Development and Growth Flashcards
What measurements made on child/baby? How take them specificially?
How long correct for prematurity?
Length/Height - using Frankfurt plane in child old enough to stand (lower border of orbit in line with upper border EAM) - chronic change
OFC - 3 successive, use largest; macro may be due to NFM, raised ICP, familial, CNS storage disorders
Weight - naked babies; useful for acute changes
correct for prem up to 2 years old
What are the causes of growth delay? (i.e. crossing centiles)
multiple
How determine possible treatment success with GH?
Constitutional - no other physical abnormality; give testosterone for 6/12 if significant impact on ADL
Again, think
- Inadequate intake - cf organic causes of FTT
- Malabsorption - CF, coeliac
- Increased metabolism - chronic disease, hyperthyroid
- Inappropriate utilisation e.g. genetic disorders - Turner’s, Noonan’s, Prader-willi
In addition, consider
- Skeletal dysplasia - e.g. hypochodroplasia
- Endocrinopathy - low GH, hypothyroid
Bone age - score 20 bones in wrist and compare epiphyseal planes to a set standard
Signs of pathology behind short stature:
Extreme short stature
Short for parental heights
Short and relatively overweight - endocrinopathy
Short and very underweight - malabsorption
Crossing centiles
Dysmorphic features
Skeletal disproportion
Systemic signs, e.g. clubbing
Define FTT?
Causes of Failure to Thrive (in breastfed babies)?
Failure to thrive refers to children whose current weight or rate of weight gain is significantly lower than that of other children of similar age and gender
Organic - Poor intake, poor absorption, increased metabolism or defective utilisation
rare e.g. CF, coeliac, reflux, congen HD, pyloric stenosis, DM
Non-organic - most common the cause - not enough food being offered up or taken. Check technique and maternal stress, exclusion, neglect or maternal illness.
Psychological - negelect, stress at home …
How investigate and manage FTT?
Full histroy and observe feeding technique. Observe making up feed if formula
Baseline bloods, bone screen, urine dip, coeliac screen, ? sweat test and TFTs
Encourage eating through diet and behaviour modification
- Diet - Variety, reduce fluids, meals and snacks
- Beh - routine, encourage, don’t force feed
What are the 4 areas of development measured?
- Gross motor
- Fine motor
- Social/emotional comunication
- Speech, language and hearing
Gross motor
- Head control
- Rolls over
- Sits unsupported
- Gets self into sitting position
- Walks unsupported
- Hand preference
Fine motor
- Pincer grip
- Tower of 3-4 cubes
- Draw O, X, triangle or rectangle
Gross motor
- Head control - ~6 weeks
- Rolls over - 2-4 months
- Sits unsupported - 6-7 months
- Gets self into sitting position - 9 months
- Walks unsupported - 12-15 months
- Hand - 18 months
Fine motor
- Pincer grip - 10 months
- Tower of 3-4 cubes - 18 months
- Draw O, X, triangle or rectangle - 3, 4, 5 years
Speech/Language
- 2-3 words
- 2-3 word sentences
- Colours
Social interaction
- Smiles, fixes and follows
- Peek-a-boo
Speech/Language
- 2-3 words - 12m
- 2-3 word sentences - 24m
- Colours - 4y
Social interaction
- Smiles, fixes and follows - 6 weeks
- Peek-a-boo - 10m
What are two key worrying signs of dev delay? (nb none of these set in stone)
8-10 weeks
3 months
6 months
9-10 months
18 months
3 years
Maternal concern & regression of previously acquired skills
8-10 weeks - no smile
3 months - no eye contact, persistence of fisting
6 months - primitive reflexes still present; squint; hand preference; ltd interest in people or activities
9-10 months - no sitting, no pincer grip
18 months - no words, not sitting independently, mouthing/drooling
3 years - lack of sentences 2-3 words in length
Moro reflex
Rooting
Palmar grasp
Galant
Walking/stepping
Startle response, usually gone by 3-4 months
Searching for something to suck on - linked to sucking reflex
Object in infants hand - will close palm; stroke back of palm to release
Storke side of spine, infant should bend towards it
Place soles of feet on surface and baby will walk
And many more; should all be gone by 6 months
Puberty (9-15 years)
What are the first signs of puberty in boys and girls?
What is adrenarche?
Thelarche?
How stage puberty?
Growth spurt B + G?
Puberty
Testicular enlargement (4ml prader orchidometer)/breast buds
Androgen stimulated presence of pubic hair and adult odour
Presence of breast buds
Tanner staging, 1-5 where 1 is pre-pubescent and 5 is adult
- Pubic hair
- Male genitalia development
- Breast development
Growth spurt
- B 13-14y, Tanner stage 4 (10ml testis)
- G - 11y; stages 2-3; menarche at stage 4 (end puberty) - 5cm for 12-18m after
Precocious puberty
Girls
Boys
How treat?
Precocious
In girls 8.5y - usually due to premature onset of normal puberty, poss due to weight
In boys 9.5y - usually due to pathology:
- Gonadotrophin dependent (idiopathic, CNS, HypoT4)
- Bilateral enlarged testes - ? intracranial Gn
- Unilateral testes enlarged - ? gonad tumour
- Small testes - ? adrenal androgens
If necessary, use GnRH analogues
Delayed puberty
How define in boys and girls?
Possible causes?
Delayed puberty
B - 14 y, Girls - 13y
- Constitutional delay - most common
- Low Gonadotrophins - systemic disease (AN, Chron’s, CF), HP axis, acquired hypoT4
- High Gn - chromosomal (Turner’s, Klinefelter’s), steroid hormone synthesis enzymes, acquired gonadal damage
- Psychological distress
- Additional female - androgen insensitivity (XY), resistant ovary syndrome, adrenal hyperplasia (increased ACTH), Cushing’s
Hearing Tests
Signs of poor hearing?
4 tests used in the NHS
Delayed speech, learning difficulty, delayed dev, behaviour
AOEA - automated otoacoustic emissions (cochlear echo)
AABR - auto aditory brainstem response - consider if two AOEA fail
VRA - cisually reinforced audiometry - like distraction test but with reward
PTA - pure tone audiometry - only if older than 4
Early signs that sight is not ok?
When is acuity reached?
What is strabismus? How test for it? What is the risk?
Lack of fixing and follow, random eye movements, nystagmus, no red reflex etc
4 years
Improper alignment of eyes with each other (i.e. squint)
Use corneal light test - is reflection in appropriate place on each pupil
COver-Uncover test - does eye move to focus?
Amblyopia - suppressed vision from weaker eye, leading to eventual optic atrophy due to lack of use
