Childhood development Flashcards
Failure to thrive
Poor physical growth and development in a child.
Faltering growth- children fall in weight across:
- One or more centile spaces if their birthweight was below the 9th centile
- Two or more centile spaces if their birthweight was between the 9th and 91st centile
- Three or more centile spaces if their birthweight was above the 91st centile
causes of failure to thrive
inadequate energy and nutrition can lead to failure to thrive:
Inadequate nutritional intake
- maternal malabsorption, iron deficiency anaemia, neglect, family/parental problems, poverty.
Difficulty feeding
- poor suck (cerebral palsy), cleft lip/palate, genetic conditions, pyloric stenosis
Malabsorption
- CF, coeliac disease, cows milk, chronic diarrhoea, IBD
Increased energy requirements
- hyperthyroidism, congenital heart disease, CF, malignancy, HIV/immunodeficiency
Inability to process nutrition
- inborn errors of metabolism
- type 1 diabetes
assessment of failure to thrive
Pregnancy, birth, developmental and social history
Feeding or eating history
Observe feeding
Mums physical and mental health
Parent-child interactions
Height, weight and BMI (if older than 2 years) and plotting these on a growth chart
Calculate the mid-parental height centile
mid parental height (height of mum + height of dad) / 2
BMI = weight (kg) / height m2
investigations for failure to thrive
urine dipstick (UTI)
coeliac screen (anti TTG, anti eMA)
CF
pyloric stenosis
causes of short stature
a height more than 2 standard deviations below the average for their age and sex. This is the same as being below the 2nd centile.
Familial short stature
Constitutional delay in growth and development
Malnutrition
Chronic diseases, such as coeliac disease, inflammatory bowel disease or congenital heart disease
Endocrine disorders, such as hypothyroidism
Genetic conditions, such as Down syndrome
Skeletal dysplasias, such as achondroplasia
normal reflexes
- the moro reflex= baby is startled by loud sound / movement. lasts 2 months old. baby cries, throws back head and pulls limb into body
- the tonic reflex (fencing)
baby is turned to one side, and the same arm stretches out whilst hte opposite arm bends at elbow. lasts 5-7 months - rooting reflex
stroke corner of baby’s mouth. baby turns head and opens mouth. lasts 4 onths - suck reflex. roof of baby’s mouth is touched = baby starts to suck, (premature babies will have a weak or immature suckling ability)
- grasp reflex. stroke palm of baby’s hand- baby will close their fingers. 5-6 months.
- stepping reflex. 2 months. baby takes steps when held upright.
senses
sight: unco-ordinated eye movement, focus only at close range (8-10 inches) can track an object. improves to 20/20 in first 2-3 years. can detect light and dark but not colours
hearing: fully developed in newborns. startles to loud noises. prefer higherp itch voice
smell: strong sense of smell, prefers smell of mum and breast milk
taste: sweet taste, human milk
touch: comforted by touch
Gross motor development
4 months: able to support their head and keep it in line with the body
6 months: keep their trunk supported on their pelvis (i.e. maintain a sitting position)
9 months: sit unsupported by 9 months. crawling at this stage
**refer if unable to sit supported at 12 months
12 months: cruising (walking whilst holding onto furniture).
15 months: Walk unaided.
**refer if unable to stand independently by 18 months
18 months: Squat and pick things up from the floor.
2 years: Run. Kick a ball.
- **refer if unable to walk independently at 2 years
- **refer if unable to run at 2.5 years
3 years: Climb stairs one foot at a time. Stand on one leg for a few seconds. Ride a tricycle.
4 years: Hop. Climb and descend stairs like an adult.
fine motor development
early milestones
8 weeks: Fixes their eyes on an object 30 centimetres in front of them and makes an attempt to follow it. preference for a face rather than an inanimate object.
6 months: Palmar grasp of objects (wraps thumb and fingers around the object).
*** refer if at 5 months not able to hold an object at 5 months
9 months: Scissor grasp of objects (squashes it between thumb and forefinger).
12 months: Pincer grasp (with the tip of the thumb and forefinger).
14-18 months: They can clumsily use a spoon to bring food from a bowl to their mouth.
hand preference before 12 months is abnormal and could indicate cerebral palsy
emotional and social development
6 weeks: Smiles
3 months: Communicates
pleasure
6 months: Curious and engaged with people
9 months: They become cautious and apprehensive with strangers
12 months: Engages with others by pointing and handing objects. Waves bye bye. Claps hands.
18 months: Imitates activities such as using a phone
***refer if no words at 18 months and no interest in others.
2 years: Extends interest to others beyond parents, such as waving to strangers. Plays next to but not necessarily with other children (parallel play). Usually dry by day.
3 years: They will seek out other children and plays with them. Bowel control.
4 years: Has best friend. Dry by night. Dresses self. Imaginative play.
hearing and vision
newborn: startled by sudden noise 1m startled by loud noise 3m moves head to gaze 6m adjust to see and turns to sound 12m good vision, knows name 18m self in mirror 2y/o interested in conversation 30m photos 4y/o colours, long stories 5 y/o 10 colors
speech and language development
expressive:
3 months: Cooing noises
6 months: Makes noises with consonants (starting with g, b and p)
9 months: Babbles, sounding more like talking but not saying any recognisable words
*refer if not babbling or imitating sounds by the age of 9 months.
12 months: Says single words in context, e.g. “Dad-da” or “Hi”
*refer if does not respond to own name by 1 year old
18 months: Has around 5 – 10 words
2 years: Combines 2 words. Around 50+ words total.
**less than ten spoken words by the age of 2 is indicative of ASD.
2.5 years: Combines 3 – 4 words
3 years: Using basic sentences
4 years: Tells stories
receptive:
3 months: Recognises parents and familiar voices and gets comfort from these
6 months: Responds to tone of voice
9 months: Listens to speech
12 months: Follows very simple instructions
18 months: Understands nouns, for example “show me the spoon”
2 years: Understands verbs, for example “show me what you eat with”
2.5 years: Understands propositions (plan of action), for example “put the spoon on / under the step”
3 years: Understands adjectives, for example “show me the red brick” and “which one of these is bigger?”
4 years: Follows complex instructions, for example “pick the spoon up, put it under the carpet and go to mummy”
fine motor
drawing skills
tower of bricks
pencil grasp
drawing: 12 months: Holds crayon and scribbles randomly 2 years: Copies vertical line 2.5 years: Copies horizontal line 3 years: Copies circle 4 years: Copies cross and square 5 years: Copies triangle
towers: 14 months: Tower of 2 bricks 18 months: Tower of 4 bricks 2 years: Tower of 8 bricks 2.5 years: Tower of 12 bricks 3 years: Can build a 3 block bridge or train 4 years: Can build steps
pencils:
Under 2 years: Palmar supinate grasp (fist grip)
2-3 years: Digital pronate grasp
3-4 years: Quadruped grasp or static tripod grasp
5 years: Mature tripod grasp
3 years: Can thread large beads onto string. Can make cuts in the side of paper with scissors.
4 years: Can cut paper in half using scissors
learning disability
different conditions that effect ability of a child to develop new skills. mild-severe
Dyslexia refers to a specific difficulty in reading, writing and spelling.
Dysgraphia refers to a specific difficulty in writing.
Dyspraxia, also known as developmental co-ordination disorder, refers to a specific type of difficulty in physical co-ordination. It is more common in boys. It presents with delayed gross and fine motor skills and a child that appears clumsy.
Auditory processing disorder refers to a specific difficulty in processing auditory information.
Non-verbal learning disability refers to a specific difficulty in processing non-verbal information, such as body language and facial expressions.
Profound and multiple learning disability refers to severe difficulties across multiple areas, often requiring help with all aspects of daily life.
IQ: 55 – 70: Mild 40 – 55: Moderate 25 – 40: Severe Under 25: Profound
reasons for developmental delay
global developmental delay (in all developmental domains) - down's syndrome - fragile X - fetal alcohol syndrome - Rett syndrome - Metabolic disorders
Gross motor delay Cerebral palsy Ataxia Myopathy Spina bifida Visual impairment
fine motor delay Dyspraxia Cerebral palsy Muscular dystrophy Visual impairment Congenital ataxia (rare)
language delay Specific social circumstances, for example exposure to multiple languages or siblings that do all the talking Hearing impairment Learning disability Neglect Autism Cerebral palsy
personal/social delay
Emotional and social neglect
Parenting issues
Autism
