1b Postnatal and Child Development Flashcards
What are major prenatal hormones influencing growth?
IGF-2 most important for embryonic growth
IGF-1 most important for later fetal and infant growth
What are the environmental factors that affect prenatal growth?
Uterine capacity and placental sufficiency important in providing optimal environment for fetus
placental function is more influential in fetal growth than uterine capacity
How does the brain grow in the first 2 years?
Grows rapidly for the first 2 years, before slowing
Cranial sutures 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 the life course?
Fetal phase
What % of eventual height does the fetal phase account for?
30%
What is the main driver of growth in the fetal phase?
Hyperplasia
How many cycles of cell division occur before birth compared to after birth?
- 42 cycles of cell division before birth,
- only further five cycles of cell division occur from birth to adulthood.
What ages are included in the infantile phase?
0-18 months
What % of eventual height does the infantile phase account for?
15%
What happens to length, head circumference and weight during the infantile phase?
Length increases by 50%, head circumference by 30% and weight triples vs birth
What is growth largely dependent on in the infantile phase?
Nutrition dependent
What ages are included in the childhood phase?
18 months - 12 years
What % of eventual height does the childhood phase account for?
40%
What is the annual increase in height and weoght in the childhood phase?
5-6 cm annual increase in height, and 3-3.5kg annual increase in weight
What drives growth in the childhood phase?
Good nutrition and health important, but endocrine growth regulation increasing
What % of eventual height does the pubertal phase account for?
15%
What drives growth in the pubertal phase?
Rising levels of sex hormones boost hGH production
Temporary growth spurt as sex hormones also cause fusion of growth plates
What is the average increase in height in the pubertal phase?
~25cm (XY boys) ~20cm (XX girls) increase in height over 3-4 years
What causes mini-puberty after birth?
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
What is the importance of mini-puberty in males?
Elevated sex steroids in males during mini-puberty seems to be important for normal gonadal development (testicular tissue and penile development)
What could be potential role of mini puberty in females?
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?
What triggers puberty?
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
What mutations may affect puberty timing?
Mutations in KISS1R affect puberty timing, implicating Kisspeptin-KISS1R signalling in regulation of this process.
Compliance with the predictable sequence of developmental events is called?
Consonance
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 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 will babies begin to walk?
12 months - walks unsteadily, broad gait, hands apart
15 months - waalks steadily
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 are babies able to palmar grasp?
4-6 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 fine motor skills are developed between 14 months and 4 years?
Ability to build towers of three progressing to bridges and steps
What fine motor skills are developed from age 2-5 years?
Ability to draw differnt shapes without seeing it done, can copy from 6 months earlier
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
At 7 months, sounds used indiscriminately
At 10 months, sounds used discriminately to parents
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
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
12 months = drinks from a cup using two hands
18 months = holds spoon and gets food safely to mouth
18-24 months = symbolic play
2 years = dry by day, pulls on some clothing, and involved in parallel play with other children
2.5-3 years = parallel play
Describe the limit ages for different gross motor activities?
head control - 4 months
Sits unsupported - 9 months
Stands independntly - 12 Months
Walks independently - 18 months
Describe the fields of development with limit ages for vision and fine motor development?
Fixes and follows visually - 3 months
Reaches for obhjects - 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
health education and promotion
supporting care giving and care givers
sign posting
identification of high risk families/individuals ofr additional support
What are the fundementals for a good screening test?
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
What are examples of important early childhood screening?
Newborn Check
Newborn Hearing Screen
Blood spot check
what screening is done at less than 12 weeks into pregnancy?
Hbopathy, Rhesus, infection
What screening is done 12 weeks into pregnany?
US scan dating and nuchal scan = for downsyndrome
What screening is done 18-20 weeks into pregnancy
Detailed US scan
When is the newborn physical exam done and what does it entail?
Within 72 hours
weight, eyes, heart, hips, testes
When is a blood spot test done and what does it test for?
Done within 7 days but ideally on day 5
Tests for CF, Sickle Cell, Congenital hypothyroidism, inherited metabolic diseases
When is the newborn hearing test done?
3-5 weeks – sometimes done in hospital before discharge, can be done up to 3 months
When is infant physical exam done and what does it entail?
exam (6-8 weeks) – with GP, as newborn physical, with length and head circumference – opportunity to discuss vaccinations.
What are the two broad types of developmental delay?
Global = delay in reaching two or more developmental milestones
Specific = delay in either language, motor, sensory or cognitive
What are some causes of global delay?
Chromosomal abnormalities- Down Syndrome and Fragile X
Metabolic - Hypothyroidism, inborn errors of metabolism
Infections, drugs, trauma, toxins, folate deficiency
Environmental-social issues
Chronic illness
What are the causes of motor delay?
Cerebral palsy
down’s Syndrome
Congenital Hip Dislocation
Social deprivation
MDD
Neural tube defects - spina bifida
Hyrdocephalus
sWhat are causes of language delays?
Hearing loss
ASD
Lack of stimulation
Development Dysphasia = impaired comprehension of language
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
What is schedule of growing skills?
(0-5y) – standardised test examining 8 criteria (Locomotor, manipulative, self-care, social skills, hearing and language, speech and language, visuals and cognitive)
What is griffiths developmental scale?
(0-6y) – measures trends indicative of functional mental growth and the domains listed above through play activities.
What is bayley scales of infant development?
(1m-42m) – assesses cognitive, motor and language skills
What is denver developmental screening tests?
(0-6y) – assesses ability in domains relative to %age blocks of children from a population who could achieve a skill by a particular age.
