Development

Question 1

Define the phases of childhood

Answer 1

• Neonate (<4w)
• Infant (<12m/1y)
• Toddler (~1-2y)
• Pre-school (~2-5y)
• School age
• Teenager/ Adolescent

Question 2

List the key developmental domains

Answer 2

Gross motor skills
Fine motor skills
Speech (and language)
Social
Self-help
Hearing and vision

Question 3

Give the four key milestones for which a child requires immediate referral if not met

Answer 3

Social smile by 8 weeks
Sitting unsupported by 9 months
Walking unsupported by 18 months
First words by 2 years

Question 4

List some red flags (besides the key milestones) for developmental problems

Answer 4

Regression (or plateau)
Concern about vision
Hearing loss
No speech by 18 months
Asymmetry of movement
Floppiness
Not walking/persistent toe walking (18 months)
OFC
Clinician uncertainty

Question 5

What are the main skills expected of a 3-month old baby?

Answer 5

Social smiling (should start smiling at 6 weeks, latest 8 weeks)
Babbling (sociable)

Question 6

What are the main skills expected of a 9 month old?

Answer 6

Crawling
Object permanence
Pincer grip: picking up objects with thumb and finger (10 months)

Question 7

What is object permanence?

Answer 7

Looking for objects which fall out of sight

Question 8

What are the main skills expected of a 12 month old?

Answer 8

Walking without help
1-2 words with meaning, plus “mama” and “dada”
Shared attention, points to things of interest
Feeds self with spoon

Question 9

What are the main skills expected of an 18 month old?

Answer 9

Running
Scribbling with a crayon (random)
Starting to join words into sentences
Early pretend play

Question 10

What are the main skills expected of a 2 year old?

Answer 10

Scribbling with circular motion
Climbs on play equipment
Vocab 30-50 words, uses two-word "sentences"
"Helps" with simple household tasks
Opens door by turning knob

Question 11

What antenatal factors can adversely affect development?

Answer 11

o	Infections (CMV, Rubella, Toxo, VZV)
o	Toxins (Alcohol, Smoking, Anti-epileptics)

Question 12

What postnatal factors can adversely affect development?

Answer 12

o	Infection (Meningitis, encephalitis)
o	Toxins (solvents mercury, lead) 
o	Trauma (Head injuries)
o	Malnutrition (iron, folate, vit D)
o	Metabolic (Hypoglycaemia, hyper + hyponatraemia)
o	Maltreatment/ under stimulation/ domestic violence
o	Maternal mental health issues

Question 13

Give two different patterns of developmental delay

Answer 13

Global (all domains affected)

Specific (only one or two domains affected)

Question 14

What parameters are measured to monitor growth?

Answer 14

Weight (grams and kg)
Length / Height (before/after 2 yrs)
Head circumference (OFC)

Question 15

Describe how weight increases in the first 3 years (on average)

Answer 15

Birth - 3.3kg
4 months - 6.6 kg
12 months - 10kg
3 years - 15kg

Question 16

Describe how length increases in the first 3 years of life (on average)

Answer 16

Birth - 50cm
4 months - 60cm
12 months - 75cm
3 years - 96cm

Question 17

What OFC measurements would be expected (as average) at birth and at 12 months?

Answer 17

Birth - 35cm

12 months - 45cm

Question 18

What can cause failure to thrive? (broadly speaking)

Answer 18

Deficient intake (maternal and/or infant factors)
Increased metabolic demands
Excessive nutrient loss
Non-organic causes

Question 19

What maternal factors might result in deficient intake in an infant and cause FTT?

Answer 19

 Poor lactation
 Incorrectly prepared feeds
 Unusual milk or other feeds
 Inadequate care

Question 20

What infant factors might result in deficient intake in an infant and cause FTT?

Answer 20

 Prematurity
 Small for dates
 Oro palatal abnormalities (e.g. cleft palate)
 Neuromuscular disease (e.g. cerebral palsy)
 Genetic disorders

Question 21

What conditions can increase an infant’s metabolic demands, and cause FTT?

Answer 21

o	Congenital lung disease
o	Heart disease
o	Liver disease
o	Renal disease
o	Infection
o	Anaemia
o	Inborn errors of metabolism
o	Cystic fibrosis
o	Thyroid disease
o	Crohn’s/ IBD
o	Malignancy

Question 22

What conditions can cause excessive nutrient loss in an infant, and cause FTT?

Answer 22

o Gastro oesophageal reflux
o Pyloric stenosis
o Gastroenteritis (post-infectious phase)
o Malabsorption

Question 23

Give six causes of malabsorption in young children/infants

Answer 23

	Food allergy
	Persistent diarrhoea
	Coeliac disease
	Pancreatic insufficiency
	Short bowel syndrome
	Lactose intolerance

Question 24

Give some non-organic causes of FTT

Answer 24

o Poverty/ socio-economic status
o Dysfunctional family interactions (especially maternal depression or drug use)
o Difficult parent-child interactions
o Lack of parental support (eg, no friends, no extended family)
o Lack of preparation for parenting/ education
o Child neglect
o Emotional deprivation syndrome
o Poor feeding or feeding skills disorder
o Feeding disorders (eg, anorexia, bulimia- later years)

Question 25

When would a child be able to play cooporatively with other children?

Answer 25

Parallel play: 18 months

Cooperative play: 2.5 years