Development Flashcards
What are the advantages and disadvantages of breast and bottle milk?
WHO encourages breastfeeding exclusively until 6 months old. Will help to fight infections, reduce obesity in later life, reduce mothers risk of breast/ovarian cancer, protective against sudden infant death syndrome.
However babies are more likely to be dehydrated/underfed, difficulty latching on. poor milk supply, painful/uncomfortable for mother.
Bottle feeding provides better nutrition for the baby, but it is more associated with overfeeding.
What is the normal feeding regimen for babies?
60ml/kg- day 1
90ml/kg- day 2
120ml/kg- day 3
150ml/kg- day 4 onwards
Premature babies may need to drink more.
Initially feed every 2-3hrs, then 4hrs then longer breaks in between, then eventually on demand.
Breast fed babies will lose 10% of BW by age 5 days, bottle fed will lose 5%. However, this should return to normal by day 10, if not need admitting as could be underlying cause of dehydration.
Start weening onto pureed food from 6 months, by 1 yr should resemble a healthy child’s diet.
What are the phases of growth?
What is obesity?
0-2yrs- Rapid growth based off nutrition.
2yrs-puberty- Slow phase of growth. Usually pick up disorders in this phase.
Puberty- Rapid growth driven by sex hormones.
Becomes concerning if a child has dropped by the centiles dramatically, compared to being consistently low.
Overweight- BMI >85th centile
Obesity- BMI >95th centile
What is the difference between failure to thrive and faltering growth?
Failure to thrive- poor development.
Faltering growth- Reduction in weight;
If <9 centile then by 1 centile space
If 9th-91st centile then by 2 centile spaces
If >91st centile then by 3+ centile spaces.
What are the causes of failure to thrive?
(1) Poor nutritional intake; neglect, poverty, breastfeeding mother has malabsorption, iron deficiency anaemia
(2) Malabsorption; IBD, coeliac, CM intolerance, CF, chronic diarrhoea
(3) Processing problems; T1DM, error with metabolism
(4) Poor feeding; cleft lip/palate, poor suck (cerebral palsy), pyloric stenosis, genetic conditions affecting facial structure
(5) Increased energy requirements; hyperthyroidism, chronic condition (congenital heart disease), malignancy, chronic infection i.e HIV
How is failure to thrive assessed and investigated?
How is it managed?
Assessment: Feeding Eating and feeding history (feeding relating to drinking milk, breast/bottle, n.o of feeds etc), encourage food diary Maternal co-morbidities Parent-baby relationship BMI, weight and height centiles Mid-parental height (MPH)
Consider nutritional impairment/growth problem if BMI <2nd centile OR >2 centiles below the MPH.
Investigate with urine dip to screen for UTI, also need coeliac screen blood test.
Management: MDT approach Support for breastfeeding Dietician review Encourage structured meal times Nutritional supplement drinks
If becomes serious may need enteral feeding tube.
What is a short stature?
What is the predicted height in males and females?
Height <2nd centile.
Male (MPH + 14cm)/2
Female (MPH - 14cm)/2
What are the causes of short stature?
Familial short stature
Genetics i.e. Downs
Spine abnormality i.e. Achondroplasia
Chronic disease i.e. coeliac, IBD
Endocrine dysfunction i.e. Hypothyroidism
Malnutrition
Constitutional delay in growth and puberty- Delayed growth spurt until later in puberty, will still reach adulthood height. Can confirm diagnosis with Hx and by using wrist XR to look for delayed bone age.
What are the domains of developmental milestones?
Gross motor
Fine motor
Language
Personal and social
What are the gross motor developmental milestones?
Develop from head downwards.
4 months- hold head up
6 months- sit up, whilst supported
9 months- sit up, unsupported
12 months- stand up, cruising (walking whilst holding furniture)
15 months- walk unaided
18 months- squat and pick things up from the floor
2yrs- run, kick a ball
3yrs- walk up the stairs, one foot at a time
4yrs- hop, walk down the stairs like an adult
What are the fine motor developmental milestones?
Early milestones:
2 months- can fixate on object 30cm away and move towards it. Will prefer people to inanimate objects.
What are the language milestones?
What are the personal and social milestones?
What are the underlying causes to consider in global developmental delay?
Down's syndrome Fragile X syndrome Fetal Alcohol syndrome Rett Syndrome Metabolic disorder
What are the underlying causes to consider in gross motor delay?
Cerebral palsy Visual impairment Ataxia Myopathy Spina bifida
