A Child's Journey - Growth, Development and Health Flashcards
- Recognise and describe the normal pattern of childhood development.
- To be familiar with the principle developmental domains and their key component skills.
- Describe the key components of the Child Health/ Healthy Child Programmes.
- Know the current UK vaccination schedule.
- Understand growth monitoring and a basic approach to a child who has faltering growth
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UK Childhood immunisation
Routine childhood surveillance
Normal patterns and developmental assessment
Abnormal patterns and delay!!!!!
What age are children at these phases of childhood
- neonate
- infant
- toddler
- pre-school
- school
- teenager
Neonate: <4 weeks Infant: <1 year Toddler: 1-2 years Pre-school: 2-5 years School: 5-12 years Teenager: 13+
Development of key functional skills usually occurs from birth to what age
5
5 key developmental domains
Gross motor skills Fine motor skills Speech + language Hearing + vision Social + self help
Key component skills of each developmental domain
- Gross motor skills
- Fine motor skills
- Speech + language
- Hearing + vision
- Social + self help
Gross motor - walking, jumping etc
Fine motor - grasping –> pinching, drawing
Speech - fluent sentences
Social + self help - interacting, doing things when asked, self-feed, changing clothes
Key milestones
Social smile Sitting Crawling Walking First words
The following should be achieved by what age
- social smile
- sitting
- walking
- words
Social smile - 2 months
Sitting - 9 months
Walking - 18 months
Words - 18 months - 2 years
Factors affecting normal childhood development (3)
Genetics Positive childhood experience Environmental -antenatal/post-natal insults -abuse + neglect
Adverse environmental ANTENATAL factors that could affect childhood development (2)
Infections, e.g. rubella, CMV
Toxins, e.g. drugs, alcohol, smoking
Adverse environmental POSTNATAL factors that could affect childhood development (2)
Infection, e.g. meningitis Toxins, e.g. alcohol, smoking Trauma Malnutrition Metabolic, e.g. hypoglycaemic, hypo/hypernatraemic
Why is developmental assessment needed?
Reassurance and showing progress
Early diagnosis and intervention of any conditions
Discuss positive stimulation/parenting strategies
Genetic counselling of any inherited disease
Who assesses a child’s development?
Parents Health visitors Teachers GPs/other doctors in acute setting Paediatricians
Key components of the Healthy Child Programme (HCP) UK
a programme from antenatal period until 5 years of age
Antenatal appointments Screening Immunisations Health and development reviews Supplemented by advice around health, wellbeing and parenting (health promotion)
When assessing development, what questions to ask yourself?
What sequence of events has come before this?
What skills have been achieved and what has not been achieved?
Is one developmental field falling behind compared to the other?
Are the skills gained age appropriate?
Development is not the same in every child, what normal variations should you be aware of?
Early developers
Late but normal developers
Bottom shufflers - indicating walking delay
Bilingual kids may have a language delay
RED FLAGS OF DEVELOPMENTAL DELAY
No social smile by 2 months
Not sitting unsupported by 9 months
Not walking unsupported by 18 months
No words by 2 years
Problems with vision Hearing loss Low muscle tone Asymmetrical movements Head circumference (OFC) >99.6th or <0.4th gentile
How to assess developmental as a non-specialist (i.e. someone who’s not a doctor)
Drawing skills
Throwing skills
Recognising colours/shapes
Animal sounds
Approximating a child’s age based on a description of skills given (usually can be worked out by any of the domains described and what skills they are able of)
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Being able to match skills to its respective developmental domain
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Expected skills for 6 month old
- gross motor
- fine motor
- language
- social
- self-help
Gross motor - SITTING UNSUPPORTED (by 9), back to belly
Fine motor - grasping toy from one hand to another
Language - BABBLES, RESPONDS TO NAME
Social - reaches for familiar people
Self-help - self-feed BISCUIT
Expected skills for 1 year old
- gross motor
- fine motor
- language
- social
- self-help
Gross motor - WALKING UNSUPPORTED (by 18), run maybe (but falls)
Fine motor - stack blocks, pincer grip (by 9 months)
Language - SIMPLE SINGLE WORDS (some are meaningful)
Social - SHARED ATTENTION/POINTING TO THINGS OF INTEREST, copies others
Self-help - self-feed with SPOON
Expected skills for 2 year old
- gross motor
- fine motor
- language
- social
- self-help
Gross motor - kicking ball, climbing on ladders/slides
Fine motor - SCRIBBLING WITH CIRCULAR MOTION
Language - vocal of 30 words min, PUTS FEW WORDS TOGETHER INTO SENTENCES
Social - PRETEND PLAY (e.g. tea party), helps with simple tasks, points at things when asked, e.g. where’s nose
Self-help - takes off clothes
Expected skills for 3 year old
- gross motor
- fine motor
- language
- social
- self-help
Gross motor - ride on tricycle, walk backwards
Fine motor - DRAWS OR COPIES COMPLETE CIRCLE
Language - starts questioning (why, how), simple sentences, colours
Social - playing with other children, sorts objects into categories, follows simple instructions
Self-help - self-toileting
Child health programme includes what scheduled appointments from birth (6)
Newborn examination by 72 hours Blood screening by 5 days Newborn hearing screening by 4 weeks 6-8 week review by GP or HV 27-30 month review by HV Orthoptist vision screening at 4-5 years
What does the blood spot test on day 5 screen for
Phenylketonuria (PKU) Congenital Hypothyroidism Cystic Fibrosis Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCADD) Sickle Cell Disorder (SCD)
If child is immunocompromised, cannot give what type of vaccine
Live vaccine, e.g. MMR
3 key physical measurements taken to monitor growth of babies/children
Weight
Length or height (if >2)
Head circumference (OFC)
Normal values for a newborn
- weight
- length
- OFC
Weight - 3.3kg
Length - 50cm
OFC - 35cm
Normal values for a 12 month old
- weight
- length
- OFC
10kg
75cm
45cm
On growth charts, they talk about centiles
What is a centile?
What is the 50th centile?
What is the 0.4th centile?
% division of the reference population sampled
50th centile - the average measurement of that population sampled so if 100 kids sampled then 50 above and 50 below that point
0.4th centile - if 100 children sampled, then 4 below this point and 96 above
Basic approach to a child who has faltering growth/failure to thrive (FTT)
(FTT = growing too slowly at expected rate for his/her age due to supply < demand for energy/nutrients)
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Causes of failure to thrive
- maternal causes
- infant causes
Poor lactation
Incorrectly prepared feeds
Premature
Cleft palate
Neuromusuclar disease, e.g. cerebral palsy
Genetic disorders
Causes of failure to thrive due to increased metabolic demands
Congenital lung/heart/liver/renal disease Infection Anaemia Inborn errors of metabolism CF IBD
Causes of failure to thrive due to excessive nutrient loss
GOR
Pyloric stenosis
Gastroenteritis
Malabsorption, e.g. milk allergy, coeliac, short bowel syndrome
Non-medical causes of failure to thrive
Low socio-economic status Dysfunctional family Lack of parental support Lack of parenting education, e.g. poor feeding skills Child neglect
Know the immunisation schedule
See infection table
