Development Flashcards
When should you be concerned about a child’s growth?
1) Fall over 2 or more percentiles
2) Are persistently below 3rd/5th percentile
3) Are less than 80th percentile of median weight for height
What is child’s growth dependent on? Adolescent growth?
Children’s growth is dependent on nutrition and growth hormone
In adolescence sex hormones drive the majority of growth and cause the growth plates to fuse.
Causes of short stature
- Chronic disease
- Familial short stature (bone age appropriate for chronologic age, normal growth velocity, and predicted adult height appropriate to the familial pattern)
- Constitutional delay of growth and development (delayed bone age, normal growth velocity, and predicted adult height appropriate to the familial pattern)
- Growth failure (pathologic state of abnormally low growth rate over time, usually endocrine, usually not skinny)
Malnutrition is a huge cause
Consider anorexia/bulemia
Metabolic disease?
Formula/food intolerance/allergy
GI causes of growth failure
Malabsorption
IBD
Cardiac causes of growth failure
Hypoxaemia
Congestive heart failure
Pulmonary causes of growth failure
Severe asthma (chronic steroid use)
CF
Sleep apnoea
Renal/endocrine causes of growth failure
Chronic renal disease Hypothyroidism Growth hormone or IGF deficiency GHRH deficiency Panhypopituitarism Poorly controlled T1DM Chronic hyponatraemia Cushing's Addison's
Genetic causes of growth failure
Down’s
Turner’s
Hypochondroplasia
What is normal puberty in girls?
Begins aged 11 with breast budding Pubic hair Axillary hair Height spurt Ends aged 13 with menarche
What is normal puberty in boys?
Begins aged 12 with testicular enlargement Penis enlargement Pubic hair Height spurt Ends aged 14/15 with facial hair
What counts as precocious puberty?
Pubertal changes before 8 in girls and 9 in boys
Central: gonadotropin-dependent, is the early maturation of the entire hypothalamic-pituitary-gonadal (HPG) axis, with the full spectrum of physical and hormonal changes of puberty.
Precocious pseudopuberty: much less common-> increased production of sex steroids is gonadotropin-independent
What happens to growth in precocious puberty?
The early growth spurt initially can cause tall stature, but rapid bone maturation can cause linear growth to cease too early and can result in short adult stature.
Causes of precocious puberty?
• Usually no CNS change is seen but sometimes->
• Tumours (eg, astrocytomas, gliomas, germ cell tumours secreting HCG)
• Hypothalamic hamartomas
• Acquired CNS injury caused by inflammation, surgery, trauma, radiation therapy, or abscess
• Congenital anomalies (eg, hydrocephalus, arachnoid cysts, suprasellar cysts)
Congenital adrenal hyperplasia
Ovarian oestrogen secreting tumours
Treatment of precocious puberty
Excision/radiotherapy of tumour
GnRH analogue to provide negative feedback on system
GnRH agonist at constant rate (axis only responds to pulsatile secretions)
Progestin (to stop menses)
What counts as delayed puberty?
No change seen at 13 in girls or 14 in boys
What should be screened for in delayed puberty?
Turner's syndrome Hypogonadism Hypopituitarism Hypothyroidism Hyperprolactinaemia Malnutrition (IBD, anorexia, CF) CNS disease
Treatment of delayed puberty
Counsel about Turner’s
Treat hypothyroid (levothyroxine)
Treat hyperprolactinaemia (bromocriptine)
Oestrogen/testosterone therapy
When do children usually smile responsively?
By 6 weeks
When do children usually wave byebye?
7-9 months
What age can children independently brush teeth and get dressed?
Age 3
When are children usually able to grasp a rattle?
3 months
When are children usually able to thumb-finger grip?
8-10 months
When can children speak a 3 word sentence?
Age 3
When can children life their head up 90º?
At about 6 weeks
When can children roll over?
At about 2-4 months
When can children sit with no support?
7 months
When can children walk well?
11-15 months
What allowances do you make for prematurity?
Make allowances for how many weeks prem until age 2
4 sections of development
Gross motor
Vision and fine motor
Hearing, speech and language
Social, emotional and behavioural
What can help if children aren’t reaching milestones?
Hearing check (hearing aids)
Physiotherapy
SALT
Age of crawling?
10 months
What checks do infants have in the 1st year of life?
Newborn NIPE within 72hrs 5-8days midiwfe 14 days midwife/health visitor 6-8 weeks GP 3 months clinic 4 months clinic 7-9 months health visitor
Name 8 infant reflexes
- Moro (sudden extension)
- Grasp
- Rooting (head turns towards stimulus when touched near mouth)
- Stepping response
- Asymmetric tonic neck reflex
- Labyrinthine righting
- Postural support
- Lateral propping
What can cause delayed development?
Antenatal: infection, toxins (alcohol, smoke, radiation), drugs (cytotoxics, antiepileptics)
Post natal: infections, metabolic disorders, toxins, trauma, malnutrition, maltreatment
Causes of peripheral precocious puberty
Gonadotrophin independent
Adrenal tumour
Ovarian/testicular tumour
18 month old who can scribble with pencil, stack 3 blocks, tries to take off tshirt and is bum shuffling: normal?
Usually walking 11-14 months but normal variant
All other parts are normal 18month old traits
• Benign (runs in families)
• Check in boys for myopathy/muscular dystrophy (bell shaped, floppy baby)
• Exclude cerebral/syndromic reasons
Define floppy infant
Differential?
No flexion in supine position, frog leg and rag doll ‘slip through’
• Benign
• Central (global delay, seizures, hypoglycaemic history, normal/brisk tendon reflexes)
• Peripheral (FH, isolated motor delay)
When is hand preference normal
Above 12 months
