Council on Medical Student Education in Pediatrics

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COMSEP Clinical Cases

GROWTH AND DEVELOPMENT

  1. A three-month-old full-term infant has gained 15 ounces (420 gm) since birth. Her height velocity is normal. Her parents want to know if this is adequate. What would you tell them?
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  2. A fifteen-month-old boy says no recognizable words. His parents are concerned and wonder if he needs speech therapy. How would you respond to their concern?
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  3. An infant rolled over at four months and sat with assistance at six months, but at one year he is unable to stand or sit alone. His parents are quite concerned and ask if this is normal. Explain your answer.
  4. The parents of a nine-month-old infant are concerned because she is not sitting. She has increased tone and scissoring of her lower extremities. She can grasp a rattle, but does not reach for objects. She coos and has a social smile. What would you tell her parents?
  5. A six-month-old has a head circumference in the 50th percentile, height in the fifth percentile, and weight in the fifth percentile (baby was at 50th percentile for all measurements at three months). How would you evaluate this child?
  6. The parents of a fourteen-month-old boy born at 30 weeks gestational age are concerned he is not walking. He sat alone at nine months and says two to three words in addition to Mama and Dada. How would you Council these parents?
  7. The mother of a ten-year-old girl wants to know when she might start her periods. What would you tell her?
  8. A twelve-year-old boy complains that he is the shortest person in his class. He is 54 inches tall. He wants to know if he should take a "growing medicine". What additional information do you need from the history and physical examination before counseling him regarding his growth potential? What are the indications for using growth hormone in children?
  9. A six-month-old infant is seen for a well child examination. His height and weight have remained at the 25th percentile but his head circumference has gone from the 25th percentile to greater than the 95th percentile over the past four months. What would you be most concerned about? How would you evaluate this child?

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  10. A nine month-old child has a head circumference of < 5th percentile. Her height and weight are at the 25th percentile. How would you evaluate this child?
  11. A three-month-old full-term infant, who was 3000 g. at birth, now weighs 3420 g. Her height velocity has been normal. Her parents want to know if this is an adequate weight gain. What would you tell them? What are the common causes of poor weight gain at this age? How would you evaluate the infant?

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