Peds Growth-Devo.txt

Girls: [(dad's ht - 13) + mom's ht] / 2

Boys: [(mom's ht + 13) + dad's ht] / 2

All heights are in cm (13 cm = 5 in). Most children with in 5 cm of predicted height.

Initially normal height and weight which drop off proportionately in first 2 years of life.

Grows parallel to but low on curve through middle childhood.

Rapid growth in late childhood/adolescence yields normal adult height

Bone age delayed but consistent with "height age"

head circumference spared, if this is affected, investigate.

4-6 months

12 months

24 months

5 lbs/year (about 2 kg/year)

1 year

3-4 years

13 years

2 in/year (about 5cm)

• Boys: 36cm
• Girls: 35cm

Fastest growth at 0-2 months (0.5 cm/wk)

• abuse/neglect or high likelihood of
• severe malnutrition
• medically unstable
• failed outpatient management
• need for close observation

• wt <3rd%
• wt for ht < 5%
• wt 20% or more below ideal wt for height

wt gain < 20gm/day 0-3months

wt gain< 15gm/day 3-6 months

dropping down 2 or more major percentile lines (is this after a specific age or just after a curve is extablished?)

• Excessive loss
• GI/malabsorption
• Renal/RTA

• Increased caloric requirement
• Cardiopulm disorders/CHF
• Malignancies
• Hyperthyroidism
• Chronic infection (fungal, HIV, etc.)

bone abnormality or lack of brain development

CT or MRI of head

hydrocephalus

head US

genetic/chromosomal cause

will be present at birth

CT may be normal

infection (pre or post-natal), toxin, or CNS injury the arrests previously normal brain growth

may present at birth or after several months (prenatal infections rarely cause head growth abnormalities before 4-6 months)

Head CT often abnormal

• CMV
• Toxoplasmosis

primary craniosynostosis has abnormally shaped skul and palpably thickened suture lines

suture form normally when lack of brain growth leads to premature closure

12-24 months

prevalence 0.1%

85% of affected are caucasian

3:2 M:F ratio

most often sagital suture (50%)

• breast fed infants (start in first few days of life)
• bottle fed infants taking less than 32oz of vitamin D fortified formula or whole milk
• toddlers taking less than 32oz of cow's milk
• Anyone getting less than 400IU from combined dietary sources

infant formula, iron-fortified cereal, FeS04 drops

supplement premie at 2 months, and term baby at 4-6 months

1mg/kg/day of elemental iron (FeSO4 drops) by 6 months if exclusively breast fed (though should be starting cereal soon)

Not in anyone under 6mo!!

• Supplementation depends on fluoridation level of community water
• <0.3PPM --> supplement at 6 months and increase at 3-6 years and again at 6-16 years
• 0.3-0.6PPM --> begin at 3 years and increase at 6 years
• >0.6PPM --> no supplementation

Only pea-sized quantity of toothpaste until 6yo (avoid fluorosis)

bottled water usually has no Fl, filtered water ok