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Paeds > Growth & Development > Flashcards

Growth & Development Flashcards

1
Q

What are the 6 major phases of childhood?

A 
<4wks = Neonate
<12months = Infant
<2yrs = Toddler
<5yrs = Pre-schooler
Primary Schooler
Adolescent
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2
Q

What are the 5 key developmental fields?

What are the key developmental milestones? [4]

A 
Gross Motor
Fine Motor
Speech &amp; Language
Social &amp; self-care
Hearing/Vision

Social smiling
Sitting
Walking
Words

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3
Q

How do you do milestones with premature kids?

Whats different for immunizations in premies?

A

Correct for how premature they are up to 2yrs of age then stop correcting
Use chronological age don’t correct age

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4
Q

What are the red flags of developmental delay? [5]

A
  • 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
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5
Q

What are the steps of the Child Health Programme Scotland?

A

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

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6
Q

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]

A

Do delay if unwell
Avoid live vaccines if immunocompromised

Mild Temp
Discomfort
Swelling

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7
Q

What are the 3 growth parameters?

A

Weight
Length then height (after 2yrs)
Head Circumference

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8
Q

Whats the average growth measurements at birth?

A

3.3Kg, 50cm long and 35cm head

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9
Q

Whats the average growth measurements at 12 months?

A

10Kg, 75cm and 45cm head

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10
Q

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]
A

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

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11
Q

What skills would you expect from a 6 month old

  • Gross motor
  • Fine motor
  • Speech
  • Social, self care
  • Hearing, vision
A

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

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12
Q

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]
A

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

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13
Q

What skills might you expect from a 1yr old?

  • Gross motor [3]
  • Fine motor [2]
  • Speech [1]
  • Social, self care [3]
  • Hearing, vision [1]
A

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

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14
Q

What skills might you expect from a 18month old?

  • Gross motor
  • Fine motor
  • Speech
  • Social, self care
  • Hearing, vision
A

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

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15
Q

What skills might you expect from a 2yr old?

  • Gross motor [1]
  • Fine motor [x]
  • Speech [2]
  • Social, self care [3]
  • Hearing, vision [1]
A

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

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16
Q

What skills might you expect from a 3yr old?

  • Gross motor [2]
  • Fine motor [1]
  • Speech [1]
  • Social, self care [3]
  • Hearing, vision [1]
A

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

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17
Q

At what age would you expect social smiling?

A

2 months

18
Q

Describe the step wise progression of the development of sitting in babies [4]

A 
Full support (2months)
hand support (5 months)
without support (7/8months)
twists/moves while sat (18months)
19
Q

At what age would you expect a child to walk? [2]

Indication for referral [1]

A

Take first steps by 1yr (avg)
Be up to running by 2

Refer at 18 months if not

20
Q

Describe the step wise progression of the development of speech in babies [4]

A 
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
21
Q

Define Failure to Thrive?

A

Growing too slowly in form or function for the expected level at their age

22
Q

What could cause failure to thrive? [4]

A

Deficient intake of mom and/or child
Increased demand
Increased nutrient loss
Non-organic causes

23
Q

What might cause deficient intake in a baby? [3]

A

Maternal issue: poor lactation or incorrectly prepared feeds

Maybe baby can’t feed e.g. cleft palate or cerebral palsy

24
Q

What could cause increased demand in a baby? [3]

A

Heart disease, lung disease
Infection, malignancy
IBD

25
Q

What could cause increased loss of nutrients? [3]

A

GORD
Gastroenteritis
Coeliac

26
Q

What non-organic or psychosocial things could cause FTT? [4]

A

Low socioeconomic status
Neglect
Emotional Deprivation
Lack of parental support or education

27
Q

How would you approach FTT?

A

After history and exam trial feeding the baby in hospital where you can observe the feeding, mums handling etc

28
Q

How would we follow up FTT if hospital trial showed good intake?

A

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

29
Q

How would we follow up FTT if hospital trial showed poor intake? [3]

A

Organic cause
Feeding Disorder
Non-organic that should be able to spot while observing feeding etc

30
Q

What Antenatal Factors could negatively influence baby’s development? [2]

A

Infections e.g. CMV, rubella or VZV

Toxins e.g. Alc, smoking or anti-epileptics

31
Q

What postnatal things could -negatively affect baby’s development? [7]

A 
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
32
Q

What is considered developmental delay?

A

Performance that is 2 SD below the mean of age appropriate norm referenced testing

33
Q

Differentials of developmental delay [6]

A

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

34
Q

What do the terms mean: positive red flags and negative red flags

A

Positive red flags are an abnormal sign that is present

Negative red flags are a failure to do something and a form of regression

35
Q

Positive red flags [6]

A 
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
36
Q

Negative red flags [6]

related to timeline of developmental milestones

A 
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
37
Q

Management of developmental delay in general [5]

A

Investigate the identify the underlying cause by MDT
Manage said underlying cause
Personal learning planning
Individualised educational plan
Co-ordinated support plan (legal document)

38
Q

Global developmental delay
Definition [3]
Ax [4]
Mx

A
  • 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

39
Q

Tools to investigate developmental delay

A

SOGS-2

Bayley scales of intelligence

40
Q

First line investigations of developmental delay

A 
Karyotype
U&amp;E, CK, urate
Lead
TFTs
FBC, ferritin
Biotinides
41
Q

What metabolic tests would you as part of investigating delay? [3]
When would you do metabolic testing? [4]

A
  • amino and organic acids, NH4, lactate
  • FHx
  • consanguinity
  • regression
  • organomegaly
  • coarse facial features
42
Q

When would you do neuroimaging like MRI and CT? [3]

When would you do EEG? [3]

A

Neuroimaging:
Abnormal head signs
Seizures
Focal neurological deficits

EEG:
Speech regression
Seizures
Neurodegenerative disorders

Paeds (33 decks)

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