Updated: 8/12/2022

Normal Development Landmarks

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
14
0
0
0%
0%
Evidence
10
0
0
0%
0%
Videos / Pods
1
Topic
Overview
 
 
Age
Motor
Language
Social
NEONATE
(0-3 mos)
0-1 mo moro grasp and reflex, visual tracking
  • crying
minimal
2 mos holds head up, swipes at objects 
  • cooing
social smile
INFANT (3-12 mos) 3 mos lifting head and chest, moro reflex disappears    
4 mos

rolls from prone to supine,grasps objects

 

 

  • orients to voice
  • colic resolves in most babies by this age

 

laughs
6 mos   sits upright
  • babbles
stranger anxiety
9 mos crawls, pull-to-stand, pincer grasp, eats with fingers
  • mama-dada (nonspecific)
waves bye-bye, responds to name

TODDLER
(12-24 mos)

12 mos stands
  • mama-dada (specific)  
picture book
15 mos walks, uses cup
  • several words
temper tantrums
18 mos walks up stairs, throws ball
  • names objects
toilet-training begins 
24 mos runs
  • 2-word sentences, several hundred word vocabulary
follows 2-step commands  
PRESCHOOL
(3-6 years)
36 mos rides tricycle (3yrs), eats with utensils

 

  • 3-word sentences 
  • Clinical correlate
    • selective mutism  
      • selectively mute in specific settings 

 

 

knows first and last name

average age of potty training 

SCHOOL AGE
(6-11 years)
development of conscience (super-ego), has same-sex friends
ADOLESCENCE
(Girls-11yrs, Boys-13 yrs)
abstract reasoning, the formation of personality, may have friends of opposite sex
  • Feeding patterns
    • From birth to six months of age, breastfeeding has preferred the source of nutrition
    • All breastfed infants should be supplemented with vitamin D
    • Preterm breastfed infants should be additionally supplemented with iron
    • Solid foods introduced at six months of age
    • Cow's milk introduced at 12 months of age
  • Cyclic vomiting syndrome - an idiopathic disorder in 4-7 yr old children
    • repeated, stereotypical bouts of acute vomiting accompanied by severe nausea, lethargy, and possibly fever, pallor, diarrhea, headache, and/or photophobia with a return to normal health between episodes 
    • diagnosis of exclusion
    • supportive therapy for management; amitryptiline may be useful in the prevention
    • children outgrow by teenage years
  • Physical activity
    • should be encouraged at a young age to develop habits
    • children should engage in activities they enjoy with structured time allocated
      • weight lifting is appropriate in young children with proper form and instruction 
Breath-Holding Spells
  • Introduction
    • breath-holding spells may be
      • cyanotic or pallid
  • Epidemiology
    • incidence
      • 4.6%
    • age
      • can occur between 6 months to 6 years of age
        • most cases occur before 18 months of age
  • Prognosis
    • usually resolves by school age
    • iron supplementation may reduce the breath-holding spell frequency in
      • patients who are anemic or iron-deficient
Breath-Holding Spells
Type
Trigger Clinical Features Treatment
  • Cyanotic (~80% of cases)
  • Emotional insults such as
    • pain
    • anger
    • frustration
  • Typically the patient vigorously cries, which is followed by
    • forced expiration and breath-holding resulting in
      • cyanosis
        • patients often collapse and lose consciousness and can become limp
  • May be associated with
    • generalized clonic jerks
    • opisthotonos
    • bradycardia
  • Education and reassurance
 
  • Pallid (~20% of cases)
  • The patient may become quiet, which is followed by
    • breath-holding in the expiratory phase that results in
      • pallor
      • brief loss of consciousness
      • loss of muscle tone
      • diaphoretic
  • There is cardiac bradycardia
  • Tonic rigidity may be seen

References

Please rate topic.

Average 4.5 of 11 Ratings

Questions (14)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M2.PD.15.196) A mother brings her 10 month-old boy to the pediatrician for a check-up. His birth was without complications and his development to-date has been progressing normally. He currently crawls, pulls himself up to standing, says 'mama' and 'dada' nonspecifically, and responds when called by his name. However, his mother is concerned, as she has noted over the past several weeks that he has periods where he stops breathing when he gets frightened or upset. These episodes last for 20-30 seconds and are accompanied by his lips and face become bluish. His breathing has always resumed normally within 45 seconds after the start of the episode, and he acts normally afterwards. One instance resulted in the child passing out for a 5-10 seconds before a spontaneous recovery. Which of the following is the most appropriate management of this patient's condition?

QID: 104202

Education and reassurance of the mother

74%

(20/27)

Echocardiogram

11%

(3/27)

Electroencephalogram

7%

(2/27)

Basic metabolic panel

0%

(0/27)

Lung spirometry

4%

(1/27)

M 7 E

Select Answer to see Preferred Response

(M2.PD.15.5) A 5-year-old male is brought to the pediatrician by his mother, who relates a primary complaint of a recent history of five independent episodes of vomiting over the last 10 months, most recently 3 weeks ago. Each time, he has awoken early in the morning appearing pale, feverish, lethargic, and complaining of severe nausea. This is followed by 8-12 episodes of non-bilious vomiting over the next 24 hours. Between these episodes he returns to normal activity. He has no significant past medical history and takes no other medications. Review of systems is negative for changes in vision, gait disturbance, or blood in his stool. His family history is significant only for migraine headaches. Vital signs and physical examination are within normal limits. Initial complete blood count, comprehensive metabolic panel, and abdominal radiograph were unremarkable. What is the most likely diagnosis?

QID: 105403

Reye's syndrome

0%

(0/28)

Intracranial mass

11%

(3/28)

Cyclic vomiting syndrome

86%

(24/28)

Gastroesophageal reflux

0%

(0/28)

Intussusception

0%

(0/28)

M 6 E

Select Answer to see Preferred Response

(M2.PD.15.21) A 1-year-old male presents to his pediatrician for a well-child visit. Through a history from the mother and physical examination, the pediatrician learns that the baby babbles non-specifically, takes several steps independently, and picks up his cereal using two fingers. His weight is currently 22 lbs (birth-weight 6 lbs, 9 oz), and his height is 30 inches (birth length 18 inches). Are there any aspects of this child's development that are delayed?

QID: 105419

Inadequate growth

4%

(1/26)

Language delay

77%

(20/26)

Gross motor skill delay

0%

(0/26)

Fine motor skill delay

4%

(1/26)

There are no developmental concerns

12%

(3/26)

M 6 E

Select Answer to see Preferred Response

(M2.PD.15.52) A mother brings her 4-year-old son to his pediatrician. Over the last eight months, her son has been exhibiting several "odd" behaviors. Most importantly, he repeatedly says that he is playing games with a friend named "Steven," though she is certain that he does not exist. She has often found him acting out magical scenarios as though someone else is present, when no one is there. What is the most likely diagnosis in this patient?

QID: 105450

Developmental delay

0%

(0/25)

Schizophrenia

0%

(0/25)

Normal development

92%

(23/25)

Schizoid personality disorder

4%

(1/25)

Schizophreniform disorder

0%

(0/25)

M 6 E

Select Answer to see Preferred Response

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Evidence (10)
VIDEOS & PODCASTS (2)
EXPERT COMMENTS (7)
Private Note