Growth and Development Flashcards
Until what age are you considered a neonate?
4 weeks
How long are you considered to be an infant?
until 1 year
How long are you considered a toddler?
1-2 years
What is the pre-school range of age?
2-5 years
What are the 4 key developmental domains?
- gross motor
- fine motor
- social and self help
- speech and language
At what age would you start to worry if a child was not walking?
18 months
What would you expect a child to be able to do at 6 months of age?
- make simple sounds
- play with simple objects
- recognise several people
- smile
- turns head and shifts weight
- rolls back to belly
- scoots or crawls
- reaches and grasps with whole hand
What would you expect a child to be able to do by 12 months of age?
- begin to use simple words
- begins to do simple things when asked
- drinks alone from cup
- takes longer interest in toys and activities
- imitates and copies people
- copies simple actions
- moves and holds head easily in all directions
- takes steps
- understands simple words (like touch your nose)
What would you expect a child to be able to do by 2 years of age?
- begins to use words together
- like to be praised after completing simple tasks
- takes off simple clothing
- sorts different objects
- begins to play with other children
- points at things when asked
- can grasp with pincer
- runs
What would you expect a child to be able to do by age 3?
- use simple sentences
- interact with both children and adults
- be toilet trained
- sort different objects
- plays independently with children and toys
- follows simple instructions
What are red flags of development?
- Loss or plateau of developmental skills
- Parental/ professional concern re. vision (simultaneous referral to paediatric ophthalmology)
- Hearing loss (simultaneous referral for audiology/ ENT)
- Persistent low muscle tone/ floppiness
- No speech by 18 months, esp if no other communication (simultaneous referral for urgent hearing test)
- Asymmetry of movements/ increased muscle tone
- Not walking by 18m/Persistent toe walking
- OFC > 99.6th / < 0.4th / crossed two centiles/ disproportionate to parental OFC
- Clinician uncertain/ thinks that development may be disordered
What is involved in the child health programme?
-New-born exam and blood spot screening*
-New-born hearing screening (by Day 28)
-Health Visitor First Visit
-6-8w Review (Max 12w)
-27-30 month Review (Max 32m)
-Orthoptist vision screening (4-5y)
-If needed
Unscheduled review
Recall review
What would happen at the 6-8 week review by GP or health visitor?
- Identification data (Name, address, GP)
- Feeding (breast/ bottle/ both)
- Parental concerns (appearance, hearing; eyes, sleeping, movement, illness, crying, weight)
- Development (gross motor, hearing + communication, vision + social awareness)
- Measurements (Weight, OFC, Length)
- Examination (heart, hips, testes, genitalia, femoral pulses and eyes (red reflex))
- Sleeping position (supine, prone, side)
What would happen at the 27-30 week review?
-Identification data (name, address, GP)
-Development
Social, behavioural, attention and emotional
Communication, speech and language
Gross and fine motor
Vision, hearing
-Physical measurements (height and weight)
-Diagnoses / other issues
What additional things can a health visitor promote for the health of a new mother and her child?
- smoking, alcohol, drugs etc
- information regarding immunisations
When would immunisation be postponed?
if the child is unwell
What are the 3 parameters of growth monitoring?
- weight (grams and Kg)
- length (cm) or height (if>2years)
- head circumference (cm)
What are useful reference values to remember in regards to weight at different ages? A. birth B.4 months C. 12 months D. 3 years
A. 3.3kg
B. 6.6kg
C. 10kg
D. 15kg
What are useful reference values to remember in regards to length at different ages? A. birth B. 4 months C. 12 months D. 3 years
A. 50cm
B. 60cm
C. 75cm
D. 95cm
What are useful reference values to remember in regards to occipital-frontal circumference at different ages? A. birth B. 12 months
A. 35cm
B. 45cm
What do we mean by the 50th centile?
if you take the average 100 healthy children, 50 are above this point and 50 are below
What is meant by the 0.4th centile?
if you take the average healthy 1000 children, 4 are below this point, 996 are above
What do we mean by ‘failure to thrive’?
child growing too slowly in form and usually in function at the expected rate for his or her age
What are the gross reasons for failure to thrive in early life?
- deficient intake
- increased metabolic demands
- excessive nutrient loss
What are some examples of how deficient intake might lead to FTT?
maternal:
- poor lactation
- incorrectly prepared feeds
- unusual milk or other feeds
- inadequate care
infant:
- prematurity
- small for dates
- oro palatal deformities
- neuromuscular disease e.g. cerebral palsy
- genetic disorders
What are some examples of how increased metabolic demands might lead to FTT?
- congenital lung disease
- heart disease
- lung disease
- renal disease
- infection
- anaemia
- inborn errors of metabolism
- cystic fibrosis
- thyroid disease
- Crohn’s/IBD
- malignancy
What are some examples of ways that excessive nutrient loss might lead to FTT?
- gastro-oesophageal reflux
- pyloric stenosis
- gastroenteritis
- malabsorption e.g. coeliac, pancreatic insufficiency, short bowel syndrome
What are non-organic causes of FTT?
- Poverty/ socio-economic status
- Dysfunctional family interactions (especially maternal depression or drug use)
- Difficult parent-child interactions
- Lack of parental support (eg, no friends, no extended family)
- Lack of preparation for parenting/ education
- Child neglect
- Emotional deprivation syndrome
- Poor feeding or feeding skills disorder
- Feeding disorders (eg, anorexia, bulimia- later years)
If the child is in hospital for investigation of failure to thrive, what would you do if the child had good food intake in hospital?
check if there is weight gain:
- if there is then consider non-organic cause for FTT
- if there is no weight gain consider organic cause
If the child is in hospital for investigation of failure to thrive, what would you do if the chid had poor uptake of food in the hospital?
consider:
- organic cause
- feeding disorder
- non-organic or mixed
