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
2
Q
What are the 5 key developmental fields?
A
- Gross motor
- Fine motor
- Speech and language
- Social and self help
- Hearing and vision
3
Q
What are the 4 key milestones?
A
- Social smile
- Sitting
- Walking
- First words
4
Q
When should children be referred for not meeting milestones?
A
If not achieved by limit age (2 SDs from mean)
5
Q
What must you correct for with milestones?
A
Correct for prematurity until 2 years old
6
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
7
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)
8
Q
What antenatal factors can influence development?
A
- Infections (CMV, Rubella, Toxo, VZV)
- Toxins (Alcohol, Smoking, Anti-epileptics)
9
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
10
Q
Why do we assess development?
A
- Reassurance
- Early diagnosis and intervention
- Discuss positive stimulation
- Provision of information
- Improving outcomes (pre-school years critical)
- Genetic counselling
- Coexistent health issues
11
Q
Who assesses child development?
A
- Parents and wider family
- Health visitors, nursery, teachers
- -GPs, A+E, FYs, STs, students
- Paediatricians and community paediatricians
12
Q
How is development observed in a child?
A
- 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)
13
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
- Good observation of play and activity
- Medical history and examination
14
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
15
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
16
Q
Where is a child’s progress recorded?
A
The RED book
17
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)
18
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
19
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)
20
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
21
Q
What are the components of the Healthy Child Programme?
A
- 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)
22
Q
What health promotion is given to parents?
A
- Smoking
- Alcohol/ Drugs
- Nutrition
- Hazards and safety
- Dental Health
- Support services
23
Q
Why are children vaccinated?
A
- Highly effective public health measure
- Reduction and eradication of diseases
24
Q
Who receives vaccinations?
A
- All children (additional if “at risk”)
- Chronological age (i.e. don’t correct prems)
- Egg allergy is not a contraindication to MMR
25
When should children not receive vaccines?
* No live vaccines if child is immunocompromised
* Postpone if child is unwell
26
What are the 3 key physical measurements?
* Weight (grams and Kgs)
* Length (cm) or height (if \>2y)
* Head circumference (OFC) (cm)
27
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
28
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
29
Useful reference values to remember
OFC at birth and 12 months
* Birth 35cm
* 12 months 45cm
30
What is a centile?
% division of population sampled
31
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
32
What can cause failure to thrive?
* Maternal deficient intake
* Infant deficient intake
* Increased metabolic demands
* Excessive nutrient loss
* Non-organic causes
33
What maternal intake deficiency causes of FTT are there?
* Poor lactation
* Incorrectly prepared feeds
* Unusual milk or other feeds
* Inadequate care
34
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
35
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
36
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
37
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)
