Growth and development 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 is Turner’s syndrome and at what age will patients usually present?
45XO
If clinical features aren’t severe a patient will usually present at around the age of puberty wondering why they aren’t developing the same as their peers
How can Turner’s syndrome present antenatally?
Oedema of the hands and the feet
Cystic hygroma
What are some presenting features of Turner’s syndrome?
Lymphoedema of hands and feet Spoon shaped nails (also with B12 def) Short stature - cardinal feature and often reason for presentation Neck webbing Low set ears Low hairline Shield chest Widely spaced nipples Wide carrying angle Pigmented moles
What other conditions/abnormalities might people with Turner’s syndrome experience?
Congenital heart defects Delayed puberty - another reason for presentation Ovarian dysgenesis Hypothyroidism Renal abnormalities Recurrent otitis media NORMAL INTELLECTUAL FUNCTION
How should we manage Turner’s syndrome and what might be important to tell parents/patients?
GROWTH HORMONE can be given to encourage normal stature
Oestrogen replacement therapy to encourage secondary sexual characteristics in females
Let parents know there is NO correlation between 45XO and maternal age
Risk of recurrence is very small
What is Edward’s syndrome and what are some clinical features?
Trisomy 18 Low birth weight Prominent occiput Small mouth and chin (micrognathia) Low set ears Rocker bottom feet Short sternum Flexed, overlapping fingers Cardiac and renal abnormalities
What is Patau’s syndrome and what are some abnormalities?
Trisomy 13 Structural defects of the brain Scalp abnormalities Cleft palate Polydactyly Microcephaly with small eyes
How does sexual differentiation happen in utero and what can occur if this goes wrong?
Fetal gonads initially ambiguous - expression of SRY on Y chromosome causes male genitalia to develop. If not expressed then female develops
If this doesn’t occur properly then there can be some DISORDER OF SEXUAL DEVELOPMENT (DSD)
What are some causes of DSD?
Excessive androgens causing virilisation in females
Inadequate androgens causing under-virilisation in males
Gonadotrophin insufficiency
Ovotesticular disorders of sexual development
What is the most common cause of excessive androgens in females?
Congenital adrenal hyperplasia
What are some causes of lack of androgens in males?
Inability to respond to androgens (androgen insensitivity syndrome) or failure to convert testosterone to dihydrotestosterone or failure to produce any at all from cholesterol
In what common syndrome is gonadotrophin insufficiency seen and what is involved in this syndrome?
Prader-Willi syndrome 15q11-13 deletion
IMPRINTING GENETIC DISORDER - depends on which copy of gene deletion is on - if Mother it is Angelman’s
FEATURES: Hypotonia, Hypogonadism, obesity, learning difficulties, small stature, infertility
