Board Review

Growth and Development

July 2018
Check out that head shape Just keep growing The joys of development Screens

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Check out that head shape: $100

A premature neonate presents with possible macrocephaly.

What is the diagnostic test of choice?

Answer
Answer:
Ultrasound of the head

A premature neonate is at risk for hydrocephalus, often the result of an

intraventricular hemorrhage. If a test question describes a premature neonate
with an enlarged head circumference, a cranial ultrasound to rule out
hydrocephalus is indicated. A CT or MRI is not needed for the diagnosis of
hydrocephalus.
Check out that head shape: $200
If an infant presents with abnormally slow head growth or absolute micocephaly,
what is the best diagnostic test to order?

Answer
Answer: CT or MRI of the head

Microcephaly may be primary (ie due to a genetic disorder) or secondary (ie due to
infection). Structural abnormalities are often associated with microcephaly and are
best evaluated by MRI (if MRI is not listed as an option, choose CT). An ultrasound (the
correct choice for infants with macrocephaly to evaluate hydrocephalus) is not
indicated in the evaluation of microcephaly.
Check out that head shape: $300
A child was born with a “large head” (but within normal range). Now at 3 months
of age, he presents with a head circumference that exceeds the 98th percentile.
Radiologic study confirms isolated enlargement of the subarachnoid space.

What is the recommended treatment?

Answer
Answer: Reassurance

Enlargement of the subarachnoid space is a benign condition that requires no

intervention. About 2/3 of affected infants are boys.

*Evaluation of macrocephaly starts with measurement of the parents’ head

circumferences and a head ultrasound if the fontanelle is still open.

*Hydrocephalus may require emergent neurosurgical intervention if there is

evidence of increased intracranial pressure.
Check out that head shape: $400

When is the fastest rate of head growth?

Answer
Answer: Between 0 and 2 months of age

The fastest rate of growth is between 0 and 2 months of age when the child
grows at 0.5 cm/week (2 cm/month). The average head circumference at full
term is 33-37 cm. By 12 months, the brain is 75% of adult size.
Check out that head shape: $500
What is the most common type of craniosynostosis?

Answer
Answer:
Scaphocephaly

Scaphocephaly is premature closure of the midline sagittal suture and is

characterized by a long, narrow skull. It has a 4:1 male predominance.
Just keep growing: $100

How soon does an infant regain birth weight?

Answer
Answer:

10-14 days of life

Infants gain 20-30 g/day for the first 3-4 months and then gain 15-20 g/day for the
rest of the year
Just keep growing: $200

What is the most common reason for failure to thrive (FTT)?

Answer
Answer:
Inadequate consumption of appropriate amounts/calories of food

Most cases of FTT are caused by inadequate consumption of appropriate amounts

and/or kinds of food. Most cases can be managed on an outpatient basis.
Just keep growing: $300
When does birth weight double? Triple? Quadruple?

Answer
Answer:
4 months; 12 months; 24 months

After the age of 2 years, normal weight gain is 5 lbs/year until adolescence
Just keep growing: $400
How much does birth length increase by 1 year of age?

Answer
Answer:
Birth length increases by 50% at 1 year of age. The average birth length is 20
inches; average height at 1 year of age is 30 inches.
Just keep growing: $500
When does birth length double? Triple?

Answer
Answer:
4 years; 13 years
The joys of development: $100
At what age does a child roll from front to back? Back to front?

Answer
Answer:
4-5 months; 5-6 months
The joys of development: $200

At what age should a child be able to sit with support; with no support?

Answer
Answer:
6 months; 7 months
The joys of development: $300

At what age should a child be able to hold their head up to 90 degrees and lift their
chest?

Answer
Answer:
4 months

Head lag at this age is a red flag for referral

Also, most infants lose their Moro reflex by 3-4 months of age
The joys of development: $400

A young girl can do the following:

-Run well
-Climb up and down stairs, 2 feet each step
-Balance on 1 foot for 2-3 seconds
-Dress herself
-Use 3-word sentences

She cannot:
-hop on 1 foot Answer
-use 4 word
sentences
-skip
How old is this girl?
Answer:
3

A 4 year old should be able to hop on one foot and use 4 word
sentences

A 5 year old should be able to skip

The joys of development: $500

At what ages can a child copy a circle? A cross? A square? A

triangle?

Answer
Answer:
Circle – 3
Cross – between 3 and 4
Square – 4
Triangle - 5
Screens: $100
If you suspect a language disorder, what is the first test to order?

Answer
Answer:

Hearing screen – this is the most important thing to do when evaluating a

language problem!
Screens: $200

At what age does the AAP recommend that children being seeing a
dentist?

Answer
Answer:

12 months

The AAPD recommends that children begin seeing a dentist at 12 months of

age. However, if a pediatric dentist is unavailable, the AAP states that all
children should have their first dental visit by no later than 3 years of age
Screens: $300

According to the 2014 AAP Bright Futures guidelines, at what age is

hemoglobin or hematocrit screening to be performed?

Answer
Answer:
12 months
Screens: $400
At what age does the AAP recommend initial autism screening?

Answer
Answer:
18 months

The AAP recommends universal screening for autism in children with an

autism specific tool (ie MCHAT) at both the 18 and 24 month visit.
Screens: $500

According to the AAP, at what age should you begin a

discussion with children about “sex and drugs”?

Answer
Answer:

10 years
 2 months
• They can follow their mom around the room through at 180 degree arc,
which is really 2 sides; 2 months = 2 sides
• A 2 month old can lift his or her head and chest while prone (picture it
as a number 2 rolling up), and coo (rhymes with 2)
 4 months
• A 4 month old scratches and grabs clothes, and will clutch at
and hold onto a rattle. They can also place objects deliberately
in their mouths.
• Picture a number 4 as a rattle.
 6 months
• A 6 month old can sit up
• Picture a number 6 sitting with the bottom of the number as
its butt. They can transfer a cube from one hand to another
(picture a 6 transforming into a 9 from hand to hand).
• You can also change the word “six” to “sit” as in: “sit months
old can sit”
 1 year
• A one year old can walk with one hand held. They can also
point because pointing takes ONE finger and they say ONE
word besides “mama” and “dada”
 18 months
• An 18-month old walks fast, falls occasionally, walks upstairs
with hand held, and climbs into and sits in a chair
• They will feed themselves, but it is quite messy
• All very similar to the average 18 year old
 2 years
• A 2 year old builds a 6 cube tower
 3 years
• A 3 year old can walk up stairs alternating feet, ride a tricycle (3
wheels) and hop 3 times
 4 years
• 4 year olds can identify opposites, which is easy to remember
since they practice them all the time. You say “yes”, they say
“no”. You say “wear your red coat” they say “Blue”. You get
the picture.
• A 4 year old can draw 4 body parts
• Rule of 4s: Count to 4, Recite a 4 word sentence, Identify 4
primary colors, draw a 4 part person, build a gate out of blocks
(picture a #4 as a gate), a stranger will understand 4/4 of what
they are saying
 5 years
• Can tie a knot, correctly grab a pencil, and print letters. These
are skills required in school, making it easy to remember. At 5,
they can draw a square.
• A 5 year old walks backward from heel to toe.
• This is often the age they start school, so picture a child trying
to avoid school by walking backwards.