Growth and Development

Question 1

What are the 4 phases of normal growth? What are each phase determined by?

Answer 1

Foetal - fastest period - determined by size of mother and by placental nutrient supply

Infancy - dependent on nutrition

Childhood - dependent on growth hormones

Puberty - dependent on sex steroids, which causes increased GH.

Question 2

What are the first signs of puberty in males and females?

Answer 2

Male - testicular enlargement

Female - breast development

Question 3

What factors affect height and growth?

Answer 3

Genetics (parents height)
Birth size
Timing of growth (puberty)
General health
Psychosocial environment

Question 4

How to measure what normal height of child should be?

Answer 4

Mid-parental height and target:
Mothers height + fathers height / 2

Add 7 for boys
Subtract 7 for girls

Target height is mid-parental height +/- 8.5

Question 5

What are the 3 ways of measuring growth?

Answer 5

Weight
Height
Head circumference

Question 6

What are the tools used in assessing childhood development?

Answer 6

Denver II assessment form

Ages and stages questionnaires.

Question 7

When would you refer to paediatrician with regards to developmental problems?

Answer 7

Can’t smile at 10 weeks (6 weeks)
Can’t sit unsupported at 12 months (7-8 months)
Can’t walk at 18 months (12 months)

Abnormal muscle tone - floppy or increased
Hand preference before 12 months - ?cerebral palsy
Speech and language problem - check hearing, consider environmental deprivation or general developmental delay.
Fits or seizures.

Question 8

What could global developmental delay indicate?

Answer 8

Down's syndrome
Fragile X syndrome
Fetal alcohol syndrome
Rett syndrome
Metabolic disorders

Question 9

What could gross motor delay indicate?

Answer 9

Cerebral palsy
Ataxia
Myopathy
Spina Bifida
Visual impairment

Question 10

What could fine motor delay indicate?

Answer 10

Cerebral palsy
Ataxia
Visual impairment

Question 11

What could language delay indicate?

Answer 11

Hearing impairment
Learning disability
Neglect
Autism
Exposure to multiple languages or siblings that do all the talking.

Question 12

What could personal and social delay indicate?

Answer 12

Autism
Emotional and social neglect
Parenting issues

Question 13

Whats the definition of short stature?

Answer 13

Height below 3rd gentile/2 SD below mean
OR
Height velocity <25th percentile.

Question 14

What investigations would you do for short stature?

Answer 14

FBC, blood film, ferritin - anaemia, CD, coeliacs
Prolactin, cortisol, IGF-1
TFTs
Biochemistry - renal/bone disorders
U&Es - creatinine high in CKD
LFTs
CRP and ESR - increased in CD
Endomysial ab/TTG - coeliacs
X-ray of left wrist - shows bone age, may indicate growth delay.
Karyotyping - Turners syndrome in girls 45XO

Question 15

Causes of short stature?

Answer 15

Short parents
IUGR and extreme prematurity
Constitutional growth delay
Endocrine disorders - hypothyroidism, hypopituitarism, Cushing’s
Chronic disease - coeliacs, Crohn’s, CKD
Psychosocial deprivation
Chromosomal disorder - Tuner’s, Down’s, Prader-Willi
Dysmorphic syndromes/skeletal dysplasia - Achondroplasia.

Question 16

Indications for biosynthetic growth hormone?

Answer 16

GH def.
Turners syndrome
Prader-Willi syndrome
CKD
IUGR

Question 17

Causes of tall child?

Answer 17

Familial 
Hyperthyroidism
GH secreting adenomas
Marfans
Klinefelters (47XXY)
Homocystinuria
Lateral diabetes - macrosomia
Soto's syndrome

Question 18

Treatment of tall child?

Answer 18

Puberty induction with oestrogen/testosterone
Surgical destruction of epiphyses in legs in extreme cases
Management of underlying condition
Genetic counselling in inherited disorders.

Question 19

What is the immunisation schedule?

Answer 19

At birth - BCG if risk factors

2 months - 6-1 vaccine, Oral rotavirus, PCV, Men B

3 months - 6-1 vaccine, oral rotavirus

4 months - 6-1 vaccine, PCV, Men B

12-13 months - Hib/Men C, MMR, PCV, Men B

2-8 years - Flu vaccine (annual)

3-4 years - 4-1 pre-school booster, MMR

12-13 years - HPV vaccination

13-18 years - 3-1 teenage booster, Men ACWY

Question 20

Child risk factors for maltreatment?

Answer 20

Being unwanted
Prematurity/low birth weight
Children under 4
Disability
Chronic ill health
Crying persistently
Unable to fulfil parental expectations

Question 21

Adult risk factors for maltreatment?

Answer 21

Postnatal depression
Mental illness
Learning disability
Alcohol and drug misuse
Own child abuse
Financial difficulties
Criminal activity
Lack of support network

Question 22

Types of child abuse

Answer 22

Emotional - refection, isolation, terrorising, ignoring, cyberbullying

Neglect - commonest form of child abuse.

Sexual - sexual activity with child under 13 is statutory rape.

Physical - brusing, laceration, head injuries, fractures, burns, bites. Children under 2 years highest risk of physical abuse.

Question 23

Suspicious signs of physical abuse?

Answer 23

Bruising on baby or immobile child (can’t move, can’t bruise)
Bruises seen away from bony prominences
Bruises to face, ears, neck, trunk, arms, hands, buttocks.
Bruises of uniform shape, imprints, clusters.

Suspicious history:
Mechanism of injury not compatible with injury sustained
Developmental stage inconsistent with injury present
Significant injury with little to no explanation
Inconsistent history
Delay in presentation
Recurrent injuries

Question 24

Investigations of physical abuse in child <2

Answer 24

Full skeletal survey
CT head
Blood test - FBC, full coag screen
Fundoscopy

Question 25

Features of a shaken baby?

Answer 25

Caused by intentional shaking of child (0-5 years)

Retinal haemorrhages, subdural haematoma, encephalopathy.

Question 26

Consequences of child abuse?

Answer 26

Aggressive behaviour
Attachment disorder
PTSD
Somatic symptoms and dissociation
Sexual dysfunction
Emotional disorders
Self-harm
Alcohol and drug abuse
Antisocial personality