Development Flashcards

1
Q

How is short stature defined

A

Height below the second centile

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2
Q

What is height velocity and why is it useful

A

Height velocity measures the rate of growth in cm/year, taken from 2 height measures at least 6 months apart preferably 1 year

Useful as even though a child may be in the normal centile for height or weight this can identify a growth delay

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3
Q

How is genetic target centile calculated

A

Average of parents height
Add 7cm for boy with 9th-91st centile calculated +-10cm
Subtract 7cm for girl 9th-91st centile calculated +-8.5cm

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4
Q

Causes of short stature

A

Familial normal variant
IUGR or extreme prematurity
Delayed puberty (normally familial)
Endocrine causes- cushings syndrome, IGF-1 or GH deficiency, hypothyroidism
Chronic illness
Nutritional deficit
- GI diseases
- insufficient food
Chronic disease
- crohns
- coeliac
- CF
- CKD from renal tubular acidosis
Psychosocial deprivation

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5
Q

How is bone aged assessed

A

X-ray of the wrist and hand looking at epiphyseal maturity

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6
Q

What does a delayed bone age suggest in short stature

A

If moderately delayed suggests puberty delay or nutritional/chronic illness cause
If severely suggests endocrine causes

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7
Q

What does weight centile greater than height centile suggest in short stature

A

Endocrine cause

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8
Q

What does height centile greater than weight centile suggest in short stature

A

Nutritional cause or chronic illness

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9
Q

In delayed puberty what is physical sign of this causing short stature

A

Legs long compared to the back

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10
Q

What can cause GH deficiency in a child

A

Can either be isolated defect or secondary to panhypopituitarism
Mid facial defects
Craniopharyngioma
Laron syndrome
Hypothalamus affected
- tumour
- trauma
- meningitis

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11
Q

What is laron syndrome and blood findings

A

Where insensitivity to GH
- high GH
- low IGF-1

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12
Q

What suggests craniopharynioma causing low GH in short stature

A

Papilloedema
Bitemporal hemianopia

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13
Q

Investigations for short stature

A

Bloods
- FBC
- U&Es
- calcium and phosphate
- TSH
- CRP
- coeliac hormones
- GH provocation, IGF-1, dexamethasone provocation test
If neuro symptoms MRI
X ray of wrist and hand

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14
Q

Chronic diseases leading to short stature

A

CF
CHD
Coeliac
IBD
SCD
Thalassaemia

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15
Q

When refer to developmental delay when does this apply

A

0-5 years

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16
Q

Causes of delayed motor development

A

CP
Congenital myopathy
Spinal chord lesions
Spina bifida
Part of global delay
Varied initial moving- commando crawl or bottom shuffling

17
Q

How does method of initial movement affect motor development

A

Bottom shuffling and commando crawling delay walking
Expect by 27 months

18
Q

How does prematurity affect developmental milestones

A

Calculate from expected date of delivery
After 2 years do not make exception

19
Q

Causes of speech and language development delay

A

Hearing loss
Difficulty in production of of speech from anatomical deficit ie cleft lip
Oromotor incoordination - CP
Environmental lack of delay/understimulation
Normal variant/familial pattern

20
Q

How are speech and language development issues managed

A

Hearing tests
Referral to SALT

21
Q

Causes of abnormal social communication developmental delay

A

Autism spectrum disorders

22
Q

Classify causes of global developmental delay

A

Prenatal
- genetic conditions- downs, fragile X
- metabolic (hypothyroidism, inborn errors of metabolism)
- congenital infections
Perinatal
- prematurity linked IVH
- HIE
- hypoglycaemia
- kernicterus
Postnatal
- meningitis/encephalitis
- anoxia
- trauma

23
Q

Causes of learning difficulty/slow school progress

A

Common
Hearing impairment
Visual impairment
Low IQ

Rarer
Specific learning impairments

24
Q

What are specific learning impairments and the examples

A

Skill described is more delayed than would be expected for the child’s
level of cognitive ability
ADHD
Dyslexia
Dysgraphia
Dyscalculia

25
What is dyslexia a disorder of
Reading disproportionate to IQ
26
What are dysgraphia and dyscalculia
These are disorders in the development of writing skills and calculation skills
27
How would you explain the management of specific learning disorders
Aimed at impriving skill acquisition with educational and IT support where necessary Through variety of therapists
28
What is dyspraxia
Disorder of coordination, motor planning with no significant findings on standard neuro examination
29
How is obesity assessed in children
BMI adjusted for gender and sex
30
What is inheritance and mutation of achondroplasia
Autosomal dominant Fibroblast growth factor receptor 3 which results in abnormal cartilage
31
Presentation of achondroplasia
Shortened limbs and fingers Large head with frontal bossing Midface hypoplasia Flattened nasal bridge Trident hands Lordosis of lumbar region
32
Management of achondroplasia
Limb lengtening surgeries where are targeted bone fractures or apply frames
33
What is included in the national child health surveillance programme
As a newborn - clinical examination - oto-acoustic emissions test First month - Guthrie blood spot - midwife visit Following months - health visitor input - GP examination at 6-8 weeks - immunisations Pre school - orthoptist led programme for pre school vision
34
Large head with out of proportion sized limbs
Achondroplasia
35
How often should children have their growth measured
0-1= 5x annually 1-2= 3x annually 2 onwards= annually
36
How should height centiles be assessed with regards to referrals
Under 2nd centile= seen by GP Under 0.4th centile= seen by paediatrician in outpatient setting
37
If failure to thrive starts around 6 months what could be cause
Coeliac as start to wean off milk Thalassaemia however would not survive much longer without it
38
Clinical features of GH deficiency
Normal growth until 6-12 months Drastically reduced bone age Associated with neonatal hypoglycaemia, doll like face( round face with short chin and nose) and jaundice
39
According to NICE what is first line investigation for global development delay
Karyoptyping