Development Flashcards
What does the standard deviation measure?
A measure of variability
What is a z score?
A number of sd from the mean
How far apart are centile lines placed?
2/3 of a standard deviation apart
A child shows normal growth if what?
- their measurements are within the normal range compared with children of their age
- their rate of growth is within the normal range compared with children of their age
How should children be weighed?
- babies should be weighed without any clothes or nappy
- children older than two years can be weighed in vest and pants, but no shoes, footwear, dolls or teddies in hand
- only class 3 clinical electronic scales in metric setting should be used
How should head circumference be measured?
- measured using a narrow plastic or disposable paper tape
- measurement should be taken where the head circumference is the widest
How should height be measured?
- height should be measured from ages 2 years using a rigid rule with T piece, or stadiometer
- ensure heels, bottom, back and head are touching the apparatus with eyes and ears at 90 degrees
- dont try to stretch up, measure on expiration
What is the average age for a girl to enter puberty?
Average age for girls is 11 years, boys 6 months later on average
What are the gonadotrophins?
FSH and LH
What is precocious puberty?
True central precocious puberty (TCCP) is normal pubertal development occuring abnormally early; <8 years for girls, <9 years for boys. Girls more likely than boys
When is puberty delayed?
Pubertal delay is the absence of secondary sexual development in a girl aged 13 or a boy aged 14 years. Boys more likely than girls
What is the average height difference between adult males and females?
- 5-12cm due to;
- boys have delayed PHV
- boys PHV > girls
- boys taller in pre-puberty
What is the signs of onset in puberty in boys and girls?
- girls = breast development
- boys = testicular volume increase
What system is used to stage puberty?
Tanner chart
Name the different classifications of short stature
- genetic short stature
- constitutional growth delay
- dysmorphic syndromes
- endocrine disorders
- chronic diseases
- psychosocial deprivation
Define adolescence, youth and young people
- adolescence = 10-19 years
- youth = 15-24 years
- young people 10-24 years
How does the brain change in early, middle and late adolescence?
- early; rapid increase in white mater
- middle; increase in myelination, improves decision making
- late; pruning of synaptic connections, further improves decision making, rationalising and judgement
A competent young person should be able to what?
- understand simple terms and the nature, purpose and necessity for proposed treatment
- understand the benefits, risks and effects of, as well as the alternatives to, non-treatment
- understand that the information applies to them
- retain the information long enough to make a choice
- make a choice free from pressure
Name the components of the HEEADSSS framework of things to discuss with young people
H - home (home life / relationships) E - education / employment E - eating, weight, body image A - activities D - drugs S - sex S - suicidality S - safety (risk taking behaviour / criminality)
Describe the basic embryology of the embryonic period
- starts after conception and continues until gestational week 8
- 2 layered embryo
- epiblast and hypoblast
- primitive streak and primitive node
- migration of cells through streak the rostral-caudal migration
- determined by nodal signalling
The ectoderm goes on to create what?
- skin
- nails
- hair
- neural tissue
The mesoderm goes on to form what?
- muscle
- bone
- cartilage
- vascular system
The endoderm goes on to form what?
- gut
- respiratory system
Describe the neural tube
- first well defined neural structure to from
- occurs at day 20-27
- neural progenitor cells form the neural plate
- neural groove
- neural tube formation
The anterior / rostral tube will become what?
The brain
The caudal tube will become what?
The spinal cord
The hollow centre of the neural tube will become what?
The ventricular system and central channel of the spinal cord
The neural progenitor cells line what?
Lune the inside of the neural tube - termed the ventricular zone
Describe neocortical patterning
- the mature neocortex has distinct functional and structural areas
- signalling molecules; Emx2 and Pax6
- high conc Pax6 with low conc Emx2 induce progenitor cells to differentiate into motor neurones
- low conc Pax6 and high conc Emx2 induce visual cortical neurones
What happens to the neurological system during the foetal period?
- development of the gyri and sulci required to accommodate the proliferating neuronal populations
- neuronal progenitor cells in the ventricular zone divide initially ‘symmetrically’ (days 25-42)
- asymmetrical cell division then follows
Describe the development of the sulci
- brain is initially smooth in contour (lisencephalic)
- week 8-26; primary sulci eg longitudinal fissue, sylvian, cingulate, parieto-occipital and calcarine, temporal etc
- secondary sulci weeks 30-35
- tertiary sulci weeks 36 and into post natal period and early infancy
How can neuronal migration occur?
- somal translocation
- radial glial guides
- transgenital migration and signalling pathways
- orderly 6 layered structure with an ‘inside-out arrangement of migrated neurones’
Describe the function of axons
- transmit signals from neurons
- guidance molecules determine their path
- synapses develop when connected with another neuron
Describe the function of dendrites
- gather info and transmit to neurons
- multiple dendrites form ‘arbours’ around the neuron
Describe myelination
- oligodendrocyte progenitor cells develop processes which wrap around axons > myelin sheaths
- multi-layered sheaths increase axonal conduction rates dramatically
- other functions; maintain axonal integrity, survival, neuronal size and axonal diameter
- occurs in a sequential manner from bottom to top and from the back to the front of the brain
- mainly in the first 2 years of life but ongoing into twenties
Frontal and prefrontal cortex subserves what?
Higher cognitive functions, behavioural control, planning and assessing the risk of decisions
Describe hormones and the teenage brain
- physical maturation is associated with rising gonadal hormone concentrations
- the brain is full of steroid receptors
- pubertal hormones affect the brain restructuring > permanent reorganisation
- different effects on the hypothalamic pituitary - adrenal axis in males vs females; oestrogens may make girls more prone to stress, androgens supposed to make boys more resilient to stress
What is holoprosencephaly?
Failure of brain vesicles to form
What are the different forms of disorders of myelination?
- hypomyelination
- dysmyelination
- demyelination
The PLP1 gene encodes what?
- a transmembrane proteolipid protein (myelin protein in the CNS)
- it is responsible for compactions, stabilisation and maintenance of myelin sheaths, oligodendrocyte development and survival
- located on X chromosome
Mutations in the PLP1 gene cause what?
- a spectrum of disorders
- pelizaeus merzbacher is the most severe
- presents in infancy or early childhood with nystagmus, hypotonia and cognitive impairment
- progresses to severe spasticity and ataxia
- life span is shortened
- spastic paraparesis 2 manifests as spastic paraparesis with or without CNS involvement and usually normal life span
What effects can malnutrition have on brain development?
- impact on brain growth and volume
- impact on myelination
- lack of energy and deprivation > lack of post natal stimulation and experiences
- disease and debilitation
What is the most important predictor of personality development?
Childs early relationship with primary caregiver
What is attachment theory?
- infants are evolutionary primed to form a close, enduring dependent bond on a primary caregiver beginning in the first moments of life
- vulnerability of the infant requires that care be provided by the adult and infants behaviour and inherent faculties ensure that a bond will be created
Describe the different stages of attachment
- asocial stage; 0-6 weeks, smiling and crying not directed at specific people
- indiscriminate attachment; 6 weeks to 7 months, attention sought from different individuals
- specific attachments; 7-11 months, strong attachment to one individual, separation and stranger anxiety
- multiple attachments
Name the different attachment styles
- secure
- insecure avoidant
- insecure ambivalent / resistant
- disorganised
Describe the features of secure attachment (baby)
- distressed when mother leaves
- avoidant of stranger when alone but friendly when mother present
- positive and happy when mother returns
- will use the mother as a safe base to explore their environment
- 70% of infants
Describe the features of ambivalent attachment (baby)
- infant shows signs of distress when mother leaves
- infant avoids the stranger, shows fear of stranger
- child approached mother but resists contact, may even push her away
- infant cries more and explores less than other type 2s
- 15%
Describe the features of avoidant attachment (baby)
- infant shows no sign of distress when mother leaves
- infant is okay with the stranger and plays normally when stranger present
- infant shows little interest when mother returns
- mother and stranger able to comfort infant equally
- 15%
Describe the features of the insecure avoidant attachment in adolescence
- view of self; unloved, self reliant
- view of others; rejecting, controlling, intrusive
- avoid intimacy, dependence, disclosure
- hard to engage
- view relationships as unimportant
- dont feel a huge need for other people
- seen as cold
- are indifferent to others views, assume others dislike them
- linked with higher incidence of somatising illness and hard drug use
Describe the features of ambivalent attachment in adolescents
- view of self; low value, ineffective, depedent
- view of others; insensitive, unpredictable, unreliable
- disruptive, attention seeking
- insecure and coercive
- can alternate between friendly charm and hostile aggression
- display antisocial behaviour, impulsivity, poor concentration
- feel a growing sense of unfairness and injustice; lots of complaining
- dysregulated emotions
Define secure base
The attachment figure / relationship provides a safe space (literally or symbolically) from which to explore the world
Define safe haven
The attachment figure / relationship is a safe place (literally or symbolically) to retreat to at times of danger or anxiety
Describe attunement
- process between caregiver and infant in which they are able to ‘tune in’ to each others physical and emotional states
- through a process of co-regulation the infant learns to manage stress and anxiety
Describe the types of temperament
- easy (40%); readily approach and easily adapt to new situations, react mildly to things, regular in their sleep / wake and eating routines, overall positive mood
- difficult (10%); withdraw from or are slow to adapt to new situations, intense reactions, irregular routines, negative mood, long and frequent crying episodes
- slow to warm up (5-15%); withdrawn from or are slow to adapt to new things, low level of activity, shows a lot of negativity, thought of as shy or sensitive
- no category 40%
What is reactive attachment disorder?
Markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before 5 years, less than 4% of the population
Describe the inhibited subtype of RAD
- refers to children who continually fail to initiate and respond to social interactions in a developmentally appropriate way
- interactions are often met with a variety of approached; avoidance, resisting comfort, hypervigilant or highly ambivalent
Describe the disinhibited subtype of RAD
- refers to a child who has an inability to display appropriate selective attachments
- also known as disinhibited social engagement disorder (DSED)
- more enduring over time than the inhibited type
Describe the signs of RAD
- noticeable neglectful behaviour by the primary caregiver; not comforting the baby or child in distress, not responding to needs such as hunger or a dirty nappy
- inappropriate interaction between the baby or child and the primary caregiver
- lack of smiling or responsiveness in the baby or child; does not eek comfort or resorts to extreme measures to gain attention, rejection of demonstrations of comfort, avoidance of touch or gestures of affection
- lack of distress in situations which would be expected to cause distress
- indiscriminate, excessive friendliness towards healthcare workers
- inconsolable crying
- emotional and behavioural difficulties
Name differentials of RAD
- conduct disorder; children with CD are able to form some satisfying relationships with peers and adults
- depression; depressed children are often able to form appropriate social relations with those who reach out to them
- ASD: present historical and pervasive difficulties, coventry grid
- ADHD: children with ADHD are more able to initiate and maintain relationships
Describe the process for investigating and treating attachment difficulties (NICE)
- preschool age children with or at risk of attachment difficulties
- video interaction guidance
- multi-agency review
- parental sensitivity and behaviour training
Describe the management of school age children with attachment difficulties
- parental sensitivity and behavioural therapy
- intensive training and support for foster carers, guardians and adoptive parents
- group therapeutic play sessions (children of primary school age)
- group based educational sessions for caregivers and children / young people (late primary school or early secondary school stage)
- trauma focused CBT for those who have been maltreated
What is a conduct disorder?
- a repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate norms or rule are violated
- to a lesser degree, it is called oppositional defiant disorder in younger children (less than 10)
- CD is classified under ‘behavioural disorders’ which are the second most common mental health disorders in children and adolescents
How does a conduct disorder present?
- the presence of three or more of the following criteria in the past 12 months with at least on criterion present in the past 6 months
- aggression to people or animals
- destruction of property
- deceitfulness or theft
- serious violation of rules
Describe the two forms of severe conduct disorders
Unsocialised;
- predominantly violent behaviour and more likely to be dealt with in the criminal justice system
Socialised;
- more covert antisocial acts or better ability to avoid getting involved with criminal justice system
ADHD is characterised by what triad of difficulties?
- inattention
- hyperactivity
- impulsivity
Define child abuse
Any action by another person - adult or child - that causes significant harm to a child. It can be physical, sexual or emotional but just as often can be about a lack of love, care and attention
Define child protection
The process of protecting individual children identified as either suffering, or likely to suffer significant harm as a result of abuse or neglect. It involves measures and structures designed to prevent and respond to abuse and neglect
What is the median age and limit age of developmental milestones?
- median age; age when 50% of population achieve a skill
- limit age; age when skill should have been achieved by 97.5% of children
What are the principles of devlopment?
- continuous process
- maturation of nervous system
- sequence same but rate varies
- cephalocaudal direction
- generalised mass activity changing to more specific controlled movements
Name the four areas of development
- gross motor
- fine motor and vision
- language and hearing
- social behaviour and play
Describe the milestones for gross motor development
- head control; 3 months
- sitting balance; 6 months
- crawling; 9 months
- standing; 12 months
- runs; 18 months
- stairs, 2 feet/ tread; 24 months
- stairs alternate feet; 36 months
- hops; 48 months
Name the primitive reflexes
- sucking and rooting
- palmar and plantar grasp
- moro
- ATNR
- stepping and placing
Describe the milestones for fine motor and vision development
- hand regard in midline; 3 months
- grasps toy - palmar; 6 months
- scissor grasp; 9 months
- pincer grasp; 12 months
- tower of 3-4 bricks; 18 months
- 6-7 bricks / scribble; 24 months
- 9 bricks / copies circle; 36 months
- draws simple man; 48 months
Describe the milestones for hearing and language development
- vocalises; 3 months
- babbles; 6 months
- imitates sounds; 9 months
- knows name; 12 months
- 2 body parts / 5-20 words; 18 months
- simple instructions / 50+ words; 24 months
- complex instructions / asks questions; 36 months
- can tell stores of experiences 48 months
Describe the milestones for social behaviour and play
- social smile; 6 week s
- pleasure on friendly handling; 3 months
- plays with feet / friendly with strangers; 6 months
- plays peek a boo / stranger awareness; 9 months
- drinks from cup / waves bye bye ; 12 months
- feeds with spoon; 18 months
- symbolic play / put on some clothes; 24 months
- pretend interactive play / toilet trained; 36 months
- understands turn taking / dresses fully; 48 months
Define developmental delay
Failure to attain appropriate developmental milestones for childs corrected chronological age
Name the different patterns of abnormal development
- delay; global (eg downs syndrome) or specific (eg duchennes muscular dystrophy)
- deviation; eg autism spectrum disorder
- regression; eg retts syndrome, metabolic disorders
Define learning disability
A significant reduction in the ability to understand new or complex information, to learn new skills and a reduced ability to cope independently which started before adulthood
Name red flags for development
- asymmetry of movement, increased or decreased tone
- not reaching for objects by 6 months
- unable to sit unsupported by 12 months
- unable to walk by 18 months
- no speech by 18 months
- concerns re vision or hearing at any age
- loss of skills at any age
Name causes of global developmental delay
- prenatal; genetic, metabolic, CNS malformation, infection, toxins
- perinatal; prematurity, asphyxia, infection
- postnatal; infection, trauma, environmental
Gowers manoeuvre is associated with which condition?
Duchennes muscular dystrophy - indication of proximal weakness of pelvic girdle muscles
Name the three forms of cerebral palsy
- hemiplegic
- paraplegic
- quadriplegic
Name conditions associated with cerebral palsy
- mobility problems, spasticity and orthopaedic problems
- learning difficulties
- epilepsy
- visual / hearing impairment
- communicating difficulties
- feeding difficulties
- sleep problems
- behaviour problems
Describe the autistic triad
- communication
- social interaction
- flexibility of though / imagination
Also;
- restricted, repetitive behaviours
- sensory difficulties
