A Child's Journey Flashcards
What are the recognised phases of childhood?
Neonate (<4w) Infant (<12m/1y) Toddler (~1-2y) Pre-school (~2-5y) School age Teenager/Adolescent
What are the main childhood objectives?
To grow To develop and achieve their potential To attain optimal health To develop independence To be safe To be cared for To be involved
What are the cellular stages of development?
Cell growth, migration, connection, pruning, and myelination (Use it or lose it)
What are the key developmental fields?
- Gross Motor
- Fine Motor
- Social and Self Help
- Speech and Language
- Hearing and Vision
What factors influence development?
Genetics (Family, race, gender) Environment Positive early childhood experience Developing brain vulnerable to insults -Antenatal -Post natal -Abuse and neglect
What are some antenatal adverse environments?
IInfections (CMV, Rubella, Toxoplasmosis, VZV)
Toxins (Alcohol, Smoking, Anti-epileptics)
What are some postnatal adverse environments?
Infection (Meningitis, encephalitis)
Toxins (solvents mercury, lead)
Trauma (Head injuries)
Malnutrition (iron, folate, vit D)
Metabolic (Hypoglycaemia, hyper + hyponatraemia)
Maltreatment/under stimulation/domestic violence
Maternal mental health issues
Why is assessing development important?
Reassurance and showing progress
Early diagnosis and intervention
Discuss positive stimulation/parenting strategies
Provision of information
Improving outcomes (pre-school years critical)
Genetic counselling
Coexistent health issues
What is the Healthy Child Programme (HCP) UK?
An evidence-based framework for the delivery of public health services to families with a child between conception and age 5
What is a simplified way of looking at child development?
How do they move their body around?
What do they do with their hands?
How do they communicate?
What can they do for themselves?
How may you decide what is normal?
Think about each developmental field (deficiency may predominantly affect one area)
What sequence/ pattern has come before?
What skills have been achieved?
What has not yet been achieved?
Is one field falling behind the other? - Global delay v.s. specific developmental delay
Are the skills gained age appropriate?
How may normal variation in development present?
Early developers Late normal Bottom shufflers- walking delay Bilingual families- apparent language delay (total words may be normal) Familial traits
What are red flags?
- Loss of developmental skills
- Parental/professional concern re. vision (simultaneous referral to paediatric ophthalmology)
- Hearing loss (simultaneous referral for audiology/ ENT)
- Persistent low muscle tone/floppiness
- No speech by 18 months, esp if no other communication (simultaneous referral for urgent hearing test)
- Asymmetry of movements/increased muscle tone
- Not walking by 18m/Persistent toe walking
- OFC > 99.6th/< 0.4th/crossed two centiles/disproportionate to parental OFC
- Clinician uncertain/thinks that development may be disordered
How is child health screened for?
- UK - Healthy Child Programme
- Child Health Programme (Scotland) based on HAL4
- Based in primary care (GP, HV, MW)
- Parental (carer) observations and concerns crucial
What is the structure of the Child Health Programme?
New-born exam and blood spot screening* New-born hearing screening (by Day 28) Health Visitor First Visit 6-8w Review (Max 12w) 27-30 month Review (Max 32m) Orthoptist vision screening (4-5y) If needed: -Unscheduled review -Recall review
What does the blood spot screening look for?
Phenylketonuria (PKU) Congenital Hypothyroidism (CHT) Cystic Fibrosis (CF) Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCADD) Sickle Cell Disorder (SCD) Maple syrup urine disease (MSUD) Isovaleric acidaemia (IVA) Glutaric aciduria type 1 (GA1 ) Homocystinuria (HCU)
What happens at the 6-8 week review?
CARRIED OUT BY GP AND HV
Identification data (Name, address, GP)
Feeding (breast/ bottle/ both)
Parental concerns (appearance, hearing; eyes, sleeping, movement, illness, crying, weight)
Development (gross motor, hearing + communication, vision + social awareness)
Measurements (Weight, OFC, Length)
Examination (heart, hips, testes, genitalia, femoral pulses and eyes (red reflex))
Sleeping position (supine, prone, side)
What happens at the 27-30 week review?
CARRIED OUT BY HV Identification data (name, address, GP)
Development
- Social, behavioural, attention and emotional
- Communication, speech and language
- Gross and fine motor
Vision, hearing
Physical measurements (height and weight)
Diagnoses/other issues
What is the structure of the Healthy Child Programme (HCP)?
- Antenatal
- Birth -1w (Feeding, hearing, examination, Vit K immunisations, blood spot
- 2w (Feeding, mat mental health, jaundice, SIDS)
- 6-8w (Exam, Imms, measure, mat mental health)
- 1y (Growth, health promotion, questions)
- 2-2.5y (development, concerns, language)
- 5y (Imms, dental, Support, hearing, vision, dev)
How does the HCP encourage health?
Smoking Alcohol/ Drugs Nutrition Hazards and safety Dental Health Support services Additional input during immunisations and as issues are identified
Who gets vaccinations?
All children
When do you not give a child a live vaccine (MMR)?
When they are immunocompromised e.g. HIV
What allergy is not a contraindication to MMR vaccine?
Egg
When might vaccines be postponed?
If the child is unwell
NORMAL TIMES FOR PREMATURE, NO DELAY
What are the common side-effects of immunisations?
Mild temp, discomfort, swelling
What are the rare side-effects of immunisations?
Anaphylaxis
What are the 3 key measurements monitoring growth?
Weight (grams and Kgs)
Length (cm) or height (if >2y)
Head circumference (OFC) (cm)
What are some derived (not routine but may be done) measurements taken?
Weight for age Length (height) for age Body mass index (BMI) …. Kg / m2 Weight for length Rate of weight gain … g / kg / day (infants only)
What are the reference values for birth weight, length and OFC?
Weight - 3.3kg
Length - 50cm
OFC - 35cm
What are the reference values for weight and length at 4 months?
Weight - 6.6kg
Length - 60cm
What are the reference values for weight, length and OFC at 12 months?
Weight - 10kg
Length - 75cm
OFC - 45cm
What are the reference values for weight and length at 3 years?
Weight - 15kg
Length - 95cm
What is a centile?
% divisions of the reference population sampled
What is failure to thrive (FTT)/weight faltering?
Child growing too slowly in form and usually in function at the expected rate for his or her age
Significantly low rate of weight gain
Crossing centile spaces
Not a diagnosis but a description of a pattern
SUPPLY OF ENERGY/NUTRIENTS IS LESS THAN DEMAND
How may FTT be due to the mother?
Poor lactation
Incorrectly prepared feeds
Unusual milk or other feeds
Inadequate care
How may FTT be due to the child?
Prematurity
Small for dates
Oro palatal abnormalities (e.g. cleft palate)
Neuromuscular disease (e.g. cerebral palsy)
Genetic disorders
What are some conditions that increase metabolic demand in children?
Congenital lung disease Heart disease Liver disease Renal disease Infection Anaemia Inborn errors of metabolism Cystic fibrosis Thyroid disease Crohn’s/IBD Malignancy
What are some conditions that excessive nutrient loss in children?
Gastro oesophageal reflux Pyloric stenosis Gastroenteritis (post-infectious phase) Malabsorption: -Food allergy -Persistent diarrhoea -Coeliac disease -Pancreatic insufficiency -Short bowel syndrome
What are some non-medical causes for FTT?
Poverty/socio-economic status
Dysfunctional family interactions (especially maternal depression or drug use)
Difficult parent-child interactions
Lack of parental support (eg, no friends, no extended family)
Lack of preparation for parenting/ education
Child neglect
Emotional deprivation
Poor feeding or feeding skills disorder
