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Development

  1. Mile stones
  1. Motor

The examiner suspends the infant in a prone position by supporting the abdomen of the baby on his palm. The extension of neck and flexion of the extremities is observed

 

New born

  1. Head hangs completely and back is rounded
  2. 4 weeks - Head momentarily lifted up, elbow flexed
  3. 8 weeks - Head maintained in the same plane as rest of the body
  4. 12 weeks - Head raises above the plane of rest of the body
  5. 3 Month -  Neck holding
  6. 5 month - sitting with support
  7. 6 month - prone to supine, supine to prone
  8. 8 month - sitting without support
  9. 9 month - crawling
  10. 10 month - creeping
  11. 11 month - walks two hands held or on holding the furniture
  12. 12 month - walks few steps independently
  13. 2 year -  Walks up and down stairs with two feet on each step, runs, can kick a ball
  14. 3 year - Goes upstairs with one foot on each step riding tricycle
  15. 4 year - Comes down stair with one foot on each step
  16. 5 year - skip
  1. Fine motor
    1. New born - Grasp reflex
    2. 12 weeks - Grasp reflex disappear
    3. 5 months - goes for object and gets them usually with bidexterous approach, puts object into mouth plays with toes.
    4. 6 months - Drops one object when another is given
    5. 7 months - Unidexterous approach to object transfers object; retains one cube when another is offered
    6. 10 months - pincer grasp
    7. 1 year- Gives toy to examiner mouthing is much reduced casting.
    8. 15 months -  Self feeding with spoon
    9. 18 months - Self feeding with cup, Makes tower of 3-4 cubes, scribble; self feeding with spoon without spillage  
    10. 2 year - Makes tower of 6-7 cubes, Can turn page of book one at a time, vertical strokes
    11. 3 year - Makes tower of 10 cubes draw a circle
    12. 4 year- Draw plus (+), and square ()
    13. 5 year- Draw cross X, and triangle (Δ)
  2. Social
    1. 2 month - Social smile                        
    2. 3 month- Recognizes mother
    3. 6-7 month- Smiles at mirror image/start enjoying mirror image Q
    4. 9 month- Waves bye-bye
    5. 1 year- Shakes head for no                
    6. 15 month - Hugs the parent / Pointing objects Q
    7. 18 month - Kisses the parent                      
    8. 2 year - Dry by day
    9. 3 year- Dry by night                            
    10. 4 year- Goes to toilet alone Linguistic
    11. 2 months- Vocalizes                            
    12. 3 months - Cooing
    13. 6 months- Monosyllables (ma, ba)              
    14. 9 months- Bisyllable (ma-ma, ba-ba)
    15. 12 months - Two words with meaning        
    16. 18 months - Ten words / domestic mimicry Q
    17. 2 years- Simple Sentence                  
    18. 3 years- Know age and Gender and Name
    19. 4 years - Tells story                                    
    20. 5 years- Names four colours, dress / undress without assistance
Some important age related mile stone
  1. 7 month    -  Enjoy mirror image, transfer object, stranger anxiety.
  2. 10 month -  Creeping, pincer grasp, play pat a cake wave bye-bye, ma-ma, ba-ba
  3. 2 years     -  Run/Jump/walk backward/climb stair (up & down with 2 feet per step), unscrew lid/ turn door knob, draw street line, use I / Me / You, Point 5 to 6 objects, Name 2-3 object, Point 3-4 body part,  dry by day,  
  4. 3 year      -  Stands momentarily one feet, Rides tricycle, draw circle, tower of 10 cube,climb up stair with alternate feet, know age name and gender/sex, start counting, identify 1 to 2 color.  
  5. 4 year      -  Climb down stairs with alternate feet, can hope, make gate with tower, discrimination right and left.
  6. 5 year     -  Skip, 3 step command, identified 4 color, repeat 4 digits, tie shoe lace.
  7. Adolescent boys and girls gain about 25% of the adult height and 50% of the total adult weight during puberty.
  8. Increase muscle mass is due to adrenal hormones**
  9. First sign of puberty
    1. Boys—increase in testicular size
    2. Girls— breast development
    3. In girls the peak Growth velocity occurs just before the Menarche.
  Table: Red flags signs in child development
  Milestone   Age
  No visual fixation or following by          
  No vocalization by    
  Not sitting without support by  
  Not standing alone by      
  Not walking alone by       
  No single words by  
  Lack of imaginative play at      
  2 months
  6 months
  9-10 months
  16 months
  18 months
  18 months
  3 years
  Loss of comprehension, single words or phrases at any age
  1. Bone Age Estimation
  1. At Birth: Epiphysis of distal femur & proximal tibia present.  
  2. Till 1yrs of Age: Shoulder joint , Wrist joint
  3. 1-12 yrs of Age: Wrist joint                                   
  4. 12 – 18 yrs : Elbow joints
  5. >18 yrs : HIP Bone. 
Mnemonic to remember wrist bone appearance for Age estimation
 
Sneh Lata Tinde Paka Tere Tinde Cache Hain
Scaphoid Lunate Triquetral Pisiform Trapezium Trapezoid Capitate Hamate
5yr +4yr + 3yr     = 12 yrs 5 yrs 5 yrs 2 mo 3mo
  1. Short stature
    • If the length or height of the child is below the 3 rd percentile or less than 2 S.D. from the mean
    • Causes of Short stature
      1. Proportionate
        1. Constitutional delay in growth
        2. IUGR
        3. Intrauterine infection
        4. Chromosomal disorders / genetic dimorphic syndromesQ
          1. Prader Willi syndrome
          2. Skeletal dysphasia’s achondropasia
          3. Glycogen storage disorders
          4. Noonan s syndrome
          5. Silver Russell syndrome
          6. Turner syndrome
          7. William syndrome
          8. Down syndrome
        5. Endocrine disorders
          1. Hypopituitarism
          2. Adrenal hyperplasia
          3. Hypothyroidism
          4. Congenital adrenal hyperplasia
          5. Cushing syndrome
          6. Hypogonadism
          7. Diabetes mellitus
          8. Hypercalecema / hypercalciuria
        6. ​Emotional deprivation
      2. Disproportionate
        1. With short limbs-Q
          1. Achondroplasia, chondroectodermal dysplasias
          2. Deformities due to rickets
          3. Osteogenesis imperfecta
        2. With short trunksQ
           
          Mucopolysaccharidosis Q, spondylo-epiphyseal dysplasiasQ
Constitutional delay in growth
  1. Ultimate height is normal
  2. Short stature in mid childhood
  3. H/o of one of the parent being short stature
Familial short stature
Growth velocity is less than normal, but they gain more than 4 cm/yr

Human growth hormone deficiency:
  1. Normal Birth weight. Length            
  2. Delay- around one yr
  3. Less than 4 cm /yr                                
  4. BONE AGE DELAYED
  5. Episodes of hypoglycemia                    
  6. Delayed puberty
Comparison of constitutional delay and familial short stature
Features Constitutional growth delay Familial short stature

Height
Height velocity
Family history
Bone age
Puberty
Final height

 

Short
Normal
Of delayed puberty
Less than chronological age
Delayed
Normal

 

Short
Normal
Of short stature
Normal
Normal
Low but normal for target height
  1. Tall stature
    1. Constitutionals or familial
    2. Gigantism
    3. Klinefelter s syndromeQ
    4. Marfan syndrome Q
    5. Pituitary adenoma XYY syndromeQ
  2. Bone age:
    1. Delayed
      1. Constitutional delay in puberty
      2. Hypothyroidism
      3. Hypopituitarism
      4. Malnutrition
      5. Chronic illnesses
    2. Bone age is advance to height ageQ
      1. Genetic short stature
      2. ChondrodystrophiesQ
      3. Down syndromeQ
      4. Turner syndromeQ
      5. Intrauterine infection




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