A Child's Journey: Growth, Development and Health Flashcards
Neonate is…
<4w
Infant is …
12m/1yr
Toddler is…
~1-2yr - usually on feet - toddle on feet
5 Key Developmental Fields
Gross motor Fine motor Socail and self help Speech and language Hearing and vision
How we get about is called
Gross motor
What we do with our hands
Fine motor
Whats a milestone?
Achievement of key development skills
E.g.s of Milestones
Social smile, sitting, walking, first words
What to do if not achieved milestones by limit age (2 SDs from mean)?
Refer
milestones; correct for prematurity?
Yes until 2yrs
Influencing Factors on development
Genetics (Family, race, gender) Environment Positive early childhood experience Developing brain vulnerable to insults Antenatal Post natal Abuse and neglect
Antenatal adverse environmental factors for development
infections
toxins
Postnatal adverse environmental factors for development
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 specific groups of kids that should be developmentally assessed
premature, syndromes, events
Milestones : e.g. walking
early walkers…
9-10 months
Milestones : e.g. walking
median age walkers…
12months
refer if not walking by
18 months
Problem if not smiling by
8wks
RED FLAGS
…. of Development skills
loss
RED FLAGS
Parental/ professional concern re….
vision
hearing loss
RED FLAGS
tone…
Low - floppy
increased muscle tone
RED FLAGS
no speech by
18 months
RED FLAGS
type of walking
toe walking
OFC stands for
Occipitofrontal circumference
RED FLAGS
OFC >
99.6th centile
RED FLAGS
OFC
0.4th centile
Expected Skills at 6 months
Sits steadily without support (by 8-9 months)
Transfers toy from one hand to the other.
Responds to name (turns and looks).
Reaches for familiar people.
Feeds self biscuits or similar food.
Expected Skills at 12 months
Walks without help. (By 18 months)
Stacks 2 or more blocks.
Uses “Mama” or “Dada” specifically for parents, or similar.
Shows shared attention/ pointing to things of interest.
Feeds self with spoon.
Expected Skills at 2 yrs
Climbs on play equipment
Scribbles with circular motion.
Has a vocabulary of at around 30-50 words.
“Helps” with simple household tasks.
Opens door by turning knob.
Expected skills at 3yrs
Rides on a tricycle, using pedals.
Draws or copies a complete circle.
Asks questions beginning with “Why? When? How?”
Gives directions to other children.
Toilet trained (but may need help with wiping etc.).
How do they communicate?
(Speech and Language)
What can they do for themselves?
Social and Self Help)
Main components of Child health programme (Scotland)
Health promotion
Developmental screening (including hearing)
Immunisation
Childs progress is reordered in the…
Red Book
Child health Programme involves:
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)
6-8w Review (GP and HV) involves…
Identification data (Name, address, GP)
Feeding (breast/ bottle/ both)
Parental concerns (appearance, hearing; eyes, sleeping, movement, illness, crying, weight)
Development
Measurements (Weight, OFC, Length)
Examination (heart, hips, testes, genitalia, femoral pulses and eyes (red reflex))
Sleeping position (supine, prone, side)
27-30m Review (HV)
Identification data (name, address, GP)
Development
Physical measurements (height and weight)
Diagnoses / other issues
Do you correct age for immunisations in prematures?
No
Growth Monitoring
3 key parameters
Weight (grams and Kgs)
Length (cm) or height (if >2y)
Head circumference (OFC) (cm)
birth weight
length
OFC
3.3kg
50cm
35cm
4 months weight
length
6.6kg
60cm
12 months weight
length
OFC
10kg
75cm
45cm
3y weight
lenght
15kg
95cm
A ‘Centile’ is…
% divisions of the reference population sampled
50th Centile means
“If you take the average 100 healthy children 50 are above this point and 50 are below” “About half the kids in class are smaller…”
0.4th centile means
“If you take the average 1000 healthy children 4 are below this point 996 are above”
0.4th centile means
“If you take the average 1000 healthy children 4 are below this point 996 are above”
Failure to thrive (FTT) also known as
Weight Faltering
FTT is when a child grows too … in …. and usually in … at the expected rate for his or her age
slowly in form and usually in function at the expected rate for his or her age
In FTT there is a significantly low rate of
weight gain
-crossing centile spaces
FTT is not a diagnosis but a…
description of a pattern
FTT means the SUPPLY of Energy and/or nutrients is
< DEMAND
for Energy and nutrients
Causes of FTT in early life
Deficient intake can be either
maternal or infant
Maternal causes for deficient intake in FTT
Poor lactation
Incorrectly prepared feeds
Unusual milk or other feeds
Inadequate care
Infant causes for deficient intake in FTT
Prematurity
Small for dates
Oro palatal abnormalities (e.g. cleft palate)
Neuromuscular disease (e.g. cerebral palsy)
Genetic disorders
Increased metabolic demands causes for FTT
Congenital lung disease Heart disease Liver disease Renal disease Infection Anaemia Inborn errors of metabolism Cystic fibrosis Thyroid disease Crohn’s/ IBD Malignancy
Excessive nutrient loss causes of FTT
Gastro oesophageal reflux Pyloric stenosis Gastroenteritis (post-infectious phase) Malabsorption Food allergy Persistent diarrhoea Coeliac disease Pancreatic insuffiency Short bowel syndrome
4 broad causes of FTT
Deficient intake
Increased Metabolic demands
Excessive nutrient loss
Non medical causes
Non medical causes of 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
History in FTT
Presenting symptoms
Dietary assessment
Birth/family/social
Physical exam FTT
Dysmorphic features
Anthropometry
Systems, Development
After physical exam in FTT what do you do?
Trial of feeding in Hospital
What is involved in a Trial of feeding in Hospital in FTT?
Observe feeding, mothers handling
Dietician / SALT assessment
Developmental assessment
What is a SALT?
speech and language therapist
FTT If child has good feeding intake in hospital assess…
Weight gain
FTT If child has good feeding intake in hospital and does gain weight condition is …
Non organic
FTT If child has good feeding intake in hospital and does NOT gain weight condition is …
Organic
investigate accordingly
FTT If child has poor feeding intake in hospital causes are…
Organic cause
Feeding disorder
Non-Organic or mIxed
