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BRS DEVELOPMENT AND AGEING > 1b Postnatal and Child Development > Flashcards

1b Postnatal and Child Development Flashcards

1
Q

What are the genetic impacts on a fetus prenatally?

A
  • 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
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2
Q

What are the genetic impacts on a fetus postnatally?

A
  • Largely determines final adult height
  • Sex chromosomes have an effect: XY boys are taller than XX girls
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3
Q

What are the endocrine impacts on a fetus prenatally?

A
  • 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)
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4
Q

What are the endocrine impacts on a fetus postnatally?

A
  • Human growth hormone (hGH) is the major hormone controlling growth after birth
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5
Q

What are the nutrition impacts on a fetus prenatally?

A
  • 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
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6
Q

What are the nutrition impacts on a fetus postnatally?

A
  • 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
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7
Q

What are the environmental impacts on a fetus prenatally?

A
  • Uterine capacity and placental sufficiency important in providing optimal environment for fetus
  • placental function is more influential in fetal growth than uterine capacity
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8
Q

What are the environmental impacts on a fetus postnatally?

A

The following factors are known to influence growth:
* Socioeconomic status
* Chronic disease
* Emotional status
* Altitude (mediated by lower oxygen saturation levels)

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9
Q

What is the head size compared to the body at birth?

A

Head disproportionately large for the body (1/3rd vs 1/7th in adulthood) at birth

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10
Q

What is the pattern of growth after birth?

A

Grows rapidly for the first 2 years, before slowing

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11
Q

When do cranial sutures open and close?

A

open at birth, close by 18months

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12
Q

What are the four recognised phases of growth?

A
  • Fetal
  • Infantile
  • Childhood
  • Pubertal
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13
Q

What is the fastest period of growth over life-course?

A

fetal phase

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14
Q

What percentage of eventual height does the fetal phase account for?

A

30% of eventual height

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15
Q

How does growth occur in the fetal phase?

A
  • 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.
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16
Q

What period of time does the infantile phase cover?

A

Covers 0-18 months after birth

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17
Q

What percentage of eventual height does the infantile phase account for?

A

15% of eventual height

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18
Q

How does growth occur in the infantile phase?

A
  • Rapid, but decelerating growth (vs fetal phase)
  • Length increases by 50%, head circumference by 30% and weight triples vs birth
  • Growth largely nutrition dependent
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19
Q

What period of time does the childhood phase cover?

A

18 months to 12 years of age

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20
Q

What percentage of eventual height does the childhood phase account for?

A

approximately 40% of eventual height

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21
Q

How does growth occur in the childhood phase?

A
  • 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
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22
Q

What is the pubertal phase also known as

A

The pubertal growth spurt

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23
Q

What percentage of eventual height does the pubertal phase account for?

A

15% of eventual height

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24
Q

How does growth occur in the pubertal phase?

A
  • 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
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25
Q

What happens to gonadotrophin secretions in pregnancy?

A

Gonadotrophin secretion commences towards the end of the first trimester, peaks mid-pregnancy, then declines

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26
Q

What causes mini puberty?

A

HPG axis is transiently activated after birth (mini-puberty), after release from restraint by placental hormones

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27
Q

How long does the mini-puberty last?

A

Continues for around 6 months after birth before declining

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28
Q

What is the benefit of elevated sex steroids in males during mini-puberty?

A

Important for normal gonadal development (testicular tissue and penile development)

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29
Q

What is the effect of the minipuberty in females?

A
  • 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?
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30
Q

What are other effects of elevated sex steroids in minipuberty?

A

*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.

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31
Q

What triggers puberty?

A

Release of neurokinin KNDy neurons may regulate release of Kisspeptin peptides, which act on GnRH neurons to promote pulsatile GnRH release

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32
Q

What can mutations in KISS1R do?

A

Affect puberty timing, implicating Kisspeptin-KISS1R signalling in regulation of this process

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33
Q

What is the name for compliance with the predictable pattern of developmental events in puberty?

A

Consonance

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34
Q

What is the Moro reflex?

A

When the babies neck is suddenly extended and the arms abduct and then adduct

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35
Q

When does the Moro reflex develop and disspear?

A

Develops - 28-32 weeks gestation

Should disapear between 3-6 months gestation

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36
Q

What is the persistence of primitive reflexes a sign of?

A

sign of impaired development

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37
Q

What is the standing reflex?

A

Extension of the lower extremities
Hips slightly flexed
Head free to turn

38
Q

When does the standing reflex present?

A

From newborn to three months

39
Q

What is the Grasp Reflex?

A

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

40
Q

What is the grasp reflex replaced with?

A

voluntary movements of the hands around 6-9 months

41
Q

What is the parachute reflex?

A

When the baby is placed in the forward tilting position - they will protect them selves with out stretched hands

42
Q

What is development?

A

Global impression of a child - increase in understanding, acquisition of new skills and more sophisticated responses and behaviours

43
Q

What are the four domains of child development?

A

Speech and language skills, social skills, gross motor skills and fine motor skills

44
Q

Describe what happens when a baby is pulled to sit?

A

Lying down = limited flexed, symmetrical posture

Lift them up = lag of the head dye to the lack of maturity of the neck muscles

45
Q

Describe the typical positioning of babies at 6-8 weeks and 6-8 months?

A

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

46
Q

At what point in development is a baby able to roll independantly?

A

3-5 months

47
Q

What is the typical age at which babies start to crawl?

A

8-9 months

48
Q

At what age do babies start to pull them selves up to furniture?

A

10 months

49
Q

At what age is the baby following an object or face by turning the head?

A

6 weeks

50
Q

At what age will a baby be reaching out for toys?

A

4 months

51
Q

At what age will babies be transfering objects from one hand to the next?

A

6-7 months

52
Q

At what age will the bay develop a pincer grip?

A

10 months - able to hold object between their thumb and fore finger

53
Q

At what age will a child be able to make marks with a crayon?

A

16-18 months

54
Q

What is the first sign that a new born baby can hear?

A

responding / startled by loud noises

55
Q

At what age will a baby vocalise alone or when spoken to, coo and laugh?

A

at 3-4 months

56
Q

What hearing test is carried out at 7 months?

A

Hearing distraction test

57
Q

What type of speech will babies displaying at 7-10 months?

A

Polysyllabic babble

58
Q

what speech will chilren with a hearing impairment make?

A

Much more monosyllabic

59
Q

What are the stages of hearing speech and language development between 12, 18, 20 months and 2-3 years?

A

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

60
Q

What do children with autism show?

A

Disordered speech and language development

61
Q

Describe the changes which occur to emotional, social and behavioural development in children?

A

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

62
Q

What are the patterns of abnormal development?

A

Slow but steady, plateau, regression

63
Q

Describe the limit ages for different gross motor activities?

A

head control - 4 months
Sits unsupported - 9 months
Stands independently - 12 Months
Walks independently - 18 months

64
Q

What is the abnormal motor development by 2 months which could suggest cerebral palsy?

A

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

65
Q

Describe the abnormal motor development which might be seen from 3-6 months?

A

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

66
Q

What would you see in a baby between 6-9 months with potential cerebral palsy which represent abnormal motor development?

A

Poor head control
Difficulty getting arms forward
Stiff legs and pointed toes
Rounded back
Poor Ability to lift head and take weight

67
Q

What would you see in a baby between 9-13 months with potential cerebral palsy which represent abnormal motor development?

A

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

68
Q

What would you see in a baby between 12-18 months with potential cerebral palsy which represent abnormal motor development?

A

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

69
Q

Describe the fields of development with limit ages for vision and fine motor development?

A

Fixes and follows visually - 3 months
Reaches for objects - 6 months
Transfers - 9 months
Pincer grip 12 months

70
Q

Describe the fields of development with limit ages for hearing speech and language development?

A

Polysyllabic babble = 7 months
Consonant babble = 10 months
Saying 6 words with meaning - 18 months
3 word sentances = 2 years

71
Q

Describe the fields of development with limit ages for social emotional and behavioural development?

A

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

72
Q

what are the three components of the healthy child programme?

A

Screening, general exam / immunisation and health education and promotion

73
Q

what screening is done at less than 12 weeks into pregnancy?

A

Hbopathy, Rhesus, infection

74
Q

What screening is done 12 weeks into pregnancy?

A

US scan dating and nuchal scan = for downsyndrome

75
Q

What screening is done 18-20 weeks into pregnancy

A

Detailed US scan

76
Q

What screening is done for new borns?

A

Bloodspot, hearing and physical screens

77
Q

What are the elements of health promotion?

A

Relationships, breast feeing, vaccination, reading, weaning, social and emotional etc

78
Q

When are the child health reviews conducted?

A

first year review and second year review

79
Q

Describe the screening which is done from age 3-19

A

4-5 = Vision
5-11 = share infomation about preschool background
11-16 = health review as school transition occurs

80
Q

What review is done at 4-5 years?

A

School entry review

81
Q

How do the health promotion priorities shift as child development occurs?

A

5-11 = Promote health weight
11-16 = sexual health as well
16-19 = promote physical activity

82
Q

What are prenatal factors which might influence developing human?

A

Nutrition - folate which is needed for spinal cord development

Iron which is needed for brain development

83
Q

What are perinatal factors which might influence developing human?

A

Delivery of the baby = oxygen deprivation, drugs used like aminoglycosides

84
Q

What are postnatal factors which might influence developing human?

A

Trauma
Meningitis

85
Q

What is one of the most important considerations when evaluating a child for abnormal development?

A

Parental concern

86
Q

What are the factors which might influence developmental delay?

A

Ill Health
Lack of physical or psychological stimuli in family home
Sensory / Motor Impairment
Reduced inherent Potential

87
Q

What are the two broad types of developmental delay?

A

Global = delay in all four domains

Specific = delay in either language, motor, sensory or cognitive

88
Q

What are some causes of global delay?

A

Down Syndrome and Fragile X
Hypothyroidism, inborn errors of metabolism
Infections, drugs, trauma, chronic illness
Environmental-social issues

89
Q

What are the causes of motor delay?

A

Cerebral palsy
down’s Syndrome
Congenital Hip Dislocation
Social deprivation
MDD
Neural tube defects - spina bifida
Hyrdocephalus

90
Q

What are causes of language delay>?

A

Hearing loss
Learning diability
ASD
Lack of stimulation
Development Dysphasia
Stammer, dysarthia = impaired speech production

91
Q

What are commonly used assessment tools for development?

A

Schedule of growing skills, griffits development scale, Bailey developmental scale and Denver

BRS DEVELOPMENT AND AGEING (6 decks)

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