Child development and Growth Flashcards
Phases of growth
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
Importance of Growth
An index and signal of health and well-being
Physical and psychological problems of being short
Intellectual benefits of improved growth
Principles of Measuring growth
Define normal growth – growth charts and centiles
If abnormal growth is discovered – the aetiology should be investigated and treated
What is Auxology?
a metaterm used to cover all measures of growth
Uses a standard technique with acceptable intra/inter observer error - also affordable and robust
Measurements used to record growth
Weight - naked up to 2yrs, light clothes only after
Height
Length
Head Circumference (OFC)
The four Factors required to growth
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?
Describe Normal growth curves
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
Which Factors effecting growth?
Gender is most important Variation in families, populations and ethnicity Social class has epi-genetic and nutritional features
Explain Growth charts
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
Williams syndrome
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
What types of Abnormal growth are there?
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)
Changes of BMI throughout childhood
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
Investigating small stature (History) (4x2)
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
Investigating small stature (Anthropometry) (5,5)
Short legs - hypothyroid, rickets, skeletal dysplasia, turner syn.
Short spine - scoliosis, irradiation, haemoglobinopathy, spinal anomaly, Severe emotional disturbance
Long legs - delayed puberty
Causes of short, fat children
Mainly endocrine causes - hypothyridism, GH deficiency, Cushings
Causes of short thin children
Chronic systemic diseases - cardiac, respiratory, renal, metabolic
Malabsorption - Coeliac disease or Crohn’s disease
Malnutrition, neglect or cerebral palsy
Causes for low birth weight
Prematurity Chromosomal abnormality
Intrauterine infection Fetal alcohol syndrome
Silver-Russell syndrome (dwafism) Maternal/placental factors
Features of underweight children with Coeliac disease (5)
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%)
What is Bone age?
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
Investigations of short stature
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
Turner’s syndrome
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
Delayed onset of puberty
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)
Management of short stature in children
Growth promoting agents - GH, oxandrolone or testosterone
Also consider nutritional or social interventions
Classification of Growth hormone deficiency
Developmental –> isolated partial or total, multiple pituitary hormone deficiency
Secondary –> tumours, histocytosis X, mid-facial defects or septo-optic dysplasia
Indications for GH treatment
GH deficiency –> Severe GH deficiency (isolated or multiple) or transient deficiency due to irradiation
Other –> turners syndrome, chronic renal insufficiency, Prader-willi syndrome, SGA
Developmental domains
Gross motor
Fine Motor (eye-hand coordination)
Language & hearing (receptive and expressive)
Social development (behaviour and self help skills)
Cognitive development and special senses
Factors affecting developmental outcomes
Genetic potential
Acquired pathology in utero, perinatal or infant
Environmental factors restricting potential – maternal health, mental health, SE status
Definition of developmental delay
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
Developmental progress in vision
Bright lights and faces at birth – attends to progressively smaller objects over the first year –> underpins fine motor abilities
Developmental progress in hearing
Screened in early life
Will startle at birth – by 6months should be turning head towards sound – hearing underpins language acquisition
Developmental progress in Gross motor development
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
Red flags for motor development
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
Developmental progress in Fine motor development
0-1 Grabbing things 1-2 Putting things down
2-3 Guiding things around 3-4 Two hand maneuvers
4-5 Planning movements
Developmental progress in Language
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
Red flags for language development
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
Developmental progress in social development
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
Red flags for social development
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
Development history (4)
What’s the complaint? –> any developmental delay? (specific or global)
Has the delay caused the complaint? What can be done about it?
Gross motor targets in the first year
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,
Age of walking
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
Gross motor milestones after two years
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
Development of fine motor skill
Grips: From 8 to 14months –> palmar grasp, intermediate then mature and eventually pincer
From 1yr to 2yrs (pencil) –> palmar –> extended finger –> dynamic tripod
Distinguishing specific and global delay
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
Self care and toileting milestones
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
Presentation of DMD
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
Height potential for a child
Mean of parents height plus 7cm for a male and minus 7cm for a female
Nocturnal Enuresis
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.
Gower’s sign
where a child with DMD will ‘climb’ up their own legs with their hands because their legs are weak
Test for DMD
Check their Creatinine Kinase - will be very raised (up to 100x)
Growth velocity
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)
Normal values for growth velocity
Under 4cm/yr is low (<5th centile)
Handedness in young children
Displaying a hand preference before 12months is abnormal and indicates Cerebral Palsy
