Development Flashcards
What are the gastro differentials for failure to thrive and how do they present?
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
What are the non gastro differentials for failure to thrive?
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
What are some other differentials for failure to thrive that are not gastro?
Prenatal: -Prematurity -Intrauterine growth restriction -Chromosomal abnormalities -Toxins (alcohol, smoking, drugs) Others: -Errors in metabolism -Chronic infections -Malignancy
What are the differentials for weight increase in a child?
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
What are the differentials for a generalised developmental delay?
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
What are the differentials for motor delay indevelopment?
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
What are the differentials for a language delay in development?
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
What is the order of development for puberty in boys?
Testicular enlargement
Pubic hair
Penis enlargement
Height spurt
What is the order of development for puberty in girls?
Breast development
Pubic/axillary hair
Height spurt
Menarche
What are the gonadotrophin dependent (central) causes of precocious puberty?
Familial/idiopathic - majority of girls
Central nervous system abnormalities e.g. hypoxic brain injury
Intracranial tumour - would have associated neurological symptoms
What ages are precocious puberty in girls and boys?
In boys <9 and girls <8
What are the gonadotrophin independent (peripheral) e.g. sex hormones not under pituitary control causes of precocious puberty?
Adrenal tumour/ hyperplasia - excessive pubic hair, penis/clitoris enlargement
Ovarian/testicular tumour - Ovarian - bloating, menorrhagia, pelvic pain - testicular - painless lump
At what age does puberty become delayed in girls and boys?
Girls >14
Boys >15
What is the most common cause of delayed puberty?
Constitutional delay - familial, majority of cases
What are the hypogonadotropic hypogonadism causes of delayed puberty?
systemic disease e.g. IBD, CF, anorexia
Hypothyroidism - delayed growth
What are the hypergonadotropic hypogonadism causes of delayed puberty?
Klinefelter/Turner syndrome - Turner - femlae, short stature, amenorrhoea - Kleinfelter - male, small testes, gynaecomastia, tall and thin
PCOS - Oligo/amenorrhoea, hirsutism, acne
What are the differentials for childhood bruising?
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
What are the differentials for a faint/fit/funny turn?
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
What are the developmental landmarks for a neonate?
Motor - moves all limbs
Fine motor and vision - looks, startles
Hearing and language - startles to noise
Social - Cries, smiles (6 weeks)
What are the developmental landmarks for a 3 month old?
Motor - head control
Fine motor and vision - Reaches for objects, fixes and follows
Hearing and language - cries, laughs, vocalises (4 months)
Social - Laughs
What are the developmental landmarks for a 6 month old?
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
What are the developmental landmarks for a 9 month old?
Motor - sits alone, crawls
Fine motor - pincer grip
Hearing and language - Inappropraite sounds
Social - stranger anxiety
What are the developmental landmarks for a 12 month old?
Motor - stands alone
Fine motor - pincer grip
Hearing and language - babbles, understands simple commands, first words
Social - socially responsive, waves bye
What are the developmental landmarks for an 18 month old?
Motor - walks alone
Fine motor - uses spoon
Language - uses words
Social - stranger shyness, tantrums
What are the developmental landmarks for a 2 year old?
Motor - runs, stairs
Fine motor - circular scribbles and lines
Language - 2 word phrases
Social - knows identity, parallel play
What are the developmental landmarks for a 3-4 year old?
Motor - stands on one foot
Fine motor - builds bridge with bricks
Language - short sentences, knows colours
Social - interactive play
What are the developmental landmarks for a 5 year old?
Motor - skips/hops
Fine motor - full drawings
Language - fluent speech
Social - dresses self
What are the causes of short stature?
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
What is constitutional delay of growth and how can it be assessed?
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
