Growth, Development and Health Flashcards
What are the recognised phases of childhood?
Neonate - < 4 weeks Infant - < 12 months/1 year Toddler - around 1-2 years Pre-school - around 2-5 years School age Teenager/adolescent
Main childhood objectives
To grow To develop and achieve their potential To attain optimal health To develop independence To be safe To be cared for To be involved
Features of development
Gaining functional skills throughout childhood
Gradual but rapid process
Typically from birth to 5 years (but brain develops in utero)
Fairly consistent pattern but rate will vary
Cell growth, migration, connection, pruning and myelination
Sequence of events in each domain
School - cognitive and though development, early skills become more refined
Key developmental fields
Gross motor Fine motor Social and self-help Speech and language Hearing and vision
Key milestones
Achievement of key development skills
Social smile, sitting, walking, first words
When do you refer a child for concerns about milestones?
If not achieved by age limit - 2 standard deviations from the mean
For how long do you correct for prematurity?
Until 2 years
What is the median age for walking?
12 months - 50% by this age
When do you refer a child who is not walking?
If not walking by 18 months
Why is development important?
Learning functional skills for later life
Hone skills in a safe environment
Allow brain’s genetic potential to be fully realised
Equip us with tools needed to function as older children and adults
Many are completely automatic
Influencing factors of development
Genetics
- family
- race
- gender
Environment
- use of technology very early on tends to have adverse effect on development
Positive early childhood experience
Developing brain vulnerable to insults
- antenatal
- postnatal
- abuse and neglect
Adverse environmental factors
Antenatal
- infections e.g. CMV, rubella, VZV
- toxins e.g. maternal smoking/drinking/drugs
Postnatal
- infection e.g. meningitis, encephalitis
- toxins e.g. solvents, mercury
- trauma e.g. head injuries
- malnutrition e.g. iron, folate, vitamin D
- metabolic e.g. hypoglycaemia, hyper/hyponatraemia
- maltreatment/under-stimulation/domestic violence
- maternal mental health issues
Why do you 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
Co-existent health issues
Who assesses development?
Patients
- Child surveillance vs developmental screening vs developmental assessment
- Specific groups e.g. premature, syndromes, events
Assessors
- Parents and wider family
- Health visitors, nursery, teachers
- GPs, A&E, FYs, STs, students
- Paediatricians and community paediatricians
What are the features/components of assessing development?
Health Child Programme (HCP) UK
Screening may not always be sensitive/specific
Listen to parental concerns/videos on phone
Opportunistic questions - target the right area
Review the red book
Good observation of play and activity
Medical history and examination
Most common mistake is not thinking about it
How do we assess development?
Building blocks - grasping, moving, building
Crayons - just holding, holding and moving, deliberately drawing
Balls - central core stability then throwing then kicking
Tea sets - imaginary play
Colouring books - identify colours, language assessment
How do you decide what is normal in development?
Not always easy
Think about each developmental field - deficiency may predominantly affect one area
What sequence/pattern has come before?
What skills have been achieved?
What has not yet been achieved?
Is one field falling behind the other e.g. global delay vs specific developmental delay
Are the skills gained age-appropriate?
What do you need to consider to recognise normal variation?
Early developers Late normal Bottom shufflers - walking delay Bilingual families - apparent language delay Familial traits
What are the red flags for development?
Loss of developmental skills or plateau of development
Parental/professional concern re vision - simultaneous referral to paediatric ophthalmology
Hearing loss - simultaneous referral for audiology/ENT
Persistent low muscle tone/floppiness
No speech by 18 months, especially if no other communication - simultaneous referral for urgent hearing test
Asymmetry of movements/increased muscle tone
Not walking by 18 months/persistent toe walking
OFC > 99.6th or < 0.4th/crossed two centiles/disproportional to parental OFC
Clinical uncertainty/think development may be disordered
What does child health screening provide an overview of?
Health and development
What are the child health screening programmes?
UK Healthy Child Programme
Child Health Programme (Scotland) based on HAL4
Where is child health screening based?
Primary care - GP, health visitor, midwife
What are the main components of child health screening?
Health promotion
Developmental screening (including hearing)
Immunisation
Parental/carer observations and concerns are crucial
Record, advise and refer as appropriate
Where is the progress of development recorded?
In red book
What does the child health programme include screening for?
PKU Congenital hypothyroidism CF Medium chain acyl-CoA dehydrogenase deficiency Sickle cell disorder
Components of child health programme
Newborn exam and blood spot screening Newborn hearing screening (by day 28) Health visitor in first week 6-8 week review (max 12 weeks) 27-30 month review (max 32 months) Orthoptist vision screening (4-5 years) If needed - unscheduled review, recall review
Components of 6-8 week review (GP and health visitor)
Identification data - name, address, GP
Feeding - breast/bottle/both
Parental concerns - appearance, hearing, eyes, sleeping, movement, illness, crying, weight
Development - gross motor, hearing and communication, vision and social awareness
Measurements - weight, OFC, length
Examination - heart, hips, testes, genitalia, femoral pulses and eyes (red reflex)
Sleeping position - supine, prone, side
Components of 27-30 month review (GP and health visitor)
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
Components of healthy child programme
Antenatal
Birth-1 week - feeding, hearing, examination, vitamin K, immunisations, blood spot
2 weeks - feeding, maternal mental health, jaundice, SIDS
6-8 weeks - examination, immunisations, measurements, maternal mental health
1 year - growth, health promotion, questions
2-2.5 years - development, concerns, language
5 years - immunisations, dental, support, hearing, vision, development
Components of health promotion
Smoking Alcohol/drugs Nutrition Hazards and safety Dental health Support services Additional input during immunisations/as issues are identified
Why and who do we immunise?
Highly effective public health measure
Reduction and eradication of diseases
All children (additional if “at risk”)
Chronological age i.e. don’t correct premature
No live vaccines e.g. MMR if child is immunocompromised (except HIV)
Egg allergy is not a contraindication to MMR
Postponed if unwell - fever, systemic symptoms
Components of history taking of immunisations
Frequently updated
Different schedules in different countries
Older children may not have been immunised against the current list
Check with the parents and red book (but they may just say they’re up-to-date)
Mild temperature, discomfort, swelling - common
Anaphylaxis - rare
No link with autism
What are the 3 key parameters of physical measurements?
Weight - grams and kg
Length (cm) or height if > 2 years
Head circumference in cm
Physical measurements that are not routine but may be done
Weight for age Length (or height) for age BMI in kg/m^2 Weight for length Rate of weight gain in g/kg/day - infants only
What is the average weight, length and OFC at birth?
3.3kg
50cm
OFC 35cm
What is the average weight and length at 4 months?
6.6kg
60cm
What is the average weight, length and OFC at 12 months?
10kg
75cm
OFC 45cm
What is the average weight and length at 3 years?
15kg
95cm
What is a centile?
% divisions of population sampled
What is failure to thrive?
Child growing too slowly in form and usually function at the expected rate for his or her age
Significantly low rate of weight gain - crossing centile spaces
Not a diagnosis but description of pattern
Means supply of energy/nutrients < demand for energy/nurients
Causes of failure to thrive in early life due to deficient intake
Maternal
- poor lactation
- incorrectly prepared feeds
- unusual milk or other feeds
- inadequate care
Infant
- prematurity
- small for dates
- oro-palatal abnormalities
- neuromuscular disease
- genetic disorders
Causes of FTT due to increased metabolic demands
Congenital lung disease Heart disease Liver disease Renal disease Infection Anaemia Inborn errors of metabolism Cystic fibrosis Thyroid disease Crohn's/IBD Malignancy
Causes of FTT due to excessive nutrient loss
Gastro-oesophageal reflux
Pyloric stenosis
Gastroeneteritis (post-infectious phase)
Malabsorption
- Food allergy
- Persistent diarrhoea
- Coeliac disease
- Pancreatic insufficiency
- Short bowel syndrome
Non-organic causes of FTT
Poverty/socio-economic status
Dysfunctional family interactions (especially maternal depression or drug use)
Difficult parent-child interactions
Lack of parental support e.g. no friends, no extended family
Lack of preparation for parenting/education
Child neglect
Emotional deprivation syndrome
Poor feeding or feeding skills disorder
Feeding disorders e.g. anorexia, bulimia in later years
