小兒科的問診、病史詢問-2 @ ~Teachingcenter的醫學筆記~

兒科的個人簡史Brief History of Pediatrics
= 其中應該要包含：出生史、餵食狀況、疫苗史、生長與發育、過去史、家族史

生長與發育Growth and Development
= 體重、身高、頭圍在正常生長曲線上，位於第3至第97百分位(the third to the 97th percentile) 為正常
= 這些生長參數與遺傳有關，父母體重與身高的平均值可大致上作為小孩的正常生長預測值，頭大與前額突出(frontal bossing)都可能與遺傳有關
= 突然極度增加或減少百分位，代表異常狀況
※但是出生時的體重與子宮環境有關，所以在兩歲以前的生長百分位可能出現較明顯的變化
= 早產兒在產後初期不能以一般的生長曲線直接比對，尤以極度早產兒為然。可以將產後年齡減去提早出生的週數後，再比對生長曲線，此稱為校正之產後年齡(corrected postnatal age)
= 這種校正對頭圍必須做到18個月，體重到24個月，身高到40個月
= 營養不良等後天因素，最容易影響到體重，其次身高，再其次為頭圍
= 一般正常兒童的發育情形可分為細動作、粗動作、語言、人際社會等：

平均月齡	Gross motor	Fine motor	Language	Personal-social
2	head steady in sitting	follow past the midline		smile in response to face, voice
3	head control	follow in circular pattern		smile spontaneously
4	roll front to back	reach for objects		stare at own hand
5	rolls back to front	hold 1-in. cube		distinguish strangers from family
6	sit leaning forward on arms	transfer object hand to hand, palmar grasp	monosyllabic babble	displeased when toy removed
7	sit erect briefly	actively shake rattle		bite and chew on toy
8-9	crawling	thumb-finger grasp	“mama” or “baba” nonspecifically	inhibit to “no”, uncover toy
12-13	walk alone	turn pages of book; scribble	speak first real word	hug doll or animal
15-17	run	tower of 2-3 cubes	4-10 words	pretend play with doll
19			2-word sentence
22-24	jump with both feet	tower of 6-7 cubes	3-word sentence	indicate toilet need, feed self
30	going upstairs	tower of 8-9 cubes	multiple-word sentence, refer to self as “I”	put on shoes and pants
36	pedals tricycle, stand on one foot-2 sec	tower of 10 cubes, copy vertical & horizontal stroke, copy circle	give name and own gender	toilet training, dressed with supervision
48	hop on one foot	copy cross	understand color, opposite, preposition; ask questions	dress without supervision

= 嬰兒大多在5-7月左右長第一顆牙齒(mandibular central incisors)，在6-7歲換第一顆恆齒，但是其個人差異很大而與遺傳因素有關，與智力、鈣質無直接相關
= 出生就有的牙齒稱為natal teeth，一個月以內出現的牙齒稱為neonatal teeth，發生率約為1/2000-3000，大多是兩顆下門牙，除非影響到吸奶，否則不須處理
= 長牙齒的時候，體溫有時候會稍高，但是大多只稍微超過攝氏三十八度，而且只持續一天