Growth, Development and Health Flashcards

1
Q

What are the recognised phases of childhood?

A
  • Neonate (<4w)
  • Infant (<12m/1y)
  • Toddler (~1-2y)
  • Pre-school (~2-5y)
  • School age
  • Teenager/ Adolescent
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2
Q

What are the main objectives of childhood?

A
  • 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
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3
Q

What are the 5 key developmental fields?

A
  • Gross motor
  • Fine motor
  • Speech and language
  • Social and self help
  • Hearing and vision
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4
Q

What are the 4 key milestones?

A
  • Social smile
  • Sitting
  • Walking
  • First words
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5
Q

When should children be referred for not meeting milestones?

A

If not achieved by limit age (2 SDs from mean)

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6
Q

What must you correct for with milestones?

A

Correct for prematurity until 2 years old

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7
Q

What is the usual development of walking?

A
  • Some start 9-10 months
  • 50% by 12 months
  • Refer if not walking by 18 months
  • Beware of bottom shufflers and commando crawlers
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8
Q

Why is development important?

A
  • Learning functional skills for later life
  • Hone skills in a safe environment
  • Allow our brain’s genetic potential to be fully realised
  • Equip us with tools needed to function as older children and adults
  • Many are completely automatic
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9
Q

What factors influence development?

A
  • Genetics (Family, race, gender)
  • Environment
  • Positive early childhood experience
  • Developing brain vulnerable to insults (including antenatal, post natal and abuse and neglect)
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10
Q

What antenatal factors can influence development?

A
  • Infections (CMV, Rubella, Toxo, VZV)

- Toxins (Alcohol, Smoking, Anti-epileptics)

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11
Q

What post-natal factors can influence development?

A
  • 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
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12
Q

Why do we assess development?

A
  • 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
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13
Q

Who assesses child development/

A
  • Parents and wider family
  • Health visitors, nursery, teachers
  • GPs, A+E, FYs, STs, students
  • Paediatricians and community paediatricians
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14
Q

What is involved in assessing development?

A
  • Healthy 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
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15
Q

Give examples of normal variation.

A
  • Early developers
  • Late normal
  • Bottom shufflers- walking delay
  • Bilingual families- apparent language delay (total words may be normal)
  • Familial traits
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16
Q

What are the red flags when assessing development?

A
  • Loss of developmental skills
  • Parental/ professional concern re. vision
  • Hearing loss
  • Persistent low muscle tone/ floppiness
  • No speech by 18 months, esp if no other communication -Asymmetry of movements/ increased muscle tone
  • Not walking by 18m/ -Persistent toe walking
  • OFC > 99.6th / < 0.4th / crossed two centiles/ disproportionate to parental OFC
  • Clinician uncertain/ thinks that development may be disordered
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17
Q

Where is a child’s progress recorded?

A

The RED book

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18
Q

What are the different components of the child health programme?

A
  • New-born exam and blood spot screening
  • New-born 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)
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19
Q

Give examples of conditions that are screened for using blood spotting.

A
  • PKU
  • Congenital hypothyroidism
  • CF
  • Medium chain acyl-CoA dehydrogenase deficiency
  • Sickle cell disorder
20
Q

What does the 6-8 week review consist of?

A
  • 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)
21
Q

What does the 27-30 month review consist of?

A

-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
22
Q

What are the components of the Healthy Child Programme?

A
  • 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)
23
Q

What health promotion is given to parents?

A
  • Smoking
  • Alcohol/ Drugs
  • Nutrition
  • Hazards and safety
  • Dental Health
  • Support services
24
Q

Why are children vaccinated?

A
  • Highly effective public health measure

- Reduction and eradication of diseases

25
Who receives vaccinations?
- All children (additional if “at risk”) - Chronological age (i.e. don’t correct prems) - Egg allergy is not a contraindication to MMR
26
When should children not receive vaccines?
- No live vaccines if child is immunocompromised | - Postpone if child is unwell
27
What are the 3 key physical measurements?
- Weight (grams and Kgs) - Length (cm) or height (if >2y) - Head circumference (OFC) (cm)
28
Useful reference values to remember | Weight at birth
3.3kg
29
Useful reference values to remember | Length at birth
50cm
30
Useful reference values to remember | OFC at birth
35cm
31
Useful reference values to remember | Weight at 4 months
6.6kg
32
Useful reference values to remember | Length at 4 months
60cm
33
Useful reference values to remember | Weight at 12 months
10kg
34
Useful reference values to remember | Length at 12 months
75cm
35
Useful reference values to remember | OFC at 12 months
45cm
36
Useful reference values to remember | Weight at 3 years
15kg
37
Useful reference values to remember | Height at 3 years
95 cm
38
What is a centile?
% division of population sampled
39
What is failure to thrive?
- Child growing too slowly in form and usually function at the expected rate for his or her age - Demand for energy and nutrients> supply
40
What can cause failure to thrive?
- Maternal deficient intake - Infant deficient intake - Increased metabolic demands - excessive nutrient loss - Non-organic causes
41
What maternal intake deficiency causes of FTT are there?
- Poor lactation - Incorrectly prepared feeds - Unusual milk or other feeds - Inadequate care
42
What infant intake deficiency causes of FTT are there?
- Prematurity - Small for dates - Oro palatal abnormalities (e.g. cleft palate) - Neuromuscular disease (e.g. cerebral palsy) - Genetic disorders
43
What increased metabolic demands can cause FTT?
- Congenital lung disease - Heart disease - Liver disease - Renal disease - Infection - Anaemia - Inborn errors of metabolism - Cystic fibrosis - Thyroid disease- - Crohn’s/ IBD - Malignancy
44
What excessive nutrient loss causes of FTT are there?
- Gastro oesophageal reflux - Pyloric stenosis - Gastroenteritis (post-infectious phase) Malabsorption due to: - Food allergy - Persistent diarrhoea - Coeliac disease - Pancreatic insuffiency - Short bowel syndrome
45
What non-organic causes of FTT are there?
- Poverty/ socio-economic status - Dysfunctional family interactions (especially maternal depression or drug use) - Difficult parent-child interactions - Lack of parental support (eg, no friends, no extended family) - Lack of preparation for parenting/ education - Child neglect - Emotional deprivation syndrome - Poor feeding or feeding skills disorder - Feeding disorders (eg, anorexia, bulimia- later years)