Study Guide: Test 1: Well Child Fall 2010

**There will be about 50 questions on the test from the material below!!!!

1. What is developmental screening? What are the purposes of the

Denver Developmental tool? Developmental Screening is a first-
level contact with an individual to identify potential and actual
developmental concerns. It is conducted on all children assuming
that some will be identified as being outside normal limits.
Developmental assessment is done when a more intense approach is
needed to decide if there is a developmental concern. This is the
second level of analysis. Our main goal as pcp’s is to maintain and
encourage health. (As a pcp, we have a responsibility to monitor a
child’s physical health, psychosocial development and to provide
anticipatory guidance. Development is a lifelong, dynamic process.

The purpose of the Denver Developmental tool is to screen for

developmental delays in the 1st 5 years of life. It covers 5
developmental areas: communication, gross motor, fine motor,
problem solving, and personal-social.

2. What are the leading causes of infant mortality in the US? SIDS,
congenital malformations, shorter gestation, and maternal
complications

3. What is the average growth of an infant in the first month? Infants

lose 5 to 10% of their birth weight initially, but regain within 10-14
days. Wt gain after initial loss is .5 to 1 oz per day or about 2 lb per
month. During 1-3 months, infants continue to gain .5 to 1 oz per
day with 6-8 feedings. Length increases 3.5 cm per month. Head
circumference increases by 2 cm per month. May have growth spurt
around 6-8 weeks.

4. Cognitive development of a newborn? Newborn can give clear

signals of distress: crying, arching, and gagging. Newborn quiets to
the sound of the parents voice. Vision is limited. Infants can focus
briefly if object is in visual range.
5. Anticipatory guidance 9-12 mos.

6. Gross motor development seen in an average 5 y/o. Walk with

control, step easily over a balance beam, climb stairs with alternate
feet up and down, up ladders, run around corners, stop voluntarily,
light on toes, ride a tricycle, able to pedal, more control in throwing,
catching, bouncing, and kicking a ball, kip using alternate feet,
easily walk a narrow line, move rhythmically to music.

7. Physical development of a school-age child (Early 5-7, Middle 8-10,

and Late (11-12): School age children gain strength and coordination
and become more physically capable, in preparation for participation
in sports, dance, etc., rate of growth of SAC increases dramatically
from that of a toddler or preschooler and spurts occur, they literally
outgrow their clothes overnight, head circumference increases
slowly, by middle childhood the brain is 90% of its adult size, full
adult size of the brain is reach about age 12, the cerebral cortex,
responsible for intelligence, and the frontal lobe (responsible for
problem solving and decision making) are the last part of the brain
to develop. Organ development is complete in the SAC. Decreased
fat, however, the epidemic of childhood obesity has altered this.
Sleep about 12 hours per night, without nap.

• Lymphatic system is at its peak of development.

• Tonsils and adenoids are their largest at age 6 and then

atrophy later. Head become smaller in proportion to the rest of
the body.

• Sinus cavities are not fully developed and are thus highly
sensitive to exposure to smoke, allergens, and infections.

• Middle childhood: visual acuity is altered from farsighted to

20/20 in most children. Eustachian tube grows longer,
narrower, and more slanted in middle childhood. Fewer ear
infection occur. Learning a 2nd language is easier than
adulthood, but is easiest in toddlers and preschoolers. P

• rimary teeth are shed and permanent teeth emerge at 5-6 ,

first central incisor. About 4 teeth are replaced per year.
 • Lungs descend into the thoracic cavity with complete alveolar
development by age 8. Increased lung growth allows for a
slower, more adult like respiratory rate of 18-30. \

• By 5, the heart is 4x larger than at birth. This allows for

increased activity tolerance. By age 7, the LV thickens with
increased muscle mass 2-3 x the RV. CV continues to increase.
HR gradually decreases to 60-100.

• GI is more matured but is susceptible to environmental and

hereditary issues. Stomach aches, diarrhea, and constipation
are common complaints. By middle childhood, the GI system is
of adult size and function

• GU: By 6, urinary elimation patterns are established for 90% of

children. Occasional enuresis occurs

• Musculoskeletal: develops as the epiphyses of the bones grow,

become thinner, and disappear or “fuse”, No further skeletal
growth can occur at this point. Bone age via x-rays can be
estibmated by looking at the number of epiphyses that are
fused. Facial bones are dynamic and everchanging during this
period of time, particularly with the growth of the nasal
accessory sinuses.

• Immune system: matured quickly during middle childhood,

however, increased incidence of infections during first years of
school due to increased exposure to sick children and poor
hygiene. Late childhood: increased maturity of immune system
and fewer infections.

• TAKE ALL VS, HT, WT, HEARING AND VISION SCREENED

ANNUALLY. H/H EARLY CHILDHOOD AND AGAIN AT LATE
CHILDHOOD AND ADOLESCENCE. CHECK IMMUNIZATION
STATUS: IMPORTANT NOW WITH TDAP AND GARDASIL.

8. Tanner stages

I. Girls

Tanner Stage Stage of develop Pubic Hair Breasts

Stage 1 Early adolescence Preadolescent Preadolescent
(10-13 years)
Stage 2 Sparse, straight small mound
Stage 3 Middle adolescence Dark, curl bigger; no contour separation
(12-14 years)
Stage 4 Coarse, curly, abundant Secondary mound of areola
Stage 5 Late Adolescence Triangle; medial thigh nipple projects; areola part of
(14-17 years) breast

9. I. Boys

Tanner Stage of develop. Pubic Hair Penis Testes

Stage
Stage 1 Early adolescence None Preadolescent preadolescent
(10.5-14 years)
Stage 2 Scanty Slight increase larger
Stage 3 Middle adolescence Darker, curls Longer larger
(12.5-15 years)
Stage 4 adult, coarse, curly Larger scrotum dark
Stage 5 Late adolescence adult - thighs Adult adult
(14-16 years)

10. Cognitive development of an adolescent

11. Anticipatory guidance adolescents

12. Vitamin and mineral supplementation with breast feeding

13. Dental health in a two year-old

14. What medications are avoided in children and why?

15. 4 key indicators during H & P regarding a sick child.

16. How to dose Tylenol and motrin in pediatrics

17. Primitive reflexes in infants

18. Benefits of breastfeeding to mother and infant

19. General principles regarding development overall

20. Best way to approach a preschooler

21. Toilet training: when and why?

22. What to examine first in an infant that is quiet?

23. Fontanels, what do they tell us.

24. How to use growth charts: see the CDC website or your Burns
text for examples.

25. Pubertal development including Tanner staging

26. Visual acuity in school age children

27. Infant nutrition and physical development

28. Consequences of pediatric obesity

29. Energy drinks, the good, the bad and the ugly. Why should
children avoid them.

30. Car seat usage in infants

31. Toy safety

32. Lab screening in healthy pediatric patients during a well child

visit