Growth, development and Nutrition

Question 1

Skills of a Newborn

Answer 1

Gross Motor - Flexes Limbs
Fine Motor/Vision - Fixes on Faces
Speech and Language - Startles to noises
Social skills -

Question 2

Skills at 2 Months

Answer 2

Gross Motor - Lifts head from Prone
Fine Motor/Vision - Fixes and Follows Faces
Speech and Language -
Social skills - Smiles

Question 3

Skills at 3 Months

Answer 3

Gross Motor - Rolling
Fine Motor/Vision - Reaching for Objects
Speech and Language - Coos/Laughs
Social skills - Shows Pleasure

Question 4

Skills at 6 months

Answer 4

Gross Motor - Sitting
Fine Motor/Vision - Palmer Grip Transfer
Speech and Language - Babbling + localises Sounds
Social skills - shows interest in games and surroundings

Question 5

Skills at 9 months

Answer 5

Gross Motor - Crawling
Fine Motor/Vision - Pincer Grip
Speech and Language - Understand the word No
Social skills - Stranger anxiety

Question 6

Skills at 1 Year

Answer 6

Gross Motor - Walking
Fine Motor/Vision - Object permanence
Speech and Language - First Word
Social skills - Waves “Bye Bye”

Question 7

Skills at 2 years

Answer 7

Gross Motor - Running
Fine Motor/Vision - Scribbles and builds tower (6 blocks)
Speech and Language - > 20 words, can join 2
Social skills - Uses a spoon

Question 8

Skills at 3 years

Answer 8

Gross Motor - Climbs stairs
Fine Motor/Vision - Draws circle and can make bridge
Speech and Language - Can Join 3 words and give full name
Social skills - Can Undress

Question 9

Skills at 4 Years

Answer 9

Gross Motor - Ride Tricycle
Fine Motor/Vision - Draw Cross and Can build 3 steps from 6 blocks
Speech and Language - Knows Nursery Rhymes
Social skills - Can Dress and Undress

Question 10

Skills at 5 Years

Answer 10

Gross Motor - Hops and Skips
Fine Motor/Vision - Draws Square
Speech and Language - Fluent Speech
Social skills - Washes own Face

Question 11

Developmental Red Flags

Answer 11

No Social Smile by 2 Months
No unsupported sitting by 9 months
No Unsupported Walking by 18 months
No Words by 2 years
Loss of developmental Skills previously acquired
Vision/Hearing Issues
Persistent Loss in Muscle tone (similarly increased tone)
Asymmetry of Movement
OFC >99th % or <0.4th %or if OFC crosses 2 %

Question 12

Age of a neonate

Answer 12

<4wks

Question 13

Age of and Infant

Answer 13

up to 1 Year

Question 14

Age of Toddler

Answer 14

1-2 years

Question 15

Age of Pre-School Child

Answer 15

2-5 years

Question 16

What are the 5 Key Development Fields

Answer 16

Gross Motor
Fine Motor
Hearing and Vision
Speech and Language
Social and Self Help

Question 17

Growth Monitoring - Physical Measurements

Answer 17

Weight
Height/Length
Head Circumference (OFC)

Question 18

Growth Monitoring - Derived (not routine but may be indicated)

Answer 18

Height/Length for AGE
Weight for AGE
BMI
Rate of weight Gain (infants only)

Question 19

Average Weight of a Term baby

Answer 19

3.3 kg / 7.25lbs

Question 20

Phases of Growth

Answer 20

INFANT (0 - 18 mo) - Nutrition and Insulin Driven

Child (2 - 12 years) - Growth Hormone Driven

Pubertal - Sex Hormone Driven

Question 21

Benefits of Breast Milk

Answer 21

Bonding - Suckling and Skin to Skin Contact
Perfect nutrition for up to 6mo - easily digested by the baby
Free
Tailor made passive immunity
Increased development of babies active immunity
increased development of child’s gut mucosa
Helps mum lose weight
protects child against SIDS and allergies
Almost no Contamination
Decreased chance of breast cancer

Question 22

Breast feeding contraindications

Answer 22

Anti-thyroid medication
Amiodarone
HIV
Opiates - Cause respiratory depression

Question 23

Define Failure to Thrive

Answer 23

Faltering weight. Failure to maintain normal rate of growth
Falls across 2 Growth Centiles

Question 24

Aetiology of failure to thrive

Answer 24

Maternal Causes -Poor lactation, incorrectly preparing feed, unusual Milk

Infant causes - Premature, small for dates. neuromuscular disease, genetic disorders

Increased metabolic demand - congenital Lung disease, Heart disease, CF

Excess nutrient loss - GORD, pyloric stenosis, malabsorption

Non-organic Causes: poverty, Dysfunctional family interactions, Different Parent-child interactions, child neglect, feeding disorders.

Question 25

Abnormal Sex Development

Answer 25

Ambiguous genitalia leading to difficult gender assignment

Question 26

Aetiology of abnormal Sex Development

Answer 26

Excessive Androgens cause virilised female (e.g congenital adrenal Hyperplasia)

Androgen insensitivity leading feminised male

Gonadotrophin insufficiency (e.g. hypopituitarism

True hermaphroditism with both ovarian and testicular tissue.

Question 27

Ix. of abnormal Sex development

Answer 27

Adrenal/sex hormone levels
Karyotyping
USS pelvis

Question 28

Rx. of abnormal sex developement

Answer 28

Do not assign gender until Ix is complete: specialist team input required.

Question 29

Define Delayed Puberty

Answer 29

Failure of onset of puberty by 16 in males and 14 in females.

Question 30

Aetiology of delayed puberty

Answer 30

Most will have Simple Constitutional delay in growth and puberty (CDGP) - no detailed Ix needed

Central Delayed Puberty:
Malnutrition/Chronic illness: CF, Coeliac, Chronic renal
Failure, anorexia nervosa
Endocrine: Cushing’s syndrome, Growth Hormone
Deficiency (hypopituitarism), hypothyrodism

Peripheral Delayed puberty:
Chromosomal: Turner’s/ Klinefelter’s
Gonads: Gonadal Dysgenesis, testicular Torsion,
cryptochidism, mumps, androgen insensitivity, PCOS

Question 31

Examination for Delayed Puberty

Answer 31

Height and Weight (any suspicion of malnutrition
Pubertal Tanner Staging
Dysmorphic Features
General: Fundoscopy and visual Fields (pituitary tumour), and any indication of chronic disease e.g. Clubbing

Question 32

Investigations for Delayed Puberty

Answer 32

FBC, Ferritin, Renal Function, U and Es, Urinalysis for blood and protein
Coeliac Screen
TFTs
MRI/CT of pituitary and surrounding areas
Bone Age - Done developnt in CDGP, GH deficiency and hypothyroidsm
Pelvic Ultrasound
GnRH, Prolactin and GH testing

Question 33

Management of Delayed Puberty

Answer 33

Treat underlying cause

If constitutional reassure and watchful waiting

Question 34

Define Precocious Puberty

Answer 34

Onset of signs of puberty <8 years old in Girls and <9 years old in boys

Question 35

Aetiology of Precocious Puberty

Answer 35

Constitutional (idiopathic) in Girls: Particularly isolated Thelarche and Adrenarche

Central/True (gonadotrophin dependant) precocious Puberty:
Intracranial Tumour, CNS injury, infection, irradiation,
hydrocephalus, hypothyroidism, Obesity in Girls
Congenital - Silver Russell Syndrome

Peripheral/Pseudo-precocious (gonandotrophin independent) - Gonads mature independent of GnRH stimulation:
Congenital Adrenal hyperplasia, Gonadal/Germ Cell
Tumour, Cushing’s syndrome

Question 36

Ix. of Precocious Puberty

Answer 36

Levels of Sex Hormones - In Boys early morning Test is higher
Gonadotrohpins - LH and FSH
Random LH useful for Central PP
low levels of LH and FSH along with high sex
hormones will be found in peripheral PP

TFTs
Bone age
Brain MRI
Pelciv USS - Tumours/cysts

Question 37

Mx of precocious Puberty

Answer 37

Medical - Treat the underlying cause
GnRH analogue used in CPP to stimulate the pituitary
to release LH and FSH
Glucocorticoids used to treat Congenital adrenal
Hyperplasia

Surgical
Tumours may require resection - rarely causes
regression of pubertal changes