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Paediatrics > Child development and Growth > Flashcards

Child development and Growth Flashcards

1
Q

Phases of growth

A

Infancy – Nutrition and Insulin
Childhood – Growth hormone and Thyroxine
Puberty – Growth hormone and sex hormones
Consists of the acquisition of physical and intellectual skill and emotional balance

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2
Q

Importance of Growth

A

An index and signal of health and well-being
Physical and psychological problems of being short
Intellectual benefits of improved growth

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3
Q

Principles of Measuring growth

A

Define normal growth – growth charts and centiles

If abnormal growth is discovered – the aetiology should be investigated and treated

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4
Q

What is Auxology?

A

a metaterm used to cover all measures of growth

Uses a standard technique with acceptable intra/inter observer error - also affordable and robust

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5
Q

Measurements used to record growth

A

Weight - naked up to 2yrs, light clothes only after
Height
Length
Head Circumference (OFC)

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6
Q

The four Factors required to growth

A

Health - pathologies and illness limit growth
Food - is there a restriction in nutrition?
Nurturing - is the neglect or abuse?
Hormones - at the right time and right amount?

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7
Q

Describe Normal growth curves

A

Weight and height increase rapidly in the first 2yrs then steadily till 12-14 –> growth spurt (Boys:14, Girls:12) ending with boys being taller and heavier

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8
Q

Which Factors effecting growth?

A 
Gender is most important
Variation in families, populations and ethnicity
Social class has epi-genetic and nutritional features
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9
Q

Explain Growth charts

A

A way of comparing an individuals growth with the average of a reference population
Divide into centiles - 0.4, 2, 9, 25, 50, 75, 91, 98, 99.6
Each band is 2/3 of SD

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10
Q

Williams syndrome

A

Deletion of 26 genes from the long arm of chr 7 leading to small statue, low IQ but strong verbal scores, elfin appearance and being hyper social

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11
Q

What types of Abnormal growth are there?

A

Can be specific - crossing centile lines– dropping two lines defines failure to thrive
Can be relational – abnormal height to weight or abnormal body proportions (legs and arms)

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12
Q

Changes of BMI throughout childhood

A

Increases rapidly after birth to about 17/18 by age 1.
Then decreases to 15/16 through childhood and starts increasing again at age 8 for girls and 9 for boys – boys overtake girls at age 17/18

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13
Q

Investigating small stature (History) (4x2)

A

Birth weight (IUGR/SGA) - Feeding and nutrition in infancy
Developmental syndromes - chronic or recent growth failure
Ethnic and FHx – pubertal development and mother’s age of menache
Social Hx - fostered/adopted?, neglect/abuse, low family IQ, poor nutrition

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14
Q

Investigating small stature (Anthropometry) (5,5)

A

Short legs - hypothyroid, rickets, skeletal dysplasia, turner syn.
Short spine - scoliosis, irradiation, haemoglobinopathy, spinal anomaly, Severe emotional disturbance
Long legs - delayed puberty

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15
Q

Causes of short, fat children

A

Mainly endocrine causes - hypothyridism, GH deficiency, Cushings

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16
Q

Causes of short thin children

A

Chronic systemic diseases - cardiac, respiratory, renal, metabolic
Malabsorption - Coeliac disease or Crohn’s disease
Malnutrition, neglect or cerebral palsy

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17
Q

Causes for low birth weight

A

Prematurity Chromosomal abnormality
Intrauterine infection Fetal alcohol syndrome
Silver-Russell syndrome (dwafism) Maternal/placental factors

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18
Q

Features of underweight children with Coeliac disease (5)

A

Tiredness and anaemia
Positive antibodies (anti-endomysial/anti-gliadin) and jejunal biopsy
Will respond to diet
Strongly associated with HLA-DQ2 (95%) and HLA B8 (80%)

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19
Q

What is Bone age?

A

Bones change during growth in a way which can be seen on X-ray – the bone age of a child is the average age children are when they get to the stage of maturation their bones are.
A child’s current height and bone age can be used to predict adult height

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20
Q

Investigations of short stature

A

FBC, U+Es, Ca, P, ALP,
Thyroid function and GH stimulation tests (Insulin or arginine)
Coeliac antibody screen
Chromosome test and left hand and wrist X-ray to check bone age

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21
Q

Turner’s syndrome

A

45X - short with an abnormal upper to lower body ratio.
60% have high palate and small jaw
Poss: cubitus valgus, short metacarpals, neck webbing, foot oedema.
Nearly all are infertile and half have heart problems, 40% have renal problems and 40% have thyroid dysfunction

22
Q

Delayed onset of puberty

A

Common in boys, not girls - Often familial & usually ‘constitutional’
Can be due to gonadotropin deficiency or gonadal failure
May be a sign of chromosomal issue (klinefelters syndrome)

23
Q

Management of short stature in children

A

Growth promoting agents - GH, oxandrolone or testosterone

Also consider nutritional or social interventions

24
Q

Classification of Growth hormone deficiency

A

Developmental –> isolated partial or total, multiple pituitary hormone deficiency
Secondary –> tumours, histocytosis X, mid-facial defects or septo-optic dysplasia

25
Q

Indications for GH treatment

A

GH deficiency –> Severe GH deficiency (isolated or multiple) or transient deficiency due to irradiation
Other –> turners syndrome, chronic renal insufficiency, Prader-willi syndrome, SGA

26
Q

Developmental domains

A

Gross motor
Fine Motor (eye-hand coordination)
Language & hearing (receptive and expressive)
Social development (behaviour and self help skills)
Cognitive development and special senses

27
Q

Factors affecting developmental outcomes

A

Genetic potential
Acquired pathology in utero, perinatal or infant
Environmental factors restricting potential – maternal health, mental health, SE status

28
Q

Definition of developmental delay

A

A failure in the acquisition of expected skills which leads to functional impairment for the child
‘Expected’ can refer timing or order
Impairment may be physical, social, communicative, emotional or academic

29
Q

Developmental progress in vision

A

Bright lights and faces at birth – attends to progressively smaller objects over the first year –> underpins fine motor abilities

30
Q

Developmental progress in hearing

A

Screened in early life

Will startle at birth – by 6months should be turning head towards sound – hearing underpins language acquisition

31
Q

Developmental progress in Gross motor development

A

0-1 The battle with gravity (head up, sitting, crawling and standing)
1-2 Toddle to walk 2-3 Jump, throw and kick
3-4 Vehicles, catch and climb 4-5 Control and co-ordination

32
Q

Red flags for motor development

A 
If not rolling by 9 months    
If not sitting unsupported by 10 months
If not taking independent steps by 18 months 
If not running by 2 years
If not jumping by 3 years
33
Q

Developmental progress in Fine motor development

A

0-1 Grabbing things 1-2 Putting things down
2-3 Guiding things around 3-4 Two hand maneuvers
4-5 Planning movements

34
Q

Developmental progress in Language

A

0-1 mummy and daddy specifically 1-2 two word sentences
2-3 colours and own name 3-4 count to 10
4-5 Narratives and good speech

35
Q

Red flags for language development

A

Failing to respond when spoken too or not showing an interest in communicating
Not babbling by 9m or first words by 15m
No consistent words by 2yrs or phrases by 3yrs
No fluent speech by 4yrs

36
Q

Developmental progress in social development

A

6 weeks - smiling, 6 months - should be able to play ‘peek a boo’, 9 months - directed crying, 3yrs - playing make believe
5yrs - has a best friend and will comfort others

37
Q

Red flags for social development

A

Before 1yr - no eye contact If no pointing/showing by 18months
No social play by 2yrs Not sharing or toileting at 3yrs
No friends at 4yrs No concept of rules at 5yrs

38
Q

Development history (4)

A

What’s the complaint? –> any developmental delay? (specific or global)
Has the delay caused the complaint? What can be done about it?

39
Q

Gross motor targets in the first year

A

Lifting head and smiling - 3ms, rolling and trying to sit - 5ms, siting up unassisted and reaching for things - 7ms, Crawling & object permanence - 8ms, Supported standing - 10ms,

40
Q

Age of walking

A

12 months to walk but can be delayed by musculoskeletal factors (flat feet or hypermobility)
At 16 months should be pulling/dragging toys
Running by two years

41
Q

Gross motor milestones after two years

A

Can climb stairs just at 2ish, Kick a ball at 2.5yrs, 3yrs can jump and use a tricycle, increasing to adult level by 3.5yrs
Hop and stand on one leg by 4.5yrs

42
Q

Development of fine motor skill

A

Grips: From 8 to 14months –> palmar grasp, intermediate then mature and eventually pincer
From 1yr to 2yrs (pencil) –> palmar –> extended finger –> dynamic tripod

43
Q

Distinguishing specific and global delay

A

Specific is a single area with is 2SD below the average IQ
Global is more than 2 areas where developmental age is less than actual age - if it is 50% or more of expected it is mild to moderate and >50% is severe

44
Q

Self care and toileting milestones

A

Limited self cleaning in first two years, 3 years can use fork and spoon, 4 years can use knife as well
should be dry through the night by 3yrs depending on potty training -> enuresis should resolve by 8yrs
Undress themselves by 3yrs and dress by 4yrs

45
Q

Presentation of DMD

A

Motor milestones delayed with waddling gait when trying to run & hypertrophy of the calf muscles
Can also have speech/global delay, FTT or fatigue. X-linked recessive

46
Q

Height potential for a child

A

Mean of parents height plus 7cm for a male and minus 7cm for a female

47
Q

Nocturnal Enuresis

A

Most children will be dry by 3 or 4yrs. Can be primary or secondary. Alarms are 1st line for children under 7, Desmopressin can be used for over 7yos if alarm is ineffective/inappropriate.
Also advice and reward systems.

48
Q

Gower’s sign

A

where a child with DMD will ‘climb’ up their own legs with their hands because their legs are weak

49
Q

Test for DMD

A

Check their Creatinine Kinase - will be very raised (up to 100x)

50
Q

Growth velocity

A 
Utero - 60-100cm/yr
0-1 - 23-27cm/yr
1-2 - 10-14cm/yr
3-4 - 6-7cm/yr
prepubertal - 5-5.5cm/yr
pubertal - 8-12cm/yr (girls) 10-14cm/yr (boys)
51
Q

Normal values for growth velocity

A

Under 4cm/yr is low (<5th centile)

52
Q

Handedness in young children

A

Displaying a hand preference before 12months is abnormal and indicates Cerebral Palsy

Paediatrics (18 decks)

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