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Child health > Development > Flashcards

Development Flashcards

1
Q

What does the standard deviation measure?

A

A measure of variability

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2
Q

What is a z score?

A

A number of sd from the mean

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3
Q

How far apart are centile lines placed?

A

2/3 of a standard deviation apart

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4
Q

A child shows normal growth if what?

A
  • 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
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5
Q

How should children be weighed?

A
  • 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
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6
Q

How should head circumference be measured?

A
  • measured using a narrow plastic or disposable paper tape

- measurement should be taken where the head circumference is the widest

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7
Q

How should height be measured?

A
  • 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
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8
Q

What is the average age for a girl to enter puberty?

A

Average age for girls is 11 years, boys 6 months later on average

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9
Q

What are the gonadotrophins?

A

FSH and LH

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10
Q

What is precocious puberty?

A

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

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11
Q

When is puberty delayed?

A

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

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12
Q

What is the average height difference between adult males and females?

A
  1. 5-12cm due to;
    - boys have delayed PHV
    - boys PHV > girls
    - boys taller in pre-puberty
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13
Q

What is the signs of onset in puberty in boys and girls?

A
  • girls = breast development

- boys = testicular volume increase

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14
Q

What system is used to stage puberty?

A

Tanner chart

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15
Q

Name the different classifications of short stature

A
  • genetic short stature
  • constitutional growth delay
  • dysmorphic syndromes
  • endocrine disorders
  • chronic diseases
  • psychosocial deprivation
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16
Q

Define adolescence, youth and young people

A
  • adolescence = 10-19 years
  • youth = 15-24 years
  • young people 10-24 years
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17
Q

How does the brain change in early, middle and late adolescence?

A
  • 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
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18
Q

A competent young person should be able to what?

A
  • 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
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19
Q

Name the components of the HEEADSSS framework of things to discuss with young people

A 
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)
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20
Q

Describe the basic embryology of the embryonic period

A
  • 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
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21
Q

The ectoderm goes on to create what?

A
  • skin
  • nails
  • hair
  • neural tissue
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22
Q

The mesoderm goes on to form what?

A
  • muscle
  • bone
  • cartilage
  • vascular system
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23
Q

The endoderm goes on to form what?

A
  • gut

- respiratory system

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24
Q

Describe the neural tube

A
  • first well defined neural structure to from
  • occurs at day 20-27
  • neural progenitor cells form the neural plate
  • neural groove
  • neural tube formation
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25
Q

The anterior / rostral tube will become what?

A

The brain

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26
Q

The caudal tube will become what?

A

The spinal cord

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27
Q

The hollow centre of the neural tube will become what?

A

The ventricular system and central channel of the spinal cord

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28
Q

The neural progenitor cells line what?

A

Lune the inside of the neural tube - termed the ventricular zone

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29
Q

Describe neocortical patterning

A
  • 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
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30
Q

What happens to the neurological system during the foetal period?

A
  • 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
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31
Q

Describe the development of the sulci

A
  • 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
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32
Q

How can neuronal migration occur?

A
  • somal translocation
  • radial glial guides
  • transgenital migration and signalling pathways
  • orderly 6 layered structure with an ‘inside-out arrangement of migrated neurones’
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33
Q

Describe the function of axons

A
  • transmit signals from neurons
  • guidance molecules determine their path
  • synapses develop when connected with another neuron
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34
Q

Describe the function of dendrites

A
  • gather info and transmit to neurons

- multiple dendrites form ‘arbours’ around the neuron

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35
Q

Describe myelination

A
  • 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
36
Q

Frontal and prefrontal cortex subserves what?

A

Higher cognitive functions, behavioural control, planning and assessing the risk of decisions

37
Q

Describe hormones and the teenage brain

A
  • 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
38
Q

What is holoprosencephaly?

A

Failure of brain vesicles to form

39
Q

What are the different forms of disorders of myelination?

A
  • hypomyelination
  • dysmyelination
  • demyelination
40
Q

The PLP1 gene encodes what?

A
  • 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
41
Q

Mutations in the PLP1 gene cause what?

A
  • 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
42
Q

What effects can malnutrition have on brain development?

A
  • impact on brain growth and volume
  • impact on myelination
  • lack of energy and deprivation > lack of post natal stimulation and experiences
  • disease and debilitation
43
Q

What is the most important predictor of personality development?

A

Childs early relationship with primary caregiver

44
Q

What is attachment theory?

A
  • 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
45
Q

Describe the different stages of attachment

A
  • 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
46
Q

Name the different attachment styles

A
  • secure
  • insecure avoidant
  • insecure ambivalent / resistant
  • disorganised
47
Q

Describe the features of secure attachment (baby)

A
  • 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
48
Q

Describe the features of ambivalent attachment (baby)

A
  • 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%
49
Q

Describe the features of avoidant attachment (baby)

A
  • 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%
50
Q

Describe the features of the insecure avoidant attachment in adolescence

A
  • 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
51
Q

Describe the features of ambivalent attachment in adolescents

A
  • 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
52
Q

Define secure base

A

The attachment figure / relationship provides a safe space (literally or symbolically) from which to explore the world

53
Q

Define safe haven

A

The attachment figure / relationship is a safe place (literally or symbolically) to retreat to at times of danger or anxiety

54
Q

Describe attunement

A
  • 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
55
Q

Describe the types of temperament

A
  • 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%
56
Q

What is reactive attachment disorder?

A

Markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before 5 years, less than 4% of the population

57
Q

Describe the inhibited subtype of RAD

A
  • 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
58
Q

Describe the disinhibited subtype of RAD

A
  • 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
59
Q

Describe the signs of RAD

A
  • 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
60
Q

Name differentials of RAD

A
  • 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
61
Q

Describe the process for investigating and treating attachment difficulties (NICE)

A
  • preschool age children with or at risk of attachment difficulties
  • video interaction guidance
  • multi-agency review
  • parental sensitivity and behaviour training
62
Q

Describe the management of school age children with attachment difficulties

A
  • 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
63
Q

What is a conduct disorder?

A
  • 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
64
Q

How does a conduct disorder present?

A
  • 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
65
Q

Describe the two forms of severe conduct disorders

A

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

66
Q

ADHD is characterised by what triad of difficulties?

A
  • inattention
  • hyperactivity
  • impulsivity
67
Q

Define child abuse

A

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

68
Q

Define child protection

A

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

69
Q

What is the median age and limit age of developmental milestones?

A
  • median age; age when 50% of population achieve a skill

- limit age; age when skill should have been achieved by 97.5% of children

70
Q

What are the principles of devlopment?

A
  • continuous process
  • maturation of nervous system
  • sequence same but rate varies
  • cephalocaudal direction
  • generalised mass activity changing to more specific controlled movements
71
Q

Name the four areas of development

A
  • gross motor
  • fine motor and vision
  • language and hearing
  • social behaviour and play
72
Q

Describe the milestones for gross motor development

A
  • 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
73
Q

Name the primitive reflexes

A
  • sucking and rooting
  • palmar and plantar grasp
  • moro
  • ATNR
  • stepping and placing
74
Q

Describe the milestones for fine motor and vision development

A
  • 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
75
Q

Describe the milestones for hearing and language development

A
  • 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
76
Q

Describe the milestones for social behaviour and play

A
  • 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
77
Q

Define developmental delay

A

Failure to attain appropriate developmental milestones for childs corrected chronological age

78
Q

Name the different patterns of abnormal development

A
  • delay; global (eg downs syndrome) or specific (eg duchennes muscular dystrophy)
  • deviation; eg autism spectrum disorder
  • regression; eg retts syndrome, metabolic disorders
79
Q

Define learning disability

A

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

80
Q

Name red flags for development

A
  • 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
81
Q

Name causes of global developmental delay

A
  • prenatal; genetic, metabolic, CNS malformation, infection, toxins
  • perinatal; prematurity, asphyxia, infection
  • postnatal; infection, trauma, environmental
82
Q

Gowers manoeuvre is associated with which condition?

A

Duchennes muscular dystrophy - indication of proximal weakness of pelvic girdle muscles

83
Q

Name the three forms of cerebral palsy

A
  • hemiplegic
  • paraplegic
  • quadriplegic
84
Q

Name conditions associated with cerebral palsy

A
  • mobility problems, spasticity and orthopaedic problems
  • learning difficulties
  • epilepsy
  • visual / hearing impairment
  • communicating difficulties
  • feeding difficulties
  • sleep problems
  • behaviour problems
85
Q

Describe the autistic triad

A
  • communication
  • social interaction
  • flexibility of though / imagination

Also;

  • restricted, repetitive behaviours
  • sensory difficulties

Child health (5 decks)

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