Development

Question 1

What are the gastro differentials for failure to thrive and how do they present?

Answer 1

Gord - effortless regurgitation, crying during feeding, cough
Pyloric stenosis - hungry baby with projectile vomiting
Coeliac disease - any age after weaning, dirrhoea, bloating
Cystic fibrosis - recurrent chest infections, pale stools that float
Inflammatory bowel disease - Older children, abdo pain, diarrhoea with blood/mucus

Question 2

What are the non gastro differentials for failure to thrive?

Answer 2

Not being fed enough - commonest cause
Nutritional neglect - hungry, food seeking behaviour
Emotional neglect - poor interaction with parent
Eating disorder - fear of weight gain, efforts to lose weight

Question 3

What are some other differentials for failure to thrive that are not gastro?

Answer 3

Prenatal:
-Prematurity
-Intrauterine growth restriction
-Chromosomal abnormalities
-Toxins (alcohol, smoking, drugs)
Others:
-Errors in metabolism
-Chronic infections
-Malignancy

Question 4

What are the differentials for weight increase in a child?

Answer 4

Endocrine:
-Hypothyroid - delayed growth/puberty, coarse hair, fatigue
-Cushing’s syndrome - delayed growth, central obesity, easy bruising
-PCOS - Adolescent female, oligo/amenorrhoea, hirsutism, acne
Non-endocrine:
-Simple obesity
-Familial
Others:
-Oedema
-Steroid use
-Genetic syndromes e.g. Turners, Prader-willi

Question 5

What are the differentials for a generalised developmental delay?

Answer 5

Prenatal:
-Chromosomal/genetic disorders - dysmorphic features
-Alcohol/drugs in pregnancy - from history
-TORCH infections in pregnancy - Toxoplasmosis, other agents, rubella, cytomegalovirus, herpes simplex
Perinatal:
-Extreme prematurity
-hypoxic brai injury
-Intracerebral haemorrhage
Postnatal:
-Meningitis
-Head injury

Question 6

What are the differentials for motor delay indevelopment?

Answer 6

Cerebral palsy - muscle stiffness/weakness
Duchenne muscular dystrophy or other musclar dystrophys - progressive musclular weakness beginning proximally, onset 2-3 years
Hip dysplasia - usually identified at birth

Question 7

What are the differentials for a language delay in development?

Answer 7

Deafness - e.g. due to chronic otitis media
Articulation problem e.g. birth defects such as cleft palate
Familial - Similar history in family
Lack of stimulus - poor interaction with parents
Autism - imposition of routines, doesn’t seek friendships
ADHD - Hyperactivity, inattentiveness

Question 8

What is the order of development for puberty in boys?

Answer 8

Testicular enlargement
Pubic hair
Penis enlargement
Height spurt

Question 9

What is the order of development for puberty in girls?

Answer 9

Breast development
Pubic/axillary hair
Height spurt
Menarche

Question 10

What are the gonadotrophin dependent (central) causes of precocious puberty?

Answer 10

Familial/idiopathic - majority of girls
Central nervous system abnormalities e.g. hypoxic brain injury
Intracranial tumour - would have associated neurological symptoms

Question 11

What ages are precocious puberty in girls and boys?

Answer 11

In boys <9 and girls <8

Question 12

What are the gonadotrophin independent (peripheral) e.g. sex hormones not under pituitary control causes of precocious puberty?

Answer 12

Adrenal tumour/ hyperplasia - excessive pubic hair, penis/clitoris enlargement
Ovarian/testicular tumour - Ovarian - bloating, menorrhagia, pelvic pain - testicular - painless lump

Question 13

At what age does puberty become delayed in girls and boys?

Answer 13

Girls >14

Boys >15

Question 14

What is the most common cause of delayed puberty?

Answer 14

Constitutional delay - familial, majority of cases

Question 15

What are the hypogonadotropic hypogonadism causes of delayed puberty?

Answer 15

systemic disease e.g. IBD, CF, anorexia

Hypothyroidism - delayed growth

Question 16

What are the hypergonadotropic hypogonadism causes of delayed puberty?

Answer 16

Klinefelter/Turner syndrome - Turner - femlae, short stature, amenorrhoea - Kleinfelter - male, small testes, gynaecomastia, tall and thin
PCOS - Oligo/amenorrhoea, hirsutism, acne

Question 17

What are the differentials for childhood bruising?

Answer 17

Injury related:
-NAI - brusing on soft tissues, history inconsistent
-Accidental - brusing on bony prominences
Non-injury related:
-Henoch-schonlein purpura - symmetrical rash on buttocks and legs, may have abdo/joint pain with evidence of nephritis
-Idiopathic thrombocytopenic purpura - Spontaneous purpura and petechiae, usually post infection
-Meningococcal septicaemia - non blanching rash, neck stiffness, photophobia, fever
Others:
-ALL
-Coag disorders e.g. haemophilia

Question 18

What are the differentials for a faint/fit/funny turn?

Answer 18

Febrile convulsion - Short, self limiting generalised seizure, happens early on in infections when temperatures are rising
Seizure - can be absence, focal, generalised
Reflex anoxic seizure - often preceded by bump on head or emotion - stops breathing, loses consciousness and falls to floor
Vasovagal
Pseudseizure - atypical
Breath holding spell - usually when upset
Arrhythmias

Question 19

What are the developmental landmarks for a neonate?

Answer 19

Motor - moves all limbs
Fine motor and vision - looks, startles
Hearing and language - startles to noise
Social - Cries, smiles (6 weeks)

Question 20

What are the developmental landmarks for a 3 month old?

Answer 20

Motor - head control
Fine motor and vision - Reaches for objects, fixes and follows
Hearing and language - cries, laughs, vocalises (4 months)
Social - Laughs

Question 21

What are the developmental landmarks for a 6 month old?

Answer 21

Motor - rolls from front to back, pushes up
Fine motor and vision - co-ordination, transfers from hand to hand
Hearing and language - localises sound, babbles
Social - Alert and interested, starts solids

Question 22

What are the developmental landmarks for a 9 month old?

Answer 22

Motor - sits alone, crawls
Fine motor - pincer grip
Hearing and language - Inappropraite sounds
Social - stranger anxiety

Question 23

What are the developmental landmarks for a 12 month old?

Answer 23

Motor - stands alone
Fine motor - pincer grip
Hearing and language - babbles, understands simple commands, first words
Social - socially responsive, waves bye

Question 24

What are the developmental landmarks for an 18 month old?

Answer 24

Motor - walks alone
Fine motor - uses spoon
Language - uses words
Social - stranger shyness, tantrums

Question 25

What are the developmental landmarks for a 2 year old?

Answer 25

Motor - runs, stairs
Fine motor - circular scribbles and lines
Language - 2 word phrases
Social - knows identity, parallel play

Question 26

What are the developmental landmarks for a 3-4 year old?

Answer 26

Motor - stands on one foot
Fine motor - builds bridge with bricks
Language - short sentences, knows colours
Social - interactive play

Question 27

What are the developmental landmarks for a 5 year old?

Answer 27

Motor - skips/hops
Fine motor - full drawings
Language - fluent speech
Social - dresses self

Question 28

What are the causes of short stature?

Answer 28

Familial short stature
Constitutional delay in growth and development
Malnutrition
Chronic diseases e.g. coeliac
Endocrine disorders e.g. hypothyroid
Genetic conditions e.g. downs

Question 29

What is constitutional delay of growth and how can it be assessed?

Answer 29

This is where there is delayed growth with a puberty growth spurt that lasts longer
This will usually result in children reaching their predicted adult height
They can be assed with limb x rays to assess their growth plates, this will show delayed bone age compared to their peers