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dev/age > 1B postnatal and child development > Flashcards

1B postnatal and child development Flashcards

1
Q

Explain the effect of genetics on prenatal development

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

Explain the effect of genetics on postnatal development

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

Explain the endocrine effects on prenatal development

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

Explain the endocrine effect on postnatal development

A

Human growth hormone (hGH) is the major hormone controlling growth after birth

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5
Q

Explain the effect of nutrition on prenatal development

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

Explain the effect of nutrition on postnatal growth

A
  • Adequate nutrition is essential for growth
  • Starvation due to lack of substrate availability as a 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

Explain the environmental effects on prenatal growth

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

Explain the environmental effect on postnatal growth

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

Describe postnatal growth including the four recognised phases of growth

A
  • Head disproportionately large for the body (1/3rd vs 1/7th in adulthood) at birth
  • Grows rapidly for the first 2 years, before slowing
    Cranial sutures open at birth, close by 18months

Four recognised phases of growth:
- Fetal
- Infantile
- Childhood
- Pubertal

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10
Q

Describe fetal phase

A
  • Fastest period of growth over life-course
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11
Q

What ages does infantile phase cover?

A

Covers 0-18 months after birth

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12
Q

What ages does childhood phase cover?

A

18 months to 12 years of age

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13
Q

What contribution does childhood phase have to eventual height

A

Approximately 40%

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14
Q

How is growth in childhood phase characterised?

A

Steady, slow prolonged growth

  • 5-6 cm annual increase in height, and 3-3.5kg annual increase in weight
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15
Q

What factors are important in childhood phase?

A

Good nutrition and health important, but endocrine growth regulation increasing

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16
Q

What contribution does infantile have to eventual height?

A

Accounts for approximately 15% of eventual height.

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17
Q

How is growth in infantile phase characterised?

A
  • Rapid, but decelerating growth (vs fetal phase)
  • Length increases by 50%, head circumference by 30% and weight triples vs birth
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18
Q

What factors are important in infantile phase?

A

Growth largely nutrition dependent

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19
Q

What contribution does the pubertal phase have to eventual height?

A

15% of eventual height

  • ~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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20
Q

What significant event happens during pubertal phase?

A

Rising levels of sex hormones boost hGH production

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21
Q

What contribution does fetal phase have on eventual height?

A

Accounts for approximately 30% of eventual height.

  • Fetus repeatedly doubles in size over gestation
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22
Q

What is growth mainly driven by in fetal phase?

A
  • Growth mainly driven by hyperplasia (cell number) 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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23
Q

Describe reproductive hormone changes over childhood

A
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24
Q

What is mini-puberty?

A
  • Gonadotrophin secretion commences towards the end of the first trimester, peaks mid-pregnancy, then declines
  • HPG axis is transiently activated after birth (mini-puberty), after release from restraint by placental hormones
  • Continues for around 6 months after birth before declining
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25
Q

What is the point of mini-puberty in males?

A

Elevated sex steroids in males during mini-puberty seems to be important for normal gonadal development (testicular tissue and penile development)

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26
Q

What is the role of minipuberty in female infants?

A

Role of minipuberty less clear in female infants:

  • 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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27
Q

What is the effect of elevated sex steroids in minipuberty?

A

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.

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28
Q

What triggers puberty?

A

Control of puberty onset remains unclear, but influenced by metabolic status.

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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29
Q

What mutations affect puberty timing and what does it implicate?

A
  • Mutations in KISS1R
  • Implicates Kisspeptin-KISS1R signalling in regulation of puberty triggering
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30
Q

What is consonance?

A

The compliance of the sequence of developmental events of puberty that typically follow a predictable pattern

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31
Q

How have developmental milestones changed during puberty across the decades?

A

Age of menarche decreased by ~4 years 1850-1960, then by a further 3 months per decade from 1977-2013

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32
Q

What are the four developmental domains?

A
  • Gross motor skills
  • Fine motor skills
  • Speech, language and hearing skills
  • Social behaviour and play skills
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33
Q

How do newborn babies look when lying flat?

A

Limited flexed, symmetrical posture

  • When body is lifted, there is marked head lag due to neck muscles not having developed properly yet
34
Q

At 6-8 weeks how well can babies raise their head?

A

Head raise to 45° in prone

35
Q

What happens at 6-8 months?

A

Sits without support

  • At 6 months- with round back
  • At 8 months- with straight back
36
Q

What action can babies do well by 4-5 months?

A

Rolling around

37
Q

What gross motor skill can babies do by 8-9 months?

A

Crawl around

38
Q

What can babies do by 10 months?

A

Stand up and cruise around furniture

39
Q

What can babies do in 12 months?

A

Walks unsteadily, broad gait, hands apart

40
Q

What can babies do in 15 months?

A

Walk steadily

41
Q

By 6 weeks what can babies do coordination wise?

A

Follow moving object or face by turning the head

42
Q

Vision and fine motor wise, what can babies do in 4 months?

A

Reaching out for toys

43
Q

What can the baby do by 4-6 months with its hands?

A

Palmar grasp

44
Q

What can the baby do by 7 months with its hands?

A

Transferring toys from one hand to another

45
Q

What can babies do by 10 months grip wise?

A

Mature pincer grip

46
Q

What can babies do by 16-18months grip wise?

A

Make marks with a crayon

47
Q

By the time the child reaches 4 how does their hand-eye coordination develop?

A

Becomes quite sophisticated e.g. can build increasingly more difficult structures with building blocks

48
Q

By the time the child reaches 4 how does their hand-eye coordination develop in drawing?

A

Through 2-5 years they can draw without seeing how it’s done and can copy from 6 months earlier after seeing how it’s done

49
Q

How do newborns react to noise?

A

Startled by loud noises

50
Q

What can babies do by 3-4 months language wise?

A

Vocalise alone or when spoken to, coos and laughs

51
Q

How do babies react to sound at 7 months?

A

Turn to soft sounds out of sight

52
Q

What can babies do by 7-10 months language wise?

A
  • At 7 months, sounds used indiscriminately
  • At 10 months, sounds used discriminately to parents
  • Polysyllabic babble heard at this stage with tones and variations
53
Q

What can babies do by 12 months language wise?

A

2 or 3 words other than dada or mama

54
Q

What can toddlers do at 18 months language wise?

A

6-10 words and show 2 parts of the body

55
Q

What can a child do at 20-24 months language wise?

A

Use 2 or more words to make simple phrases e.g. give me teddy

56
Q

What can child do at 2.5-3 years language wise?

A

Talk constantly in 3-4 word sentences

57
Q

What social behaviour can babies do at 6 weeks?

A

Smiling responsively

58
Q

What social behaviour can babies do 6-8 months?

A

Self-feeding

59
Q

What social behaviour can babies do at 10-12 months?

A

Wave bye bye and play peek a boo

60
Q

What can babies do at 12 months social behaviour wise?

A

Encourage parents to get rid of bottle to aid speech and language development- prolonged usage of juice bottles can also lead to dental caries

61
Q

What can kids do at 18 months behaviour wise?

A

Hold spoon and get food safely to mouth

62
Q

What can kids do at 18-24 months behaviour wise?

A

Symbolic play i.e. imaginary play

63
Q

What can children do at 2 years behaviour wise?

A
  • Potty training
  • Pull off some clothing
64
Q

What can children do at 2.5-3 years?

A

Parallel play with other kids

65
Q

What are the fundamentals of a good screening test?

A
  • The disease it is screening for should be:
    • Able to identified early/before critical point
    • Treatable
    • Prevent/reduce morbidity/mortality
  • Acceptable/easy to administer
  • Cost effective
  • Reproducible and accurate results
66
Q

What health and development baby reviews are done by the NHS?

A
  • Newborn physical exam
  • Blood spot test
  • Newborn hearing test
  • Infant physical exam
67
Q

When is the newborn physical exam performed?

A

Within 72hrs of birth

68
Q

What does the newborn physical exam review?

A

Weight, eyes, heart, hips and testes

69
Q

When is the blood spot test done?

A

Within 7 days, ideally day 5

70
Q

What does the blood spot test assess?

A

CF, sickle cell, congenital hypothyroidism, inherited metabolic diseases (e.g. PKU)

71
Q

When is the newborn hearing test done?

A

3-5 weeks

Sometimes done in hospital before discharge, can be done up to 3 months

72
Q

When is the infant physical exam performed?

A

6-8 weeks

73
Q

Where is the infant physical exam done?

A

With GP, as newborn physical, and head circumference- opportunity to discuss vaccinations

74
Q

What are the causes of global developmental delay?

A
  • Chromosomal abnormalities (e.g. Down’s syndrome, Fragile X)
  • Metabolic e.g. hypothyroidism, inborn errors of metabolism
  • Antenatal and perinatal factors (infections, drugs, toxins, anoxia, trauma, folate deficiency)
  • Environmental-social issues
  • Chronic illness
75
Q

What are causes of language skill development delay?

A
  • Hearing loss
  • Autism spectrum disorders
  • Lack of stimulation
  • Impaired comprehension of language (development dysphasia)
  • Impaired speech production (stammer, dyarthria)
76
Q

What commonly used assessment tools are there?

A
  • Standardised tests
  • Schedule of growing skills
  • Griffiths developmental scale
  • Bailey developmental scale
  • Denver developmental screening tests
77
Q

What causes of motor delay are there?

A
  • Cerebral palsy
  • Global delay e.g. Down’s
  • Congenital dislocation hip
  • Social deprivation
  • Muscular dystrophy- Duchenne’s
  • Neural tube defects: spina bifida
  • Hydrocephalus
78
Q

What are the two types of developmental delay?

A
  • Global developmental delay
  • Specific developmental disorder
79
Q

What is global developmental delay?

A

Significant delay in reaching two or more developmental milestones

80
Q

What is specific developmental disorder?

A

Refers to delays in developmental domains in the absence of sensory deficits, subnormal intelligence or poor educational conditions:
- learning disorders
- motor skill disorders
- communication disorders

dev/age (4 decks)

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