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Paeds > Development > Flashcards

Development Flashcards

1
Q

What are the benefits of breastfeeding

A

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

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2
Q

How much milk should a formula fed baby drink

A

150 ml per kg per day

Preterm and underweight babies need more

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3
Q

What is the pattern of initial weight loss in neonates

A

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

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4
Q

What are the causes for failure to thrive

A

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)

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5
Q

What investigations are needed for failure to thrive

A

Urine dip

Coeliac screen (anti-TTG, anti-EMA)

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6
Q

What is the management for failure to thrive

A

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

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7
Q

What is short stature

A

> 2 standard deviations below average height for their age and sex

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8
Q

What is the predicted height for boys

A

(Mother height + father height + 14) / 2

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9
Q

What is the predicted height for girls

A

(Mother height + father height - 14) / 2

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10
Q

What are the causes of short stature

A

Familial short stature

Constitutional delay

Malnutrition

Chronic disease (coeliac, IBD, congenital heart disease)

Endocrine disorders (hypothyroidism)

Genetic conditions (Down’s syndrome)

Skeletal dysplasia (achondroplasia)

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11
Q

What are the gross motor developmental milestones

A

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)

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12
Q

What are the fine motor early developmental milestones

A

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)

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13
Q

What are the fine motor drawing skills developmental milestones

A

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)

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14
Q

What are the fine motor tower of bricks developmental milestones

A

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)

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15
Q

What are the fine motor pencil grasp developmental milestones

A

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)

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16
Q

What are the expressive language developmental milestones

A

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)

17
Q

What are the receptive language developmental milestones

A

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)

18
Q

What are the personal and social developmental milestones

A

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)

19
Q

What are the red flags for developmental milestones

A

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

20
Q

When is developmental delay worrying

A

Slow to reach all milestones

Lags behind in one specific domain

21
Q

What are the causes for global developmental delay

A

Down’s syndrome

Fragile X syndrome

Fetal alcohol syndrome

Rett syndrome

Metabolic disorders

22
Q

What are the causes for gross motor delay

A

Cerebral palsy

Ataxia

Myopathy

Spina bifida

Visual impairment

23
Q

What are the causes for fine motor delay

A

Dyspraxia

Cerebral palsy

Muscular dystrophy

Visual impairment

Congenital ataxia

24
Q

What are the causes for language delay

A

Specific social circumstances (exposure to multiple languages, siblings do all the talking)

Hearing impairment

Learning disability

Neglect

Autism

Cerebral palsy

25
Q

What are the causes of personal and social delay

A

Emotional and social neglect

Parenting issues

Autism

26
Q

What are learning disabilities associated with

A

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

27
Q

What happens in normal puberty in girls

A

At age 8-14

Takes about 4 years

Development of breast buds

Pubic hair

Menstrual periods (2 years from start of puberty)

28
Q

What happens in normal puberty in boys

A

At age 9-15

Enlargement of testes

Enlargement of penis

Darkening of scrotum

Development of pubic hair

Deepening of voice

29
Q

What is hypogonadism

A

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)

30
Q

What investigations are needed for delayed puberty

A

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)

31
Q

What is the management for delayed puberty

A

Treat underlying condition

Replace sex hormones

32
Q

What are the types of abuse

A

Physical

Emotional

Sexual

Neglect

Financial

33
Q

What are the risk factors for abuse

A

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

34
Q

What are the possible signs of abuse

A

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

35
Q

What is Gillick competence

A

If child’s understanding and intelligence is sufficient, they can consent to treatment

On a case by case basis

36
Q

What are the Fraser guidelines

A

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

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