📖 Summary & Clinical Pearls
🎯 Top 10 Clinical Takeaways
- Developmental surveillance at every visit + standardized screening at 9,18,30 months (ASQ-3) and autism at 18,24 months (M-CHAT).
- Toxic stress is buffered by Safe, Stable, Nurturing Relationships (SSNRs) — promote relational health.
- Temperament (easy 40%, difficult 10%, slow-to-warm-up 15%) — 'goodness of fit' prevents behavior problems.
- Colic rule of 3: crying >3hr/d, >3d/wk, >3wk; resolves by 3-4mo. Never shake — Period of PURPLE Crying.
- BEARS sleep screen at every visit: Bedtime, Excessive sleepiness, Awakenings, Regularity, Snoring.
- OSA: loud snoring + pauses → polysomnography; adenotonsillectomy first-line.
- Growth assessment: midparental height, bone age, growth velocity. BMI ≥95th %ile = obesity.
- IDEA Part C (birth-3): early intervention without medical diagnosis. Refer positive screens immediately.
- Child care exclusion (CFOC): fever with behavior change, diarrhea >2 above normal, vomiting ≥2 times.
- Bereavement: use clear language ('died'), avoid euphemisms. Children grieve intermittently.
🧠 Mnemonic Master List
- BEARS — Sleep screening domains
- PURPLE Crying — Normal crying curve/colic
- ASQ-3 domains — Communication, Gross motor, Fine motor, Problem-solving, Personal-social
- 5 Rs of early education — Read, Rhyme, Routines, Reward, Relationships
- CHiMP — Bone age delay causes: Constitutional delay, GH deficiency, Hypothyroidism, Malnutrition/Psychosocial
- FED for exclusion — Fever with behavior change, Excessive diarrhea, Difficulty breathing
- T&A first — Tonsillectomy & Adenoidectomy for OSA
- Midparental height — Boys: [(M+13)+F]/2; Girls: [(M-13)+F]/2