Stony Brook Pediatrics Primary Care Clinic CurriculumHealth Supervision I

August 2018Some materials developed by Joseph Lopreiato MD, MPH and Jennifer Hepps MD of the National Capital

Consortium Pediatric Residency Program Bethesda, MD, adapted for use by Susan Walker, MDOther materials developed by Susan Walker, MD

Goal:  To understand recommended growth monitoring for childrenObjectives:

1. Utilize growth charts to identify children with abnormal growth2. Plan the initial workup of children with abnormal growth3. Understand the differential diagnosis and plan the evaluation of a child with

microcephaly/macrocephaly4. Know the utility of mid-parental target height in the evaluation of short and tall stature5. Know the utility of bone age in the evaluation of short and tall stature6. Explain the difference in physical exam findings between positional plagiocephaly and

craniosynostosis

ABP Content Specifications covered in this session:Growth and Development:Understand the uses and limitations of the various anthropometric techniques available to assess growth and/or nutritional statusLinear growth and weight gain:Use a growth chart to monitor linear growth and weight gain Differentiate between normal and abnormal variations in linear growth and weight gain Differentiate between normal and abnormal growth velocity in neonates and infants Understand the effect of chronic disease on linear growth velocity Recognize the differences in upper body segment-to-lower body segment ratio in children compared with that of adultsHead growth:Differentiate between normal and abnormal variations in head shape and/or growth (eg, craniosynostosis, plagiocephaly, microcephaly, macrocephaly) Differentiate among the possible causes of abnormal head shape and/or growth (eg, craniosynostosis, plagiocephaly, microcephaly, macrocephaly) Plan the management of a patient with an abnormal head shape and/or growth (eg, craniosynostosis, plagiocephaly, microcephaly, macrocephaly)

Pre-reading requirements:1. Bright Futures recommendations for preventive health care:

https://www.aap.org/en-us/Documents/periodicity_schedule.pdfThis chart is a useful guide for your well visits in clinic. For now, a brief review is sufficient. Please note how many items are on this table- and realize what a critical service preventive pediatric health care is!

2. Disorders of Growth and Stature. Pediatrics in Review (2017) 38:7:293-304http://pedsinreview.aappublications.org/content/38/7/293

3. Guidelines for the Management of Patients With Positional Plagiocephaly. Neurosurgery (2016) 79:5:623-624

https://www.cns.org/sites/default/files/guideline-pdf/summary_with_recommendations_final_12.1.16.pdf

4. Head Growth. Pediatrics in Review (2015) 36:9:426-427http://pedsinreview.aappublications.org/content/36/9/426

Extra readings (helpful, but not required for this session):1. Congenital Muscular Torticollis and Positional Plagiocephaly. Pediatrics in Review

(2014) 35:2:79-86http://pedsinreview.aappublications.org/content/35/2/79

Before your clinic session:Write the formula for calculation of the mid-parental target height:

List the differential for and plan the evaluation of a child with short stature

List the differential for and plan the evaluation of a child with tall stature

During your clinic session:1. Discuss figure 1A and B from the “Disorders of Growth and Stature” Pediatrics in Review article with your clinic partners. Which of the children depicted in each curve warrants further evaluation or intervention? What would you do in each case?

2. The following growth chart plots the head circumference of a 19-month-old female with poor weight gain and mild hypotonia.

What is your differential diagnosis?

When would you image this patient?

3. You are seeing a two-month-old infant in your office for his well visit. His parents are concerned about his head shape. On exam, his head circumference plots at the 50th percentile for age. He has some difficulty turning his head to the left. When you examine his head from above, you note a parallelogram-shaped head, with a somewhat flattened right occiput and anterior displacement of the right ear (see image on the left of the figure below). What is your diagnosis, and how will you counsel the parents? List four interventions to improve this condition.