Growth, development and Nutrition Flashcards
Skills of a Newborn
Gross Motor - Flexes Limbs
Fine Motor/Vision - Fixes on Faces
Speech and Language - Startles to noises
Social skills -
Skills at 2 Months
Gross Motor - Lifts head from Prone
Fine Motor/Vision - Fixes and Follows Faces
Speech and Language -
Social skills - Smiles
Skills at 3 Months
Gross Motor - Rolling
Fine Motor/Vision - Reaching for Objects
Speech and Language - Coos/Laughs
Social skills - Shows Pleasure
Skills at 6 months
Gross Motor - Sitting
Fine Motor/Vision - Palmer Grip Transfer
Speech and Language - Babbling + localises Sounds
Social skills - shows interest in games and surroundings
Skills at 9 months
Gross Motor - Crawling
Fine Motor/Vision - Pincer Grip
Speech and Language - Understand the word No
Social skills - Stranger anxiety
Skills at 1 Year
Gross Motor - Walking
Fine Motor/Vision - Object permanence
Speech and Language - First Word
Social skills - Waves “Bye Bye”
Skills at 2 years
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
Skills at 3 years
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
Skills at 4 Years
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
Skills at 5 Years
Gross Motor - Hops and Skips
Fine Motor/Vision - Draws Square
Speech and Language - Fluent Speech
Social skills - Washes own Face
Developmental Red Flags
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 %
Age of a neonate
<4wks
Age of and Infant
up to 1 Year
Age of Toddler
1-2 years
Age of Pre-School Child
2-5 years
What are the 5 Key Development Fields
Gross Motor Fine Motor Hearing and Vision Speech and Language Social and Self Help
Growth Monitoring - Physical Measurements
Weight
Height/Length
Head Circumference (OFC)
Growth Monitoring - Derived (not routine but may be indicated)
Height/Length for AGE
Weight for AGE
BMI
Rate of weight Gain (infants only)
Average Weight of a Term baby
3.3 kg / 7.25lbs
Phases of Growth
INFANT (0 - 18 mo) - Nutrition and Insulin Driven
Child (2 - 12 years) - Growth Hormone Driven
Pubertal - Sex Hormone Driven
Benefits of Breast Milk
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
Breast feeding contraindications
Anti-thyroid medication
Amiodarone
HIV
Opiates - Cause respiratory depression
Define Failure to Thrive
Faltering weight. Failure to maintain normal rate of growth
Falls across 2 Growth Centiles
Aetiology of failure to thrive
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.
Abnormal Sex Development
Ambiguous genitalia leading to difficult gender assignment
Aetiology of abnormal Sex Development
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.
Ix. of abnormal Sex development
Adrenal/sex hormone levels
Karyotyping
USS pelvis
Rx. of abnormal sex developement
Do not assign gender until Ix is complete: specialist team input required.
Define Delayed Puberty
Failure of onset of puberty by 16 in males and 14 in females.
Aetiology of delayed puberty
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
Examination for Delayed Puberty
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
Investigations for Delayed Puberty
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
Management of Delayed Puberty
Treat underlying cause
If constitutional reassure and watchful waiting
Define Precocious Puberty
Onset of signs of puberty <8 years old in Girls and <9 years old in boys
Aetiology of Precocious Puberty
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
Ix. of Precocious Puberty
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
Mx of precocious Puberty
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