1b Postnatal and Child Development Flashcards
What are the genetic impacts on a fetus prenatally?
- Minor effect overall
- Maternal size important in determining birth size
- Paternal genetic factors have little effect on birth
- Maternal factors tend to override fetal genetic factors in determining prenatal growth
What are the genetic impacts on a fetus postnatally?
- Largely determines final adult height
- Sex chromosomes have an effect: XY boys are taller than XX girls
What are the endocrine impacts on a fetus prenatally?
- Insulin and insulin-like growth factors (IGFs) are major prenatal hormones influencing growth:
- IGF-2 most important for embryonic growth
- IGF-1 most important for later fetal and infant growth
- (Growth hormone has no effect on early growth)
What are the endocrine impacts on a fetus postnatally?
- Human growth hormone (hGH) is the major hormone controlling growth after birth
What are the nutrition impacts on a fetus prenatally?
- Placenta provides all nutrients to growing fetus, therefore essential for growth
- Placental insufficiency most common cause of intrauterine growth restriction
- Placenta also controls hormones necessary for fetal growth
- Maternal diet influences nutritional availability
What are the nutrition impacts on a fetus postnatally?
- Adequate nutrition is essential for growth (Starvation due to lack of substrate availability can limit growth potential)
- Obesity occurs mostly as a result of excessive intake of food
- Poor nutrition may delay the onset of puberty; Malabsorption of nutrients may cause reduced growth
What are the environmental impacts on a fetus prenatally?
- Uterine capacity and placental sufficiency important in providing optimal environment for fetus
- placental function is more influential in fetal growth than uterine capacity
What are the environmental impacts on a fetus postnatally?
The following factors are known to influence growth:
* Socioeconomic status
* Chronic disease
* Emotional status
* Altitude (mediated by lower oxygen saturation levels)
What is the head size compared to the body at birth?
Head disproportionately large for the body (1/3rd vs 1/7th in adulthood) at birth
What is the pattern of growth after birth?
Grows rapidly for the first 2 years, before slowing
When do cranial sutures open and close?
open at birth, close by 18months
What are the four recognised phases of growth?
- Fetal
- Infantile
- Childhood
- Pubertal
What is the fastest period of growth over life-course?
fetal phase
What percentage of eventual height does the fetal phase account for?
30% of eventual height
How does growth occur in the fetal phase?
- Fetus repeatedly doubles in size over gestation
- Growth mainly driven by hyperplasia during fetal life:~42 cycles of cell division before birth,
~only further five cycles of cell division occur from birth to adulthood.
What period of time does the infantile phase cover?
Covers 0-18 months after birth
What percentage of eventual height does the infantile phase account for?
15% of eventual height
How does growth occur in the infantile phase?
- Rapid, but decelerating growth (vs fetal phase)
- Length increases by 50%, head circumference by 30% and weight triples vs birth
- Growth largely nutrition dependent
What period of time does the childhood phase cover?
18 months to 12 years of age
What percentage of eventual height does the childhood phase account for?
approximately 40% of eventual height
How does growth occur in the childhood phase?
- Steady, slow prolongued growth
- 5-6 cm annual increase in height, and 3-3.5kg annual increase in weight
- Good nutrition and health important, but endocrine growth regulation increasing
What is the pubertal phase also known as
The pubertal growth spurt
What percentage of eventual height does the pubertal phase account for?
15% of eventual height
How does growth occur in the pubertal phase?
- Rising levels of sex hormones boost hGH production
- ~25cm (XY boys) ~20cm (XX girls) increase in height over 3-4 years
- Temporary growth spurt as sex hormones also cause fusion of growth plates
What happens to gonadotrophin secretions in pregnancy?
Gonadotrophin secretion commences towards the end of the first trimester, peaks mid-pregnancy, then declines
What causes mini puberty?
HPG axis is transiently activated after birth (mini-puberty), after release from restraint by placental hormones
How long does the mini-puberty last?
Continues for around 6 months after birth before declining
What is the benefit of elevated sex steroids in males during mini-puberty?
Important for normal gonadal development (testicular tissue and penile development)
What is the effect of the minipuberty in females?
- Effect is less clear
- Estradiol levels fluctuate through first few months after birth
- Follicular development occurs in the ovary
- Important for patterning and development of mammary tissue?
What are other effects of elevated sex steroids in minipuberty?
*may also influence programming of body composition and linear growth.
*High testosterone levels in boys during minipuberty, may partly explain the higher growth velocity observed in boys compared to girls.
What triggers puberty?
Release of neurokinin KNDy neurons may regulate release of Kisspeptin peptides, which act on GnRH neurons to promote pulsatile GnRH release
What can mutations in KISS1R do?
Affect puberty timing, implicating Kisspeptin-KISS1R signalling in regulation of this process
What is the name for compliance with the predictable pattern of developmental events in puberty?
Consonance
What is the Moro reflex?
When the babies neck is suddenly extended and the arms abduct and then adduct
When does the Moro reflex develop and disspear?
Develops - 28-32 weeks gestation
Should disapear between 3-6 months gestation
What is the persistence of primitive reflexes a sign of?
sign of impaired development
What is the standing reflex?
Extension of the lower extremities
Hips slightly flexed
Head free to turn
When does the standing reflex present?
From newborn to three months
What is the Grasp Reflex?
When an object is placed into the hands of a newborn, the fingers grasp the object tightly, and then stroking of the lateral side of the hand will release the fingers again
What is the grasp reflex replaced with?
voluntary movements of the hands around 6-9 months
What is the parachute reflex?
When the baby is placed in the forward tilting position - they will protect them selves with out stretched hands
What is development?
Global impression of a child - increase in understanding, acquisition of new skills and more sophisticated responses and behaviours
What are the four domains of child development?
Speech and language skills, social skills, gross motor skills and fine motor skills
Describe what happens when a baby is pulled to sit?
Lying down = limited flexed, symmetrical posture
Lift them up = lag of the head dye to the lack of maturity of the neck muscles
Describe the typical positioning of babies at 6-8 weeks and 6-8 months?
6-8 weeks = lying down by raises head to the 45 degree position
6-8 months = sitting upright unsupported, at 6 months back might be rounded, but at 8 months, much straighter seated position
At what point in development is a baby able to roll independantly?
3-5 months
What is the typical age at which babies start to crawl?
8-9 months
At what age do babies start to pull them selves up to furniture?
10 months
At what age is the baby following an object or face by turning the head?
6 weeks
At what age will a baby be reaching out for toys?
4 months
At what age will babies be transfering objects from one hand to the next?
6-7 months
At what age will the bay develop a pincer grip?
10 months - able to hold object between their thumb and fore finger
At what age will a child be able to make marks with a crayon?
16-18 months
What is the first sign that a new born baby can hear?
responding / startled by loud noises
At what age will a baby vocalise alone or when spoken to, coo and laugh?
at 3-4 months
What hearing test is carried out at 7 months?
Hearing distraction test
What type of speech will babies displaying at 7-10 months?
Polysyllabic babble
what speech will chilren with a hearing impairment make?
Much more monosyllabic
What are the stages of hearing speech and language development between 12, 18, 20 months and 2-3 years?
12 months = Two or three words, other than dada or mama
18 months = locating parts of their body by responding to someone
20 months = Uses two or more words to make simple phrases
2.5-3 years = talks constantly in 2-4 word sentences
What do children with autism show?
Disordered speech and language development
Describe the changes which occur to emotional, social and behavioural development in children?
6 weeks = smiles responsively
6-8 months = puts food in mouth
10-12 months = waves bye bye and plays peak a boo, drinks from a cup using two hands
18 months = spoon feeding, symbolic play
2 years = dry by day, pulls on some clothing, and involved in parallel play with other children
What are the patterns of abnormal development?
Slow but steady, plateau, regression
Describe the limit ages for different gross motor activities?
head control - 4 months
Sits unsupported - 9 months
Stands independently - 12 Months
Walks independently - 18 months
What is the abnormal motor development by 2 months which could suggest cerebral palsy?
Unable to life head or push up on arms, stiff extended legs
Pushing back with head and constantly fisted hand and stiff leg on one side
Difficulty moving out this position
Describe the abnormal motor development which might be seen from 3-6 months?
Unable to lift head, floppy trunk but stiff arms and extended legs
Arms flexed and held back, with stiff legs
Excess tone in the lower limbs = lack of disinhibition = potentially early cerebral palsy
What would you see in a baby between 6-9 months with potential cerebral palsy which represent abnormal motor development?
Poor head control
Difficulty getting arms forward
Stiff legs and pointed toes
Rounded back
Poor Ability to lift head and take weight
What would you see in a baby between 9-13 months with potential cerebral palsy which represent abnormal motor development?
Not interested in weight bearing
difficulty pulling to stand
Stiff legs
Cannot crawl on hands and knees
May only use one side of the body to move
What would you see in a baby between 12-18 months with potential cerebral palsy which represent abnormal motor development?
Holding arms bent and both arms stiffly bent
Excessive tip toe gait
Sits with weight on one side and uses one hand for play
Hyperreflexia
Describe the fields of development with limit ages for vision and fine motor development?
Fixes and follows visually - 3 months
Reaches for objects - 6 months
Transfers - 9 months
Pincer grip 12 months
Describe the fields of development with limit ages for hearing speech and language development?
Polysyllabic babble = 7 months
Consonant babble = 10 months
Saying 6 words with meaning - 18 months
3 word sentances = 2 years
Describe the fields of development with limit ages for social emotional and behavioural development?
Smiles - 8 weeks
Fear of strangers - 10 months
Feeds using a spoon = 18 months
Symbolic play = 2-2.5 years
Interactive play - 3-3.5 years
what are the three components of the healthy child programme?
Screening, general exam / immunisation and health education and promotion
what screening is done at less than 12 weeks into pregnancy?
Hbopathy, Rhesus, infection
What screening is done 12 weeks into pregnancy?
US scan dating and nuchal scan = for downsyndrome
What screening is done 18-20 weeks into pregnancy
Detailed US scan
What screening is done for new borns?
Bloodspot, hearing and physical screens
What are the elements of health promotion?
Relationships, breast feeing, vaccination, reading, weaning, social and emotional etc
When are the child health reviews conducted?
first year review and second year review
Describe the screening which is done from age 3-19
4-5 = Vision
5-11 = share infomation about preschool background
11-16 = health review as school transition occurs
What review is done at 4-5 years?
School entry review
How do the health promotion priorities shift as child development occurs?
5-11 = Promote health weight
11-16 = sexual health as well
16-19 = promote physical activity
What are prenatal factors which might influence developing human?
Nutrition - folate which is needed for spinal cord development
Iron which is needed for brain development
What are perinatal factors which might influence developing human?
Delivery of the baby = oxygen deprivation, drugs used like aminoglycosides
What are postnatal factors which might influence developing human?
Trauma
Meningitis
What is one of the most important considerations when evaluating a child for abnormal development?
Parental concern
What are the factors which might influence developmental delay?
Ill Health
Lack of physical or psychological stimuli in family home
Sensory / Motor Impairment
Reduced inherent Potential
What are the two broad types of developmental delay?
Global = delay in all four domains
Specific = delay in either language, motor, sensory or cognitive
What are some causes of global delay?
Down Syndrome and Fragile X
Hypothyroidism, inborn errors of metabolism
Infections, drugs, trauma, chronic illness
Environmental-social issues
What are the causes of motor delay?
Cerebral palsy
down’s Syndrome
Congenital Hip Dislocation
Social deprivation
MDD
Neural tube defects - spina bifida
Hyrdocephalus
What are causes of language delay>?
Hearing loss
Learning diability
ASD
Lack of stimulation
Development Dysphasia
Stammer, dysarthia = impaired speech production
What are commonly used assessment tools for development?
Schedule of growing skills, griffits development scale, Bailey developmental scale and Denver
