Child Development (W2 KPH) Flashcards
why are routine measurements of babies a standard practice?
to identify or rule out growth disorders
to identify and monitor obesity
to assess feeding
to assess disease impact
what measurements are normally distributed in healthy individuals?
height
haemoglobin
BP
plasma sodium
protein intake
what statistics would be useful to determine a normal BMI?
median
IQR (25th-75th centile)
2nd and 98th centile
how are infant growth charts constructed?
collecting samples of data at each age and gender from hundreds of healthy children
what factors are important in considering what population growth charts should be based on?
increasing height over generations
ethnic differences in growth
breastfed infants gain weight differently than bottlefed infants
what is the standard for a population representing an ideal growth chart?
healthy, breastfed infants who live in an ‘optimal’ growth potential environment
what ways can be used to judge if measurements are normal?
plotting on a growth chart
calculating BMI
assessing growth over time
describe the mid-parental centile
the point inbetween the mother and father’s percentile
most children aew within +/- 2 centile spaces of the mid-paternal centile
what is the breast made up of and comprised of?
made up of the nipple, areola, mammary glands and supporting CT
comprised of fat, blood, lymphatic vessels and nerves
explain the prevalence of alveoli in the breast
contained within lobes (~20 per breast)
lactocytes (milk-producing cells) within alveoli
surrounded by myoepithelial cells (smooth muscle)
what is the role of oxytocin in the breast?
stimulates myoepithelial cells to contract, pushing milk into lactiferous ducts towards the nipple
what is the role of montgomery tubercles in the breast?
glands secreting sebaceous fluid that lubricates the nipple and protects the skin
the fluid has an individual aroma attracting the infant
explain the hormonal control in breast development
oestrogen promotes mammogenesis by developing the ductal system
progestorone and human/placental lactogen enhance milk producing structures
explain the posterior pituitary mechanism of lactation
suckling -> stimulus to hypothalamus -> posterior pituitary secretes oxytocin -> contracts myoepithelial cells -> milk released into lactiferous ducts
explain the anterior pituitary mechanism of lactation
suckling -> anterior pituitary produces prolactin -> allows lactocytes to secrete milk into alveoli
compare the protein composition of breast milk and infant formula
breast milk - whey based (alpha lactalbumin)
formula - bovine serum albumen
compare the carbohydrate composition of breast milk and infant formula
breast milk - lactose (~40%) improves Ca absorption
formula - lactose (+ sucrose, fructose and glucose)
compare the fat composition of breast milk and infant formula
breast milk - long chain fatty acids
formula - vegetable or egg based
compare the vitamin/mineral composition of breask milk and infant formula
breast milk - present in small quantities
formula - extras added to the powder
what substances are present in breast milk that are not present in human milk?
growth factors
immune cells
enzymes
stem cells
lactoferrin
milk lipids
name some of the benefits provided by breast milk not present in formula milk
prevents pathogenic entry (IgA on gut surface)
improves immune response (Il-7 increases thymus size)
Promotes healthy bacteria growth (oligosaccharides)
how does a mother transfer her microbial heritage to her infant?
vaginal birth
skin-skin contact
breastfeeding
what are the functions of an infants microbiome?
produces vitamin K, biotin and folate
immune system development
prevents toxin absorption
provides energy sources for enterocytes
what is colostrum?
the first milk produces from breasts
thick, yellowish fluid increasing in amount over first 3-4 days to accomodate infants needs
what are the main components and functions of colostrum?
rich in vitamin A
creates acidic environment
contains Ig’s, antibodies and anti-inflammatory molecules
contains EGF
is a mild purgative (laxative)
high in viral fragments and white cells
explain how breastfeeding can result in immunity for the infant against pathogens
the mother creates sensetised lymphocytes which create secretory antibodies in the breast
then transferred through breast milk to infant
name 3 developmental advantages to breastfeeding
promotes brain development (long chain fatty acids)
promotes maturation of gut
protects mothers health
what are the benefits of skin-skin contact in mothers/infants?
triggers lactation and mothering hormones
triggers calming hormones
stimulates digestion
stimulates instinctive feeding behaviour
provides protective bacteria for infant
explain the positioning of effective breastfeeding
keep baby close
tilt baby’s head back so chin can lead
keep baby’s head and body in line
nose to nipple positioning for effective attachment
(acronym - CHIN)
what is responsive breastfeeding?
the sensitive, reciprocal relationship developed between mother and infant during breastfeeding
why might women choose not to breastfeed?
negative public attitude
breast pain/discomfort
perception of inadequate breastmilk supply
mother and infant routine reasons
name some of the societal reasons why women may not breastfeed
cultural/social barriers
public breastfeeding frowned upon
little support for longer-term breastfeeding
can be seen as a sign of sexual display
what is complimentary feeding?
mothers express milk with a pump and give it to the infant in a bottle
breastfeeding can later be introduced
this is often done if there is maternal breastfeeding complications
what is the role of the health visitor in breastfeeding?
measure growth/development of infant
promote skin-skin contact
ensure adequate breastfeeding technique
what are some of the clinical features of childhood obesity?
acanthosis nigricans
asthma
skin striae
obstructive sleep apnoea
constipation
how can childhood obesity impact the immune system?
metabolic inflammation - fat in adipose tissue activates immune response causing chronic inflammation (cytokines, macrophages etc)
also linked to MS
what are the biological determinants of obesity?
genetics, leptin and appetite regulation
what are the psychological determinants of obesity?
personality, impulse regulation, attachment security, self esteem
what are the social environment determinants for obesity?
time, money, food insecurity
what are the physical environment determinants of obesity?
walkability, greenspace, fresh food availability
what is the main commercial determinant of obesity?
production and marketing of processed unhealthy foods (often appealing)
what are some of the common negative effects of childhood obesity?
CV disease
type 2 diabetes
psychosocial problems
malignancies
orthopaedic problems
what is an obesogenic environment?
an environment promoting obesity
what is food insecurity?
uncertain or unreliabe access to food for individuals or household
can be mild (worry), moderate (compromise/reduction) or severe (regular hunger)
explain the 2 aims of immunisation programmes
to protect those at highest risk (selective)
to eradicate, eliminate or contain diseases (mass)
what might put someone in a high risk category for a vaccination? give an example for each
travel (typhoid)
occupational risk (hep B)
high risk groups (boosters for asplenic patients)
outbreak control (hep A)
what is the aim of an ideal vaccine?
produce same immune protection as natural infection without causing disease
generate long-lasting immunity
interrupt infection spread
what are some of the contradictions or precautions with vaccines?
those with immunodeficiency
those on immunosuppressing therapy
pregnant women
what are live vaccines?
attenuated strain which replicates in host
attenuated = weakaned pathogen so no disease
e.g: MMR, BCG
what are inactive vaccines?
do not contain a pathogen capable of replicating and causing disease
e.g Hep B, Polio
what are the pros and cons of live vaccines?
pros - long lasting immunity, strong immune response
cons - poor stability, can revert to virulence
what are the pros and cons of inactivated vaccines?
pros - unable to cause infection, stable, constitutents clearly defined
cons - shorter immunity, may need several doses
what is herd immunity?
a threshold level of infected population
if threshold reaches, infectious agent unable to transmit between population
name an example of a herd immunity disease and the infection threshold necessary
measles
95% must be vaccinated
what is passive immunity?
an immediate but temporary form of immune protection given to those at high risk of severe disease
doesnt stimulate immune system to produce any antibodies
e.g transplacental antibodies
what are the pros and cons of antibody preparations?
pros - rapid, preventative, given to those where vaccine contradicted
cons - expensive, no lasting immunity, potential for adverse events
what can be some of the outcomes of poor breastfeeding attachment?
painful/danaged nipples
engorgement
baby feeds more frequently
decreased milk production
baby struggles to gain weight
what are the signs and symptoms of iron deficiency in infants?
lethargy
breathlessness
cognitive impairment
impaired immune function
decreased capacity for physical activity
what factors should be taken into consideration when creating a vaccine programme?
aim/cost of programme
population accessibility
cultural attitudes/practices
facilities available
what are age recommendations for vaccines based on?
age-specific risks for disease/complication
ability to respond to vaccine
immune system interference from different antibodies (maternal antibodies)
name a vaccine administered at each key age group
primary - rotavirus
infant - MMR
adolescent - HPV
adults - shingles
what is vaccine equity?
vaccines are distributed based on need and priority rather than evenly distributed to all regions/locations
what are some of the challenges of global immunisation?
funding
uptake
violence (war)
different priorities in different areas
