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Paeds > Development > Flashcards

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
Q

What is dyslexia a disorder of

A

Reading disproportionate to IQ

26
Q

What are dysgraphia and dyscalculia

A

These are disorders in the development of writing skills and calculation skills

27
Q

How would you explain the management of specific learning disorders

A

Aimed at impriving skill acquisition with educational and IT support where necessary
Through variety of therapists

28
Q

What is dyspraxia

A

Disorder of coordination, motor planning with no significant findings on standard neuro examination

29
Q

How is obesity assessed in children

A

BMI adjusted for gender and sex

30
Q

What is inheritance and mutation of achondroplasia

A

Autosomal dominant
Fibroblast growth factor receptor 3 which results in abnormal cartilage

31
Q

Presentation of achondroplasia

A

Shortened limbs and fingers
Large head with frontal bossing
Midface hypoplasia
Flattened nasal bridge
Trident hands
Lordosis of lumbar region

32
Q

Management of achondroplasia

A

Limb lengtening surgeries where are targeted bone fractures or apply frames

33
Q

What is included in the national child health surveillance programme

A

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
Q

Large head with out of proportion sized limbs

A

Achondroplasia

35
Q

How often should children have their growth measured

A

0-1= 5x annually
1-2= 3x annually
2 onwards= annually

36
Q

How should height centiles be assessed with regards to referrals

A

Under 2nd centile= seen by GP
Under 0.4th centile= seen by paediatrician in outpatient setting

37
Q

If failure to thrive starts around 6 months what could be cause

A

Coeliac as start to wean off milk
Thalassaemia however would not survive much longer without it

38
Q

Clinical features of GH deficiency

A

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
Q

According to NICE what is first line investigation for global development delay

A

Karyoptyping

Paeds (17 decks)

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