Growth and Development Flashcards
How are maintenance fluids for a child calculated?
Per 24 hours:
First 10kg: 100ml/kg
Next 10kg: 50ml/kg
Subsequent: 20ml/kg
How many calories a day does a child need?
1000 + (100 x age)
State the gross motor milestones
3 months: hold head up 6-9 months: sits without support 13 months: walking 18 months: running 2: jump 3: ride a tricycle 4: stand on one leg
What could cause a delay in gross motor milestones?
Cerebral palsy
Duchenne muscular dystrophy
State the fine motor and vision milestones
6 weeks: fixes and follows to 90 degrees 6-9 months: palmar grasp 10-12 months: pincer grip 18 months: 3 block tower 3: circle 4: square 5: triangle
What could cause a delay in fine motor and vision milestones?
- cataract
- retinoblastoma
- albinism
- retinopathy of prematurity
State the hearing and speech milestones
6-8 weeks: vocalise 3 months: turn to sound 10-12 months: double syllable babble 13 months: single words 2 years: 2 word sentences
What could cause a delay in hearing and speech milestones?
- cleft lip and palate
- autism
- selective mutism
- otitis media with effusion
- ototoxic drugs
- meningitis
State the social milestones
6 weeks: smile 6-9 months: stranger awareness 10-12 months: waves bye-bye 3: interactive play 4: can get dressed
What could cause a delay in social milestones?
- autism
What are some differentials for delayed walking?
- Cerebral palsy
- Duchenne muscular dystrophy
- Part of a syndrome of global delay
- Maternal alcohol use
What can cause childhood deafness?
- otitis media with effusion
- ototoxic drugs
- post meningitis
- prematurity
- down’s syndrome
How would you interpret height and weight centile charts? i.e. what is concerning?
A drop through the centiles is more concerning than always being in a low centile
How is a child’s target height calculated?
Boys:
Mid-parental height +/- 10cm
MPH = (M+F)/2 + 7
Girls:
Mid-parental height +/- 8.5cm
MPH = (M+F)/2 - 7
When would you consider that a child was failing to thrive?
- Dropping centiles on their charts
- Height less than target height
- Low weight for height
- No catch up from low birth weight
How much weight is it acceptable for a neonate to lose in the first few days? When should they regain it by?
10% for breast fed
5% for formulae fed
Catch up by 10-14 days
What are some differentials for a child failing to thrive?
Reduced intake: infections, GORD, vomiting, inability to suck/swallow, neglect, picky eaters
Reduced absorption: CF, coeliac, inborn errors of metabolism
Increased metabolic demand: congenital heart disease, hyperthyroid, malignancy
How is corrected age calculated?
Number of weeks old - number of weeks premature
Define primary and secondary causes of short stature
Primary: condition intrinsic to the growth plate
Secondary: growth plate changes due to a condition
What could cause a child to be of short stature?
a) primary
b) secondary
a) short parents, achondroplasia, Turners
b) Rickets, GH deficiency, hypothyroid, CF, coeliac
How is short stature investigated?
Left hand x-ray Karyotyping for all girls (Turner's) TFTs Vitamins inc calcium FBC: anaemia of chronic disease Growth hormone
What hormonal change occurs at the beginning of puberty?
Increase in amplitude and frequency of GnRH pulses which activates the HPG axis
What is the first sign of puberty in females?
Thelarche (breast development)
What is the first sign of puberty in males?
Testis enlargement
What is adrenarche?
Development of pubic hair
When is a child considered
a) overweight
b) obese
a) >85th centile
b) >95th centile
When does puberty start in
a) girls
b) boys
a) 8-14
b) 9-15
How is puberty staged?
Tanner staging
What are the types of pre-cocious puberty? What blood results would you expect in each?
Gonadotrophin dependant (central) - Raised LH and FSH
Gonadotrophin independent (pseudo) - Low LH and FSH (due to -ve feedback)
State some causes of precocious puberty in boys
Central lesion such as astrocytoma
Adrenal hyperplasia or tumour
Testicular tumour
Exogenous testosterone
What is the most common cause of precocious puberty in girls?
Normal as ovaries are very sensitive to gonadotrophins
When would you suspect a pathological cause of precocious puberty in girls? What could the cause be?
Occurs very fast Neurological symptoms (CNS tumour) Dissonance (ovarian tumour)
What is the role of growth hormone in precocious puberty?
Help child reach potential height before closure of the growth plates
When is puberty considered delayed?
Absence of testis enlargement by 14
Absence of thelarche by 13
Onset of puberty but no menarche by 15
What are the types of delayed puberty? What blood results would you expect with each?
Hypogonadotrophic hypogonadism
- Low LH and FSH
Hypergonadotrophic hypogonadism
- High LH and FSH
What are some causes of hypogonadotrophic hypogonadism?
- Malnutrition/ over exercising
- Chronic illness eg CF
- Hypothyroidism
- Hyperprolactinaemia
- Kallmann syndrome
What are some causes of hypergonadotrophic hypogonadism?
Congenital
- Prader-Willi, Turners, Kleinfelters
Acquired
- torsion, mumps, radiation
How is delayed puberty investigated?
Early morning serum LH and FSH TFTs Serum prolactin USS pelvis/ testis Genetic testing
What symptoms is associated with Kallman syndrome?
loss of smell
