A Child's Journey - Growth Development and Health Flashcards
when should you refer if an infant has not yet learned to walk?
- some may walk at 9-10 months
- 50% by 12 months (median age)
- refer if not walking by 18 months (limit age)
- beware bottom shufflers and commando crawlers
what are some influencing factors in child development?
- genetics (family, race, gender)
- environment
- positive early childhood experience
- developing brain vulnerable to insults: antenatal, post-natal, abuse and neglect
what are some adverse antenatal and postnatal environmental factors that can affect child development?
antenatal:
- infections (CMV, Rubella, Toxoplasmosis, VZV)
- toxins (alcohol, smoking, anti-epileptics)
postnatal:
- 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
what are the main components of the child health program (scotland)?
- health promotion
- developmental screening (including hearing)
- immunisation
what things are discussed/observed/measured at the 6-8 week review (by GP and Health visitor)?
- identification data (name, address, GP)
- feeding (breast/bottle/both)
- parental concerns (appearance, hearing; eyes, sleeping, movement, illness, crying, weight)
- development (gross motot, 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 things are discussed/observed/measured at the 27-30 month review (with health visitor)?
- 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
growth monitoring involves physical measurements of 3 key parameters:
- weight (grams and kgs)
- length (cm) or height if > 2 yrs
- head circumference (OFC) (cm)
what are some usefule references values for weight (in kgs) at birth, 4 months, 12 months and 3 years?
Birth: 3.3kg
4 months: 6.6 kg
12 months: 10kg
3y: 15kg
what are some useful reference values for length (in cm) at birth, 4 months, 12 months and 3yrs?
birth: 50cm
4 months: 60cm
12 months: 75cm]
3yrs: 95cm
what aresome useful reference values for for head circumference (OFC, in cm) at birth and 12 months?
birth: 35cm
12 months: 45cm
what would be considered failure to thrive (FTT) when looking at growth charts?
- child growing too slowly in form and usually in function at the expected rate for their age
- significant low rate of weight gain > crossing centile spaces
- not a diagnosis but a description of a pattern
what are some causes of failure to thrive in early life?
maternal causes:
- poor lactation
- incorrectly prepared feeds
- unusual milk or other feeds
- inadequate care
infant:
- prematurity
- small for dates
- oro palatal abnormalities e.g. cleft palate
- neuromuscular disease e.g. cerebral palsy
- genetic disorders
increased metabolic demands:
- congential lung disease
- heart disease
- liver disease
- renal disease
- infection
- anaemia
- CF, thyroid disease, Crohn’s/IBD etc.
- malignancy
excessive nutrient loss:
- GORD
- Pyloric stenosis
- Gastroenteritis
- malabsorption: allergy, diarrhoea, coeliac, pancreatic insufficiency, short bowel)
list some environmental factors which can cause FTT
- poverty/socio-economic status
- dysfunctional family interactions (especially maternal depression or drug use)
- difficult parent-child interactions
- lack of parental support (e.g. no friends, no extended family)
- lack of preparation for parenting/education
- child neglect
- emotional deprivation
- poor feeding or feeding skills disorder
