Pediatric Buster Dharmendra Sharma, Rinju Sharma
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Growth and Development1

  • Human fetus secretes thyroxine from 12 wk of gestation.
  • Growth is fast in 1st half of gestation.
  • Order of growth is cephalocaudal and distal to proximal.
  • Brain enlarges rapidly during later months of foetal life and early months of postnatal life.
  • Brain reaches 90% of adult head size by 2 yr.
  • The growth spurt of puberty is attributed to neurohormonal stimulation of hypophysis by hypothalamus.
  • Foetal or maternal growth hormone is not essential for growth in utero
  • Insulin stimulates foetal growth
  • Toddler means 1-3 yr of child.
    • Weight of child doubles in
    4-5 months.
    Triple in 1 yr.
    4 time in 2 yr.
    5 time in 3 yr.
    • Height at Birth
      3 mon
      1 yr
      4 yr
    - 45-50 cm
    - 60 cm
    - 75 cm
    - 100 cm (double)
1. Consider the following statements with reference to the normal child development:
(OPG5th/1)(UPSC/04)
(1) The sequence and time of attainment of milestones may vary among individual children, (2) Development always proceeds in a cephalocaudal sequence, (3) Presence of primitive reflexes is essential for attaining voluntary actions, (4) Development depends on the myelination and integrity of central nervous system. Which of these statements is/are true interpretation of the laws of normal child development?
  1. 1 only
  2. 1 and 3
  3. 2 and 4
  4. 1, 2, 3 and 4
2. A newborn baby has a head circumference of 35 cm at birth. His optimal head circumference will be 43 cm at:
(OPG5th/4) (UPSC/99)
  1. 4 months of age
  2. 6 months of age
  3. 8 months of age
  4. 12 months of age
3. Increase in height in first year is by:
(OPG5th/4) (DNB 2001)
  1. 40%
  2. 50%
  3. 60%
  4. 75%
4. Birth weight of a child doubles at five months of age while the birth length doubles at the age of:
(OPG5th/4) (UPSC 98)
  1. 1 year
  2. 2 years
  3. 3 years
  4. 4 years
5. Increase is length in the first year of life is:
(OPG5th/4) (AIIMS 81)
  1. 12 cm
  2. 15 cm
  3. 25 cm
  4. 35 cm
1 D
2 D
3 B
4 D
5 C
2
6. The optimum body weight of a baby by the end of one year is:
(OPG5th/4)(UPSC/03)
  1. Addition of three kg to birth weight
  2. Double the birth weight
  3. Three times the birth weight
  4. Four times the birth weight
7. Height of children 2-10 years increased by:
(OPG5th/4) (AI 97)
  1. 2 cm/year
  2. 3 cm/year
  3. 6 cm/year
  4. 10 cm/year
8. The infant triples weight at the age of:
(OPG5th/4) (AIIMS-96)
  1. 5 months
  2. 11 months
  3. 18 months
  4. 2 years
Weech's formula for estimating weight and height for age of normal children
Weight
Kilograms
Pounds
At birth
3.25
7
3 to 12 months
age in months + 9
Age in months + 11
2
1 to 6 years
(age in years × 2) + 8
(age in years × 5) + 17
7 to 12 years
(age in years × 7) + 5
(age in years × 7) - 5
2
Height
Centimetres
Inches
At birth
50
20
At 1 year
75
30
2 to 12 years
(age in years × 6) + 77
(age in years × 2) + 30
9. Two carpal bones are radiologically seen in the wrist X-ray of most of the children by the end of:
(OPG5th/6) (UPSC 96)
  1. 1 year
  2. 2 years
  3. 3 years
  4. 4 years
An average full-term newborn has the following 5 radiologically demonstrable ossification centers:
  • Distal end of femur
  • Proximal end of tibia
  • Talus
  • Calcaneus
  • Cuboid
By the age of 6 months, ossification centers for two carpal bones, i.e. capitate and hamate, appear that number of centers at wrist is equal to age in years plus one. Thus, a child of 2 years should have 3 centers.
10. First permanent tooth to erupt is:
(OPG5th/6) (AI 88)
  1. 1st premolar
  2. 1st molar
  3. 1st incisor
  4. 2nd premolar
Eruption sequence of temporary dentition
Central incisors
6-7 months
Lateral incisors
8-9 months
Canine
16-18 months
First molar
12-14 months
Second molar
20-24 months
Eruption sequence of permanent dentition
Central incisors
7-8 years
Lateral incisors
8-9 years
Canine
11-12 years
First premolar
10-11 years
Second premolar
10-12 years
First molar
6-7 years
Second molar
12-13 years
6 D
7 C
8 B
9 A
10 A
3
11. A child starts crawling at:
(OPG5th/42) (AP 88)
  1. 5 months
  2. 7 months
  3. 8 months
  4. 9 months
12. An infant begins to sit with support by.....months:
(OPG5th/44) (PGI 88)
  1. 4
  2. 5
  3. 6
  4. 7
13. Which of the following acts can a one-year-old child perform?
(OPG5th/44) (AIIMS 83)
  1. Sits down from standing position
  2. Drinks from cup
  3. Speaks one or two words with meaning
  4. Rings bell purposefully
Developmental Milestones in the First 2 Yr of Life
Gross motor
months
Head steady in sitting
2.0
Runs alone
16.0
Pull to sit, no head lag
3.0
Walks alone
12.0
Hands together in midline
3.0
Rolls back to stomach
6.5
Sits without support
6.0
Asymmetric tonic neck reflex gone
4.0
Cognitive
Stares momentarily at spot where object disappeared (e.g., yarn ball dropped)
2.0
Pretend play with doll (gives doll bottle)
17.0
Stares at own hand
4.0
Bangs two cubes
8.0
Uncovers to (after seeing it hidden)
8.0
Egocentric pretend play (e.g. pretends to drink from cup)
12.0
Uses stick to reach toy
17.0
Communication and Language
Follows one-step command with gesture
7.0
Follows one-step command without gesture
10.0
Smiles in response to face, voice
1.5
Monosyllabic babble
6.0
Speaks 4-6 words
15.0
Speaks 10-15 words
18.0
Speaks two-word sentences (e.g., “Mommy shoe”)
19.0
Inhibits to “no”
7.0
(e.g., “Give it to me”)
10.0
Speaks first real word
12.0
Fine Motor
Palmar grasp gone
4.0
Grasps rattle
3.5
Reaches for objects
4.0
Transfers object hand to hand
5.5
Scribbles
13.0
Builds tower of two cubes
15.0
Builds tower of six cubes
22.0
Thumb-finger grasp
8.0
Turns pages of book
12.0
11 C
12 B
13 C
4
14. Pincer grasp develops in an infant at:
(OPG5th/44) (PGI 88)
  1. 8 months
  2. one year
  3. 18 months
  4. 2 years
15. Milestones at 10 months of age are:
(OPG5th/44) (PGI 88)
  1. Pincer grasp
  2. Arranging 3 cubes
  3. Walks few steps without support
  4. Says mama dada
16. In a child, one should be worried if:
(OPG5th/44) (PAL 93)
  1. Stammering occurs at 3 years
  2. Lack of toilet control at 2.5 years
  3. Teeth do not erupt by 11 months
  4. Social smile absent by 10 weeks
17. Child recognizes and smiles at:
(OPG5th/44) (AIIMS 98)
  1. 12 months
  2. 6 months
  3. 4 months
  4. 2 months
18. Which about development is incorrect:
(OPG5th/44) (AIIMS 95)
  1. 2 years old can use pleurals
  2. Social smile at 3 months
  3. Pincer grasp at 3 months
  4. Sitting at 6 months
19. An infant is able to grasp a rattle and transfer it from one hand to the other by the age of:
(OPG5th/44) (AI 88)
  1. 3 months
  2. 6 months
  3. One year
  4. 2 years
20. Head control is possible in an infant by...months:
(OPG5th/44) (JIPMER 87)
  1. 1
  2. 2
  3. 3
  4. 6
21. A six-week-old infant cannot:
(OPG5th/44) (AIIMS 92)
  1. Grasp dangling objects
  2. Fix gaze
  3. Lift and hold head
  4. Turn head towards sound
22. A 3-year-old can do all except:
(OPG5th/44) (AIIMS 92)
  1. Walk properly
  2. Eat with a spoon
  3. Vacobulary of 20-100 words
  4. Climb stairs running
23. Consider the following factors :
(OPG5th/44)(UPSC/04)
  1. Head control
  2. Social smile
  3. Crawls
  4. Sits up
The correct sequence in the developmental milestones durin the first year of life is:
  1. 1, 2, 3, 4
  2. 2, 1, 4, 3
  3. 1, 4, 3, 2
  4. 2, 1, 3, 4
24. Absence of following sign will be considered normal is 3 months old child:
(OPG5th/44) (AIIMS 2000)
  1. Babbling
  2. Head raising upto 90°
  3. Shift red ring from one hand to other
  4. Smile to familiar faces
25. Regarding the developmental stage of a newborn, which of the following is/are true:
(OPG5th/44) (PGI 2000)
  1. He can fix his eyes on a bright object
  2. Can focus on an object 8-12inches away
  3. Turns to one side
  4. Grasps a rattle
  5. Elevates his head on the neck developmental delay
Motor Development. Developmental delay should be suspected if the child is not able to
  1. Pull up to sit by 4th months;
  2. Roll over by 5 months;
  3. Sit without support by 7-8 months;
  4. Stand holding on by 9-10 months;
  5. Walk by 15 months;
  6. Climb up or down the stairs by 2 years;
  7. Jump with both feet by 2 1/2 years;
  8. Stand momentarily on one foot by 3 years;
  9. Hop by 4 years and walk in a straight line back and forth or balance on one foot for 5-10 seconds by 5 years.
26. A 3-year-child is expected to do all except:
(OPG5th/46) (AIIMS 94)
  1. Copy a circle
  2. Speak in sentences
  3. Climb up stairs and down stairs
  4. Hobble five steps
27. A normal infant sits briefly leaning forward on her hands, reaches for and grasps a cube and transfers it from hand to hand. She babbles but cannot wave bye-bye nor can she grasp objects with the finger and thumb. Her age is:
(OPG5th/46) (UPSC/2K)
  1. 4 months
  2. 7 months
  3. 10 months
  4. 14 months
28. A child climbs with alternate steps, builds a tower of 8-9 cubes, tells”I” but not his name and cannot say his age and sex. The probabale age is:
(OPG/ 6th/46) (AIIMS /MAY/01)
  1. 24 Months
  2. 36 Months
  3. 30 Months
  4. 48 Months
14 A
15 D
16 D
17 D
18 C
19 B
20 C
21 A
22 D
23 B
24 C
25 A
26 D
27 B
28 A
5
29. A child can walk up and down the stairs alternating his feet by the age of:
(OPG5th/46) (AI 90)
  1. 12 months
  2. 24 months
  3. 36 months
  4. 48 months.
30. A two-month old child is able to:
(OPG5th/46) (AI/04)
  1. Show a positive parachute protective reflex
  2. Hold head steady in a seated position
  3. Lift head and chest off a flat surface with extended elbows
  4. Sustain head level with the body when palced in ventral suspension
31. Four years old child can do following moteractivity:
(OPG5th/46) (AIIMS 98)
  1. Hoping for 15 feets
  2. Standing on one leg for 20 sec
  3. Staircase climbing with alernate leg
  4. None of the above
32. A girl can walk upstairs, alternating feet, and make a tower of 8 cubes. She refers to herself by the pronoun ‘I’, knows her name, but not her age and gender. The most likely chronological age is:
(OPG5th/46)(UPSC/02)
  1. 24 months
  2. 30 months
  3. 36 months
  4. 42 months
33. In children, the following are true of speech development, except:
(OPG5th/47).(UPSC/03)
  1. children pronounce simple sounds such as ‘da-da’ at 8 months.
  2. children voice single, intelligible words at 13 months
  3. simple 2- to 3-word sentence sentences are composed at 15 months
  4. children can identify 4 to 5 picture cards at 2 years
34. Visual acuity reaches adult acuity by the age:
(OPG5th/47) (JIPMER 81, DNB 89)
  1. 7
  2. 9
  3. 5
  4. 3
35. Consider the following statements:
(OPG5th/48)(UPSC/04)
A 15 months old can
  1. Crawl upstairs
  2. Make a tower of
  3. Name a familiar object
  4. Indicate desire by pointing
Which of these statements is/are correct?
  1. 1 only
  2. 1 and 2
  3. 2 and 4
  4. 1, 2, 3 and 4
36. A 3-year-old child is able to perform all of the following activities except:
(OPG5th/48) (UPSC/01)
  1. Climbing stairs with alternate feet
  2. Riding atricycle
  3. Cursive writing
  4. copying a circle
37. A three-year-old child can do which of the following except:
(OPG5th/48) (UPSC/01)
  1. Ride a tricycle
  2. build a tower often cubes
  3. Knows his age and sex
  4. Use scissors to cut out pictures
38. Handedness develops at:
(OPG5th/48) (UPSC/01)
  1. 12 months
  2. 18 months
  3. 24 months
  4. 36 months
39. IUGR is caused by all except:
(OPG5th/48)
  1. Diabetes
  2. Alcohol
  3. Smoking
  4. Chronic renal failure
40. Intrauterine growth retardation can be caused by all except:
(OPG5th/51) (AIIMS 87)
  1. Nicotine
  2. Alcohol
  3. Propranolol
  4. Phenothiazine
PROBLEMS OF IUGR INFANTS
Problem
Pathogenesis
Intrauterine fetal demise
Hypoxia, acidosis, infection, lethal anomaly
Perinatal asphyxia
↓Uteroplacental perfusion during labor ± chronic fetal hypoxia-acidosis; meconium aspiration syndrome
Hypoglycemia
↓Tissue glycogen stores, ↓gluconeogenesis, hyperinsulinism, ↑glucose needs of hypoxia, hypothermia, large brain
Polycythemia-hyperviscosity Reduced oxygen consumption/hypothermia
Fetal hypoxia with ↑erythropoietin production Hypoxia, hypoglycemia, starvation effect, poor subcutaneous fat stores
Dysmorphology
Syndrome anomalads, chromosomal-genetic disorders, oligohydramnios-induced deformations, TORCH infection
29 C
30 D
31 C
32 C
33 C
34 A
35 B
36 C
37 D
38 C
39 A
40 D