Growth and Development

Question 1

What are the phases of childhood?

Answer 1

Neonate - <4 weeks
Infant - <12 months/1 year
Toddler – 1-2 years
Pre-school – 2-5 years
School age
Teenager/adolescent

Question 2

What are the key fields of development?

Answer 2

Gross motor – eg pulling yourself up to stand
Fine motor – what you do with your hands, eg grasp
Social and self-help
Speech and language – sounds become more specific
Hearing and vision

Question 3

When should a child be smiling?

Answer 3

4/6 weeks

Question 4

When should a child be sitting?

Answer 4

6/7 months

Question 5

When should a child be walking?

Answer 5

12-18 months

Question 6

When should a child say their first works?

Answer 6

12 months

Question 7

When should a child be referred if they aren’t meeting their milestones?

Answer 7

2 SDs from the mean

Corrections need to be made for prematurity

Question 8

What factors influence development?

Answer 8

Genetics
Environment
Positive early childhood experience
Developing brain vulnerable to insults

Question 9

What is the developing brain vulnerable to in the antenatal period?

Answer 9

Infections – CMV, rubella, toxoplasmosis, VZV

Toxins – alcohol, smoking, anti-epileptics

Question 10

What is the developing brain vulnerable to in the postnatal period?

Answer 10

Infection – meningitis, encephalitis
Toxins – solvents, mercury, lead
Trauma – head injury
Malnutrition – iron, folate, vitamin D
Metabolic – hypoglycaemia, hyper and hyponatraemia
Maltreatment/under stimulation/domestic violence
Maternal mental health issues

Question 11

What are red flags developmentally?

Answer 11

Loss of developmental skills
Parental/professional concern
Hearing loss
Persistent low muscle tone/floppiness
No speech by 18 months, especially if no other communication
Asymmetry of movements/increased muscle tone
Not walking by 18 months/persistent toe walking
Clinician uncertain/thinks that development may be disordered

Question 12

Child health screening in the UK and Scotland

Answer 12

UK - Healthy child programme

Scotland - child health programme based on HAL4

Question 13

Child Health Programme (Scotland) based on HAL4

Answer 13

New-born exam and blood spot screening
New-born hearing screening – by day 28
Health visitor first visit
6-8 week review – 
27-30 month review screening – 4-5 years

Question 14

What is failure to thrive?

Answer 14

A child growing too slowly in form and usually in function at the expected rate for their age
NOT A DIAGNOSIS

Question 15

What are the potential categories of causes of failure to thrive?

Answer 15

Deficient intake
Increased metabolic demand
Excessive nutrient loss
Non-medical

Question 16

Failure to thrive - deficient intake causes

Answer 16

Maternal - poor lactation, incorrectly prepared feeds, unusual milk, inadequate care
Infant - prematurity, small for date, oro-palate abnormalities (eg cleft palate), neuromuscular disease (eg cerebral palsy), genetic disorders

Question 17

Failure to thrive - increased metabolic demand causes

Answer 17

Congenital lung disease
Heart/liver/renal disease
Infection, malignancy
Anaemia, thyroid disease
CF
Crohn's/IBD

Question 18

Failure to thrive - excessive nutrient loss causes

Answer 18

GORD
Pyloric stenosis
Gastroenteritis
Malabsorption - food allergy, persistent diarrhoea, coeliac disease, pancreatic insufficiency, short bowel syndrome

Question 19

Failure to thrive - non-medical causes

Answer 19

Poverty/social-economic status
Dysfunctional family interactions - especially maternal depression or drug use
Difficult parental support
Lack of preparation for parenting/education
Child neglect
Emotional deprivation
Poor feeding or feeding skills disorder