Growth, Development and Preventive Paediatrics
This domain tests whether you can read a growth chart the way a clinician does, place a child on the correct developmental trajectory, and reproduce the Czech preventive-examination and immunisation timetable without prompting. Questions are usually data-interpretation items with a chart description, a parental height, or a list of achieved milestones.
Reading growth
- Plot height, weight and head circumference against age- and sex-specific charts; a single point matters less than the curve.
- Crossing two or more major percentile bands downwards suggests growth failure and needs a cause: coeliac disease, inflammatory bowel disease, renal tubular acidosis, hypothyroidism, psychosocial deprivation.
- Mid-parental height: (father + mother + 13)/2 for boys and (father + mother - 13)/2 for girls; the target range is about plus or minus 8.5 cm.
- Correct for prematurity until 2 years for height and head circumference.
- Weight-for-height and BMI identify obesity; BMI percentile cut-offs are age-specific because BMI changes with age.
Development
Social smile around 6 weeks, head control by 3 months, sitting without support 6-8 months, pincer grasp around 9-10 months, independent walking 12-18 months, two-word phrases by 18-24 months. Loss of a previously acquired skill is always pathological.
Preventive care
Czech preventive examinations run in the first week, at 14 days, 6 weeks, 3, 6 and 12 months, at 18 months, at 3 and 5 years, then every two years to 19 years. They include growth measurement, sensory screening, urine dipstick, blood pressure from 3 years, and scoliosis assessment in school age. Vitamin D 400-600 IU daily in infancy, vitamin K at birth, fluoride where indicated, and the statutory immunisation schedule, including the hexavalent vaccine from the ninth week, MMR from 13 months and tetanus boosters in later childhood.
Worked example
A 4-year-old boy measures 92 cm, far below the third percentile. Mother 160 cm, father 175 cm. Mid-parental height is (175 + 160 + 13)/2 = 174 cm, target range 165.5-182.5 cm; he sits far below it. The next steps are a growth-velocity calculation from earlier records, bone age, coeliac serology, thyroid function and referral for endocrine assessment.
Traps
Interpreting one measurement; forgetting the mid-parental height; plotting a preterm infant on term charts at 18 months; calling short stature constitutional without checking velocity.