Development Flashcards
What are the benefits of breastfeeding
Reduced neonatal infections
Better cognitive development
Lower risk of certain conditions later in life
Reduced risk of sudden infant death syndrome
Reduced risk of breast and ovarian cancer in mother
How much milk should a formula fed baby drink
150 ml per kg per day
Preterm and underweight babies need more
What is the pattern of initial weight loss in neonates
Breastfed babies lose 10% in first 5 days
Bottle fed babies lose 5% in first 5 days
Should be back to birth weight by day 10
Admission and assessment if not back to birth weight by day 14
What are the causes for failure to thrive
Inadequate intake (maternal malabsorption, iron deficiency anaemia, neglect, poor availability of food)
Difficulty feeding (poor suck, cleft lip or palate, genetic conditions, pyloric stenosis)
Malabsorption (cystic fibrosis, coeliac disease, cow’s milk intolerance, chronic diarrhoea, IBD)
Increased energy requirements (hyperthyroidism, chronic disease, malignancy, chronic infections)
Inability to access nutrients (T1DM, metabolism errors)
What investigations are needed for failure to thrive
Urine dip
Coeliac screen (anti-TTG, anti-EMA)
What is the management for failure to thrive
Regular reviews and monitoring
MDT support
Supplemented formulas
Encourage regular structured mealtimes and snacks
Reduce milk consumption
Dietician review
Add energy dense foods
If seriously concerned, consider enteral feeding tube
What is short stature
> 2 standard deviations below average height for their age and sex
What is the predicted height for boys
(Mother height + father height + 14) / 2
What is the predicted height for girls
(Mother height + father height - 14) / 2
What are the causes of short stature
Familial short stature
Constitutional delay
Malnutrition
Chronic disease (coeliac, IBD, congenital heart disease)
Endocrine disorders (hypothyroidism)
Genetic conditions (Down’s syndrome)
Skeletal dysplasia (achondroplasia)
What are the gross motor developmental milestones
4 months (start supporting head)
6 months (maintain a sitting posture, often don’t have balance to sit unsupported)
9 months (sit unsupported, start crawling, maintain standing position, bounce on legs when supported)
12 months (standing, cruising)
15 months (walk unaided)
18 months (squat and pick up things from floor)
2 years (run, kick a ball)
3 years (climb stairs one foot at a time, stand on one leg, ride a tricycle)
4 years (hop, climb stairs like an adult)
What are the fine motor early developmental milestones
8 weeks (fix eyes on object 30 cm away, try to follow it, preference for face rather than inanimate object)
6 months (palmar grasp of objects)
9 months (scissor grasp of objects (between thumb and forefinger))
14-18 months (clumsily use a spoon)
What are the fine motor drawing skills developmental milestones
12 months (hold crayon and scribble randomly)
2 years (copy vertical lines)
2.5 years (copy horizontal lines)
3 years (copy circles)
4 years (copy crosses and squares)
5 years (copy triangles)
What are the fine motor tower of bricks developmental milestones
14 months (2 bricks)
18 months (4 bricks)
2 years (8 bricks)
2.5 years (12 bricks)
3 years (3 block bridge or train)
4 years (build steps)
What are the fine motor pencil grasp developmental milestones
Under 2 (palmar supinate grip)
2-3 years (digital pronate grasp)
3-4 years (quadrupod grasp or static tripod grasp)
5 years (mature tripod grasp)
What are the expressive language developmental milestones
3 months (cooing noises)
6 months (noises with consonants)
9 months (babbling)
12 months (single word in context)
18 months (5-10 words)
2 years (combine 2 words, 50+ words)
2.5 years (combine 3-4 words)
3 years (basic sentences)
4 years (tell stories)
What are the receptive language developmental milestones
3 months (comfort from parent and familiar voices)
6 months (respond to tone of voice)
9 months (listen to speech)
12 months (follow very simple instructions)
18 months (understand nouns)
2 years (understand verbs)
2.5 years (understand propositions)
3 years (understand adjectives)
4 years (follow complex instructions)
What are the personal and social developmental milestones
6 weeks (smile)
3 months (communicates pleasure)
6 months (curious and engaging with people)
9 months (cautious and apprehensive with strangers)
12 months (wave bye, clap hands)
18 months (imitates activities such as using a phone)
2 years (waving to strangers, play next to other children, dry by day)
3 years (seek out other children to play with, bowel control)
4 years (have best friend, dry by night, dresses self, imaginative play)
What are the red flags for developmental milestones
Loss of a milestone
Not able to hold object by 5 months
Not sitting unsupported by 12 months
Not standing independently by 18 months
Not walking independently by 2 years
Not running by 2.5 years
No words by 18 months
Not interested in others by 18 months
When is developmental delay worrying
Slow to reach all milestones
Lags behind in one specific domain
What are the causes for global developmental delay
Down’s syndrome
Fragile X syndrome
Fetal alcohol syndrome
Rett syndrome
Metabolic disorders
What are the causes for gross motor delay
Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairment
What are the causes for fine motor delay
Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment
Congenital ataxia
What are the causes for language delay
Specific social circumstances (exposure to multiple languages, siblings do all the talking)
Hearing impairment
Learning disability
Neglect
Autism
Cerebral palsy
What are the causes of personal and social delay
Emotional and social neglect
Parenting issues
Autism
What are learning disabilities associated with
Genetic disorders (Down’s)
Antenatal problems (fetal alcohol syndrome, maternal chicken pox)
Problems at birth (prematurity, hypoxic-ischaemic encephalopathy)
Problems in early childhood (meningitis)
Autism
Epilepsy
What happens in normal puberty in girls
At age 8-14
Takes about 4 years
Development of breast buds
Pubic hair
Menstrual periods (2 years from start of puberty)
What happens in normal puberty in boys
At age 9-15
Enlargement of testes
Enlargement of penis
Darkening of scrotum
Development of pubic hair
Deepening of voice
What is hypogonadism
Lack of sex hormones (oestrogen and progesterone)
Due to hyper/hypogonadotrophic hypogonadism (either deficiency in LH and FSH, or lack of response to LH and FSH)
What investigations are needed for delayed puberty
Detailed history and examination
Bloods (normal, coeliac screen, early morning FSH and LH, growth hormone, serum prolactin)
Genetic testing (Kleinfelter’s syndrome, Turner’s syndrome)
Imaging (X-ray wrist, pelvic ultrasound, MRI brain)
What is the management for delayed puberty
Treat underlying condition
Replace sex hormones
What are the types of abuse
Physical
Emotional
Sexual
Neglect
Financial
What are the risk factors for abuse
Domestic violence
Previously abused parents
Mental health problems
Emotional volatility in household
Social, psychological, or economic stress
Disability in child
Learning disability in parent
Alcohol misuse
Substance misuse
Non-engagement with services
What are the possible signs of abuse
Changes in behaviour
Extreme emotional state
Dissociative disorders
Bullying
Self harm or suicidal thoughts
Unusually sexualised behaviours
Unusual behaviour during examination
Poor hygiene
Poor physical or emotional development
Missed appointments
Non-compliance with treatment
What is Gillick competence
If child’s understanding and intelligence is sufficient, they can consent to treatment
On a case by case basis
What are the Fraser guidelines
For contraception in under 16s without parental input
Criteria:
Mature and intelligent enough to understand treatment
Can’t be persuaded to discuss with parents
Likely to have intercourse regardless
Physical or mental health likely to suffer without treatment
In their best interest
