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Paediatrics for Finals > Growth and Development > Flashcards

Growth and Development Flashcards

1
Q

How are maintenance fluids for a child calculated?

A

Per 24 hours:
First 10kg: 100ml/kg
Next 10kg: 50ml/kg
Subsequent: 20ml/kg

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2
Q

How many calories a day does a child need?

A

1000 + (100 x age)

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3
Q

State the gross motor milestones

A 
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
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4
Q

What could cause a delay in gross motor milestones?

A

Cerebral palsy

Duchenne muscular dystrophy

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5
Q

State the fine motor and vision milestones

A 
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
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6
Q

What could cause a delay in fine motor and vision milestones?

A
  • cataract
  • retinoblastoma
  • albinism
  • retinopathy of prematurity
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7
Q

State the hearing and speech milestones

A 
6-8 weeks: vocalise 
3 months: turn to sound
10-12 months: double syllable babble 
13 months: single words
2 years: 2 word sentences
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8
Q

What could cause a delay in hearing and speech milestones?

A
  • cleft lip and palate
  • autism
  • selective mutism
  • otitis media with effusion
  • ototoxic drugs
  • meningitis
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9
Q

State the social milestones

A 
6 weeks: smile 
6-9 months: stranger awareness 
10-12 months: waves bye-bye 
3: interactive play 
4: can get dressed
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10
Q

What could cause a delay in social milestones?

A
  • autism
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11
Q

What are some differentials for delayed walking?

A
  • Cerebral palsy
  • Duchenne muscular dystrophy
  • Part of a syndrome of global delay
  • Maternal alcohol use
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12
Q

What can cause childhood deafness?

A
  • otitis media with effusion
  • ototoxic drugs
  • post meningitis
  • prematurity
  • down’s syndrome
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13
Q

How would you interpret height and weight centile charts? i.e. what is concerning?

A

A drop through the centiles is more concerning than always being in a low centile

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14
Q

How is a child’s target height calculated?

A

Boys:
Mid-parental height +/- 10cm
MPH = (M+F)/2 + 7

Girls:
Mid-parental height +/- 8.5cm
MPH = (M+F)/2 - 7

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15
Q

When would you consider that a child was failing to thrive?

A
  • Dropping centiles on their charts
  • Height less than target height
  • Low weight for height
  • No catch up from low birth weight
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16
Q

How much weight is it acceptable for a neonate to lose in the first few days? When should they regain it by?

A

10% for breast fed
5% for formulae fed

Catch up by 10-14 days

17
Q

What are some differentials for a child failing to thrive?

A

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

18
Q

How is corrected age calculated?

A

Number of weeks old - number of weeks premature

19
Q

Define primary and secondary causes of short stature

A

Primary: condition intrinsic to the growth plate
Secondary: growth plate changes due to a condition

20
Q

What could cause a child to be of short stature?

a) primary
b) secondary

A

a) short parents, achondroplasia, Turners

b) Rickets, GH deficiency, hypothyroid, CF, coeliac

21
Q

How is short stature investigated?

A 
Left hand x-ray 
Karyotyping for all girls (Turner's) 
TFTs
Vitamins inc calcium
FBC: anaemia of chronic disease
Growth hormone
22
Q

What hormonal change occurs at the beginning of puberty?

A

Increase in amplitude and frequency of GnRH pulses which activates the HPG axis

23
Q

What is the first sign of puberty in females?

A

Thelarche (breast development)

24
Q

What is the first sign of puberty in males?

A

Testis enlargement

25
Q

What is adrenarche?

A

Development of pubic hair

26
Q

When is a child considered

a) overweight
b) obese

A

a) >85th centile

b) >95th centile

27
Q

When does puberty start in

a) girls
b) boys

A

a) 8-14

b) 9-15

28
Q

How is puberty staged?

A

Tanner staging

29
Q

What are the types of pre-cocious puberty? What blood results would you expect in each?

A 
Gonadotrophin dependant (central)
- Raised LH and FSH
Gonadotrophin independent (pseudo)
- Low LH and FSH (due to -ve feedback)
30
Q

State some causes of precocious puberty in boys

A

Central lesion such as astrocytoma
Adrenal hyperplasia or tumour
Testicular tumour
Exogenous testosterone

31
Q

What is the most common cause of precocious puberty in girls?

A

Normal as ovaries are very sensitive to gonadotrophins

32
Q

When would you suspect a pathological cause of precocious puberty in girls? What could the cause be?

A 
Occurs very fast
Neurological symptoms (CNS tumour) 
Dissonance (ovarian tumour)
33
Q

What is the role of growth hormone in precocious puberty?

A

Help child reach potential height before closure of the growth plates

34
Q

When is puberty considered delayed?

A

Absence of testis enlargement by 14
Absence of thelarche by 13
Onset of puberty but no menarche by 15

35
Q

What are the types of delayed puberty? What blood results would you expect with each?

A

Hypogonadotrophic hypogonadism
- Low LH and FSH

Hypergonadotrophic hypogonadism
- High LH and FSH

36
Q

What are some causes of hypogonadotrophic hypogonadism?

A
  • Malnutrition/ over exercising
  • Chronic illness eg CF
  • Hypothyroidism
  • Hyperprolactinaemia
  • Kallmann syndrome
37
Q

What are some causes of hypergonadotrophic hypogonadism?

A

Congenital
- Prader-Willi, Turners, Kleinfelters

Acquired
- torsion, mumps, radiation

38
Q

How is delayed puberty investigated?

A 
Early morning serum LH and FSH
TFTs
Serum prolactin
USS pelvis/ testis 
Genetic testing
39
Q

What symptoms is associated with Kallman syndrome?

A

loss of smell

Paediatrics for Finals (11 decks)

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