A Child's Journey: Growth, Development and Health Flashcards
name the recognised phases of childhood and what they encompass
- Neonate <4 weeks
- Infant <12m/1year
- Toddler 1-2 years
- Pre-school 2-5 years
- 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
development of a child
- Gaining functional skills throughout childhood
- A gradual yet rapid process
- Typically birth to 5y (but brains develop in utero)
- Fairly consistent pattern but rate will vary
- Cell growth, migration, connection, pruning, and myelination (Use it or lose it)
- Sequence of events in each domain
- School- Cognitive and thought development (early skills become more refined)
- Think of the sequence within each domain
- If what you see is normal
- Chances are what follows will be normal
- If what you see is abnormal
- What came before and what comes after may well be abnormal
key developmental fields
- Gross motor
- Fine motor
- Social and self help
- Speech and language
- Hearing and vision
key milstones
Social smile, sitting, walking, first words
when should you refer a child for not meeting milestones?
2 SD from mean
when should you stop correcting for prematurity for milestones?
2 years
why is development important?
- Learning functional skills for later life
- Hone skills in a safe environment
- Allow our brain’s genetic potential to be fully realised
- Equip us with tools needed to function as older children and adults
- Many are completely automatic
what do you need to know about development?
- The usual sequence of the key skill areas
- The expected skills for key ages (6m, 12, 2y, 3y)
- Red flags for developmental delay
- How to assess development (as a non-specialist)
- What to do when there are concerns
- Recognition of normality
influencing factors for development
• Genetics (Family, race, gender) • Environment • Positive early childhood experience • Developing brain vulnerable to insults o Antenatal o Post-natal o Abuse and neglect
adverse environmental factors: antenatal
o Infections (CMV, Rubella, Toxo, VZV) o Toxins (Alcohol, Smoking, Anti-epileptics)
adverse environmental factors: postnatal
o Infection (Meningitis, encephalitis) o Toxins (solvents mercury, lead) o Trauma (Head injuries) o Malnutrition (iron, folate, vit D) o Metabolic (Hypoglycaemia, hyper + hyponatraemia) o Maltreatment/ under stimulation/ domestic violence o Maternal mental health issues
why perform a developmental assessment?
- 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
who can perform a developmental assessment?
o Parents and wider family
o Health visitors, nursery, teachers
o GPs, A+E, FYs, STs, students
o Paediatricians and community paediatricians
what does a developmental assessment involve?
- Healthy Child Programme (HCP) UK
- Screening may not always be sensitive/ specific
- Listen to parental concerns/ videos on phone
- Opportunistic questions- target the right area
- Review the red book
- Good observation of play and activity
- Medical history and examination
- Most common mistake is not thinking about it!
recognised red flags in development
• 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
describe the child health programme
• New-born exam and blood spot screening o Phenylketonuria (PKU), congenital hypothyroidism (CHT), cystic fibrosis (CF), medium chain acyl-CoA dehydrogenase deficiency (MCADD) and sickle cell disorder (SCD) • 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 o Unscheduled review o Recall review
describe the 6-8 week review
- 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)
who performs the 6-8 week review?
GP and health visitor
who performs the 27-30 month review?
health visitor
what does the 27-30 month review involve?
• Identification data (name, address, GP)
• Development
o Social, behavioural, attention and emotional
o Communication, speech and language
o Gross and fine motor
o Vision, hearing
• Physical measurements (height and weight)
• Diagnoses / other issues
health child programme
- 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)
- Health Promotion
- Smoking
- Alcohol/ Drugs
- Nutrition
- Hazards and safety
- Dental Health
- Support services
- Additional input during immunisations and as issues are identified
3 key parameters of physical measurement of children
o Weight (grams and Kgs) o Length (cm) or height (if >2y) o Head circumference (OFC) (cm)
derived measurements of children
o Weight for age o Length (height) for age o Body mass index (BMI) …. Kg / m2 o Weight for length o Rate of weight gain … g / kg / day (infants only)
what is failure to thrive?
• 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
o ‘crossing centile spaces’
• Not a diagnosis but a description of a pattern
• Demand > Supply of energy and/or nutrients
causes of FTT: deficient intake, maternal
o Poor lactation
o Incorrectly prepared feeds
o Unusual milk or other feeds
o Inadequate care
causes of FTT: deficient intake, infant
o Prematurity
o Small for dates
o Oro palatal abnormalities (e.g. cleft palate)
o Neuromuscular disease (e.g. cerebral palsy)
o Genetic disorders
causes of FTT: increased metabolic demands
- Congenital lung disease
- Heart disease
- Liver disease
- Renal disease
- Infection
- Anaemia
- Inborn errors of metabolism
- Cystic fibrosis
- Thyroid disease
- Crohn’s/ IBD
- Malignancy
causes of FTT: excessive nutrient loss
• Gastro oesophageal reflux • Pyloric stenosis • Gastroenteritis (post-infectious phase) • Malabsorption o Food allergy o Persistent diarrhoea o Coeliac disease o Pancreatic insufficiency o Short bowel syndrome
causes of FTT: non-organic causes
- 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 syndrome
- Poor feeding or feeding skills disorder
- Feeding disorders (eg, anorexia, bulimia- later years)
