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Paeds > Development > Flashcards

Development Flashcards

1
Q

When should you be concerned about a child’s growth?

A

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

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2
Q

What is child’s growth dependent on? Adolescent growth?

A

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.

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3
Q

Causes of short stature

A
  • 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

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4
Q

GI causes of growth failure

A

Malabsorption

IBD

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5
Q

Cardiac causes of growth failure

A

Hypoxaemia

Congestive heart failure

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6
Q

Pulmonary causes of growth failure

A

Severe asthma (chronic steroid use)
CF
Sleep apnoea

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7
Q

Renal/endocrine causes of growth failure

A 
Chronic renal disease
Hypothyroidism
Growth hormone or IGF deficiency
GHRH deficiency
Panhypopituitarism
Poorly controlled T1DM
Chronic hyponatraemia
Cushing's
Addison's
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8
Q

Genetic causes of growth failure

A

Down’s
Turner’s
Hypochondroplasia

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9
Q

What is normal puberty in girls?

A 
Begins aged 11 with breast budding
Pubic hair
Axillary hair
Height spurt
Ends aged 13 with menarche
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10
Q

What is normal puberty in boys?

A 
Begins aged 12 with testicular enlargement
Penis enlargement
Pubic hair
Height spurt
Ends aged 14/15 with facial hair
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11
Q

What counts as precocious puberty?

A

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

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12
Q

What happens to growth in precocious puberty?

A

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.

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13
Q

Causes of precocious puberty?

A

• 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

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14
Q

Treatment of precocious puberty

A

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)

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15
Q

What counts as delayed puberty?

A

No change seen at 13 in girls or 14 in boys

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16
Q

What should be screened for in delayed puberty?

A 
Turner's syndrome
Hypogonadism
Hypopituitarism
Hypothyroidism
Hyperprolactinaemia
Malnutrition (IBD, anorexia, CF)
CNS disease
17
Q

Treatment of delayed puberty

A

Counsel about Turner’s
Treat hypothyroid (levothyroxine)
Treat hyperprolactinaemia (bromocriptine)
Oestrogen/testosterone therapy

18
Q

When do children usually smile responsively?

A

By 6 weeks

19
Q

When do children usually wave byebye?

A

7-9 months

20
Q

What age can children independently brush teeth and get dressed?

A

Age 3

21
Q

When are children usually able to grasp a rattle?

A

3 months

22
Q

When are children usually able to thumb-finger grip?

A

8-10 months

23
Q

When can children speak a 3 word sentence?

A

Age 3

24
Q

When can children life their head up 90º?

A

At about 6 weeks

25
Q

When can children roll over?

A

At about 2-4 months

26
Q

When can children sit with no support?

A

7 months

27
Q

When can children walk well?

A

11-15 months

28
Q

What allowances do you make for prematurity?

A

Make allowances for how many weeks prem until age 2

29
Q

4 sections of development

A

Gross motor
Vision and fine motor
Hearing, speech and language
Social, emotional and behavioural

30
Q

What can help if children aren’t reaching milestones?

A

Hearing check (hearing aids)
Physiotherapy
SALT

31
Q

Age of crawling?

A

10 months

32
Q

What checks do infants have in the 1st year of life?

A 
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
33
Q

Name 8 infant reflexes

A
  • 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
34
Q

What can cause delayed development?

A

Antenatal: infection, toxins (alcohol, smoke, radiation), drugs (cytotoxics, antiepileptics)

Post natal: infections, metabolic disorders, toxins, trauma, malnutrition, maltreatment

35
Q

Causes of peripheral precocious puberty

A

Gonadotrophin independent
Adrenal tumour
Ovarian/testicular tumour

36
Q

18 month old who can scribble with pencil, stack 3 blocks, tries to take off tshirt and is bum shuffling: normal?

A

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

37
Q

Define floppy infant

Differential?

A

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)

38
Q

When is hand preference normal

A

Above 12 months

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