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?
- 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
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?
- Some start 9-10 months
- 50% by 12 months
- Refer if not walking by 18 months
- Beware of bottom shufflers and commando crawlers
Why is development important?
- 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
What factors influence development?
- Genetics (Family, race, gender)
- Environment
- Positive early childhood experience
- Developing brain vulnerable to insults (including antenatal, post natal and abuse and neglect)
What antenatal factors can influence development?
- Infections (CMV, Rubella, Toxo, VZV)
- 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
- 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
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
- 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
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
- 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)