Growth, Development and Health Flashcards
What are the recognised phases of childhood?
- Neonate
- Infant
- Toddler
- Pre-school
- School age
- Teenager / Adolescent
What is development?
- Gaining functional skills throughout childhood.
- A gradual but rapid sequential process, occurring mainly from birth until aged 5, but rates can vary.
- Cell growth, migration, connection, myelination all occur.
- At school - cognitive and thought development will become more defined.
What are the important factors to think about in terms of the sequence of development?
- If the development you see now is normal, then the chances are that the development will continue to be normal.
- However, if the development is abnormal, then the chances are that development following this will be abnormal.
What are the key developmental fields?
- Gross motor
- FIne motor
- Social and Self help
- Speech and Language
- Hearing and Vision
What are Milestones?
What if someone is late to a milestone?
- Achievement of key developmental skills.
- Such as: sitting, walking, first words
- Again this is variable.
- Refer if not achieved by limit age (2 SDs from mean.
- Correct for prematurity until age 2.
Why is development important?
- Learning functional skills for later on in life, in a safe environment.
- Allows for the genetic potential of the brain to be reached.
- Equipe us with tools to function in the future.
- Many are automatic.
What are the factors influencing development?
- Genetics
- Environment
- Positive early childhood experience
- Developing brain vulnerable to insults
- Antenatal
- Postnatal
- Abuse and Neglect
What are the adverse Environmental Factors in Antental stage?
- Infections - CMV, Rubella, Toxo, VZV
- Toxins - Alcohol, Smoking, Anti-epiletics
What are the adverse envirnomental factors in the Post natal?
- Infections - meningitis & encephalitis
- Toxins - solvents, mercury, lead
- Trauma - head injury
- malnutrition - iron, folate, Vit D
- Metabolic - hypoglycaemia, hyper/hyponatraemia
- Maltreatment/ under stimulation/ Domestic Violence
- Maternal Mental Health issues
Why do we Asses Development?
- Reassurance and to show progress.
- Earlier diagnosis and prevention
- Discuss positive stimulation and parenting strategies.
- Improving outcomes.
- Genetic counselling
- Coexistent health issues.
How is a child’s development assessed?
- Child surveillance
- Develpomental screening and assessment
Who is involved in the assessment of a child’s development?
- Parents and the wider family.
- Health visitors, Nursery and Teachers
- GPs, A&E, FYs, STs, Students
- Paediatricians and community paediatrician
What can be done to asses development?
How do you decide when development is normal and abnormal?
- Difficult to do
- Helps to think about each developmental field and the sequence of development seen in each.
- Skills achieved
- Skills not achieved
- Global delay or specific delay.
- Are the gained skills age appropriate.
Generally, outline the normal variation seen in children’s development.
Be aware that different children will react milestones at different points, be aware particularly of:
- Early developers
- Late normal developers
- Bottom shufflers (walking delay)
- Bilingual families - apparent language delay.
- Familial traits of development
What are some of the important red flags that need to be identified in terms of development?
- Loss of developmental skills
- Parent/professional concern, regarding:
- vision
- hearing
- Persistent low muscle tone/floppy.
- No speech by 18 months, esp if no communication - referral for hearing test.
- Asymmetrical movements
- Increased tone
- Not walking by 18 months / Persistent toe walking.
- Uncertain clinician
What are some of the more important points regarding development?
- Parents with concerns - usually correct.
- Parents more aware of motor milestones than lenaguage, speech, social.
-
Loss of skills is very worrying and needs further investigation.
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What are the differnt aspects of Child Health Screening?
- UK - Healthy Child Programme
- Child Health Programme (Scotland)
- Based in primary care (GP, home visits, midwives)
Main components:
- Health promotion
- Developmental screening (including hearing)
- Immunisation
- Parents observations and concerns are cruical.
What are the various aspects of the Child Health Programme?
- New-born exam and blod spot screening
- inlcuding PKU, CHT, CF, Sickle Cell and MCADD.
- New-born hearing screening (by day 28)
- Health Visitor First Visit
- 6-8 weeks Review then 27-30 months review
- Orthoptist vision screening @ 4/5 years.
Unscheduled and recall reviews can be done if needed.
What aspects of the child are covered in the 6-8 weeks review in the GP and Home Visit?
- Feeding
- breast, bottle, both
- Parents concerns
- appearance, hearing, eyes, sleeping, movement, illness, crying, weight.
- Development
- Gross motor, hearing & communication
- Vision and social awareness
- Measurements
- Weight
- OFC (Occipitofrontal Circumference)
- Length
- Examination
- Heart, hips, testes, genitalia, femoral pulses & eyes (red reflex)
- Sleeping position
- supine
- prone
- side
- Sleeping position
What aspects of the child are covered in the 27-30moth review of the child?
- Development
- Social, behavioural, attention, emotional
- Communication, speech and language.
- Gross and fine motor
- Vision and hearing
- Physical measurements (height and weight)
- Diagnoses / other issues .
In the Healthy Child Programme, what are the different ages for assessment and what is assessed here?
- Antenatal
-
Birth - 1 week
- feeding, hearing, examination, Vit K, immunisations, blood spots
-
2 weeks
- Feeding, maternal mental health, jaudice, SIDS.
-
6-8 weeks
- Exam, immunisations, measure, maternal mental health.
-
1 year
- Growth, health promotion
-
2-2.5 years
- Development, Concerns, Language
-
5 years
- immunisations, dental, hearing, vision, development l
What are the health promotion aspects fo the Healthy Child Programme?
- Smoking
- Alcohol/Drugs
- Nutrition
- Hazards and safety
- Dental Health
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Why do we give immunisations and to who?
When shouldn’t they receive immunisation?
- Immunisations are a highly effective public health measure, which helps to reduce and eradicate some diseases.
- All children should receive (more so if they are “at risk”)
- No live vaccines should be given to a child who is immunocompromised (except HIV infection).
- Immunisations are postponed if unwell (fever/systemic symptoms).
What are the key points when taking an immunisation history?
Complications of immunisations?
Is there a link with Autism?
- Remember that older children may not be immunised against the current list, these can often be updated.
- Check with parents and in the red book.
- Mild Temperature, Discomfort and Swelling are all common issues following an immunisation.
- Anaphylaxis is a rarer complication.
- NO LINK WITH AUTISM
What are the 3 key growth measurements in growth monitoring?
What other less important measurements can be taken?
- Weight (g or Kg)
- Length (cm) or height (2y/o+)
- Head Circumference
- Weight and length for age.
- BMI
- Weight for length
- Rate of weight gain (infants only)
What is a centile?
- % divisions of the population sampled.
- eg 50th centile - take 100 healthy children - 50 above and 50 belwo
- 0.4th centile - 1000 children - 4 children below, 996 above
- No single measurement itself is abnormal - must be taken in terms of pattern, progress and history.
What is failure to thrive? (weight faltering)
- Child growing too slowly in form and usually in function at the expected rate for his of=r her age.
- Significantly low rate of weight gain (not a diagnosis, just descriptive of pattern)
- This basically means supply of energy and nutrients is less than demand.
What are the broad causes of failure to thrive in early life?
- Deficient intake
- Increased metabolic demands
- Excessive nutrient loss
- Non organic causes
What are the “deficient intake” causes of failure to thrive?
Maternal
- Poor lactation
- incorrectly prepared feeds
- Unusual milk/other feeds
- Inadequate care
Infant
- Premature
- Small for dates
- Oro-palatine abnormalities (e.g. cleft)
- Neuromuscular disease (e.g. cerebral palsy)
- Genetic Disorders
What are the “increased metabolic demand” causes of failure to thrive in early life?
- Congenital lung disease
- Heart, Liver, Renal Disease
- Infection
- Anaemia
- Inborn metabolism errors
- CF
- Thyroid Disease
- Crohn’s / IBD
- Malignancy
What are the “excessive nutrient loss” causes of failure to thrive?
- GORD
- Pyloric stenosis
- Gastroenteritis
- Malabsorption
- Food allergy
- Persistent diarrhoea
- Coeliac
- Pancreatic insufficiency
- Short Bowel Syndrome
What are the non-organic causes of failure to thrive?
- Poverty/SE status
- Dysfunctional family - drug use/ maternal mental health issues
- Difficult child-parent interactions
- Lack of parental support - no friends or wider family
- Lack of education or preparation for parenting.
- Child neglect
- Emotional deprivation syndrome
- Poor feeding or feeding skills disorder
- Feeding disorders
