Development Flashcards
What does failure to thrive mean?
Suboptimal weight gain in first 3years of life
What are the causes of failure to thrive?
95% not enough food being given/taken Inadequate intake: Impaired sucking, LOA Inadequate availability: Abuse/deprivation Inadequate retention: Vomiting Malabsorption: Coeliac, Crohn's Inc requirement: Chronic illness Failure to utilise nutrients
What are the signs of failure to thrive?
Dysmorphic features
Respiratory failure
Heart failure
Marasmus
How is failure to thrive investigated?
Growth chart Bloods: FBC, Ferritin, U&E, LFT, TFT Coeliac screen Urinalysis Faecal blood Food diary Skeletal survey
How is failure to thrive treated?
Dietary advice: 3meals + 2snacks
Limit milk to 500ml/day
Admit if severe
What are the different phases of growth?
Pre-natal/intra-uterine
Infantile
Childhood
Puberty
What is the average birth weight?
7lb (3.3kg)
What is the average head circumference at birth?
35cm
When do teeth first appear?
Primary: 6months (DoH recommends weaning at this time)
Permenant: 6-12yrs
What is the normal milk requirement per day?
150mls/kg/day until weaning
25oz
What is classed as overweight & obese in children?
Overweight: >85th centile
Obese: 91-98th centile
What is the recommended exercise amount for a child till the age of 18?
1hour per day
When is development most rapid?
First 4 years
What 4 categories are assessed in a child’s development?
Gross motor
Fine motor
Speech & language (including hearing)
Social
What are the timings of the gross motor skills of a baby/child?
MEDIAN AGES (50% of children will achieve these ranges) 6-8w: Raises head to 45 degrees 6m: Rolls front onto back 7m: Rolls back onto front 6-8m: Sit without support 8-9m: Crawling 10m: Cruising- walking w/furniture 12m: Walking unsteadily 15m: Walks steadily 18m: Can run 2y: Jumps 3y: Hops 4y: Climbing frames 5y: Hops & skips
What are the red flags in a child’s development?
Not fixing and following at 6m No social smile at 3m Not babbling at 6m Can't sit without support at 9m Can't walk at 18m Hand preference before 18m (sign of cerebral palsy)
What are developmental warning signs?
Family history Maternal concern Regression Discordant development Persisting primitive reflexes (Moro reflex)
What are the primitive reflexes
Palmar grasp: Disappears at 4-6m longer= abnormal
Moro reflex: Move baby down quickly will open both arms, one arm may be indicative of weakness on one side, disappears at 4-6m longer= abnormal
Rooting reflex
Asymmetric tonic reflex/ fencing reflex: Turn head to L arm moves out to the left, disappear by 6m
Parachute reflex: From 9m, push child forward will put hands out to stop themselves
What is normal & abnormal weight loss in a baby?
Normal: 5% regained by day 10
Abnormal: 10%
What is the normal amount of sleep for babies/children?
Birth: 16hrs 6m: 14hrs 2yrs: 13hrs 4yrs: 12hrs 18yrs: 8hrs Night terrors: Before REM sleep, 4-7yrs Nightmares: During REM sleep, 8-10yrs Sleep walking: 5-10yrs
What is growth dependent on?
Intrauterine: Uterine environment
Infantile: Nutrition, thyroid hormones, good health, happiness
Childhood: Growth hormones, Genes, thyroid hormones, health & happiness
Puberty: Testosterone, oestrogen, growth hormone
What are the causes of obesity?
95% Simple-Dietary
Genetic: Prada-Willi, Leptin, Familial obesity
Endocrine: Hypothyroid, Cushing’s, PCOS, GH deficiency
Idiopathic: Antidepressants, Corticosteroids, Anticonvulsants
Nutritional obesity: Tall & fat
Pathological obesity: Short & fat
How is obesity investigated?
BMI
Bloods: Lipids, HbA1c, OGTT, Cortisol
What are the complications of obesity?
Psychological DM2 Sleep apnoea Orthopaedic Infertility Cancer
How is short stature defined?
Height below 2nd centile
What are the causes of short stature?
Familial: Constitutional Delay Chromosomal: Turner's Hormonal IUGR Dysmorphic syndromes GH deficiency Malabsorption: Coeliac, IBD Skeletal dysplasia Endocrine Nutritional
How are the causes of short stature investigated?
Bloods: TFTs, Coeliac antibody screen
Karyotyping
Urinalysis
Bone age
How is short stature managed?
Treat underlying cause
Growth hormones
What aspects of development would warrant a referral for further investigation?
Delayed walking: Failure to crawl/sit unsupported, refer at 18m
Exclude: Cerebral palsy, global delay, muscular dystrophy
Delayed speech: Language comprehension or language used to communicate, SALT referral, hearing test
Exclude: Familial hearing problems, Chronic glue ear, Autism, global delay
Global delay: Fine, motor, speech & social delays
What are the causes of neurodevelopment delay?
25% unknown
Genetics: Down’s, Fragile X, Duchenne, Phenylketonuria
Hydrocephalus
Microcephaly
Prenatal insult: Congenital infection, hypothyroid, teratogenic
Perinatal: Asphyxia, hyperbilirubinaemia, intraventricular haemorrhage
Postnatal: Brain injury/trauma, CNS infection, hypoG
What are the milestones for speech and hearing?
3m: Quietens to parents voice, squeals, turns to sound
6m: Double syllable noises
9m: mama/dada, understands no
12m: Knows & responds to own name
12-15m: Understands simple commands, knows 2-6words
2y: Combines 2 words, points to body parts
2.5y: Vocab of 200 words
3y: Short sentences 3-5words, identifies colours, ask what/who, counts to 10
4y: Asks why, when, how
What investigation should be done with delayed speech?
Hearing test
