Rapid Fire Growth &
Development
March 2008
Board Review
A word from the
esteemed
Dr. Shannon Wahl
“So much
development [on the
boards]. You must
know in DETAIL all
milestones as there
are multiple questions”
“…and when you think
you know them
all…keep studying
because these
questions really suck.”
How old am I?
• What am I doing?
• I am bringing my
hands together at
midline
• I am 2 months old
At what age do these reflexes
disappear?
Moro reflex gone by 4
months
Babinski reflex gone by 4
months…you hope
Come on baby do the Locomotion
• Name the stages in
order
• Crawling – belly is
still on the floor
• Creeping- child is on
hands and knees
• Cruising-standing
with two-handed
support on
stationary objects
• Free walking
How old am I?
•
•
•
•
Baby on the Left?
One month of age
Head lagging boo
Baby on the
Right?
• 5-6 months
• My head is
working with my
body
Put your pills away!
• Name this grasp
• Fine (mature)
pincer
• Between
fingertips/nails
• 12 months
Name this finding
• Scissoring
• Hypertonia
• May be hypotonic
as infants
• Diagnosis?
• Cerebral Palsy
• Static or
Progressive?
• Static
Look! Learn! Try it at home!
Prone Babies
• The baby whose
head is cleared
off of the floor is
how old
• 3 to 4 months
• At 2 months, they
try and try but
don’t succeed
My name is Simon and I like to do
my drawings
• How old are the
children who drew
these figures?
• Base age 3 years
old
• ¼ year for each
feature
• Eyes, nose, mouth,
hair, and legs
4 ¼ yo
4 ¾ yo
Arms and Ears
Note proportionality
She is adorable
• What specific type
of CP does she
have?
• Hemiplegia
– Ipsilateral arm and
leg; arm worse than
leg
• Diplegia- lower
extremities
Knock your block off
2+4=6
Bridge of 3
A full term female is born weighing 3kg
• She comes to the office at 2 weeks old
and weighs 2.8 kg. What is your next
step?
– Reassurance. Babies may not regain birth
weight until 3 weeks old.
– Reassess in one week!
A full term female is born weighing 3kg
• She’s at the 50% for length & head
circumference.
• What’s her length?
– 50 cm!
• What’s her head circumference?
– 35 cm!
A full term female is born weighing 3kg
• What would she weigh at 5 months?
– 6 kg
– Babies double their weight by 5 months!
• What would she weight at one year?
– 9 kg
– Babies triple their weight by one year!
Weight
• Average birth weight is 3.25 kg.
• It’s OK to lose 10% of your birth weight.
– This occurs by age 1 week
– By 2 weeks, you should be back to birth
weight.
• Babies double their weight by 5 months
(Latin babies with abuelas may do this
by three months)
Wait!
• Babies triple their birth weight by 1 year.
• They quadruple their birth weight by 2 ½
years.
Case Scenario
• A 3 year old child presents for WCC
• His weight is at the 50%.
• His height has fallen from the 25% to
below the 5th percentile.
• PE is otherwise normal and FHx is
noncontributory.
• Why is this child short?
You want choices?
•
•
•
•
•
Poor nutrition
Constitutional growth delay
Growth hormone deficiency
Neglect
Lack of high heels
Growth Hormone Deficiency
• The usual case scenario is a child that
is gaining weight ok but is short.
– Family history is non-contributory
(Constitutional Growth Delay)
– Weight is maintained (Nutrition, Neglect)
• Hypothyroidism could also present with
the same case scenario.
Which is the most concerning?
• A 6 month old who doesn’t turn to voice
OR
• A 14 month old who doesn’t walk
• The 6 month old! This requires intervention!
• The 14 month old may just be at the end of
normal for gross motor development
Which is the most concerning?
• A 4 year old who stutters
OR
• A 3 year old with unintelligible speech
• Stuttering can be normal up to 4 years
old and parents should be reassured.
• A 3 y.o. w/ unintelligible speech is VERY
concerning & warrants a full evaluation.
Which is the most concerning?
• A child who lines up toys (that’s all he
ever does!)
OR
• A little boy who plays with Barbies
• Compulsive behaviors such as lining up
toys as only form of play should be a tip
off for autism.
Autism
• Screening needs to start at 9mo
– Goal is to identify ASD before 18mos
• Parental concerns
–
–
–
–
lack of eye contact and joyful expressions
lack of to-and-fro pattern of speech
lack of recognition of parents’ voice
keen awareness for environmental sounds but doesn’t
respond to name
– delayed onset of babbling past 9 months of age
– Decreased/absent use of gestures (waving, pointing,
showing) & lack of expressions such as "oh oh" or "huh"
True or False
• The mom of a 6 year old child is worried
because the kindergarten teacher
mentioned that the child often mistakes
the letters B and D.
• True or false: This child likely has
dyslexia.
– FALSE!
– This can be a normal finding up to age 7!
Know your shapes!
3
4.5-5
5
4
Things that make you go
Hmmm.. Or help you to
remember this stuff
Aka Mnemonics
Courtesy of Dr. Hauser
and Miami Children’s
Hospital
Mnemonics
• Follows to midline:
the number “one” is
the midline.
• One month old
follows to midline
1
Mnemonics
• 2MILES 2OCIALLY
• Follows past midline: Can look at 2
sides at 2 months.
• Recognizes parent: with their 2 eyes.
Mnemonics
3
• Follows in a
circle
• C s (Coos)
• Baby is “tri”podding (on
forearms)
1
2
3
New monnix
• Rolls over: prone to
supine first.
• Smiles at 2 mo,
laughs at 4 mo. A
laugh is like a
double smile
• Rattle looks like a 4
Bubonics
• Sit and Switch at Six!
•6a66les (babbles)
• 6 looks like a baby sitting with a round
butt
Moon Onyx
• Pincher starts at
nine months.
• Throws ball: like a
pitcher in a 9inning baseball
game.
• Waves bye like this
cats with 9 lives
9
Memory things
• Starts to walk alone at 1 year. 1 baby,
1 year: get it?
• Makes a mark with crayon (He’s trying
to draw a one!)
• Follows 1 step commands with gesture.
(Bring me a beer!)
• Speaks 1 (to 2) words (mama & dada
don’t count)
Ya know
• Child uses a cup
alone, and can drop
a cube into a cup.
Think of the 5 as a
cup.
• Says 4-6 words:
that’s 5 +/- 1 (15)
Remember
• 7-10 word vocabulary: that’s 8 +/- 1 (18)
• When you turn 18 (yrs), you run away
to college. When child turns 18 (mo) he
just runs!
Don’t forget
• Parallel play: 2 parallel lines at 2 yrs
old.
• 2 yrs:
– 2 word sentences
– Follows 2 step commands
• Do the two step! This dance move
reminds you that at age 2, child can
walk up/down steps alone.
Easy as 1, 2, 3
• Now he’s 3!
–
–
–
–
–
Can ride a tricycle (3-wheeler)
Uses 3 word sentences
Knows (1) age, (2) name, and (3) gender
Builds bridge of 3 cubes
Usually can repeat 3 digits
• Can draw a circle. That one doesn’t fit, but
remember: follows in a circle at 3 mo, draws
a circle at 3 yrs.
• Plays in a group (3-some)
4’s
• (age)/4 = fraction of intelligible speech
•
•
•
•
– 25% at age one
– 50% at age two
– 75% at age three
– 100% at age four
FOUR years old
Copies a cross and square (4 ½). Both have 4
“corners.”
Asks questions: What for? (what 4?)
Names 4 body parts
Last one
• Likes to defive (define) words
• Almost ready for school:
– abides by rules
– prints first name
RED FLAGS… AGAIN
It is getting
repeated for a
reason folks
RED FLAGS
• 2 months
– No fixating/No visual attention
• 4 months
– No visual tracking, No steady head control
• 6 months
– Doesn’t turn to sound or voice
• 9 months
– Doesn’t sit, Doesn’t babble
Red Flags
• 18 months
– Doesn’t walk independently
• 24 months
– No single words
• 36 months
– No 3 word sentences
• Older than 36 months
– Unintelligible speech
A word from the
esteemed
Dr. Shannon Wahl
“So much
development [on the
boards]. You must
know in DETAIL all
milestones as there
are multiple questions”
“…and when you think
you know them
all…keep studying
because these
questions really suck.”