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Child + Family > Growth > Flashcards

Growth Flashcards

1
Q

What does RNI stand for and what does it mean?

A

Reference nutrient intake = the amount of a nutrient that is enough to ensure that the needs of nearly all the population (97.5%) are being met

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2
Q

What does EAR stand for and what does it mean?

A

Estimated average requirement = is an estimate of the average requirement for energy, for a nutrient. Approximately 50% of the population will need less energy or the nutrient and 50% of the population will need more.

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3
Q

What does DRV stand for and what does it mean?

A

Dietary reference value = an estimate of the amount of energy and nutrients needed by different population groups of healthy people in the UK population

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4
Q

What does LRNI stand for and what does it mean?

A

Lower reference nutrient intake = the amount of a nutrient that is enough for only the small number of people who have low requirements (2.5%). The majority of the population will need more.

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5
Q

Summarize what the following are individually important for:

  • EAR
  • RNI
  • LRNI
A

EAR is used for energy.

RNI is often used as a reference amount for population groups.

LRNI is a useful measure of nutritional inadequacy.

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6
Q

In ages 4-18 months, is protein generally over or under consumed?

A

Over - both girls and boys excees EAR across the board

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7
Q

Vitamin A

  • Dietary sources?
  • Intake above or below RNI?
A

Cheese, eggs, yoghurt

Above RNI for all age groups

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8
Q

Vitamin C

  • Dietary sources?
  • Intake above of below RNI?
A

Oranges, blackcurrants, potatoes
Below RNI for breast fed infants
Below RNI fpr non-breastfed infants

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9
Q

Which supplements are required for infants and under what conditions?

A

Recommended that from 6 months, all children consuming <500mls/d of infant formula should take vitamin A, C & D supplements. Proportion of children taking supplements ranged between 5% & 10%.

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10
Q

Breastfeeding mothers should take which supplement?

A

Vitamin D

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11
Q

Is sodium over or under consumed in infants?

A

Intake exceeded in all age groups except 4-6 months

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12
Q

What are the physical activity guidelines for:

  • Infants not yet walking?
  • Children capable of walking?
  • 5-18 years?
A
  • Encourage from birth, floor and water based activities
  • 180 minutes throughout the day
  • 60 minutes/day of moderate to vigorous intensity physical activity AND 3 days/week vigorous intensity activities
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13
Q

What time of feeding is recommended for newborns and for how long?

A

Exclusive breast feeding for first 6 months of infants life

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14
Q

At what age is breast milk no longer enough to meet nutritional needs?
What should you start doing here?

A

6 months

weaning

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15
Q

Full fat unmodified cows milk

  • When and how should you introduce it?
  • When should semi-skimmed milk not be given until?
  • What about skimmed milk?
A
  • Can be used in small amounts in cooking from 6-9 months
  • Can be gradually introduced as a drink from 12 months
  • Semi-skimmed milk should not be given before 2 years
  • Skimmed milk should not be given before 5 years
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16
Q

When should you introduce complementary food?

  • Gluten?
  • Sugar and salt?
  • Potential allergens?
  • Nuts and seeds?
A

6 months

  • First foods should be gluten free if <6months e.g. baby rice, cooked & mashed fruits & vegetables, peeled & mashed banana
  • Sugar & salt should not be added; salty foods should be avoided
  • Foods that may cause allergies should be introduced one at a time e.g. cereals with gluten, eggs, nuts, soya, fish, other milk
  • Avoid whole nuts & seeds until 5 years
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17
Q

What are the three principles of complementary feeding?

A
  1. Adequate - to cover the nutritional needs of the child while breast feeding
  2. Appropriate - correct texture for age of child
    Safe - clean water and good hygiene
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18
Q

Give three benefits of breastfeeding for the child

A
  1. Greater likelihood of higher IQ at 7½ years
  2. Lower obesity risk for baby in later life
  3. Lower maternal breast cancer risk
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19
Q

What is a z score?

A

The number of standard deviations from the mean

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20
Q

If 100 people are measures, how many are:

  • Within 1 sd of the mean?
  • Within 2 sd of the mean?
A

68

95

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21
Q

What is the age limit for true precocious puberty?

A

Girls <8

Boys <9

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22
Q

What are the age cut offs for pubertal delay?

A

Girls - 13

Boys - 14

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23
Q

Define:

  • Thenarche
  • Adrenarche
  • Menarche
A
  • Breast budding
  • Body hair and odour
  • Periods start (usually 2 years post thenarche)
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24
Q

Give the six classifications of short stature

A
  1. Genetic short stature
  2. Constitutional growth delay
  3. Dysmorphic syndromes
  4. Endocrine disorders
  5. Chronic diseases
  6. Psychosocial deprivation
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25
Q

What is genetic short stature?

A

Healthy, well child who has inherited short stature from parents. No underlying endocrine abnormality and normal bone age

26
Q

What is a constitutional growth delay?

A

Late maturation causing short stature. Cause usually unknown. May be genetic short stature component. Tends to present around puberty with delayed onset. Children have delayed maturation and delayed bone age. Can be very stressful.

27
Q

What are the four areas of development?

A

Gross motor
Fine motor and vision
Language and hearing
Social behaviour and play

28
Q

Organise the following gross motor development stages into chronological order and age:

  • Runs
  • Head control
  • Hops
  • Stairs - 2 feet/tread
  • Crawling
  • Sitting balance
  • Stairs - alternating feet
  • Stands
A
  • Head control - 3 months
  • Sitting balance - 6 months
  • Crawling - 9 months
  • Standing - 12 months
  • Running - 18 months
  • Stairs - 2 feet/tread - 24 months
  • Stairs - alternate feet - 36 months
  • Hops - 48 months
29
Q

What does ATNR stand for and what is it’s purpose?

When is it lost?

A

Asymmetrical tonic neck reflex - aka fencing reflex - stops you rolling
Lost at 3-6 months

30
Q

Describe the moro reflex

A

If you let the babies head go back then the arms will flail and then come in to a grasp

31
Q

Organise the following fine motor and vision development stages into chronological order and age:

  • Tower of 3-4 bricks
  • Grasps toy - palmar
  • Tower of 9 bricks/copies circle
  • Hand regard in midline
  • Tower of 6-7/scribble
  • Scissor grasp
  • Draws simple man
  • Pincer grasp
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
  • Tower of 6-7/scribble - 24 months
  • Tower of 9 bricks/copies circle - 36 months
  • Draws simple man - 48 months
32
Q

Do infant girls of boys tend to develop fine motor stages quicker?

A

Girls - so if you see a young boy who cannot pick up a pencil properly etc then it might just be normal

33
Q

Organise the following hearing and language development stages into chronological order and age:

  • 2 body parts/5-20 words
  • Can tell stories of experiences
  • Simple instructions/50+ words
  • Babbles
  • Complex instructions/asks questions
  • Vocalises
  • Knows name
  • Imitates sounds
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 stories of experiences - 48 months
34
Q

Organise the following social behaviour and play development stages into chronological order and age:

  • Feeds with spoon
  • Understands turn taking/dresses fully
  • Pleasure on friendly handling
  • Drinks from cup/waves byebye
  • Social smile
  • Plays with feet/friendly with strangers
  • Symbolic play/puts on some clothes
  • Plays peek-a-boo/stranger awareness
A
  • Social smile - 6 weeks
  • 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/puts on some clothes - 2 years
  • Pretend interactive play/toilet-trained - 3 years
  • Understands turn-taking/dresses fully - 4 years
35
Q

What is the 123 rule that nutritionists use?

A

1 Hour Physical Activity per day
2 Hours (maximum) screen time
3 Balanced meals

36
Q

Define developmental delay

A

Developmental delay = failure to attain appropriate developmental milestones for child’s corrected chronological age.

37
Q

What are the three patterns of abnormal development?

A
  1. Delay - global or specific
  2. Deviation e.g. ASD
  3. Regression e.g. Rett’s syndrome, metabolic disorders
38
Q

Name some red flags for developmental problems

A
  • Asymmetry of movement
  • Not reaching for objects by 6 months
  • Unable to sit unsupported by 12 months
  • Unable to walk by 18 months → check CK
  • No speech by 18 months
  • Concerns re vision or hearing
  • Loss of skills
39
Q

How is a global developmental delay defined?

A

Significant delay in 2+ of

  • Gross/fine motor, speech/language,
  • Cognition, social/personal, ADL
40
Q

What associated medical condition do you need to keep in mind in a child with cerebral palsy?

A

Visual impairment

41
Q

Which genetic syndrome can cause significant hearing impairment?

A

Treacher Collins syndrome

42
Q

What are the three parts to the autistic triad?

What are two other common features of ASD?

A
  1. Communication
  2. Social interaction
  3. Flexibility of thought/imagination
    Other two:
    - Restricted, repetitive behaviours
    - Sensory difficulties
43
Q

Describe the communication features of ASD

A

Receptive language is delayed with abstract language difficult (visually more able)
Expressive language is delayed and parrots others, also odd pitch with chunks of video speak
Non verbal language e.g. eye contact, facial expression is poor
Difficulty in initiating and sustaining conversation with restricted interests

44
Q

Describe the social interaction features of ASD

A

Patients find the following things difficult:

  • Turn taking
  • Unable to share pleasure
  • Social rules
  • Empathy
  • Relationships
  • Other points of view/feelings
45
Q

Describe the flexibility of thought/imagination features of ASD

A

Difficulty in flexibility of though/imagination:

  • Theory of mind
  • Concrete and literal
  • Routines
  • Concept of time
46
Q

What are some sensory issues that people with ASD have?

A
  • Fussy eater/medications
  • Texture of clothes
  • Sleep
  • Toilet training
  • Hair + nail cutting/washing
  • Noise
47
Q

What should you ask about in the history of developmental delay?

A 
Concerns – presenting complaint
Past Medical History
Perinatal and Birth
Family &amp; Social
Developmental
Play and Behaviour
School/Nursery
48
Q

What investigations should you always do in a child with developmental delay?

A

Chromosomes, FRAX & Oligoarray CGH

Neonatal PKU, thyroid studies, CK

49
Q

What does Array CGH stand for, what does it test for and how does it work?

A

Array Comparative Genomic Hybridisation allows identification of regions of the genome that are deleted or duplicated in a patient by comparison with a control DNA sample. Each dot on a microarray represents a specific genetic region. If more patient DNA than control DNA hybridises to the dot, it suggests that the region is duplicated in a patient. If less patient DNA hybridises than control DNA, then the region is deleted in the patient.
Allows you to look for sub-microscopic deletions or duplications of chromosome material across the whole human genome.

50
Q

What is one disadvantage of Array CGH?

A

Only detects chromosome imbalance – if you have a balanced translocation e.g. with recurrent miscarriages, then this is not your test.
Do full karyotyping in this case

51
Q

How many bases need to be altered to change to cause a genetic disease?
We know there are 10,000,000 possible places for a polymorphism. How many polymorphisms do you find on average in a person?

A

1

4, 000, 000.

52
Q

What is the department of education definition of intellectual disability?

A

Those children and young people who have either a learning difficulty in relation to acquiring new skills or who learn at a different rate to their peers.

53
Q

What is the DSM V definition of intellectual disability?

A

Impairment of general mental abilities that impact adaptive functioning in three domains:

  • Conceptual (intellect) - language, reading, writing, maths
  • Social - empathy, communication, friendships
  • Practical - dress and feed yourself etc
54
Q

What is the most common staging system used for puberty?

A

Tanner staging 1-5

55
Q

What is the pnemonic for assessing developmental stagein adolescents?

A

S - Sexual Maturation and Growth
T – Thinking – concrete or abstract?
E - Education/Employment – is this culturally appropriate, i.e. in school?
P - Peers/Parents – think about the relationships

56
Q

What would you say to a young person in explaining confidentiality?

A

“Anything you tell me is confidential do you understand what that means?..so that means that our conversation is private between us and anything you tell me will remain confidential, the only time I would ever break that is if I was worried that you were in real danger from something you had told me. If I was going to do that I would always tell you first”

57
Q

What is the pnemonic for remembering the things you might want to discuss with a young person?

A

HEEADSSS
Home (home life/relationships)
Education/Employment – progress at school, financial concerns
Eating – weight, body image
Activities – peers, physical activity – are they able to participate, or is their illness preventing them from doing so?
Drugs
Sex – Sexual activity, orientation, STIs
Suicidality
Safety – risk taking behaviour/criminality

58
Q

How is DKA managed differently in children to adults?

A

Don’t use lots and lots of fluids in a young person for risk of cerebral oedema

59
Q

Give seven differentials for short stature

A
  1. Normal short stature
    - Genetic
    - Constitutional delay
  2. Short stature following smallness for gestational age (SGA)
  3. Dysmorphic syndromes
    - SGA constant feature eg Russell Silver, foetal alcohol syndrome
    - SGA not a constant feature eg Turner and Noonan syndrome
  4. Skeletal dysplasias
  5. Chronic disease (e.g. Crohn’s disease, cystic fibrosis)
  6. Psychosocial deprivation
  7. Endocrine disorders
    - GH insufficiency
    - Thyroid deficiency
    - Cortisol excess
60
Q

What is the adult height predictor?

A

An estimate of adult height given the child’s current height. 4 boys out of 5 will have an adult height +/- 6cm of predicted adult height

61
Q

What is mid-parental centile?

A

Mid-parental centile: Average adult height centile to be expected for all children of these parents. 9 of 10 children’s height centiles are within +/- 2 centile spaces of the mid-parental centile.
Can plot mid-parental centile on the main chart at age 18 and read off corresponding height. 4 of 5 boys will have an adult height +/- 7 cm of this target height.

62
Q

What are the five primitive reflexes you should be aware of?

A
  1. Asymmetric tonic neck reflex aka fencing reflex – if you turn the child then their arm comes out – should disappear around 3-4 months  preserved in cerebral palsy
  2. Morow – arms out, then in, then cries
  3. Suck and root – if you stroke the babies check then the baby starts to suck
  4. Plantar/palmar grasp
  5. Stepping + placing

Child + Family (9 decks)

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