Child's journey - growth, development, and health Flashcards
What are the recognised phases of childhood?
Neonate (<4w) Infant (<12m) Toddler (around 1-2y) Preschool (around 2-5y) School age Teenager/adolescent
What are the 5 key development fields?
Gross motor - general movements Fine motor - Precise movements eg pincer grip Speech and language Hearing and vision Social and self help
What are the main childhood objectives?
To grow To develop and achieve their potential To attain optimal health To develop independence To be safe To be cared for To be involved
What are milestones?
Key skills
What are examples of milestones?
Smiling - around 2 months, issue if not by 4 months
Sitting - around 6 months, issue if not by 10 months
First steps - around 12 months, issue if not by 18 months
First words - around 12 months but if not by 2 years then concerns
What should happen to a child who is premature regarding developmental milestones?
Their prematurity should be taken off their age
What is the limit age of normal for milestones?
2 standard deviations from the mean
Why is development important?
Learning functional skills for later life
Hone skills in a safe environment
Allow our brain’s genetic potential to be fully realised
Equip us with tools needed to function as older children and adults
Many are completely automatic
What are influencing factors for development?
Genetics (family, race, gender)
Environment
Positive early childhood experience
Developing brain vulnerable to insults - antenatal, post natal, abuse and neglect
What are antenatal adverse environmental factors?
Infections - CMV, rubella, toxoplasmosis
Toxins - alcohol, smoking, anti-epileptics, etc
What are post natal adverse environmetal factors?
Infection - meningitis, encephalitis Toxins - solvent mercury, lead Trauma - head injury Malnutrition (iron, folate, vit D) Metabolic - hypoglycaemia Maltreatment/neglect Maternal mental health issues
Why do we assess development?
Reassurance and show progress Early diagnosis and intervention Discuss positive stimulation/parenting strategies Provision of information Imrpoving outcomes - pre-school years Genetic counselling Coexistent health issues
What children are especially assessed for development?
Premature
Syndromes
Adverse events
Who assesses development?
Parents and wider family
Health visitors, nursery, teachers
GPs, A&E, FYs, STs, students
Paediatricians and community paediatricians
What is used to assess development?
Healthy child programme (HCP) UK
What toys can we use to assess development?
Blocks - picking up, transferring to each hand, stacking
Crayons - drawing, fine motor skills
Ball - gross motor skills
Tea cup and tea set - imaginary play and social and language skills
Books - language
Whats important to consider about the progress of each developmental field?
One may be more prominently deficient than others - global vs specific delay
What are developmental red flags?
Loss of developmental skills Parental/professional concern Hearing loss Persistent low muscle tone No speech by 18 months, especially if no other communication Asymmetry of movement Not walking by 18 months
Who performs child health screening?
GP
Health visitor
Midwife
What are the main components of child health screening?
Health promotion
Developmental screening (including hearing)
Immunisation
What is tested for in the blood spot screening?
PKU Hypothyroid CF Sickle cell MCADD
When do children have their health checked?
New-born exam and blood spot screening New-born hearing screening (day 28) Health visitor first visit 6-8w review 27-30m review Orthoptist vision screening (4-5y)
What is assessed at the 6-8w review?
Identification data
Feeding
Parental concerns (appearance, hearing, eyes, sleeping, etc)
Development
Measurements (weight, length)
Examination (heart, hips, testes, genitalia, femoral pulses, eyes)
Sleeping position
What is done at the 27-30m review?
Identification data
Development
Physical measurements (height and weight)
Diagnoses
Should you give vaccines if a child is immunocompromised?
No
Is egg allergy contraindicated for MMR?
No
What do we monitor in growth?
Weight (grams)
Length or height if over 2y (cm)
Head circumference (OFC) (cm)
What can be derived from growth measurements?
Weight for age Length/height for age BMI Weight for length Rate of weight gain (only in infants)
What is the weight, length, and head circumference of a newborn?
Weight - 3.3kg
Length - 50cm
OFC 35cm
What is the weight, length, and head circumference of a 12 month old?
Weight - 10kg
Length - 75cm
OFC - 45cm
What is failure to thrive?
Child growing too slowly in form and usually in function at the expected rate for his or her age
Significantly low grade of weight gain
What are maternal causes of deficient intake leading to failure to thrive?
Poor lactation
Incorrectly prepared feeds
Unusual milk or other feeds
Inadequate care
What are infant causes of deficient intake leading to failure to thrive?
Prematurity Small for dates Oro palatal abnormalities ie cleft palate Neuromuscular disease Genetic disorders
What increased metabolic demands lead to failure to thrive?
Congenital lung disease Hypothyroidism Liver disease Heart diease Renal disease Infection Anaemia Cystic fibrosis IBD Malignancy
What are causes of excessive nutrient loss leading to failure to thrive?
Gastro oesophageal reflux
Pyloric stenosis
Gastroenteritis
Malabsorption
What are causes of malabsorption in the child?
Food allergy Persistent diarrhoea Coeliac disease Pancreatic insufficiency Short bowel syndrome
What are non medical causes of failure to thrive?
Poverty/socio-economic status Dysfunctional family interactions Difficult parent-child interactions Lack of parental support Lack of preparation for parenting Emotional deprivation Poor feeding or feeding skills disorder Difficult baby
What should you ask about in history about failure to thrive?
Presenting symptoms
Dietary assessment
Birth/family/social
What should be assessed on physical examination in failure to thrive?
Dysmorphic features
Anthropometry
Systems, development
What is anthropometry?
Measurement of body proportions
What is done during trial feeding in failure to thrive?
Observe feeding and mothers handling
Dietician/SALT assessment
Developmental assessment
What can cause poor food intake in hospital in trial feeding?
Organic cause
Feeding disorder
Non-organic or mixed
What can cause no weight gain in trial of feeding despite good food intake?
Organic - investigate accordingly
