers first Epiphysis fusion = Completion of skeletal growth Gonadal growth = Increases around puberty</p> Signup and view all the answers

    In Tanner stage II for females, the areola and nipple remain distinctly _____.

    <p>separate</p> Signup and view all the answers

    Match the Tanner stages with their corresponding descriptions for males:

    <p>I = No noticeable changes II = Slight enlargement of the testicles and scrotum III = Further increase in testicular volume with darkening of the scrotum IV = Further increased size of the testicles with significant darkening of the scrotum V = Adult appearance with testes and scrotum at full size</p> Signup and view all the answers

    What is the maximum duration after birth to terminate treatment for HIE in neonates?

    <p>72 hours</p> Signup and view all the answers

    Stage 2/Stage 3 HIE can be treated in neonates who are born before 36 weeks of gestation.

    <p>False</p> Signup and view all the answers

    Within how many hours after birth does treatment for HIE begin?

    <p>6 hours</p> Signup and view all the answers

    A contraindication for treatment in neonates with HIE is being __________.

    <p>preterm</p> Signup and view all the answers

    Match the following stages of HIE with their respective characteristics:

    <p>Stage 1 = Mild neurological impairment Stage 2 = Moderate neurological impairment Stage 3 = Severe neurological impairment Stage 4 = Coma or seizures</p> Signup and view all the answers

    What condition is a possible outcome of parasagittal infarction in term babies?

    <p>Spastic quadriplegia</p> Signup and view all the answers

    Selective neuronal necrosis primarily affects the motor cortex of the upper limbs.

    <p>False</p> Signup and view all the answers

    What is the initial drug of choice for treating seizures in neonates?

    <p>Phenobarbitone</p> Signup and view all the answers

    The temperature range for therapeutic hypothermia is _____°C to _____°C.

    <p>33.5, 34.5</p> Signup and view all the answers

    Match the following neonatal complications with their associated conditions:

    <p>Parasagittal infarction = Spastic quadriplegia Periventricular leukomalacia = Spastic diplegia Selective neuronal necrosis = Dystonic/extrapyramidal cerebral palsy Focal ischemic necrosis = Hemiplegic cerebral palsy</p> Signup and view all the answers

    What color represents boys on the WHO growth chart?

    <p>Blue</p> Signup and view all the answers

    Standard deviation (SD) measures frequency distribution of a given value.

    <p>False</p> Signup and view all the answers

    What is the threshold for stunted growth according to the height for age status?

    <p>&lt; 3rd percentile</p> Signup and view all the answers

    The WHO growth chart uses ______ color for girls.

    <p>pink</p> Signup and view all the answers

    Match the following statuses with their corresponding height for age interpretations:

    <p>Stunting/Short Stature = &lt; 3rd percentile Normal Growth = Between 3rd and 85th percentile Overweight = Above 85th percentile Underweight = Weight for height less than 3rd percentile</p> Signup and view all the answers

    What defines the condition of birth asphyxia according to the WHO?

    <p>Failure to initiate and sustain breathing after birth</p> Signup and view all the answers

    The National Neonatology Forum's criteria for evaluating birth asphyxia include an APGAR score of 4 to 6 as moderate asphyxia.

    <p>True</p> Signup and view all the answers

    What is considered severe birth asphyxia according to the National Neonatology Forum criteria?

    <p>APGAR score of 0 to 3</p> Signup and view all the answers

    Profound metabolic acidosis is assessed using the umbilical cord ______.

    <p>pH</p> Signup and view all the answers

    Match the following definitions of birth asphyxia to their corresponding organizations:

    <p>WHO = Failure to initiate and sustain breathing after birth NNF = APGAR score criteria for evaluating asphyxia AAP = Criteria based on umbilical cord pH measurement</p> Signup and view all the answers

    Study Notes

    Measuring Growth in Children

    • Length: Measured in supine position using an infantometer for children up to 2 years old
    • Height: Measured in standing position using a stadiometer for children older than 2 years old
    • Arm Span: Measured in uncooperative children as the distance between middle fingers of outstretched arms
    • Head Circumference (HC): Indicates brain growth, measured in centimeters
    • Chest Circumference (CC): Measured at the 4th intercostal space, compared with HC
    • Mid-Arm Circumference (MAC): Measured in age groups of 1-5 years, depends on muscle mass and fat, indicator of nutritional status

    Growth and Development

    • Growth Monitoring: Plotted on growth charts, types include WHO charts (< 5 years), Indian Academy of Pediatrics (IAP) chart (5-18 years), and consolidated charts
    • WHO Chart: Internationally used since 2006, based on multicenter growth reference study (MGRS) with children from developed and underdeveloped countries
    • Interpretation of MAC: Normal: ≥10 mm, Severe malnutrition: < 6 mm

    Abnormal Head Size and Shape

    • Microcephaly: Indicative of small brain size, head circumference for age < -2 SD = low value, head circumference for age < -3 SD = Pathological

    Phases of Growth

    • Prenatal: Zygote/fertilized ovum (< 2 wks), Embryo (3-8 wks), Fetus (>9 wks)
    • Perinatal: Newborn (1st 4 wks, early: 0-7 days, late: 7-28 days)
    • Postnatal:
      • Infancy (1st year)
      • Toddler (1-3 yrs)
      • Preschool child (3-6 yrs)
      • School age (6-12 yrs)
    • Adolescence: 10-19 yrs (Early: 10-13 yrs, Mid: 14-16 yrs, Late: 17-19 yrs)

    Pubertal Changes

    • Females: 8-13 yrs, sequence: thelarche, pubarche, growth spurt, menarche
    • Males: 9-14 yrs, sequence: ↑ size of testis, ↑ size of penis, pubarche, voice changes, pubic hair, spermarche, growth spurt, axillary & facial hair

    Tanner's Sexual Maturity Rating (SMR)

    • Used to assess puberty based on external appearance
    • Females:
      • Breast Changes: Prepubertal (No changes), I, II, III, IV, V
      • Pubic Hair Changes: Prepubertal, I, II, III, IV, V
    • Males:
      • Testicular Volume (mL) and Penis Size (cm): < 4, 4, 10, 16, 25
      • Changes: I, II, III, IV, V

    Laws of Growth

    • Pattern of Growth:
      • Cephalocaudal (Head to toe): Growth of head (in utero) → Growth of the lower body and limbs (After birth)
      • Limbs: Distal growth → Proximal growth (Example: Fingers grow first, then arms)
      • Different tissues grow at different rates: Brain tissue (90% growth completed in 2 years), Gonadal growth (Increases around puberty), Lymphoid growth (Rapid growth during ages 4-8), Skeletal growth (Steady process until puberty)
    • Completion/maturation: Fusion of epiphysis (Females: 18 years, Males: 20-22 years)

    Anthropometry

    • Methods to assess growth: Weight (Average birth weight in India: 2.8-3 kg)

    Neonatal Reflexes, HIE & Neonatal Seizures

    • Start: within 6 hours after birth
    • Indication: Stage 2 / Stage 3 HIE who are > 36 weeks
    • Termination: ≤ 72 hours after birth

    Neonatology - Complications

    • Term Babies:
      • Parasagittal infarction: Bilateral (B/L), leads to Spastic quadriplegia
      • Focal ischemic necrosis: Hemiplegic cerebral palsy
      • Selective neuronal necrosis: Dystonic/extrapyramidal cerebral palsy
    • Pre-term Babies:
      • Periventricular leukomalacia: Bilateral (B/L), affects motor cortex of lower limbs, leads to Spastic diplegia

    Investigations

    • Diffusion weighted imaging (DWI) MRI: IOC

    Management

    • Supportive Management:
      • Maintain: Normal temperature, Stable vitals, Blood glucose level between 75-100mg/dL
      • Treat seizures: Initial drug: Phenobarbitone
    • Therapeutic (Induced) Hypothermia:
      • Gaining popularity as an established treatment modality d/t improved outcome
      • Mechanism: ↓ metabolism (esp.brain), ↓ free radicals
      • Methods: Cooling crystals, Whole body cooling
      • Temperature range: 33.5°C to 34.5°C

    Definitions of Birth Asphyxia

    • WHO definition: Failure to initiate and sustain breathing after birth
    • National Neonatology Forum (NNF) criteria: Based on APGAR score 1 minute after birth
      • Moderate: 4 to 6/10
      • Severe: 0 to 3/10
    • Essential criteria: American Association of Pediatrics (AAP) criteria: Most important
      • Profound metabolic or mixed acidosis: Umbilical cord pH

    WHO Growth Chart Interpretation

    • Colour of WHO Chart: Blue: Boys, Pink: Girls
    • Variants: Percentile (Frequency distribution), Standard Deviation (SD)
    • Stature/Height for age:
      • Stunting/Short Stature: < 3rd percentile or <-2SD
      • Normal: 2-97th percentile
      • Tall Stature: > 97th percentile or >2 SD
    • Weight for age:
      • Wasting/Underweight : < 3rd percentile or <-2 SD
      • Normal: 2-97th percentile
      • Overweight: > 97th percentile or >2 SD
    • Weight for height/length:
      • Normal: 2-97th percentile
      • Overweight: > 97th percentile
      • Underweight: < 3rd percentile
    • Note: For all categories except weight for height/length, a standard deviation of 2 or more indicates a significant deviation from the average

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    Description

    This quiz covers essential methods for measuring growth in children, including length, height, arm span, head circumference, and other relevant indicators. It also discusses growth monitoring techniques and the different growth charts, such as the WHO chart and IAP chart. Enhance your understanding of pediatric growth assessment with this quiz.

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