DEVELOP - GROWTH Flashcards
What is psychomotor development?
The progressive attainment of skills that involve both mental and muscular activity
In brain development, neurlation begins at week 3-4 gestation, prosencephalic development at 2-3months then what up to birth? What is the 1 that begins post natally?
- neuronal proliferation then migration then neuronal organisation continues into life
- myelination begins after birth
What does the outer marginal layer, the middle layer and the inner layer of the neural tube form?
- outer –> white matter
- middle –> grey matter
- inner –> lining of the ventricles
At 4th week you have the prosencephalon, mesencephalon and rhombocephalon. What does the prosencephalon then divide into (at 5th week) and the rhombocephalon into?
- the telencephalon and diencephalon (from prosen.)
- the metencephalon and myelencephalon (from rhomb.)
What is Anencephaly a result of?
-faliure of anterior neural tube to fuse so prosencephalon is in contact with amniotic fluid and degenerates. Skull is open.
What is Holoprosencephaly?
- prosencephalon doesnt split, remains as one so you dont get 2 hemispheres
- impaired face and brain function e.g. 1 eye, no nose
When do synapses in the brain reach maximum density?
6-12months after birth
NB: as myelination progresses, nervous system functions improve
What spheres need to be fullfilled for a child to get optimal developmentand reach their potentials?
-psychological, physical and emotional
give 3 one-word descriptions of “development”
- innate
- incremental
- progressive
- responsive to stimuli
- interdependent
What are the 4 major spheres for milestones of development used by paediatricians to try to help achieve full potential by early management of obstacles..?
- Gross Motor
- Fine Motor (hand skills, vision)
- Communication (speech and hearing)
- Social/Emotional
Gross Motor. Newborn: reflex head turn 6months.. 12 months.. 18 months... 2-4yrs... NB: development is in a head to toe direction
6months.. sit alone 30secs
12 months.. walk independently
18 months… run around
2-4yrs… walk up stairs
Fine Motor. 3-4months - looks at hands 6months... 9months... 14months... 3yrs .. can copy circle 4.5..can draw a square 6..can draw a triangle
6months. ..transfers objects between hands
9months. ..uses pincer grip
14months. ..use pencil/build block tower
Speech/Hearing. Newborns..startled by noises 6wks... 6months.. 8months... 12months... 16months - points to body parts 2yrs - 50word vocab 2.5yrs - knows peoples 1st and last names
6wks. ..recognises mother’s voice
6months. . can babble
8months. .. can use muma/dada unspecifically
12months. .. mum/dad correctly
Social/Emotional. Newborns - can regard peoples faces 6wks... 6months.. 7months.. 10months..wave goodbye/play peekaboo 18months - uses a spoon 2yrs.. 3yrs..
6wks. ..smile
6months. .discriminate smile to enjoyed things
7months. . stranger danger anxiety
2yrs. .parallel play
3yrs. .play interactively with others
Name 3 primitive reflexes. When should they disappear by?
-Moro reflex (arms)
-rooting (suck)
-grasp
-stepping (when held vertically)
By 6months
What is Developmental Delay? 2 Types are..
Faliure to aquire a particular developmental skill at an age when 95% of peers have. Can be global or specific.
What is Global Developmental Delay?
NB: causes include genetics, asphyxia at birth, infection or trauma
delay in more than 2 areas of development due to a widespread problem of brain structure
What is Specific Developmental Delay?
in one area of development due to a more targeted abnormality e.g. speech delay, V. field defect, myopathy/neuropathy, deafness
Name a cause for concern of Developmental Delay by 8wks…
3months ..no eye contact
5months.. no reaching for objects on a play mat
3 causes of concern by 18months….
- baby is not smiling by 8wks
- baby is not walking unaided, not saying words with meaning or not making 2-3word sentences by 18months
The Diagnostic approach for Developmental Delay begins with Screening. What HCP may be involved?
- Dr/specialist midwife checks newborn
- GP checks at 6months
- heathcare visitors 6-9months, 18 months and 3yrs
The diagnostic approach for Developmental Delay after abnormal screening is Evaluation of development in clinic. What are they scorred according to? What is the next step?
Griffith’s Developmental Score
Next step is looking for causes e.g. chromosomal, brain defects, hearing issue, visual abnormality. thyroid..
So refer appropriately
In Developmental Delay we must try to correct the cause where possible e.g. hearing aid, thyroxine..why is correction important?
To promote development as skills are interdependent so a deficit will impact other spheres if not corrected early
Name 5 risk factors for Developmental Delay:
- linear growth restriction/poor maternal nutrition
- inadequate cognitive stimulation
- iron deficient
- lead exposure
- violence at home
Suggest 2 uses for monitoring growth:
- assess overall health/nutrition of child
- diagnose diseases that present as poor growth
- monitor disease and response to treatment
If a baby is born preterm (before 37wks) you plot on the far left and continue to plot on preterm section until…?
42weeks (EDD+2weeks) then plot on infancy section using gestational correction
What is the main growth influence perinatally? And after 1st year?
Perinatally: Nutrition (placental function, diet)
Later: genetics
What term is used to describe children whose weight is crossing down the centiles? When to investigate?
Faltering Growth
Investigate if crosses down 2+
What does short stature in a child refer to
Not meeting their height potential
Underweight is a child with a BMI less thean the 2nd centile for age and sex. What is overweight and obese?
Overweight: child’s BMI >91st centile for age and sex
Obese: BMI over 98th centile
Other that diet, what may condition may cause overweight/obesity in a child?
Hypothyroidism
Alveoli within CT stroma is the secretatory unit of mammary gland. What epithelia is alveolus made of? How is milk ejected from here?
- mammary cuboidal/low columnar epithelial cells
- ejected by myoepithelial cells around alveolus
What is “lactogenesis I” that begins in pregnancy? 2 hormones?
-placental lactogen and prolactin promote breast and glandular tissue development
During “lactogenesis I” that begins in pregnancy what 2 hormones supress milk production? Anything else?
- progesterone and oestrogen
- duct cells release autocrine inhib. factors
What causes “lactogenesis II” that begins post-partum? 2 hormones and what behaviour?
Abrupt fall in progesterone and oestrogen
Suckling stimulus releases PrL and oxytocin
What are the roles of Prolactin and Oxytocin in breastfeeding?
- prolactin drives milk synthesis
- oxytocin drive milk ejection
What is the “let down reflex”?
- triggered by suckling, mother/baby closeness
- causes myoepithelial contraction
- reflex can become conditioned
What are the drugs “bromocriptine” and “cabergoline” effects on lactation? When are they used?
- decrease PrL/increase DA so suppress lactation
- use if still-birth
What are the drugs “domperidone” and “metoclopramide” effects on lactation? When are they used?
- increase PrL/decrease DA
- in premature deliveries
How does breast milk vary? Composition changes within and between feeds…how to ions vs lactose % change?
- Na, K, Cl levels decrease over time
- lactose increases over time p.partum
Name 4 main benefits of breastfeeding?
- nutritional
- GI
- immunity
- mother
- societal
What fatty acids do human breast milk contain which are important for brain and retinal development?
-LCPUFA (long chain poly-unsat, fatty acids)
What effect does breast milk have on GI function?
- improves gastric emptying
- prevents NEC and pneumatosis intestinalis
Name 3 components of breastmilk and their importance in immunity:
- sIgA (esp. in preterms)
- Complement C1 to C9, C3 esp high which opsonises bacteria
- Lactoferin inhibits bacteria growth by binding Fe
- Cytokines-allow milk to protect, not injure gut epith.
- Lysozyme-cleave peptidoglycans of bact. walls
What is the enteromammary axis about?
- you produce sIgA specific to the bacteria in your baby’s environment
- so skin-skin contact is recommended to colonise the mothers flora
Name 3 long term benefits of breastfeeding:
- less type I and II diabetes
- less obesity, better growth, better cholesterol :
- prevents/delays AD, cows milk allergy and wheezing
- better cognitive outcome
- less risk of child myelo/lympho-blastic leukemia
Name 2 maternal benefits of breastfeeding:
-releases oxytocin, uterus contracts, less p.p. haem
-reduced breast and ovarian cancer
-uses loads of calories–> pre-preg. weight
-
Breastfeeding could save 800,000+ lives/yr globally and 20,000/yr from what pathology? As well as save healthcare $$$
-breast cancer
CHIN = pneumonic for effective breast feeding, what do you need?
- Hold baby Close
- Head should be free to move back
- Body should be In line
- Nose to Nipple
What are the 2 patterns of suckling and their function?
- non-nutritive: rapid bursts to stimulate milk supply to be ejective
- nutritive: follows, slower, interspersed with audible swallowing
GIve 3 risks of ineffective breastfeeding for the mother/baby:
- sore nipples and engorgement
- ineffective milk removal -> mastitis and less milk produced
- poor weight gain, jaudice, hypernatraemia in baby
What is the best formula milk? (First Steps Nutrition Trust Website is best info source)
NONE, £ is completely irrelevant.
They all require the same necessary ingredients
1st trimester-rapid growth/differentiation
2nd trimester-cellular hypertrophy
3rd trimester-?
Maturation of organs, weight/sub cut fat gain
Give 2 extrinsic and 2 intrinsic factors on pre-natal growth:
- placenta, B.flow, nutrition, maternal anatomy
- genes, hormones
What does the ICP model of post natal growth stand for?
Infancy, Childhood, Puberty
In infancy there is deceleration of growth rate, and the main influence on growth is genes/environment, what about in childhood?
-hormone influence (GH, TH) takes over nutrition
What is “Catch up Growth” - give an e.g of condition it may follow
Height Velocity above normal limit for age at least 1yr after transient period of growth inhibition e.g. IUGR/hypothyroidism
The genes KAL and FGF8 control the migration of which neurones to the hypothalamus along the olfactory tract?
-the GnRH neurones from the olfactory placode
How does bone growth come to an end?
-epiphyses and diaphyses fuse to obliterate the epiphyseal plate
Name 2 consequences of how/when bone growth cessates?
- after puberty is complete, no growth is possible
- obese children, enter puberty earlier so will be shorter adults
What does Baker’s hypothesis predict about Catch up Growth’s effect on the system? Stresses the system..
-babies born small who have a massive C.U.Growth, are more susceptible to T2DM, DT & CHD
