Development Flashcards
What are the 4 domains of child development?
Gross motor
Fine motor
Language
Personal/ Social
What does gross motor refer to?
The child’s development of large movements (e.g. sitting, standing, walking, posture)
What are the different developmental milestones of gross motor skills up to 1 year old?
4 months= able to support head
6 months= maintain sitting position (keep trunk supported by pelvis)
9 months= sit unsupported, maintain standing position
12 months= stand and begin cruising (walking while holding furniture)
What are the gross motor developmental milestones after 12 months of age
15 months= walk unaided
18 months= squat to pick things off the floor
2 years= Run, kick a ball
3 years= climb stairs one foot at a time, stand on one leg, ride tricycle
4 years= hop, climb stairs normally
What are the early milestones in fine motor skill development?
8 weeks= fix eyes on object and follow it. 6 months=Palmar grasp 9 months= Scissor grasp 12 months= Pincer grasp 14-18 months= Use of spoon
What are the developmental milestones in drawing skills?
12 months= holds crayon (scribbles randomly) 2 years= copies vertical line 2.5= copies horizontal line 3 years= copies circle 4 years= copies cross and square 5 years= copies triangle
What are the developmental milestones using a tower of bricks?
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= 3 block bridge/ train 4 years= build steps
What are the developmental milestone of pencil grasp?
<2= Palmar supinate (fist) grip 2-3= digital pronate grasp 3-4= quadrupod/ static tripod grasp 5= mature tripod grasp
What are additional fine motor milestones that should be met?
3 years= thread large beads onto string. Cut paper with scissors
4 years= cut paper in hald with scissors
What are the different elements assessed in fine motor skill development?
Drawing skills
Tower of bricks
Pencil grasp
Normal milestones
What are the two components to language development?
Expressive language
Receptive language
What are the expressive language milestones?
3 mths= Cooing 6 mths= Noises with consonants 9 mths= babbling 12 mths= single word in context 18 mths= 5-10 words 2 years= combines 2 words 2.5 years= combines 3-4 words 3 years= basic sentences 4 years= tells stories
What are the receptive language milestones?
3 mths= Recognises familiar voices 6 mths= responds to tone 9 mths= listens to speech 12 mths= follows simple instructions 18 mths= understands nouns (e.g. spoon) 2 years= Understands verbs 2.5 years= Understands propositions (e.g. instructions) 3 years= understands adjectives 4 years= follows complex instructions
What key words can you use to remember receptive language milestones?
18 months= Spoon
2 years= Spoon + Cup
3 years= Spoon under cup
4 years= Red spoon under cup
What are the personal and social developmental milestones?
6 weeks= smiles
3 mths= shows pleasure
6mths= curious/ engaged
9 mths= become cautious with strangers
12 mths= pointing/ handling objects. waving and clapping
18 mths= imitates activities (e.g. using phone)
2 years= Engages with strangers. Parallel play. Dry by day.
3 years= seek out other children to play with. Bowel control
4 years= has best friend. Dry by night. Dresses self. Imaginitive play
What are the key red flags when it comes to development?
Lost developmental milestones Not able to hold object at 5 months Not sitting unsupported at 12 months Not standing independently at 18 months Not walking independently at 2 years Not running at 2.5 years No words at 18 months No interest in others at 18 months
How do you perform a developmental assessment?
Establish rapport and play with child. Use their name and get them to show you what they can do.
Test milestones they should have achieved by that age and work way up until they are unable to complete task.
How long do the WHO recommend exclusive breast feeding?
first 6 months
What can lead to inadequate nutrition for the baby?
Issues with breastfeeding:
- Poor milk supply
- Difficulty latching
- Discomfort/ pain
What may lead to overfeeding?
Breast and bottle feeding
Why is breast milk the preferred method of feeding?
Breast milk contains antibodies that can help protect neonate from infection
Also linked to better cognitive development, lower risk of some conditions and reduced risk of sudden infant death syndrome
Less risk of obesity later in life
Can reduce risk of breast and ovarian cancer in the mother
What volume of milk should babies receive on formula feed?
150ml per kg (start with 60ml and gradually increas to this from the first week of life)
How often should feed be given?
every 2-3 hours initially
then every 4 hours
then eventually feeding on demand
How much weight loss is acceptable in the first 5 days of life?
Breast feed= 10% of body weight
Formula fed= 5% of body weight
By what day should babies be back at their birth weight?
Day 10
What is the most common cause for excessive weight loss in neonates?
Dehydration due to under feeding
What is weaning?
The gradual transition from milk to normal food
At what age does weaning usually start?
Around 6 months
What do growth charts measure?
Weight, height and head circumference
What are the 3 phases of growth in children?
First 2 years= Rapid growth driven by nutrition
2 years- puberty= Steady slow growth
Puberty= Rapid growth spurt driven by sex hormones
What is defined as overweight in children?
BMI> 85th percentile
What is defined as obese in children?
BMI> 95th percentile
What should be considered if a child is short and fat compared to tall and fat?
Tall and fat= obese
Short and fat= Endocrine condition
What does failure to thrive refer to?
Poor physical growth and development
What is the criteria for faltering growth?
- If birthweight <9th centile= Fall or 1 or more centile space
- If birthweight 9th-91st centile= Fall of 2 or more centile spaces
- If birthweight >91st centile= Fall of 3 or more centile spaces
What are the different categories of factors that cause failure to thrive?
Inadequate nutritional intake Difficulty feeding Malabsorption Increased energy requirements Inability to process nutrition
What are the causes of inadequate nutritional intake?
Maternal malabsorption in breastfeeding Iron deficiency anaemia Family/ parental problems Neglect Availability of food (e.g. poverty)
What are the causes of difficulty feeding?
Poor suck (e.g. cerebral palsy)
Cleft lip/ palate
Genetic conditions
Pyloric stenosis
What are the causes of malabsorption that lead to failure to thrive?
Cystic fibrosis Coeliac disease Cows milk intolerance Chronic diarrhoea IBD
What are the causes of increased energy requirements that cause failure to thrive?
Hyperthyroidism
Chronic disease (E.g. congenital heart disease, cystic fibrosis)
Malignancy
Chronic infections
What are the causes of inability of children to process nutrients properly?
Inborn errors of metabolism
T1 diabetes
What are the key areas that need to be assessed when investigating failure to thrive?
Pregnancy, birth, developmental and social history Feeding/ eating history Observe feeding Mums physical/ mental health Parent- child interactions Growth chart Mid-parental height centile
What should be included in a feeding history?
Asking about breast/ bottle feeding, feeding times, volume & frequency, any difficulties feeding
What should be included in an eating history?
Food choices, food aversion, meal time routies, appetite
What initial investigations are done to investigate faltering growth?
Urine dipstick (for UTI) Coeliac screen (anti-TTG/ Anti-EMA antibodies)
How is failure to thrive managed?
Regular reviews to monitor weight gain
If breastfeeding is the issue, offer support/ supplementation with formula
Inadequate nutrition is issue, offer ditician review, support and nutritional supplement drinks
What is defined as short stature?
Height more than 2 standard deviations (/ centiles) below average for their age and sex
How is a boys predicted height calculated?
(Mothers height+ Fathers height+ 14cm)/ 2
How is a girls predicted height calculated?
(mothers hieght + fathers height - 14cm)/2
What are the causes of short stature?
Familial short stature Constitutional delay in growth and puberty Malnutrition Chronic diseases Endocrine disorders Genetic conditions Skeletal dysplasias
What is constitutional delay in growth and puberty?
A variation on normal development which leads to short stature in childhood but normal height in adulthood.
What happens to puberty in constitutional delay in growth and puberty?
It happens later and the growth spurt lasts longer
What is a key feature of CDGP?
Delayed bone age (compared to reference for age and sex)
What is the management for CDGP?
Exclude other causes, reassure parents and monitor growht
What is global developmental delay?
When a child shows slow development in all domains
What are the causes of global developmental delay?
Down's syndrome Fragile X syndrome Fetal alcohol syndrome Rett syndrome Metabolic disorders
What may be the causes of delay specific to the gross motor domain?
Cerebral palsy Ataxia Myopathy Spina bifida Visual impairment
What may be the causes of delay specific to fine motor?
Dyspraxia Cerebral palsy Muscular dystrophy Visual impairment Congenital ataxia
What may be the causes of delay specific to language?
Specific social circumstances Hearing impairment Learning disability Neglect Autism Cerebral palsy
What may be the causes of delay specific to the personal and social domain?
Social/ emotional neglect
Parenting issues
Autism
What are the main types of learning disability?
Dyslexia Dysgraphia Dyspraxia Auditory processing disorder Non-verbal learning disability Profound & multiple learning disability
What is dysgraphia?
Difficulty in writing
What is dyspraxia?
Developmental co-ordination disorder (delayed gross and fine motor skills)
What is non-verbal learning disability?
Difficulty in processing non-verbal information (e.g. body language, facial expressions)
What is the severity of learning disbility based on?
IQ: 55-70= mild 40-55= moderate 25-40= severe <25= profound
What are the causes of learning disability?
Often no cause Family history Environmental factors (abuse, neglect, trauma, toxins) Genetic disorders Antenatal problems Problems at birth or early childhood autism epilepsy
When does puberty start for girls?
8-14
When does puberty start for boys?
9-15
How long does puberty usually take?
4 years
What does puberty start with in girls?
Development of breast buds, followed by pubic hair then menstrual periods
What does puberty start with in boys?
Enlargement of testicles, then penis, darkening of scrotum, development of pubic hair, deepening of voice
What staging system is used to determine pubertal staging?
Tanner staging
What is hypogonadism?
Lack of sex hormones (oestrogen and testosterone)
What are the two causes of hypogonadism?
Hypogonadotrophic hypogonadism
Hypergonadotrophic hypogonadism
What is Hypogonadotrophic hypogonadism?
Deficiency of LH and FSH
What is Hypergonadotrophic hypogonadism?
Lack of response to LH and FSH by the gonads
Which hormones are responsible of the secondary sexual characteristics and where are these released?
Androgens from the adrenals
What are some of the causes of hypogonadotropic hypogonadism?
Secondary causes (e.g. radiotherapy, surgery) GH deficiency Hypothyroidism Hyperprolactinaemia Chronic conditions Excessive excercise/ anorexia Constitutional delay Kallman syndrome
What is Kallman syndrome and what specific symptom is it usually associated with?
Genetic condition causing hypogonadotrophic hypogonadism with failure to start puberty. Associated with reduced/ absent sense of smell
What are some causes of hypergonadotrophic hypogonadism?
Previous damage to gonads (e.g. testicular torsion, cancer, infection)
Congenital absence
Kleinfelter’s syndrome
Turner’s syndrome
At what point would investigations into delayed puberty be triggered in girls?
No evidence of breast buds (stage 2 tanner) by age 13
OR no progression over 2 years (e.g. breast bud development but no menarche)
At what point would investigations into delayed puberty be triggered in boys?
No evidence of puberty at 14
How is delayed puberty investigated?
Thorough history and examination
Growth chart
Further testing
What testing can be done to look into delayed puberty?
Bloods
Hormonal blood tests
Genetic testing
Imaging: Bone age, pelvic USS, Brain MRI
What initial blood tests are done to look into delayed puberty?
FBC
U&E’s
Anti-TTG/ anti-EMA (coeliac)
What hormonal blood tests are done to investigate delayed puberty?
TFT’s, GH, Prolactin, FSH/LH
What genetic testing is done to investigate delayed puberty?
Microarray test for:
Kleinfelter’s
Turner’s
What imaging can be done to investigate delayed puberty?
Wrist X-ray for bone age
Pelvic USS
MRI brain
