Medical Archive

N2 Growth, Development, and Behavior

C18 Developmental and behavioral theories

Biopsychosocial model and ecobiodevelopmental framework: models of development

C19 Positive Parenting and Support

The importance of parenting

The role of the family

Parenting styles

Child temperament

Child behavioral problems

Defining positive parenting

Parenting as an intervention

The role of the pediatrician

C20 Assessment of Fetal Growth and Development

Gross motorFine motorLanguagePersonalSocial
1m머리 돌리기주먹쥐고 있음보고 웃음, 옹알이Response to voice
Smile
2m가슴 들기Social smile
3m목 가누기손을 펴고 있음
4m뒤집기 (P→S)Ulnar + palm크게 웃음, 재잘거림
5m뒤집기 (S→P)
6m잡아주면 앉는다Radial + palmObject permanence
낮선사람을 구별하기 시작
7m혼자 앉음, 배밀이자음소리, 단음절 소리Stranger anxiety ~ 18-24 months
8m혼자 일어나 앉음Radial alone
9m붙잡고 선다3-finger pincer grasp
Holds bottle or cup
10m붙잡고 걷는다의도적으로 놓음이름 부르면 반응, “엄마, 아빠”를 말한다Response to naming
11m혼자 서있는다
12m혼자 걷는다엄마, 아빠 외 단어옷 입힐때 협조
컵으로 마신다
15m블럭2개3-5개 단어손가락질
18m– 손잡고 층계 올라감
– 달리기, 공차기		블럭3개10개 단어흘리면서 혼자 먹음
소변 보고 알려줌
혼자 옷을 벗음
2y– 양발 동시에 계단 오르내림
– 뜀		블럭6개, 직선50개 단어
2단어 문장
Speech 50% intelligible		숟가락질Engages in parallel-playing
3y– 양발 번갈아가며 계단 오르내림.
– 한발로 서있기, 세발자전거		원3-4단어 문장
Speech 75% intelligible
이름/나이대기, “why”question		양말과 신발 신기, 손씻기. Toilet trained except wipingEngages in role-playing
Resolves separation anxiety
Showing empathy
4y– 한쪽발로 뜀십자, 네모, 가위로 오리기전치사, 반댓말, storytelling양치질, 세수
5y– 줄넘기세모단어의 의미 묻기. 10까지 센다, 글자/숫자 읽기혼자 잘 씻고 옷을 입고 벗는다. 신발끈 묶기Engages in competitive-playing

Somatic development

? ?? ?? (Ref. ??? 50cm)

1?4?8?12?
1.52.02.53

?? ?? ?? (Ref. ??? 3.3kg)

3??1?2?4?6?
6.6 (x2)10 (x3)13 (x4)17 (x5)20 (x6)

?? ???: ??~2?, ???~16?

?? ??
??: 34cm
1?: 46cm
4?: 50cm
??: 55cm

Post. Fontanelles: 6-8?
Suture line: 6-8??
Ant. Fontanelles: 14-18?? (? ? 1cm)

  • ????
    • 12??, 8?, ??? ?? 0.45, 1, 1.8
    • ??? ?? ? ????? ??
  • ???? (??/??)
    • ?? ? 1.7
    • 2? ? 1.4
    • 12~15? 1.0

Neurologic development

Behavioral development

Psychologic changes in parents

Threats to fetal development

C21 The Newborn

C22 The First Year

Q-based learning

  • ‘The ability to prop themselves up with their hands while prone’ = 6 months

??? ??? 2-3??? ???? ?? ?? -> MR ??
????? 3-5??? ???? ?? ?? -> CP ??

C22.1 Infant crying and colic

DiagnosisCrying features
NormalIntermittent, consolable, <3 hr/day
Peak at age 6 weeks, and typically resolve by age 3-4 months.
Colic?3 hr/day (usually evening), ?3 days/week
Healthy infant age <3 months
GERDFrequent spit-up
Back-arching after feeding
InfectionAOM: bulging tympanic membrane, ? fever
Meningitis: fever, lethargy, bulging fontanel
Septic arthritis: fever, limited extremity movement
UTI: fever, vomiting, poor feeding
IntussusceptionEpisodic irritability with legs drawn to abdomen
? Bilious. emesis, bloody stools
TorsionTesticular swelling or abdominal distension (ovarian)
TraumaHair tourniquet: hair accidentally wrapped around digit
Corneal abrasion: tearing, photophobia; + fluorescein test
Abuse/fracture: bruising, laceration, asymmetric movements

Management

  • Soothing techniques should be reviewed
    • Include using a pacifier; holding, rocking, or swaddling the baby; and minimizing environmental stimuli (eg, dark room)
    • Adjusting feeding techniques (eg, upright feeding position in bottle-fed babies) may help reduce air swallowing and relieve colic.

C23 The Second Year

C24 The Preschool Years

C25 Middle Childhood

C26 Adolescence

C27 Assessment of Growth

Techniques to measure growth

Growth curves

Other growth considerations

C28 Developmental and Behavioral Surveillance and Screening

Developmental and behavioral surveillance

Developmental and behavioral screening

????
?????? 3-7?
???? 9??
VisionEvery well-child visit.
Red reflex testing, corneal light reflex testing
Visual acuity testing – 3?
Hearing3?
??3? ??, ??
??????, ??, ??? ?? ??? (6??, 4?, 12? ????? ??? ??)
?????????(???)? ?? 3? ??? ??.
??3?
Autism18??, 2?
Depression12???

??? ??? ?? ??, ?? ?? ?? ??
Bayley ?? ??: 3-24??? ?? ?? ????
??-?? ??? ?? Wechsler ??: ??? ????

Beyond surveillance and screening

C29 Childcare

C30 Loss, Separation, and Bereavement

C31 Sleep Medicine

Basics of sleep and chronobiology

Developmental changes in sleep

Common sleep disorders

Insomnia of childhood

Obstructive sleep apnea syndrome

  • Pathophysiology – adenotonsillar hypertrophy
  • Clinical manifestations
    • Night symptoms
      • Loud snoring, pauses in breathing, gasping
      • Enuresis, parasomnias (eg, sleepwalking, sleep terrors)
    • Day symptoms
      • Inappropriate naps or falling asleep during school
      • Mouth breathing, nasal speach
  • Complications
    • Poor growth (ie, failure to thrive)
    • Poor school performance
    • Cardiopulmonary (eg, hypertension, structural heart changes)
  • Management
    • Tonsillectomy & adenoidectomy

Parasomnias

Sleep-Related Movement Disorders: Restless Legs Syndrome/Periodic Limb Movement Disorder and Rhythmic Movements

Narcolepsy

Delayed Sleep?Wake Phase Disorder

Health supervision

Evaluation of Pediatric Sleep Problems

## Onenote

Embryonic~?? 8? (LMP 10?)
Fetal ?? 9? ~ ??
??? neonatal?? 4?
??? perinatal?? 28? ~ ?? 1?
??? infancy1??~1?
??? early –1-5 ?
??? late6-10 ?
???, ????? 12-20 ? / ? 10-18 ?

1. ??

????

Harlequin????Salmon patchErythema toxicum
AcrocyanosisMottling (????)??? milia?? miliari

2. ???

????? ???
1cm ??, ???/?, movable, non-tender, solid.

3. ??

  1. ????? ???? ?? ?? – ???? ?? ??? ??!
  2. ??? (craniotabes) – ?? ??? ?
    1. ?? temporoparietal / parietooccipital area ? ????
    2. ???, ??, ???A ??, ???, (????? ???? ? ?)
  3. Macewen sign (+) : ?????? ??? cracked pot sound : ???

4. ??

?????? : ? ? ??
Chvostek sign : 1??~5? ???? ??? ???, tetani, ????? ?? ??

5. ENT

  • 6????? ??? ?? (? ? ??? ??? ? ??x ? ??)
  • ?? ?? ??? ?? ??? ??? ?????! (labyrinthine, neck reflex)
  • ?? ?? ??? ??? ? ??, ??, ????
  • ?? ? ? ?????. ? ???? ?????.
  • ?? ??? ?? ???? ?

6. ???

6??? ????? ??. ???? ? ??, ??? ?? (???? 1??? ??)
?? sinus arrhythmia. ?? ??? ????, ??? ?? ??
?/? ??? ??? ??? ?????.

7. ???

???? ?? ??? ???? ?? ?? ??? ???? ??? (+)
??????? ??? ?????? ?????

8. ??, ??, ??, ??

~1?: Varus phase (??? ???)
1~2?: Neutral phase
2~3?: Valgus phase
6~7?: ??? ??

3? ?? ???? ?? ??. ? ?? ???? ???.
????: 6??~6?? ???? ??! ??? knee, ??? elbow & shoulder

??: ??? ? ?? ????, ?? ??? ????.
??: ????, 20?. 8 / 12 / 20 / 16 / 30 ?? (?? – 6?)
???: ?????, 28~32?.
?1 ???(6) ??/??????, ?????2 ???(12) ??3 ???

Maxillary sinus, ethmoid sinus? ??? ??
??? ??? ??? ?? ??. ?? ?, ??, steroid ??? ???
Thorax index? ??? 1?? ?? ??
Cardiothoracic(CT) ratio? 1? ?? 50%
Liver? ?? ? 2cm??. ???? ?? ???

????

1? ?? ?? – ???. m/c: ?? ???
2? ?? ?? – ???. m/c: ?? ??
???? IUGR? ??? ? ??? 2~3??? ???? ??

GH deficiency

???<3pt
????<4cm/yr
???<???
??? ??
?? ??, ?? ??
?? ??? ??
IGF-1 ??
Insulin ?? GH ?????? max < 10ng/mL