Growth & development

Question 1

Why are human babies born earlier in development than other species?

Answer 1

Smaller head required to navigate birth canal
Therefore require more parenting postnatally as brains are immature and have less capacity for independent behaviour

(presence of fontanelles also allows baby’s head to pass through birth canal - close in infancy)

Question 2

What are primitive reflexes and their importance?

Answer 2

Involuntary reflexes present in typically developing newborn children that disappear as the frontal lobe develops during typical transition into childhood.
An important indicator of typical motor development reflecting myelination of higher cortical pathways that allow for voluntary control of movement.

Question 3

What causes increase in brain size as a baby develops?

Answer 3

Myelination and synaptogenesis increases neonatal brain from 400g to 1000g at 1 year

[Orbitofrontal region of brain almost exclusively develops postnatally]

Question 4

What is an experience-expectant mechanism?

Answer 4

Environmental input experienced by everyone that play a major part in organisation of the developing nervous system (universal experiences e.g. exposure of light and visual information necessary for normal development of visual cortex)

Question 5

At what age do fontanelles close?

Answer 5

Posterior fontanelle = 2-3 months

Anterior fontanelle = 18 months

Question 6

What is the importance of developing a secure attachment?

Answer 6

Mechanism activated by anxiety with the purpose of reducing stress and restoring security.
Secure attachment promotes optimal functioning across all domains (incl. emotional, social, behavioural and educational development)

Question 7

What is emotional regulation?

Answer 7

Process by which levels of emotions (positive and negative) are kept within bounds so they do not become overwhelming.
Parents play key role in helping baby to regulate emotion and to develop self-regulation strategies key for functioning in society

Question 8

At what age do infants develop the ability to recognise themselves?

Answer 8

Approx. 18 months (Rouge Test - able to recognise self with mark on face in mirror at around 18 months)

Question 9

What three dimensions should be assessed when observing parent-infant interactions?

Answer 9

Engagement (ranges from over-intrusiveness to unengagement)
Predictability (consistency)
Genuineness (varies from genuine to false and deceptive)

Question 10

What is the difference between organic and non-organic failure to thrive?

Answer 10

Organic = physiological reason (e.g. pyloric stenosis causing vomiting) 
Non-organic = under-feeding 

[Nb. failure to thrive is a descriptive term not a diagnosis]

Question 11

What three domains should be included in a history when developmental delay is identified?

Answer 11

Perinatal, family and environmental

[as well as physical examination]

Question 12

Name 5 diseases infants are vaccinated against

Answer 12

Rotavirus 
Mumps, measles, rubella (MMR) 
Diphtheria 
Hep B 
Pneumococcal (PCV)

Question 13

What are some primitive reflexes present in typical newborns?

Answer 13

Rooting (turning head and opening mouth towards direction of stroking when corner of baby’s mouth is stroked - helps to enable feeding)
Grasp (closing of hand around finger when palm is stroked)
Moro (startling to loud noises or movement causes baby to throw head back, extend arms and legs, cry and then pull arms and legs back in)
Asymmetrical tonic neck reflex (outstretch of arm on ipsilateral side and flexion on contralateral side when head is turned to one side)

Question 14

What are the 1001 critical days and their importance?

Answer 14

Period between conception and 2 years of age critical for building optimal security and healthy brain development
Importance reflected by the implementation of the Infant Mental Health Competency Framework

Question 15

What is an expectant-dependent mechanism?

Answer 15

Unique experiences of each baby that produce distinctive wiring of brain enabling child to adapt to specific features of the individual environment they inhabit (dependent on relationship between dyad)

Synaptogenesis dependent on these experiences

Question 16

At what age do infants begin to experience subjectively?

Answer 16

At around 3 months, infants begin to experience psycho-physiological subjective experiences as opposed to purely physiological experiences prior to this age

Question 17

What are the cephalocaudal and centrifugal principles in reference to growth?

Answer 17

Cephalocaudal = general pattern of physical and functional development whereby development follows a head-to-toe progression

Centrifugal = proximal to distal directions

Question 18

What is the Healthy Child Programme?

Answer 18

Evidence-based universal preventative programme that begins in pregnancy and continues throughout childhood involving growth and development reviews, screening, immunisations, health promotion and parenting support

Question 19

What are the purposes of growth and development reviews as outlined by the Healthy Child Programme?

Answer 19

To assess growth and development; detect abnormalities; assess family strengths, needs and risks; and to give parents an opportunity to discuss their concerns and aspirations

Question 20

What physical parameters of growth are monitored?

Answer 20

Weight
Length (from 0-2)
Height (2+)
Head circumference (occipito-frontal)

Question 21

What weight centiles are used on growth charts?

Answer 21

0.4th, 2nd, 9th, 25th, 50th, 75th, 91st, 98th and 99.6th

Different charts for males and females; adjusted for prematurity (pre 37 weeks) and different chart used for children with Down Syndrome and other common conditions

Any child dropping 2 centiles is referred

Question 22

What developmental domains does Sheriden outline to be assessed between birth and 5 years?

Answer 22

Posture and large movements (gross motor)
Vision and fine movements (fine motor)
Hearing and speech
Social behaviour and play

Question 23

What domains are assessed using the ASQ?

Answer 23

Communication
Gross motor skills
Fine motor skills
Problem solving 
Personal social skills

Question 24

What are developmental milestones?

Answer 24

Median age at which children develop specific behaviours and abilities

Question 25

How is posture and large movements assessed?

Answer 25

Head control (typically able to support own head by 4 months)
Locomotion - rolling over (prone to supine by 3-4months and supine to prone by 5-6 months)
Trunk control and sitting (with assistance by 6 months, unaided by 9 months)

Question 26

What developmental milestones should typically be achieved by 12 months?

Answer 26

Pulling to standing
Walk around furniture
May be able to stand or walk alone

Question 27

How do fine motor skills develop from birth to 9 months?

Answer 27

Reflex hand grasp (disappears at 1 month)
Voluntary grasp
Bringing both hands to midline (2-3 months)
Hold object (3 months)
Transfer of objects (5-7 months)
Inferior pincer grasp (9 months)

Question 28

What developmental milestones are assessed at 2 year developmental review?

Answer 28

Gross motor (incl. ability to walk alone, climb, throw small ball, stand on tiptoe) 
Fine motor (incl. scribbles, build tower block, make-believe play) 
Speech and language (50 + words and telegraphic speech) 
Social and emotional (incl. imitating behaviour, awareness, increasing independence, defiance)

Question 29

What language skills are assessed throughout development?

Answer 29

Receptive (comprehend communication)
Expressive (produce communication) 
Musical sounds (2-3 months) 
Babbling (6 months) 
Jargon (9-12 months)