Development Flashcards
What is plotted in a growth chart and what is it plotted against?
Plot a child’s weight, height and head circumference against the normal distribution for their age and gender.
The child’s measurements are plotted on a graph using a dot.
What is plotted on the x-axis and y-axis of a growth chart?
x-axis: age
y-axis: weight, height, head circumference
What do the curves indicate on a growth chart?
The normal distribution of growth over time.
What do the centiles indicate on a growth chart?
Centiles indicate where a child’s growth compares to the normal distribution for their age and sex.
Use chart that matches sex of child as growth is different between boys and girls.
If a child is on the 50th centile and a child is on the 1st centile for height, what does this mean?
50th centile - child is exactly average height for their age
1st centile - child is shorter than 99% of children their age
If a child is not gaining weight or height, what is important to establish with the growth chart?
Establish whether the child is maintaining their centile. If a child is on the 9th centile but has always been on the 9th centile then it is much less concerning than a child that was on the 91st centile and is now on the 9th.
What are the 3 phases of growth in children?
1) First 2 years - rapid growth driven by nutritional factors
2) From 2 years to puberty - steady slow growth
3) During puberty - rapid growth spurt driven by sex hormones
Why is obesity occurring in children?
- consuming more calories than are expended through activity and growth
- readily available, affordable, hyper-palatable, high calorie foods
- shift from physical activities and outdoor play to sedentary activities e.g. video games and screens
What is overweight defined as in terms of BMI and centiles?
BMI >85th percentile
What is obese defined as in terms of BMI and centiles?
BMI >95th percentile
What are the effects of obesity in children?
- bullying
- developing impaired glucose tolerance
- T2DM
- CVD
- arthritis
- cancers
- likely to continue into adulthood unless family engages and addresses the issue
How is failure to thrive defined?
Poor physical growth and development in a child.
What is faltering growth?
Fall in weight across:
- one or more centile spaces if birthweight was below 9th centile
- two or more centile spaces if birthweight was between 9th and 91st centile
- three or more centile spaces if their birthweight was above 91st centile
What are broad causes of failure to thrive?
- inadequate nutritional intake
- difficulty feeding
- malabsorption
- increased energy requirements
- inability to process nutrition
What are causes of inadequate nutritional intake leading to failure to thrive?
- maternal malabsorption if breastfeeding
- iron deficiency anaemia
- family or parental problems
- neglect
- availability of food (ie. poverty)
What are causes of difficulty of feeding that lead to failure to thrive?
- poor suck e.g. due to cerebral palsy
- cleft lip or palate
- genetic conditions with abnormal facial structure
- pyloric stenosis
What are causes of malabsorption that lead to failure to thrive?
- cystic fibrosis
- coeliac disease
- cow’s milk intolerance
- chronic diarrhoea
- IBD
What are causes of increased energy requirements that lead to failure to thrive?
- hyperthyroidism
- chronic disease e.g. congenital heart disease, CF
- malignancy
- chronic infections e.g. HIV, immunodeficiency
What are causes of inability to process nutrients properly leading to failure to thrive?
- inborn errors of metabolism
- T1DM
What must be involved in a history and examination for failure to thrive?
- pregnancy, birth, developmental, social history
- feeding or eating history
- observe feeding
- mum’s physical and mental health
- parent-child interactions
- height, weight, BMI (if >2 years) and plot on growth chart
- calculate mid-parental height centile
What is involved in a feeding history?
- breast or bottle feeding
- feeding times
- volume and frequency
- any difficulties with feeding
What is involved in an eating history?
- food choices
- food aversion
- meal time routines
- appetite
- consider a food diary
How is BMI calculated?
BMI = weight (kg)/height^2 (m2)
How is the mid parental height calculated?
(height of mum + height of dad) / 2
What outcomes from assessment would suggest inadequate nutrition or a growth disorder?
- height more than 2 centile spaces below mid-parental height centile
- BMI below the 2nd centile
What key investigations should be done for faltering growth?
- urine dipstick (r/o UTI)
- coeliac screen (anti-TTG, anti-EMA antibodies)
What is the management for failure to thrive?
Management depends on the cause and may involve MDT input.
Regular reviews to monitor weight gain.
How can difficulty with breastfeeding be managed?
- supplement with formula milk (successful but often results in breastfeeding stopping - encourage to feed with breastmilk prior to top-up feeds and express when not breastfeeding to encourage lactation to continue)
How can inadequate nutrition be managed?
- encouraging regular structured mealtimes and snacks
- reduce milk consumption to improve appetite for other foods
- review by dietician
- additional energy dense foods to boost calories
- nutritional supplement drinks
If other measures fail and serious concerns for failure to thrive, what may the MDT consider?
Enteral tube feeding.
Must have clear goals and a defined end point.
How is short stature defined?
- height more than 2 standard deviations below the average for their age and sex
- below the 2nd centile
How can a child’s predicted height be calculated?
Boys: (mother height + father height + 14cm) / 2
Girls: (mother height + father height - 14cm) / 2
What are the causes of a short stature?
- familial short stature
- constitutional delay in growth and development
- malnutrition
- chronic diseases e.g. coeliac disease, IBD, congenital heart disease
- endocrine disorders e.g. hypothyroidism
- genetic conditions e.g. Down syndrome
- skeletal dysplasias e.g. achondroplasia
What is constitutional delay in growth and puberty?
A variation on normal development leading to short stature in childhood when compared with peers but normal height in adulthood. Puberty is delayed and growth spurt during puberty lasts longer.
Ultimately reach predicted adult height.
What is a key feature of constitutional delay in growth and puberty?
Delayed bone age compared with the reference for their age and sex.
How is bone age estimated?
Images of wrist and hand x-ray to assess size and shape of the bones and growth plates.
How is constitutional delay in growth and puberty diagnosed?
History, examination, xray of hand and wrist to assess bone age
What is the management for constitutional delay in growth and puberty?
- exclude other causes of a short stature and delayed puberty
- reassure parents and child
- monitor growth over time
What are the differentials for ADHD?
- general developmental delay
- medication side effects e.g. salbutamol, anti-histamines
- ill-disciplined
- over-tired
- severe emotional abuse and neglect
What are the core symptoms of autism?
Impairment in:
- social interaction
- communication
- limited range of activities/repetitive behaviours
What are the core symptoms of ADHD?
- hyperactivity
- impulsivity
- inattention
What are differentials for autism?
- CNS development abnormalities
- Fragile X syndrome
- tuberous sclerosis
- expressive and receptive language disorders
- Rett syndrome (females, developmental regression, microcephaly, hand-wringing)
What age are medications used in ADHD from?
Over 6 years old
What are educational psychologists?
Go into school environment and assess child alongside peers, their processing and any signs of learning difficulties.
