Development and malnutrition Flashcards
What are the four domains of development?
Gross motor
Fine motor and vision
Hearing and speech
Social
What would you expect a child to be able to do at 6-8 weeks old?
GM - Might be making attempts at holding head (raise to 45 degrees)
FM+V - Fixing and following
H+S - Startle to loud noises
S - SMILING
What might you expect a child to be able to do at 3-4 months old?
GM - Support own head, look up when lying on abdomen, held sitting with curved spine
FM+V - Reaching out for toys
H+S - Single syllable vocalisation when alone or when spoken to
S - Laughs, enjoys friendly handling
What might you expect a child to be able to do at 6-8 months old?
GM - Roll over, sit without support, held sitting with straight spine, pull to standing
FM+V - Palmar grasp, might transfer from hand to hand and have immature pincer grip
H+S - Double syllable babbling and responding to own name, shouts
S - Not shy
What might you expect a child to be able to do at 9 months old?
GM - Crawling (not all), sit without support
FM+V - pincer grip
H+S - Respond to name
S - Stranger anxiety
What might you expect a child to be able to do at 10-12 months old?
GM - Cruising (10/12), First steps
FM+V - Points, mature pincer, looks for fallen objects, casting, banging objects together
H+S - 2-3 recognisable words
S - waving, clapping, drinking from beaker
What might you expect a child to be able to do at 12-18 months?
GM - walk steadily and possibly run at 18/12, squats at 15/12, stairs 2 feet
FM+V - 12/12 - 2 cubes, 18/12 - 4 cubes,
H+S - Repeat name, knows 6-10 words, might know body parts at 18/12
S - Eats with spoon by self
What might you expect a child to be able to do at 2-2.5 years?
GM - Run, jump and kick ball
FM+V - 6-8 cubes in tower,
H+S - use 2 words together, use pleurals and verbs
S - Become skilful with spoon
What might you expect a child to be able to do at 3-3.5 years?
GM - Rides a tricycle, uses stairs with handrail
FM+V - Can make a bridge or tower of 9
H+S - Sentences, gender, adjectives and colour, count to 10
S - Use fork and spoon, dress self under supervision, continence and plays alone
What might you expect a child to be able to do at 4-5 years?
GM - Hop, skip and use a climbing frame
FM+V - 4 = copies cross, 5 = copies square and triangle
H+S - Asks ‘why’, ‘when’ and ‘how’ questions
S - Knife and fork, dress independently (not laces and buttons) and plays with other children
What are some red flags to development?
Not sitting without support by age 9 months
Not walking by age 18 months
REGRESSION - should never LOSE SKILLS
Hand preference before 18m (Cerebral palsy)
Persisting primitive reflexes beyond 6m
What is GLOBAL DEVELOPMENTAL DELAY?
This is if you are behind for your age in 2 of the 4 domains
What are some causes of delayed walking?
Parents started walking late - always ask DDH Cerebral palsy Chromosomal abnormalities Spina bifida Genu varum DMD
What are some clinical signs of DMD?
CENTRAL WEAKNESS - ask the child to lie on the floor and then ask them to get up - if they walk up on their hands and feet suggests DMD
It is X-linked recessive
What are some causes of speech delay and what should you ask in hx?
Hearing impairment - all newborns should have hearing assessment so always check for this in red book
Multiple languages spoken at home - not pathological
Structural - tongue tie, cleft palate
What are some general causes of global developmental delay?
- Hypothyroidism
- Chromosomal abnormalities
- Fetal alcohol syndrome
- Neurometabolic conditions
- Neuroasphyxia
- PVL (peri-ventricular leukomalacia)
- IVH - Intra-ventricular haematoma
- Head trauma
- Neglect
When should parents start weaning their child?
6 months old
What things should be initially given to the weaning child and what things can only be given after a certain age?
Start with pureed fruit, root vegetables and rice, gradually increase amount and variety
AVOID eggs, wheat and fish before 6/12
AVOID cow’s milk until 12 months
AVOID honey until 12 months - has bacteria in that can cause botulinism
AVOID sugary snacks, salty foods, soft cheeses, unpasteurised products and shellfish
What are some important investigations to do in a child who you suspect might be malnourished?
ANTHROPOMETRY
- skin fold thickness over triceps muscle
- Upper arm circumference (if <115mm - severe malnutrition)
- Weight for height - if more than 3 SDs away from the mean then severe malnutrition
How should we manage malnourished children?
Always try enteral feeding first which can be done either nasogastrically or via gastrostomy
If this isn’t sufficient or there are concerns about absorption then we should consider parenteral feeding
What is marasmus and what causes it?
This is when the child appears very thin, they are wasted, can see bones.
it is caused when there is deficiency in all energy types (incl protein)
What is Kwashiorkor and what causes it?
This is when there is severe protein deficiency
Child is ascitic, has dry, unusually pigmented skin, swollen ankles, thin, dry hair and moon phase
How should we manage severe malnutrition?
- Correct hypoglycaemia and electrolyte abnormalities
- Wrap up warm
- Rehydrate but conservatively (fluid overload can lead to heart failure)
- Vitamin A really important
Start foods that are low in proteins (high protein won’t be tolerated initially)
Formula 75 then Formula 100
Why is the vision of the newborn so poor?
Unmyelinated optic nerve and immature fovea
When are adult levels of eye sight reached?
6/6 vision reached at approx 3-4 years
What is a squint and when should we consider resolving them?
Misalignment of the visual axis - consider re-aligning at 12 weeks if they have not self-resolved
What categories of squint are there?
CONCOMITANT - most common. Non-refractive error, corrected with glasses, squinting eye is usually convergent
PARALYTIC - Paralysis of motor nerves, varies with gaze direction, ?SOL
MANIFEST OR LATENT - is it there all the time or does it only come on with specific movement
In what ways can you assess for squint?
- CORNEAL LIGHT REFLEX - shine light and see whether it is reflected in the same place on both corneas. Can also assess for red reflex at this point as well
- COVER TEST. Get patient to focus on something in distance. Cover fixing eye then see if squinting eye adjusts
- Normal eye should have no movement
- Then repeat this with child looking at near object
What are some causes of visual impairment/blindness in the child?
Genetic: T21, CHARGE syndrome
Congenital: Cataracts, albinism, retinal dystrophy, retinoblastoma, congenital infection (CMV or RUBELLA)
Antenatal/perinatal: Retinopathy of prematurity, oxygen supply in newborn can lead to this - retinal vessel proliferation, HIE, Cerebral damage, optic nerve hypoplasia
Post-natal: Trauma, infection , JIA/optic neuritis
How great does hearing loss have to be to affect developing of speech and language?
At least 60dB
What are some causes of sensorineural hearing loss?
INHERITED - Connexin 26, Usher’s syndrome, Waardenberg syndrome, Pendred syndrome, Jervell-Lange-Nielson syndrome
ACQUIRED - Birth asphyxia, hyperbilirubinaemia, CMV, RUBELLA, SYPHILIS
Post-natal - drugs (aminoglycosides), meningitis, head injury, labrynthitis, acoustic neuroma
What are some causes of conductive hearing loss?
External ear abnormalities (ear canal atresia / stenosis), middle ear abnormalities, acute otitis media, chronic otitis media, secretory otitis media
Who does fragile X syndrome occur in and what are some features?
BOYS - X-linked recessive. CCG repeat in FMR1 gene (>200 is full mutation)
FEATURES: learning difficulties, macrocephaly, macro-orchidism, large everted ears, prominent mandible, broad forehead, mitral valve prolapse, joint laxity, scoliosis, autism, hyperactivity
