Development Flashcards
Define failure to thrive
Refers to poor physical growth and development in a child.
A fall in of one or more centile spaces below the 9th centila
Two or more centile spaces between the 9th and 91st centile
Three or more centile spaces above the 91st centile
Caused of failure to thrive
Inadequate nutrition
Difficulty feeding
Malabsorption
Increased energy levels
Inability to process nutrition
Causes of inadequate nutritional intake
Maternal malabsorption - breastfed
Iron deficiency anaemia
Family or parental problems
Neglect
Poor availability of food.
Causes of difficulty feeding
Poor suck - cerebral palsy
Cleft lip or palate
Genetic conditions
Pyloric stenosis
Causes of malabsorption
Cystic fibrosis
Coeliac disease
Cows milk intolerance
Chronic diarrhoea
Inflammatory bowel disease
Causes of high energy requirement
Hyperthyroidism
Chronic disease - congenital heart, cystic fibrosis
Malignancy
Chronic infection - HIV, immunodeficient
Inability to process nutrients
Inborn errors of metabolism
TIDM
Assessment of failure to thrive
Full history examination and investigations
Pregnancy, birth, developmental and social history
Feeding or eating history
Observe feeding
Mums physical health
Parent-child interactions
Height weight and BMI - charts
Calculate mid-parental height
Investigations in failure to thrive
Urine dip - UTI
Coeliac screen
Cystic fibrosis
Pyloric stenosis - US
Management of failure to thrive
Manage cause
Encourage regular structured mealtimes and snacks
Reduce milk consumption - improve appetite for other snacks
Review by dietician
Additional energy dense food
Nutritional supplements
Enteral tube feeding
Define short stature
Height more than 2 standard deviations below the average for their age and sex
Causes of short stature
Familial short stature
Constitutional delay in growth and development
Malnutrition
Chronic disease - coeliac, IBD, congenital heart disease
Endocrine - hypothyroidism
Genetic - Down’s
Skeletal dysplasias - achondroplasia
Define constitutional delay
Considered a variation on normal development
Leads to short stature in child hood but normal height in adulthood
What is assessed in a developmental assessment
Gross motor
Fine motor
Language
Personal and social
Milestones of gross motor development
4 months - support head
6 months - sitting supported
9 months - sitting unsupported
12 months - walking (cruising
15 months - walking unaided
18 months - squat and pick things up
2 years - Run, kick a ball
3 years - climb stairs one foot at a time
4 years - hop, climb and descend stairs like adult
Milestones of fine motor development
8 weeks - fixes eyes on object
6 months - palmar grasp
9 months - scissor grasp
12 months - pincer grip
14-18 months - use spoon
Further - drawings, blocks in tower
Milestones of language deelopment
3 months - cooing, recognises parents voices
6 months - consonants (g,b,p), responds to tone of voice
9 months - babbles, listens to speech
12 months - single words, simple instructions
18 months - 5-10 words, understands nouns
2 years - combine 2 words, understands verbs
3 years - using basic sentences, understands adjectives
4 years - tells stories, complex instruction
Milestones of personal and social development
6 weeks- smiles
3 months - communicates pleasure
6 months - curious and engaged
9 months - cautious with stranegrs
12 months - engages with others by pointing, waves bye bye
18 months - imitates
2 years - waving to strangers, plays, dry by day
3 years - seek out other children to play, bowel control
4 years - best friend, dry by night, dresses self
Red flags of development
Loss of developmental milestones
Not able to hold object by 5 months
Not sitting by 12 months
Not standing by 18 months ?walking
Not running by 2.5 years
No words at 18 months
No interest in others at 18 months
Causes of global developmental delay
Down’s syndrome
Fragile X
Fetal alcohol
Rett syndrome
Metabolic disorders
Causese of gross motor delay
Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairment
Causes of fine motor delay
Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment
Congenital ataxia
Causes of language delay
Specific social circustances
Hearing impairment
Learning disability
Neglect
Autism
Cerebral palsy
Causes of personal and social delay
Neglect
Parenting issues
Autism
Define learning disablitiy
Umbrella term encompassing a range of different conditions that affect the ability of a child to develop new skills/
Examples of learning disabiloty
Dyslexia
Dysgraphia - writing specifically
Dyspraxia - coordination
Auditory processing disorder
Non-verbal learning disability
Profound and multiple learning disability
Causes of learning disability
Genetics
Antenatal - fetal alcohol, chickenpox
Problems at birth - Prematurity, hypoxic ischaemic encephalopathy
Problems in early childhood - meningitis
Autism
Epilepsy
Define hypogonadism
Refers to lack of sex hormones, oestrogen and testosterone.
Define hypogonadotropic hypogonadism
Deficiency of LH and FSH leading to dificiency in sex hormones.
Causes of hypogonadotropic hypogonadism
Damage to hypothalamus or pituitary
Growth hormone deficiency
Hyperprolactinaemia
Serious chronic conditions - cystic fibrosis, IBD
Excessive exercise or dieting
Constitutional delay
Kallaman syndrome
Define hypergonadotropic hypogonadism
Where the gonads fail to respond to gonadotropins - no negative feedback and large amounts of LH and FSH
Causes of hypergonadotropic hypogonadism
Damage to gonads - torsion, cancer, mumps
Congenital absence
Kleinfelter’s syndrome - XXY
Turner’s syndrome - XO
Define Kallaman syndrome
Genetic condition causing hypogonadotropic hypogonadism resulting in faiolure to start puberty - associated with reduced smell, anosmia
Investigations in delayed puberty
FBC UE antiTTG anti EMA
FSH
LH
Thyroid function
Growth hormone - insulin like growth factor
Prolactin
Genetic testing
Xray 0 growth plates
Pelvic US - ovaries
MRI brain - pituitary
Normal age of puberty
Female - 8-14 years
Male - 9-15 years
Investigate at 13 and 14 respectively
Risk factors for abuse
Domestic violence
Previously abused parent
Mental health problems
Emotional volatility in the household
Social psychological or economic stress
Disability in child
Learning disability in parent
Alcohol or substance misuse
Non-engagement with services
Possible signs of abuse
Change in behaviour or extreme emotional states
Dissociative disorders
Bullying, self harm or suicidal behaviours
Unusually sexualised
Unusual behaviours during examination
Poor hygiene
Poor physical or emotional development
Missing appointments
Frazer guidlines
- Mature and intelligent enough to understand treatment
- Can’t be persuaded to discuss it with their parents
- They are likely to have intercourse regardless
- Physical or mental health is likely to suffer without treatment
- Treatment is in their best interest
