Growth and Development Flashcards
What are the 4 phases of normal growth? What are each phase determined by?
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.
What are the first signs of puberty in males and females?
Male - testicular enlargement
Female - breast development
What factors affect height and growth?
Genetics (parents height) Birth size Timing of growth (puberty) General health Psychosocial environment
How to measure what normal height of child should be?
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
What are the 3 ways of measuring growth?
Weight
Height
Head circumference
What are the tools used in assessing childhood development?
Denver II assessment form
Ages and stages questionnaires.
When would you refer to paediatrician with regards to developmental problems?
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.
What could global developmental delay indicate?
Down's syndrome Fragile X syndrome Fetal alcohol syndrome Rett syndrome Metabolic disorders
What could gross motor delay indicate?
Cerebral palsy Ataxia Myopathy Spina Bifida Visual impairment
What could fine motor delay indicate?
Cerebral palsy
Ataxia
Visual impairment
What could language delay indicate?
Hearing impairment Learning disability Neglect Autism Exposure to multiple languages or siblings that do all the talking.
What could personal and social delay indicate?
Autism
Emotional and social neglect
Parenting issues
Whats the definition of short stature?
Height below 3rd gentile/2 SD below mean
OR
Height velocity <25th percentile.
What investigations would you do for short stature?
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
Causes of short stature?
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.
Indications for biosynthetic growth hormone?
GH def. Turners syndrome Prader-Willi syndrome CKD IUGR
Causes of tall child?
Familial Hyperthyroidism GH secreting adenomas Marfans Klinefelters (47XXY) Homocystinuria Lateral diabetes - macrosomia Soto's syndrome
Treatment of tall child?
Puberty induction with oestrogen/testosterone
Surgical destruction of epiphyses in legs in extreme cases
Management of underlying condition
Genetic counselling in inherited disorders.
What is the immunisation schedule?
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
Child risk factors for maltreatment?
Being unwanted Prematurity/low birth weight Children under 4 Disability Chronic ill health Crying persistently Unable to fulfil parental expectations
Adult risk factors for maltreatment?
Postnatal depression Mental illness Learning disability Alcohol and drug misuse Own child abuse Financial difficulties Criminal activity Lack of support network
Types of child abuse
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.
Suspicious signs of physical abuse?
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
Investigations of physical abuse in child <2
Full skeletal survey
CT head
Blood test - FBC, full coag screen
Fundoscopy
Features of a shaken baby?
Caused by intentional shaking of child (0-5 years)
Retinal haemorrhages, subdural haematoma, encephalopathy.
Consequences of child abuse?
Aggressive behaviour Attachment disorder PTSD Somatic symptoms and dissociation Sexual dysfunction Emotional disorders Self-harm Alcohol and drug abuse Antisocial personality
