Developmental Assessment Station in One Page

Age Gross Motor Fine Motor / Vision Speech / Language Social

Draw Brick Cut Beads
6 weeks  Good head control – raises head to  Tracks object/ face  Stills, startles at loud noise  Social smile (visual problem if not)
45o when on tummy,
 Stabilises head when raised to sitting
position
6 months  Sit without support, rounded back  Palmar grasp (5m)  Turns head to loud sounds  Puts objects to mouth (stops at 1yr)
 Rolls tummy (prone) to back (supine)  Transfer hand to hand  Understands “bye bye” / “no” (7m)  Shakes rattle
. Vice versa slightly later.  Babbles (monosyllabic)  Reaches for bottle / breast
9 months  Stands holding on  Inferior pincer grip  Responds to own name  Stranger fear (6-9 mths – 2yrs)

l
 Straight back sitting (7 ½ m)  Object permanence  Imitates adult sounds  Holds and bites food
Draw Brick Cut Beads
12 months  Walks alone (9-18m) 2  Shows understanding of nouns  Waves “bye bye”
 18m is threshold for worry (“where’s Mummy?”)  Hand clapping
 Neat pincer grip (10m)
– i.e. Duchenne’s MD, hip problems,  3 words (50% at 13m)  Plays alone if familiar person
 Casting bricks (should disappear by 18m – persistence
cerebral palsy etc  Points to own body parts (15m), doll nearby
beyond this = abnormal)
(18m)  Drinks from beaker with lid
18 months  Runs (16m) To and fro 4  Shows understanding of nouns  Imitates every day activities
 Jumps (18m) (15m) (“show me the xxxxx”)
 1 to 6 different words
2 Years  Runs tiptoe Vertical line 8  Shows understanding of verbs  Eats skilfully with spoon (2½ years)
 Walks upstairs, both feet / each step. (“what do you draw with, what do
 Throws ball at shoulder level  Puzzles – shape matching is >2 yr skill. Random effort <2 yr you eat with?”)
 Turns several pages of book at a time  2 words joined together (50+ words)
2 ½ Years  Kicks ball Horizontal  Shows understanding of prepositions
line in/on (“put the cat on the bowl”)
 3 – 4 words joined together
3 Years  Hops on one foot for 3 steps (each Circle Bridge Single cuts Griffiths beads  Understands negatives (“which of  Begins to share toys with friends
foot) □ these is NOT an animal?”)  Plays alone without parents
□ □
 Walks upstairs, one foot per step; (or train)  Understands adjectives (“which one  Eats with fork and spoon
downstairs two feet per step.  Turns one page of book at a time is red?”)  Bowel control
3 ½ Years Cuts pieces  Understands comparatives (“which
boy is bigger than this one?” while
pointing to middle-sized boy! Or draw
circles to illustrate point)
4 Years  Walks upstairs / downstairs in adult Cross 12 blocks Cuts paper in Small beads  Understands complex instructions  Concern/sympathy for others if hurt
manner half (“Before you put x in y, give z to  Has best friend
Square Steps Mummy”)  Bladder control (4½ years)
(4.5 yrs) □  Uses complex narrative / sequences  Engages in imaginative play,
□□
□□□ to describe events. observing rules (4½ to 5 years old)
Triangle /  Eats skilfully with little help
person Big steps (5y)  Handles knife (at 5 yrs)
□
(5 yrs) □□  Dressing and undressing
□□□
□□□□
By Christopher Kelly, MRCPCH Clinical Revision – http://mrcpch.paediatrics.co.uk
 NATIONAL IMMUNISATION SCHEDULE FOR MALAYSIA (MINISTRY OF HEALTH, MALAYSIA)
Age in months Age in years
Vaccine birth 1 2 3 5 6 9 12 18 21 7 yrs 13 yrs 15 yrs
BCG 1 if no scar

Hepatitis B 1 2 3
DTaP 1 2 3 4 DT (B) T (B)
Chapter 2: Immunisations

IPV 1 2 3 4
Hib 1 2 3 4

9
Measles Sabah
MMR 1 2 MR*
JE (Sarawak) 1 2
HPV 2 doses
Legend: B, Booster doses; BCG, Bacille Calmette-Guerin; DTaP, Diphhteria, Tetanus, acellular Pertussis; DT, Diphtheria, Tetanus;
T, Tetanus; IPV, Inactivated Polio Vaccine; Hib, Haemophilus influenzae type B; MMR, Measles, Mumps, Rubella;
JE, Japanese Encephalitis; HPV, Human Papilloma Virus;
* Until the present cohort (9 and 12 months MMR) reaches 7 years
I

a GENERAL PAEDIATRICS
 GENERAL PAEDIATRICS
Chapter 1: Normal Values in Children

É
VITAL SIGNS

Normal Ranges forRespiratory Rate (RR) and Heart rate (HR)

Age Guide weight RR at Rest HR
(kg) Breaths per minute Beats per minute
Boys Girls 5th to 95th Centile 5th to 95th Centile

a
Birth 3.5 3.5 25 - 50 120 - 170
1 month 4.5 4.5
3 months 6.5 6 25 - 45 115 - 160
6 months 8 7 20 - 40 110 – 160
12 months 9.5 9
18 months 11 10 20 - 35 100 - 155
2 years 12 12 20 - 30 100 - 150
3 years 14 14 90 - 140
4 years 16 16 80 - 135
5 years 18 18
6 years 21 20 80 - 130
7 years
8 years
23
25
22
25 15 - 25 70 - 120
pp
9 years 28 28
10 years 31 32
11 years 35 35
12 years 43 43 12 - 24 65 - 115
14 years 50 50 60 - 110
Adult 70 70

17
 Birth to 36 months: Boys NAME
Length-for-age and Weight-for-age percentiles RECORD #

Birth 3 6 9 12 15 18 21 24 27 30 33 36
in cm AGE (MONTHS)
cm in
41 41 L
40 95 40 E
100 90 100 N
39 39
75 G
38 38
95 50 95 T
37 37 H
25
36 36
90 10 90
35 5 35
34
85
33
32 95 38
80 17
31
L 90 36
30
E 75 16
N
29
75
34
G 28
70 15
T 27 32
H 26 50
65 14
25 30 W
24 25 E
60 13
23 28 I
10 G
22 55 12 H
5 26
21 T
20 50 11 24
19
18 45 10 22
17
16 40 9 20
15
8 18

16 16
7 AGE (MONTHS)
kg lb
12 15 18 21 24 27 30 33 36
14
6 Mother’s Stature Gestational
W Father’s Stature Age: Weeks Comment
E 12
Date Age Weight Length Head Circ.
I 5 Birth
G 10
H
T
4
8
3
6
2
lb kg
Birth 3 6 9
Published May 30, 2000 (modified 4/20/01).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 Birth to 36 months: Boys
Head circumference-for-age and NAME
Weight-for-length percentiles RECORD #

Birth 3 6 9 12 15 18 21 24 27 30 33 36
in cm AGE (MONTHS) cm in H
E
95 A
52 90 52
D
20 75 20
50 50 C
50
I
25 R
H 19 19
48 48 C
E 10 U
A 5 M
D 18 46 46 18 F
E
R
C 44 44 E
I 17 17 N
R C
C 42 42 E
U 16
M 40 50
F 22 48
E
15 38 21 46
R
E 20 44
N 36 19 42
14
C
E
95
18 40
34 90
17 38
13 75
36
32 50
16
34
12 25 15
30 10 32
5 14
30 W
13 28 E
12 I
26 G
24 11 11 24 H
22 10 10 22 T
20 9 9 20
18 8 8 18
16 7 7 16
W
E 14 14
6 6
I 12 12
G 5 5
10 kg lb
H 4 LENGTH
T 8 cm
64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98100
6 3
26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 in
4 2
Date Age Weight Length Head Circ. Comment
2 1
lb kg
cm 46 48 50 52 54 56 58 60 62
in 18 19 20 21 22 23 24

Published May 30, 2000 (modified 10/16/00).

SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 Birth to 36 months: Girls NAME
Length-for-age and Weight-for-age percentiles RECORD #

Birth 3 6 9 12 15 18 21 24 27 30 33 36
in cm AGE (MONTHS)
cm in
41 41 L
40 40 E
100 95 100
39 90 39 N
38 G
75 38
95 95 T
37 50 37 H
36 25 36
90 90
35 10 35
5
34
85
33
32 38
80 95 17
31
L 30 36
75 90 16
E
N
29
34
G 28
70 75
15
T 27 32
H 26 65 14
25 50 30 W
24 E
60 13
23 25 28 I
G
22 55 12 H
10 26
21 5 T
20 50 11 24
19
18 45 10 22
17
16 40 9 20
15
8 18

16 16
7 AGE (MONTHS)
kg lb
12 15 18 21 24 27 30 33 36
14
6 Mother’s Stature Gestational
W Father’s Stature Age: Weeks Comment
E 12
Date Age Weight Length Head Circ.
I 5 Birth
G 10
H
T
4
8
3
6
2
lb kg
Birth 3 6 9
Published May 30, 2000 (modified 4/20/01).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 Birth to 36 months: Girls
Head circumference-for-age and NAME
Weight-for-length percentiles RECORD #

Birth 3 6 9 12 15 18 21 24 27 30 33 36
in cm AGE (MONTHS) cm in H
E
A
52 52
D
95
20 90 20
50 50 C
75 I
50 R
H 19 19
48 48 C
E 25 U
A 10 M
D 18 46 5 46 18 F
E
R
C 44 44 E
I 17 17 N
R C
C 42 42 E
U 16
M 40 50
F 22 48
E
15 38 21 46
R
E 20 44
N 36 19 42
14
C 95
E 18 40
34 90
17 38
13 75 36
32 16
50 34
12 25
15
30 32
10 14
5 30 W
13 28 E
12 I
26 G
24 11 11 24 H
22 10 10 22 T
20 9 9 20
18 8 8 18
16 7 7 16
W
E 14 14
6 6
I 12 12
G 5 5
10 kg lb
H 4 LENGTH
T 8 cm
64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98100
6 3
26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 in
4 2
Date Age Weight Length Head Circ. Comment
2 1
lb kg
cm 46 48 50 52 54 56 58 60 62
in 18 19 20 21 22 23 24

Published May 30, 2000 (modified 10/16/00).

SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 2 to 20 years: Boys NAME
Stature-for-age and Weight-for-age percentiles RECORD #

12 13 14 15 16 17 18 19 20
Mother’s Stature Father’s Stature cm in
Date Age Weight Stature BMI*
AGE (YEARS) 76
95
190
74
90
185 S
75
72
180 T
50 70 A
175 T
25 68 U
170 R
10 66
165 E
in cm 3 4 5 6 7 8 9 10 11 5
64
160 160
62 62
155 155
S 60 60
T 150 150
A 58
T 145
U 56
140 105 230
R
54
E 135 100 220
52
130 95 95 210
50
125 90 200
90
48 190
120 85
46 180
115 80
75
44 170
110 75
42 160
105 50 70
150 W
40
100 65 140 E
25
38 I
95 60 130 G
10
36 90 5 H
55 120
T
34 85 50 110
32 80 45 100
30
40 90
80 35 35 80
W 70 70
30 30
E 60 60
I 25 25
G 50 50
H 20 20
40 40
T
15 15
30 30
10 10
lb kg AGE (YEARS) kg lb
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Published May 30, 2000 (modified 11/21/00).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 2 to 20 years: Girls NAME
Stature-for-age and Weight-for-age percentiles RECORD #

12 13 14 15 16 17 18 19 20
Mother’s Stature Father’s Stature cm in
Date Age Weight Stature BMI*
AGE (YEARS) 76
190
74
185 S
72
180 T
70 A
95
175 T
90
68 U
170 R
75 66
165 E
in cm 3 4 5 6 7 8 9 10 11 50
64
160 25 160
62 62
155 10 155
60 5 60
150 150
58
145
56
140 105 230
54
S 135 100 220
T 52
A 130 95 210
50
T 125 90 200
U
48 190
R 120 85
E 95 180
46
115 80
44 170
110 90 75
42 160
105 70
150 W
40 75
100 65 140 E
38 I
95 60 130 G
50
36 90 H
55 120
25 T
34 85 50 110
10
32 80
5
45 100
30
40 90
80 35 35 80
W 70 70
30 30
E 60 60
I 25 25
G 50 50
H 20 20
40 40
T
15 15
30 30
10 10
lb kg AGE (YEARS) kg lb
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Published May 30, 2000 (modified 11/21/00).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 GENERAL PAEDIATRICS
É
ANTHROPOMETRIC MEASUREMENTS

Age Weight Height Head size

Birth 3.5 kg 50 cm 35 cm
6 months 7 kg 68 cm 42 cm
1 year 10 kg 75 cm 47 cm
2 years 12 kg 85 cm 49 cm
3 years 14 kg 95 cm 49.5 cm
4 years 100 cm 50 cm
5-12 years 5 cm/year 0.33 cm/year

Points to Note
Weight
• In the first 7 - 10 days of life, babies lose 10 - 15% of their birth weight.
• In the first 3 months of life, the rate of weight gain is 25 gm/day
• Babies regain their birth weight by the 2nd week, double this by 5 months
age, and triple the birth weight by 1 year of age
• Weight estimation for children (in Kg):
Infants: (Age in months X 0.5) + 4
Children 1 – 10 years: (Age in yrs + 4) X 2

Head circumference
• Rate of growth in preterm infants is 1 cm/week, but reduces with age.
Head growth follows that of term infants when chronological age reaches term
• Head circumference increases by 12 cm in the 1st year of life (6 cm in first 3
months, then 3 cm in second 3 months, and 3 cm in last 6 months)

Other normal values are found in the relevant chapters of the book.
References:
1. Advanced Paediatric Life Support: The Practical Approach Textbook,
5th Edition 2011 im
2. Nelson Textbook of Pediatrics, 18th Edition.

7
 TSB LEVELS FOR PHOTOTHERAPY AND EXCHANGE TRANSFUSION IN BABIES ≥35 WEEKS GESTATION
adapted from AAP Guidelines
Age LOW RISK MEDIUM RISK HIGH RISK
>38 weeks and well >38 weeks with risk factors, or 35 - 37 weeks + 6 days
35 - 37 weeks + 6 days and well with risk factors
Hours Conventional Exchange Conventional Exchange Conventional Exchange
of life Phototherapy Transfusion Phototherapy Transfusion Phototherapy Transfusion
TSB mg/dL (µmol/L) TSB mg/dL (µmol/L) TSB mg/dL (µmol/L) TSB mg/dL (µmol/L) TSB mg/dL (µmol/L) TSB mg/dL (µmol/L)
*6 5(80) 17((290) 4(60) 14(240) 2(30) 13(220)
*12 6(100) 18(310) 5(80) 15(260) 3(50) 14(240)
24 9(154) 19(325) 7(120) 17(291) 5(86) 15(257)
48 12(205) 22(376) 10(171) 19(325) 8(137) 17(291)

139
72 15(257) 24(410) 12(205) 21(359) 10(171) 18.5(316)
96 17(291) 25(428) 14(239) 22.5(385) 11(188) 19 (325)
>96 18(308) 25(428) 15(257) 22.5(385) 12(205) 19 (325)
• Start intensive phototherapy at TSB of 3 mg/dL (51 µmol/L) above the level for conventional phototherapy or when TSB increasing
at >0.5 mg/dL (8.5 µmol/L) per hour.
• Risk factors are isoimmune haemolytic disease, G6PD deficiency, asphyxia and sepsis.
The AAP exchange transfusion guidelines for babies ≥35 weeks gestation recommend:
• ET if baby shows signs of ABE or if TSB ≥5 mg/dL (85 µmol/L) above the ET levels.
• ET if TSB rises to ET levels despite intensive phototherapy in hospitalised babies.
• For readmitted babies without signs of ABE, if the TSB is above the ET levels, repeat TSB every 2 - 3 hours and consider ET if it is
not expected to drop below ET levels after 6 hours of intensive phototherapy.

NEONATOLOGY