growth, development and health Flashcards
what are the recognised phases of childhood?
neonate (<4w) infant (<12m/1y) toddler (~1-2y) pre-school (~2-5y) school age teenager/ adolescent
what are the main objectives of childhood?
- grow
- develop and achieve their potential
- attain optimal health
- develop independence
- be safe
- be cared for
- be involved
what are the 5 key developmental fields?
- gross motor
- fine motor
- speech and language
- social and self help
- hearing and vision
what are the 4 key milestones?
- social smile
- sitting
- walking
- first words
when should children be referred for not meeting milestones?
if not achieved by limit age (2 SDs from mean)
what must you correct for with milestones?
correct for prematurity until 2 years old
what is the usual development of walking?
- 9/10 months: start
- 12 months: 50% have started walking (median age)
- 18 months: refer
- beware of bottom shufflers and commando crawlers
why is development important?
allow our brain’s genetic potential to be fully realised
equip us with tools needed to function as older children and adults
what factors influence development?
genetics: family, race, gender
environment
childhood: positive experience
insults: developing brain (including antenatal, post natal and abuse and neglect)
what antenatal factors can influence development?
- infections (toxoplasmosis, rubella CMV, herpes simplex)
- toxins (Alcohol, Smoking, Anti-epileptics)
What post-natal factors can influence development?
- infection (meningitis, encephalitis)
- toxins (solvents mercury, lead)
- trauma (Head injuries)
- malnutrition (iron, folate, vit D)
- metabolic (hypoglycaemia, hyper + hyponatraemia)
- maltreatment/ under stimulation/ domestic violence
- maternal mental health issues
why do we assess development?
- reassurance and showing progress
- early diagnosis and intervention
- discuss positive stimulation/parenting strategies
- provision of information
- improving outcomes (pre-school years critical)
- genetic counselling
- coexistent health issues
who assesses child development
- parents and wider family
- health visitors, nursery, teachers
- GPs, A+E, FYs, STs, students
- paediatricians and community paediatricians
What is involved in assessing development?
- Healthy Child Programme (HCP) UK
- screening (may not always be sensitive/ specific)
- parental concerns/ videos on phone
- observation of play and activity
- medical history and examination
- review the red book
give examples of normal variation
- early developers
- late normal
- bottom shufflers - walking delay
- bilingual families- apparent language delay (total words may be normal)
- familial traits
What are the red flags when assessing development?
- loss of developmental skills
- muscle tone: low (floppiness), high
- no speech, hearing, walking
- occipital frontal circumference (OFC) disproportion
where is a child’s progress recorded?
the RED book
what are the different components of the child health programme?
- new-born exam and blood spot screening
- hearing screening (by day 28)
- health visitor first visit
- 6-8w review (Max 12w)
- 27-30 month review (Max 32m)
- orthoptist vision screening (4-5y)
give examples of conditions that are screened for using blood spotting
- PKU (phenylketonuria)
- congenital hypothyroidism
- CF
- medium chain acyl-CoA dehydrogenase deficiency
- sickle cell disorder
what does the 6-8 week review consist of?
- identification data (name, address, GP)
- feeding (breast/ bottle/ both)
- parental concerns (appearance, hearing; eyes, sleeping, movement, illness, crying, weight)
- development (gross motor, hearing + communication, vision + social awareness)
- measurements (weight, OFC, Length)
- examination (heart, hips, testes, genitalia, femoral pulses and eyes (red reflex))
- sleeping position (supine, prone, side)
what does the 27-30 month review consist of?
- identification data (name, address, GP)
development
- social, behavioural, attention and emotional
- communication, speech and language
- gross and fine motor
- vision, hearing
- physical measurements (height and weight)
- diagnoses / other issues
What are the components of the Healthy Child Programme?
- antenatal
- birth 1w (feeding, hearing, examination, Vit K immunisations, blood spot
- 2w (feeding, mat mental health, jaundice, SIDS)
- 6-8w (exam, imms, measure, mat mental health)
- 1y (growth, health promotion, questions)
- 2-2.5y (development, concerns, language)
- 5y (Imms, dental, support, hearing, vision, dev)
What health promotion is given to parents?
- Smoking
- Alcohol/ Drugs
- Nutrition
- Hazards and safety
- Dental Health
- Support services
why are children vaccinated?
highly effective public health measure to reduce and eradicate diseases
who receives vaccinations?
all children (additional if “at risk”)
When should children not receive vaccines?
no live vaccines if child is immunocompromised
postpone if child is unwell
What are the 3 key physical measurements?
- Weight (grams and Kgs)
- Length (cm) or height (if >2y)
- Head circumference (OFC) (cm)
what are the useful reference values to remember for weight, length and head circumference
what is a centile?
% division of population sampled
what is failure to thrive?
child growing too slowly in form and function at the expected rate for his age
demand for energy and nutrients> supply
what can cause failure to thrive?
maternal: poor lactation, incorrectly prepared feeds, inadequate care
infant: prematurity, small for dates, oro palatal abnormalities, neuromuscular disease, genetic disorders
what increased metabolic demands can cause FTT?
- congenital lung disease
- ♡ disease
- liver disease
- renal disease
- infection
- anaemia
- inborn errors of metabolism
- cystic fibrosis
- thyroid disease-
- crohn’s/ IBD
- malignancy
what excessive nutrient loss causes of FTT are there?
- gastro oesophageal reflux
- pyloric stenosis
- gastroenteritis (post-infectious phase)
- malabsorption (food allergy, diarrhoea, coeliac disease, pancreatic insuffiency, short bowel syndrome)
what non-organic causes of FTT are there?
- poverty/ socio-economic status
- family: lack of parental support (eg, no friends, no extended family or preparation for parenting
- neglect: emotional deprivation syndrome
- feeding: poor, disorders (eg, anorexia, bulimia- later years)
