--- module: 070-01 language: en chapter: 70 title: "Child Growth, Development, Paediatric Assessment, and Longitudinal Care" module_title: "Mechanistic foundations, classification, normal variation, and clinical presentation" source_sha256: 57a482514b2ddafa1cb35d8a22feaf27d34f4149f37bb4986ae257171a251189 --- # Paediatric foundations and presentation ## Development-based paediatrics ### Organs mature at different rates ### Body composition changes ### Disease threatens future growth ### Trajectory, proportion, skills inform ## Growth ### Genetics, placenta, nutrition, hormones, environment ### Velocity beats a single centile #### Accurate, serial, plotted measurements ### Centile crossing #### Catch-up or catch-down can be normal #### Sustained fall or discordance needs evaluation ### Poor intake: weight falls before length ### Endocrine: linear growth falls, weight kept ### Head size read with parents and neurology ### Bone age estimates skeletal maturation #### Delayed maturation vs impaired potential ### Mid-parental height is a target, not a guarantee ## Puberty ### Reactivated hypothalamic GnRH pulsatility #### Gonadotropins, then gonadal steroids ### Adrenarche partly independent #### Pubic or axillary hair, body odour ### Staged by physical development, not age ### Timing varies with genetics, nutrition, illness ## Developmental domains ### Motor, language, cognitive, social, adaptive, executive ### Milestones are distributions, not deadlines #### Sequence, quality, practice, regression matter ### Primitive reflexes inhibited by cortical control #### Asymmetry, abnormal tone, early handedness ### Language needs hearing and interaction #### Bilingual children not inherently delayed #### Assess hearing in every speech delay ### Attachment from responsive caregiving #### No single behaviour proves family circumstance ### Executive function matures into adolescence #### Reward sensitivity precedes regulatory control #### Not a reason to exclude from decisions ## Delay, regression, neurodevelopment ### Delay vs intellectual disability vs specific disorder ### Regression is always important #### Epileptic, degenerative, metabolic, inflammatory #### Apparent loss when demands exceed capacity #### Which skill, which settings, sensory change ### Autism: social communication, restricted patterns #### Identify strengths and needs #### Does not explain every symptom ### ADHD: across settings with impairment #### Sleep, anxiety, hearing, absence seizures mimic ## Paediatric physiology ### Airway and breathing #### Small radius loss sharply raises resistance #### Fatigue after prolonged work of breathing #### Bradycardia signals hypoxia, pre-arrest ### Fluids #### High body water, immature concentration #### Rapid dehydration, hypotonic hyponatraemia ### Maturing drug handling prevents linear scaling ### Neonatal thermoregulation inefficient #### Brown fat non-shivering thermogenesis #### Hypothermia may signal sepsis ### Limited glycogen, hypoglycaemia risk ### Immature immunity: serious infection, subtle signs ## Presentations by mechanism ### Fever #### Height does not separate bacterial from viral #### Young infants: invasive infection without fever ### Noisy breathing localised by sound and phase #### Stridor: upper-airway narrowing #### Wheeze: intrathoracic obstruction #### Stertor: nasopharynx ### Vomiting #### Bilious: obstruction distal to ampulla #### Projectile non-bilious: pyloric stenosis #### With lethargy: metabolic decompensation ### Rash #### Morphology, distribution, blanching, mucosa #### Non-blanching plus illness: invasive infection #### Purpura with shock needs urgent assessment ## Family, school, longitudinal reasoning ### Function across home, school, play, sleep ### Hear the child directly ### Poverty, housing, food security shape health ### Adolescents need confidential time #### Limits explained, safeguarding may share ### Compare with the child's own trajectory ### Act early when growth and learning are threatened