Growth & Development Flashcards
What are the 6 major phases of childhood?
<4wks = Neonate <12months = Infant <2yrs = Toddler <5yrs = Pre-schooler Primary Schooler Adolescent
What are the 5 key developmental fields?
What are the key developmental milestones? [4]
Gross Motor Fine Motor Speech & Language Social & self-care Hearing/Vision
Social smiling
Sitting
Walking
Words
How do you do milestones with premature kids?
Whats different for immunizations in premies?
Correct for how premature they are up to 2yrs of age then stop correcting
Use chronological age don’t correct age
What are the red flags of developmental delay? [5]
- Loss of skills/regression, hearing loss
- Not walking or talking at all by 18 months
- Visual problems - parental or professional concern
- Abnormal tone - floppy or asymmetry of movements
- OFC crossing centiles
What are the steps of the Child Health Programme Scotland?
1) New born exam and blood spot screening
2) By 28 days = newborn hearing screening
3) 2 wks = HV visits
4) 6-8wks = Review by GP and HV
5) 27-30 months = Review by HV
6) 4-5yrs = Orthoptist screening
Reviews cover measurments, feeding, domains of development, exam and any parental concerns
What are 2 instances where immunizations have to be postponed or contraindicated?
NB egg allergy is not a contraindication to MMR - all recorded in red book
SEs of vaccines [3]
Do delay if unwell
Avoid live vaccines if immunocompromised
Mild Temp
Discomfort
Swelling
What are the 3 growth parameters?
Weight
Length then height (after 2yrs)
Head Circumference
Whats the average growth measurements at birth?
3.3Kg, 50cm long and 35cm head
Whats the average growth measurements at 12 months?
10Kg, 75cm and 45cm head
What skills would you expect from a 3 month old
- Gross motor [3]
- Fine motor [1]
- Speech [1]
- Social, self care [3]
- Hearing, vision [3]
Gross motor –> holds head up, roll belly to back and begin to creep
Fine Motor –> palmar grasp reflex
Speech –> “coo”
Social/safe care –> sucks breast, recognising mum, cries at loud noise/hungry/uncomfortable
Hearing/Vision –> should be following objects with eyes and turning to sounds, enjoys bright object
What skills would you expect from a 6 month old
- Gross motor
- Fine motor
- Speech
- Social, self care
- Hearing, vision
Gross motor –> Scoot/crawling, roll back to belly and ~sitting w/ support
Fine Motor –> reach and grasping with whole hand
Speech –> Simple sounds (vowels)
Social/self care –> Recognises people & plays with simple objects
Hearing & Vision –> enjoy rhythmic music, recognizes some faces
What skills would you expect from a 9 month old?
- Gross motor [4]
- Fine motor [1]
- Speech [2]
- Social, self care [2]
- Hearing, vision [2]
Gross Motor –> Hold up head when lifted, roll over & over in play and ~pull to standing, sits without support
Fine motor –> Pass across midline (from one hand to another)
Speech –> responds to “No” and uses certain sounds for things, ~understand simple words
Social/self care –> Plays social games e.g. peekaboo & starts solids/feeding self
Seeing/Hearing –> Focus on distant objects & look for toys that fall out of sight
What skills might you expect from a 1yr old?
- Gross motor [3]
- Fine motor [2]
- Speech [1]
- Social, self care [3]
- Hearing, vision [1]
Gross Motor –> Easily moves head around, sits well and twists, starts walking
Fine Motor –> grasp with thumb and forefinger
Speech –> Uses simple words
Social/self care –> Drinks alone from glass, takes longer interest & imitates others.
Hearing & vision –> Understands simple instructions
What skills might you expect from a 18month old?
- Gross motor
- Fine motor
- Speech
- Social, self care
- Hearing, vision
Gross motor = Twist in seat, walk and maybe run
Fine motor = grasp with thumb & finger
Social/Self care = May remove simple clothes and copy actions
Speech = use of simple words and doing simple requests
Hearing & vision = look at pictures
What skills might you expect from a 2yr old?
- Gross motor [1]
- Fine motor [x]
- Speech [2]
- Social, self care [3]
- Hearing, vision [1]
Gross Motor = Running
Speech = Using words together & pointing at things when asked
Social = May being to play with other kids, enjoys praise, can remove clothes
Hearing & vision = Hears and understands lots of simple language
What skills might you expect from a 3yr old?
- Gross motor [2]
- Fine motor [1]
- Speech [1]
- Social, self care [3]
- Hearing, vision [1]
Gross Motor = Walking on tiptoes, heels and backwards
Fine Motor = Moving fingers from nose to moving object and back
Speech = may use simple sentences
Social = follow simple instructions, plays independently with other kids, toilet trained
Hearing & vision = Sees shapes clearly at 6m
At what age would you expect social smiling?
2 months
Describe the step wise progression of the development of sitting in babies [4]
Full support (2months) hand support (5 months) without support (7/8months) twists/moves while sat (18months)
At what age would you expect a child to walk? [2]
Indication for referral [1]
Take first steps by 1yr (avg)
Be up to running by 2
Refer at 18 months if not
Describe the step wise progression of the development of speech in babies [4]
Cries when wet/hungry = 1 month Coos when comfy = 3 months Simple vowel sounds = 6 months Certain words for certain things = 9months Simple words = 1yr Words together = 2yrs Simple sentences = 3yrs
Define Failure to Thrive?
Growing too slowly in form or function for the expected level at their age
What could cause failure to thrive? [4]
Deficient intake of mom and/or child
Increased demand
Increased nutrient loss
Non-organic causes
What might cause deficient intake in a baby? [3]
Maternal issue: poor lactation or incorrectly prepared feeds
Maybe baby can’t feed e.g. cleft palate or cerebral palsy
What could cause increased demand in a baby? [3]
Heart disease, lung disease
Infection, malignancy
IBD
What could cause increased loss of nutrients? [3]
GORD
Gastroenteritis
Coeliac
What non-organic or psychosocial things could cause FTT? [4]
Low socioeconomic status
Neglect
Emotional Deprivation
Lack of parental support or education
How would you approach FTT?
After history and exam trial feeding the baby in hospital where you can observe the feeding, mums handling etc
How would we follow up FTT if hospital trial showed good intake?
If the baby starts to gain weight then the problem was something non-organic happening at home that doesn’t happen in hospital
If baby still isn’t gaining weight despite feeding well then theres an organic pathology e.g. GORD, IBD, Heart disease, inf, coeliac etc
How would we follow up FTT if hospital trial showed poor intake? [3]
Organic cause
Feeding Disorder
Non-organic that should be able to spot while observing feeding etc
What Antenatal Factors could negatively influence baby’s development? [2]
Infections e.g. CMV, rubella or VZV
Toxins e.g. Alc, smoking or anti-epileptics
What postnatal things could -negatively affect baby’s development? [7]
Brain infections Toxins e.g. lead Trauma e.g. head Malnutrition --> Iron, folate, vit D deficiency Metabolic --> Glc or Na derangement Maltreatment Maternal mental health
What is considered developmental delay?
Performance that is 2 SD below the mean of age appropriate norm referenced testing
Differentials of developmental delay [6]
Global developmental delay
Motor impairment: CP, congenital myopathy
Sensory impairment
Speech and language impairment
Social and self-help ipairment
Variations of normal: early or late developers
What do the terms mean: positive red flags and negative red flags
Positive red flags are an abnormal sign that is present
Negative red flags are a failure to do something and a form of regression
Positive red flags [6]
o LOSS of developmental skills (mitochondrial disease) o Visual or hearing concerns o Floppiness o Asymmetry of movement o Persistent toe walking o Head circumference >99.6thC or <0.4 C
Negative red flags [6]
related to timeline of developmental milestones
o Hold objects by 5 months o Reach for objects by 6 months o Sit unsupported by 1 y/o o Walk by 1.5 y/o (boys) or 2 y/o (girls) o Speak by 1.5-2y/o o Run by 2.5y/o
Management of developmental delay in general [5]
Investigate the identify the underlying cause by MDT
Manage said underlying cause
Personal learning planning
Individualised educational plan
Co-ordinated support plan (legal document)
Global developmental delay
Definition [3]
Ax [4]
Mx
- performance is 2SD
- below the man of age-appropriate norm referenced testing
- in >2 domains
Ax:
- prematurity
- genetic disorder, inborn errors of metabolism
- congenital infection
- neglect
Mx: as general developmental delay
Tools to investigate developmental delay
SOGS-2
Bayley scales of intelligence
First line investigations of developmental delay
Karyotype U&E, CK, urate Lead TFTs FBC, ferritin Biotinides
What metabolic tests would you as part of investigating delay? [3]
When would you do metabolic testing? [4]
- amino and organic acids, NH4, lactate
- FHx
- consanguinity
- regression
- organomegaly
- coarse facial features
When would you do neuroimaging like MRI and CT? [3]
When would you do EEG? [3]
Neuroimaging:
Abnormal head signs
Seizures
Focal neurological deficits
EEG:
Speech regression
Seizures
Neurodegenerative disorders
