Developmental milestones
https://www.childrens.health.qld.gov.au/wp-content/uploads/PDF/red-flags-a3.pdf
- The Red Flags Early Identification Guide will:
- Assist with early identification of developmental concerns in a child’s developmental domains
- social/emotional
- communication
- fine motor/cognition/self-care
- gross motor
that are impacting on their day-to-day functioning.
- A single red flag is not always an indication for concern or referral, rather the functional impact of one or more red flags on the child’s everyday functioning and participation, should be taken in to consideration
- The red flags have been linked to the absence or delay of skill/s which lie at the boundary of the typical developmental range.
- Therefore the guide should not be used as a ‘milestones’ screener, as the red flags are not developmental milestones.
- Use evidence-based screening tools
- Parents Evaluation of Developmental Status (PEDS)
- Ages and Stages Questionnaire (ASQ)
HEIGHT
- Mid parental height ( girls – 6.5cm, boys +6.5cm)
- Most people should reach within 10cm of this
- Short stature = height that is more than 2 standard deviations below average
- Most common cause – constitutional delay, familial short stature
- Puberty should be correlated with growth
- Delayed puberty if not reached —
- Early signs females > 13- beast bud
- Males > 14 – increase in testicular volume
- Can consider inducing puberty in males over 14.5
- Don’t use growth hormone
- Other causes
- Turner syndrome
- Consider if short stature, or delayed or arrested puberty
- Acquired growth hormone deficiency
- May be due to other endocrine issues
- E.g. Hypothyroidism, Cushing syndrome
- Acquired growth hormone deficiency – intracranial tumour, cranial radiation, brain tumour
- Screen with serum IGF-1 level
- Needs provocation testing to confirm
- Can consider supplementation
- Non endocrine
- Antenatal – extreme pre term, birth weight, IUGR
- Nutrition
- Extreme physical activities
- Chronic disease
- Inflammatory conditions
- Stimulant medications
- Turner syndrome
- Investigations to do before referral
- FBC, U+Es, CMP, ESR, coeliac serology, TFTs, IGF-1
- Karyotype of girls whos height is significantly abnormal, pubertal delay
- Bone age XR of L wrist — need experienced radiologist