Growth & Development
2023
Dr. Mahmoud Faour
Newborn primitive reflexes
• Primitive reflexes: are involuntary movements or reflexes during
infancy triggered by stimulation , present during infancy and
disappear during baby development.
• Persistance of Primitive reflex indicates impaired brain development.
Rooting Reflex
• Stroking the cheeck elicits turning of
the head towards the stimulus.
• Age of resolution: Last for 4 months
Moro Reflex
• Infant startle i.e. extend head,
arm and legs followed by flexion
in response to sudden noise voice
or unexpected movement
• Age of Resolution: until 6
months of age
Sucking Reflex
• Touching the roof of the mouth
elicits sucking motion
• Age of Resolution: until 4 months
of age
•
Tonic Neck Reflex
• Turning the head to one side elicits
extension of the arm and leg on the
head side and flexion of the
contralteral arm and leg
• Age of resolution: until 4 – 6 months
of age
IMLE 6/2021
Grasp Reflex
Touching the palms elicits grasping
motion.
Age of resolution: until 6 months of age
Babinski reflex
• Stroking the sole of the foot will cause
dors-flexion of the big toe and fanning
of other toes.
• Age of resolution: Last until 1 -2 years
of age
Stepping reflex
• Holding the infant in upright position
with feet on examination table elicit
stepping motion [the baby try to move
their leg as trying to walk]
• Age of resolution: last for about 2
months
Parachute
Reflex
• Elicited by holding the
child in ventral supsension
and suddenly lowering
him à arms will extend as
a defensive reaction
• Appear At around 7 – 8
months of age and persist
therafter !
Developmental
Milestones
• There is 4 Developmental Milestones
• refers to group of skills & behavior
that the child should normally acquire
during his life, in comparison to other
normally children with the same age
group.
• Differentiate Growth from
Development
- Growth of organ: increase in the size
of the organ , while development of
organ refers to acquiring new function
by that organ.
Neonatal Period
• Defined as the first 28 days of newborn life [first 4 weeks]
• Neonatal Developmental characteristics
1. Upon putting the baby in prone position , the Neonate lie in flexed attitude
2. Neoborn able to turn his head from side to side
3. Able to Grasp the caregiver’s finger
4. Can sense the pain
5. Visual acuity 20/150
IMLE 10/2014
At 1 month old
• Baby able to see & follow moving objects 2- 3 feets away
At 1.5 month old
• Social Smile expected at this age , Limit age: 2 months
à Delay considered above 2 months
At 2 month old
• Baby can able to look at and follow [tracking] moving objects 180
degrees
IMLE 2/2014
At 3 months old
• Baby can brings hand together to midline
• able to pull to sitting position
At 6 months old
• Child attain 20/20 vision [ in neonate 20/150]
• Child sit unsupported [limit age 9 months]
At 7 month old
• Child expected to tranfer object from one hand to another
At 8 months old
• Roll back to front
• Bulids up 2 cubes
• Thumb finger grasp [ Still immature , mature at ~ 10 months old]
At 10 months old
• One Step command
• Standing unsupported [ limit age 12 months old ]
• Thumb finger grasp /Pincer grip [ Limit age 12 months old]
At 12 months old = 1 year
• Walk independently [ limit age 18 months ]
• Take several steps
• Release objects upon request to another person
• Says 1 – 2 (2-3 ) words in addition to baba & mama
• Able to play simple ball games
• Turn the pages of the book
At 15 months old
• Tower building of 3 Cubes
At 18 months old
• Sit in a chair
• Ability to walk upstairs with assistance
• Identifying at least 1 body part
• Social skills: Feed himself, seek help if needed , kiss a parent
• Make a tower of 4 cubes
• 18 month old infant is expected to say 10 -15 words , if he cannot say even
few words à Refer to developmental evaulation.
At age of 2 years
• Motor Skills: Run, jump , climb on furntiure
• Builds tower of 7 cubes , scribble in circular pattern
• Social skills: Eat with spoon , listen to stories , tell experiences
• Speak sentence made up of 3 words + > 50 words vocabulary
• Follow 2 steps command
• Begin toilet training [ Completed in 5 years of age]
IMLE 03/2019
At age of 3 years (36 months)
• Driving tricycle
• Standing on one leg
• Copying a circle
• Ability to count objects
At age of 4 years
• Jumping on one leg
• Copy sqaure
At age of 5 years
• Copy Triangle
IMLE 7/2022
Langauge Development
• At 6 months old: Monosyllabic babble [e.g. ma, ba ] – the first step in the
lanaguage development
• At 10 months old: child able to say Mama & Baba
• At 1 year old: child able to say 1-2 words in addition to Mama & Baba
• At 18 months old: child should say at least 10 -15 words
• At 2 years old: Build up sentence of 2 – 3 words , has Vocabulary words >
50 words.
IMLE 10/2019
Child abuse
• Clinically, we should suspect child abuse when child is presented with
typical injuries , fractures or bruises , when
histroy of parents doesn’t fit with the clinical child injruies
• Main sites of Fractures indicate abuse: Mostly rib, skull , metaphyseal
fracture
• Immersion burns: symmetrical burns
• Risk Factors: Young or single parents , lack of social support ,
psychiatric conditions
Israel finals 2020
Newborn – Normal Values
• At birth:
- Weight: 2.5 – 4 kg
- Length: 47 -56 cm [ Average 50 cm]
- HC [Head circumference]: 33 – 37 cm [ Average 35 cm]
Facts about Newborn weight
• A Physiological weight loss (5 – 10% of body weight) in the first few days of life
occur, while return to normal birth weight within 7 – 10 days of life
• at the End of the 1st month there is gain of 0.75 kg
• A baby doubles birth weight by 4-5 months
• A baby triples his weight by the age of 1 year
• Daily weight gain
- from 20 to 30 grams for first 4 months and 15-20 grams for the next months to
one year of age
Facts about newborn Height & HC
o Height
- Average Length/Height at birth = 50 cm [ 47 – 56 cm]
- A baby at 1 year à 75 cm
- A baby Double the height from birth [i.e. 100 cm] à at 4 years
o Head Cricmference
- HC ↑2cm/month in the first 3 months of life , rest to one year à 1 cm/month
- 90% of HC achieved by 2 year ; Completed by 5 year.
Final Exam 2018
Faliure to thrive
• Means Faliure in maintaing a rate of weight gain , it is under-nutrition state
, or Imbalance between the nutrient requirement and intake
• Etiology: can be related to organic/illness and non-organic/non-illness
causes.
• More than half of Cases are related to psycho-social causes
• Organic/illness related: infections, congneital anomalies
• Non-organic/non-illness related: Enviornmental , psychosocial or
behavioral factors
IMLE 2/2014
Infantile colic
§ A common condition affect all babies under 2 months
§ Characterized by prolong crying at the same time each day especially in later afternoon or
evening , otherwise these infants are health with normal weight gain.
§ Epidemiology: Equally common in Breast fed infants & Bottle-fed infants
§ Diagnosis: Rule of 3:
- begins at 3rd week of life
- 3h/day
- 3 days/week
- Lasting for > 3 weeks [peak cry ]
- resolve by 3 months of age [self limited condition ]
§ Management: just reassure parents & observe
§ Complication: Shaken baby syndrome !!!
Israel final Exam 2020
Audiogram
• Indication:
1. if hearing impairment is suspected
2. if speech delay is present
- Remember that hearing , speech & langaue are linked together as
fundamental milestone.
Contraindications to breast-feeding
§ Infants with IEM [inborn error of metabolism ]
- e.g. galactosemia, maple syrup urine disease, Phenylketonuria
§ Mother with
- HTLV-1 or HTLV-2
- Active TB [until 2 weeks of treatment]
- herpesvirus in the breast
- HIV in developed countries [However in 3rd world is possible to breastfed ]
- maternal treatment with radioactive products /Chemoradiotherapy
§ Drugs such as clozapine , doxorubicin, illicit drugs
§ NOTE:
- Woman with Mastitis is able to breast-feed from inflamed breast unless Abscess is present
!
Israel final 2022
Growing Pain
• Growing pain among children is COMMON
• Usually manifest as Lower limb pain [ Hip pain , knee pain, shin pain ]
– almost always at evening/night hours
• Physical examination, imaging and Labs NORMAL !
• Treatment: Supportive [ Stretching exercise , message to relief pain ,
painkiller NSAID or acetaminophen ]. Condition resolve by its own.
Final Exam 2018
Puberty
§ first sign of puberty
- in Girls à breast buds (Thelarche)
- in Boys à The Testicular Enarlgement / growth of testicles
§ NOTE: growth spurt in boys occur appx. 2 years later than Girls
IMLE 7/2022
Principles for healthy Sleep in Adolescence
• Eat regular meals , don’t eat a meal within 1 hour before sleep
• Sleep 8 – 10 h/day
• Don’t use Alcohol , smoking or sleeping pills/melatonin
• Try to wake up and go to bed at the same time
• Do regular exercise
• Question: Sleeping difficulty during Adolescent , what 1st step to Do ?
Try Lifestyle changes First before conducting any medical treatment !!!
IMLE 2/2022
Restless Leg syndrome
Rickets
• Defect in bone formation à Weak & soft bones in children.
• Vitamin D Deficiency !
• Clinical Features
1. Rachitic Rosary in CXR
2. Craniotabes
3. Knee Deformity “Genu varum” in Leg X-ray
Final exam 2022
Rumination Disorder
• Characterized by recurrent POSTPRANDIAL food regurgitation for a
period of AT LEAST 1 MONTH following a period of normal functioning
• Main Risk Factor: Divorce / Parent separation
• Treatment: Behavioral & Supportive
IMLE 02/2023