Developmental milestones / failure to thrive / CAHMS Flashcards
Outline the difference between growth and development
Growth is the physical process of getting bigger
- Involves getting taller, gaining weight and increasing head circumference
Whereas development is the process of hitting developmental milestones
- Walking
- Talking
- Fine motor skills
- Smiling
State the way to roughly estimate a child’s weight
(age + 4) x 2
Or can use Broselow tape in emergencies
State some causes of short stature
Constitutionally small (familial)
Chronic diseases e.g. coeliac disease, IBD, paediatric malignancies, hypothyroidism, CKD
Genetic syndromes e.g. Prader-Willi syndrome, Turner syndrome and Noonan syndrome
Growth hormone deficiency
Malnurition
Psychological stress e.g. abuse
State some causes of tall stature
Constitutionally tall (familial)
- Precocious puberty
- Excessive growth hormone secretion
- Hyperthyroidism
- Chromosomal disorders e.g. Klinefelter Syndrome, Fragile X
- Syndromes e.g. Marfan Syndrome, Beckwith-Wiedemann Syndrome
Outline what developmental delay means and the rough categories it includes
Developmental delay = broad term referring to a delay in any of the four developmental areas
- Gross motor
- Fine motor
- Speech and language
- Social and emotional
Outline what global developmental delay means
Global developmental delay = a delay in 2 or more of the developmental areas simultaneously
I.e. 2 or more of the following
1. Gross motor
2. Fine motor
3. Speech and language
4. Social and emotional
Suggest some causes of developmental delay in the following categories:
- Global developmental delay
- Gross motor delay
- Fine motor delay
- Language delay
- Social / emotional
Idiopathic or environmental:
- Infection e.g. CMV
- Prematurity
Global developmental delay:
- Down’s syndrome
- Fragile X syndrome
- Foetal alcohol syndrome
- Metabolic disorder
Gross motor delay:
- Cerebral palsy
- Visual impairment
- Muscular dystrophy
- Spina bifida
Fine motor delay:
- Cerebral palsy / dyspraxia
- Visual impairment
- Muscular dystrophy
Language delay:
- Cerebral palsy
- Autism / learning disability
- Hearing impairment
- Neglect
- Social factors e.g. talkative siblings
Social / emotional:
- Autism
- Parenting issues/ neglect
Suggest a red flag sign for the following developmental signs
1. Gross motor
2. Fine motor
3. Speech and language
4. Social and emotional
- Gross motor:
- Not sitting unsupported by 12 months
- Not walking by 18 months - Fine motor
- Showing hand preference BEFORE 12 months of age - Speech and Language
- Not knowing 2-6 words by 18 months - Social and emotional
- Not smiling by 10 weeks
Suggest some first line investigations to consider for global developmental delay
FBC and haematinics = iron / folate deficiency
U&Es = renal failure or hyponatraemia
Creatinine kinase = Duchenne Muscular Dystrophy
Thyroid function tests = congenital hypothyroidism
Liver function tests = metabolic disorders (particularly if dysmorphic features)
Vitamin D = linked to motor delay
Hearing test = if isolated speech and language delay
Briefly suggest how to manage a child with developmental delay
- Referral to a community paediatrician (detailed developmental assessment)
- Can use standardised developmental assessment e.g. Griffiths Scales of Child Development
Management is mainly MDT e.g. SALT or occupational therapists
Briefly outline Down’s syndrome
Genetic condition by which there are 3 copies of trisomy 21 (extra copy)
- This gives characteristic dysmorphic features
- Extent to which individuals are affected varies
State the frequency of Down’s syndrome and the average life expectancy
1:1000 live births
Most common chromosomal abnormality in the UK
Average life expectancy: 60 years
State a risk factor for Down’s syndrome
Increased maternal age
State some dysmorphic features of Down’s syndrome
- Epicanthic folds
- Single palmar crease
- Upward sloping palpable fissures
- Flattened face and nasal bridge
- Low set, folded ears
- Brachycephaly
- Short neck
- Short stature
- Hypotonia
State some complications of Down’s syndrome (general and ENT)
General:
- Learning disability
- Cardiac defects: ASD, VSD, patent ductus arteriosus, TOF
- Hypothyroidism
- Leukaemia
- Dementia
ENT:
- Recurrent otitis media
- Hearing impairment
- Visual impairment
Outline the combined test for Down’s syndrome and when it occurs
Combined test:
1. Maternal blood test
- Beta-HCG
- PAPPA
2. Ultrasound for nuchal translucency
Occurs between 11-14 weeks
Provides a risk score to then suggest whether to do either amniocentesis or chorionic villus sampling
State some regular follow up investigations that are needed in children diagnosed with Down’s syndrome
- Audiometry
- Visual tests
- Thyroid checks
State some reasons for failure to thrive to do with inadequate nutritional intake
- Unable to access food (poverty)
- Maternal malabsorption issues (breastfeeding)
- Neglect
State some reasons for failure to thrive to do with difficultly feeding
- Cleft lip or palate
- Abnormal facial structure e.g. genetic conditions
- Poor suck e.g. cerebral palsy
- Pyloric stenosis
State some reasons for failure to thrive to do with malabsorption
- Coeliac disease
- IBD
- Cystic fibrosis
- Cows milk intolerance
- Chronic diarrhoea
State some reasons for failure to thrive to do with increased energy requirements
- Hyperthyroidism
- Chronic diseases e.g. congenital heart disease and cystic fibrosis
- Chronic infections e.g. HIV or immunodeficiency
- Malignancy
State some reasons for failure to thrive to do with process nutrients properly
- Type 1 diabetes
- Inborn errors of metabolism
At what age should a child achieve the following gross motor milestones:
- Limbs flexed in symmetrical pattern and head lag on pulling up
- Lifts head
- Sits without support
- Crawling
- Stand independently / cruise around furniture
- Walks unsteadily with a broad gait
- Walks steadily
- Run and jump
Limbs flexed, symmetrical pattern and head lag on pulling up = newborn
Lifts head = 6 – 8 weeks
Sits without support = 6 – 8 months
Crawling = 8 – 9 months
Stand independently / cruise around furniture = 10 months
Walks unsteadily with a broad gait = 12 months
Walks steadily = 15 months
Runs and jumps = 2.5 years
At what age should a child achieve the following vision / fine motor milestones:
- Follows moving object / face by turning head (fixing and following)
- Reaches for toys
- Palmar grasp
- Transfers toys from one hand to another
- Mature pincer grip
- Makes marks with crayons
- Tower of 3
- Tower of 6
Follows moving object / face by turning head (fixing and following) = 6 weeks
Reaches for toys = 4 months
Palmar grasp = 4-6 months
Transfers toys from one hand to another = 7 months
Mature pincer grip = 10 months
Makes marks with crayons = 16-18 months
Tower of 3 = 18 months
Tower of 6 = 2 years
