Growth and Development Flashcards
How much milk should babies be taking per day from 0-6 months ish?
150ml/kg
What is the equivalence between ounces and ml?
1 Oz roughly = 30ml
What two hormones are majorly responsible for growth acceleration during puberty and how?
Oestrogen surge both has a direct effect on bone growth and induces increased GH surges
What hormone causes epiphyseal fusion in kids?
Oestrogen
What measurement can indicate bony dysplasia as a cause for short stature?
Subischial leg length
What is an acquired cause of growth hormone deficiency?
Craniopharyngioma
At what age should primitive reflexes disappear?
4 months ish
When should baby be able to have 45 degrees of head control?
6-8 weeks
When should baby be kicking legs when on back?
3 months
When should baby be sitting without support?
6-8 months, round back initially then straight
When should baby be able to lift head when supporting chest on arms?
6m
When should kids be crawling around?
9m
When should kids be cruising around furniture/walking with broad based gait?
10-12 months
When should kids be walking with increased steadiness and starting to crawl up stairs?
15m
When should kids be walking well and starting to walk up stairs, carry objects while walking, starting to run?
18m
When should kids be running well and starting to kick ball?
2 years
When should kids be jumping and using tricycle?
3 years
When should kids be able to hop on one foot?
4 years
When should kids be able to start riding bike with stabilisers?
5 years
What should babies be able to do in terms of vision at 4-6 weeks?
Watch within midline and follow by turning head
When can kids gaze attentively, recognise feeding bottle, clasp and bring to midline and play with fingers?
3m
When should kids be reaching for toys?
4m
When should kids be developing palmar grasp?
6m
When should kids be transferring between hands with palmar grasp?
7m
When should kids have developed object permanence by?
9m
When do kids start to gain a pincer grip and over what period do they refine it?
9m
Mature by 10-12m
When should kids be pointing at what they want and holding/banging cubes?
12m
When should kids be making a 2 block tower and scrawling back and forth with crayon?
15m
When should kids be turning pages several at a time, making a 3 block tower and scribbling with some suggestion of hand preference?
18m
When should kids be turning pages one at a time, recognising fine detail in books and building 6 block towers with hand preference?
2 years
What should newborns do in terms of hearing speech and language?
Startle to loud noises
When should kids be starting to coo and vocalise when spoken to?
3m
When should kids be turning to out of sight sound and babbling, laughing and squeaking?
6-7m
When should kids be imitating sounds and starting to shout discriminatively for parents attention?
9-10m
When should kids be saying dada mama etc as well as responding to own name and understanding simple instructions?
12m
When should kids be pointing to familiar people and objects when asked?
15m
By what age should kids have at least 1 recognisable word?
15m
When should kids have at least 6 words and be demanding objects by vocalisation, understanding body parts?
18m
When should kids be making simple 2 word sentences and referring to self by name, understanding body parts, talking to self while playing?
2 years
When should kids be talking in 3-4 word sentences?
2.5 to 3 years
When should kids be comforted by talking and stop crying?
1m
When should kids be smiling responsively and responding when played with?
6 weeks
When should kids be mouthing food and other objects, putting hands round bottle when feeding?
6m
When should kids be developing stranger awareness?
7m
When should kids be able to find partially hidden toys, play peek a boo, wave bye bye and cling to known adults?
9m-10m
When should kids be starting to grasp spoon?
10m
When should kids be drinking from cup with 2 hands, holding spoon with poor control and showing affection in familiar adults/interest in pictures?
12m
When should kids be starting to push wheeled toys, curiously exploring surroundings, controlling spoon better, helping with dressing and informing when wet/soiled?
15m
When should kids be safely using spoon, drinking without spilling, taking off socks and shoes and knowing where objects belong?
18m
When should kids be taking part in symbolic play, be dry by day, putting on shoes?
2 years
When should kids be rebelling with no danger awareness, defending and not sharing possessions, playing near but not with other kids?
2 years
When should kids be parallel playing with evolving interactive play and turn taking?
3 years
How long do you adjust growth charts for in premature babies?
Less than 32 weeks up to 2 years
Less than 37 weeks up to 1 year
What adjustments are made to the plotting of height weight etc. For children with syndromes e.g. Downs, Turner?
Use modified growth charts
What are the differences between wasted and stunted in terms of growth?
Wasted refers to weight and may be subacute
Stunted refers to height and tends to be more severe/chronic
Standard investigations for faltering growth of uncertain aetiology?
Fbc and ferritin, inflammatory markers Us and Es LFTs incl albumin (can drop albumin early in IBD) Bone profile and Vit D TFTs Urine dip and MCS TTG Sweat test Blood gas
What are the 4 general mechanisms of faltering growth?
Inadequate intake
Excessive demand
Excessive output
Inadequate absorption
Why can’t you give honey to under 1s?
Risk of botulism
What is pseudohypoPTH? What about pseudopseudohypoPTH?
Short overweight children with short fingers, low PTH
The above phenotype but no PTH disturbance
What is hydrolysed milk?
Milk with cows milk protein broken down into peptides, can get amino acid formulas where is further broken down
What is the difference between lactose intolerance and cows milk protein intolerance?
Lactose intolerance is a carbohydrate breaking down insufficiency and is very rare in children
Cows milk protein intolerance is inability to break down a protein and is not uncommon
Why should you beware the short fat child?
Obese children are often tall too so short and fat suggests an underlying cause which needs management to attain full growth potential
Give 6 syndromic causes of obesity in children?
Prader Willi syndrome Fragile X syndrome Barnet-Biedl syndrome Cohen syndrome Albrights hereditary osteodystrophy TRKB deficiency
What does TRKB deficiency cause?
Severe hyperphagia and reduced nociception
What is Cohen syndrome?
Obesity, prominent central incisors, ophthalmopathy and microcephaly
What does Barnet Biedl syndrome feature?
Obesity, night blindness (pigmentary retinopathy/retinal dystrophy), hypogonadism, renal impairment, polydactyly
What does Albrights hereditary osteodystrophy cause?
Short, fat, brachydactyly
Ectopic soft tissue ossification with hormone resistance e.g. To PTH
When should child be able to follow red ball 15cm from their face from side to midline?
1 month
What is the neurocutaneuous feature of Sturge Weber syndrome and what sequelae can this cause?
Trigeminal port wine stain - can be associated with ipsilateral meningeal vascular abnormalities resulting in venous hypertension, cortical hypoperfusion and stroke, as well as vascular eye abnormalities
How would you examine a child with suspected developmental delay?
Full CVS and neurological exam incl primitive reflexes
Look for dysmorphism particularly hands and face
Including vision, red reflex, hearing tests
Plot height, weight, head circumference
Neurocutaneous hints of syndromes
What are the 3 patterns of abnormal development?
Slow and steady - always behind but always makes milestones eventually
Plateau effect - something has halted growth, or growth potential is limited but has been reached
Regression - always concerning and suggests serious underlying cause
What are some causes of developmental regression?
Metabolic and genetic disorders Progressive hydrocephalus Space occupying lesion Chronic viral infection e.g. HIV, rubella Hypothyroidism untreated
What is a child’s vision at birth?
200/6
When should a child’s vision normalise to 6/6 by?
Age 3-4
When should neonatal physiological strabismus be gone by?
12 weeks
Prenatal causes of developmental delay?
Chromosomal defects Cerebral dysgenesis Metabolic e.g. PKU Endocrine e.g. Hypothyroidism Alcohol, drug, teratogens Congenital infection (TORCH) Neurological syndromes
Perinatal causes of developmental delay?
Birth trauma or asphyxia - cerebral palsy
Prematurity
Hypoglycaemia
Neonatal jaundice and kernicterus
Postnatal causes of developmental delay?
Infection e.g. Meningitis Seizures Head injury Hypoglycaemia Stroke Iron deficiency
2 ‘other’ causes of developmental delay?
Neglect
Autism
Appropriate investigations for developmental delay?
Bloods - FBC UE LFT TSH Ca and bone Lactate CK ammonia urate amino acids
TORCH serology
Chromosomal karyotype/array, fragile X test
Urine amino and organic acids, GAGS (LSDs), urate, creatine
2nd line investigations for developmental delay?
Neuroimaging - MRI generally, CT for calcification e.g. TSC
EEG
Genetic tests
Audiology, ophthalmology (Electroretinogram, VEPs)
When does swimming reflex disappear?
6-7 months
What are the 3 types of cerebral palsy? Subdivisions of each?
Spastic - hemiplegia, quadriplegia, diplegia/paraplegia
Dyskinetic - choreoathetoid, dystonic
Ataxic/hypotonic
Discuss the use of growth charts for preterm kids?
From 32-36+6 gestation use left hand side of normal chart, plot up to EDD+2 weeks. Thereafter from 0-1 use gestationally corrected age on normal chart
For under 32 weekers used low birthweight chart
What age do you plot on growth chart for babies born under 37 weeks? How long for?
Gestationally corrected age (so plot the baby’s calendar age minus how early they were by an arrow)
For 1 year if 32-36+6
For 2 years if less than 32 weeks
How might newborn babies weight change and why? What is abnormal?
After first few days may lose 5-10% of body weight (more than 10% abnormal) due to fluid loss
Should start putting back on at 5d and be BW+ by 10-14days
