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 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
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
- Early diagnosis and intervention
- Discuss positive stimulation
- 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
How is development observed in a child?
- How do they move their body around? (Gross Motor)
- What do they do with their hands? (Fine Motor)
- How do they communicate? (Speech and Language)
- What can they do for themselves? (Social and Self Help)
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
- 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)
Give examples of conditions that are screened for using blood spotting.
- PKU
- 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, maternal mental health, jaundice, SIDS)
- 6-8w (Exam, Immunisations, measure, maternal mental health)
- 1y (Growth, health promotion, questions)
- 2-2.5y (development, concerns, language)
- 5y (Immunisations, dental, hearing, vision)
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
- Reduction and eradication of diseases
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
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)
Useful reference values to remember
Weight at birth, 4 months, 12 months and 3 years (kg)
- Birth 3.3
- 4 months 6.6
- 12 months 10
- 3 years 15
Useful reference values to remember
Length at birth, 4 months, 12 months and 3 years
- Birth 50cm
- 4 months 60cm
- 12 months 75cm
- 3 years 95cm
Useful reference values to remember
OFC at birth and 12 months
- Birth 35cm
- 12 months 45cm
What is a centile?
% division 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
- Crossing centile spaces
- Demand for energy and nutrients > supply
What can cause failure to thrive?
- Maternal deficient intake
- Infant deficient intake
- Increased metabolic demands
- Excessive nutrient loss
- Non-organic causes
What maternal intake deficiency causes of FTT are there?
- Poor lactation
- Incorrectly prepared feeds
- Unusual milk or other feeds
- Inadequate care
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
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
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
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)
