This document provides guidance on managing bedwetting in 4-year-olds and discusses testing for conditions like precocious puberty, Turner's syndrome, and failure to thrive. It also reviews normal infant weight gain, crying patterns that could indicate underlying issues, and ranges to know like stridor.

1. Development
Management for bedwetting in 4-yo – reassurance; if after 5, 1st line: night-time fluid
restriction, timed voiding, positive reinforcement, 2nd line: desmopressin, imipramine, urine
alarm.
Umbilical hernia repair recommended after age 5.
Organic vs. non-organic causes of failure to thrive
Turner’s baby – lymphedema (puffy hands & feet) + neck webbing (most likely seen in
neonate), underlying cardiac defects 44%
Synacthen test for precocious puberty
Bone age – XR of left wrist & hand is compared with biological age, if low = constitutional
delay (they’ll take longer to grow)
Keys from online quizzes:
Tetralogy is not assc. w/ turner’s but PVAL is
What is the average weight gain per week for infants aged 3-6
months? – 100-150g
CRYING:
 Crying peaks earlier in formula fed infants (4-6 weeks).
 Colic has an evening predominance of crying.
 High-pitched crying = meningitis
 Absence of crying pattern/clustering + post-feeding distress
+ skin changes = cow’s milk protein intolerance/allergy
 Constipation + abdominal swelling + cry = Hirschsprung
disease
 Also consider testicular torsion, non-accidental head injury

2. Ranges to KNOW:
Stridor – inspiratory noise